Updated: 11/28/2019

Pathologic Gambling

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Snapshot
  • A 27-year-old male presents to the general medical clinic with his wife who complains that he has lost all of their savings gambling. She reports that her husband was a successful trader on Wall Street but has been laid off after missing work to place bets. He has tried multiple times to quit but repeatedly relapses.
Introduction
  • Epidemiology
    • prevalence 1-3% of adults
    • men account for two thirds of cases
    • peak prevalence in adolescence and young adulthood, less common in older adults
    • increased incidence of mood disorders, anxiety disorders, OCD
    • predisposed in patients who have lost a parent during childhood, experienced inappropriate parental discipline, have a diagnosis of ADHD, or lack a family emphasis on saving money
  • Sub-categorized under substance-related disorder (DSM-V)
    • similar neurochemistry as other drug addictions
Presentation
  • Symptoms
    • preoccupation with gambling
    • need to gamble with increasing amount spent to achieve enjoyment
    • repeated unsuccessful attempts to cut down
    • irritability with attempts at stopping gambling
    • using gambling to avoid facing problems or to relieve dysphoria
    • returning to reclaim losses after gambling
    • lying to therapist, family, and friends about intensity of gambling
    • committing illegal acts to finance gambling activities
    • jeopardizing interpersonal relationships or professional work because of gambling
    • relying on others to financially support gambling
Evaluation
  • Diagnosis
    • persistent and recurrent maladaptive gambling behavior as evidenced by five of the symptoms listed above
Treatment
  • Participation in Gamblers Anonymous
    • 12-step program
    • the most effective treatment
  • Insight-oriented psychotherapy
    • may be initiated after 3 months of abstinence from gambling
  • SSRIs, mood stabilizers, or opioid antagonists
    • important to treat comorbid mood, anxiety, or substance abuse disorders
    • SSRI's are a common therapy for diseases associated with impulse control
Prognosis, Prevention, and Complications
  • Prognosis 
    • like other addictive disorders, pathological gambling is a long-term problem that tends to get worse without treatment
    • however, one-third of patients may improve without treatment
    • even with treatment, patients often relapse
    • the prognosis is often quite good with appropriate therapy
  • Prevention
    • limiting lifetime exposure to gambling may be helpful to people at risk

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