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Updated: May 13 2022

Pathologic Gambling

  • 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
    • Sub-categorized under substance-related disorder (DSM-V)
      • similar neurochemistry as other drug addictions
  • Epidemiology
    • Prevalence 1-3% of adults
      • peak prevalence in adolescence and young adulthood, less common in older adults
    • men account for two thirds of cases
    • 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
  • 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
  • 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
  • Prevention
    • Limiting lifetime exposure to gambling may be helpful to people at risk
  • 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
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