Pathological gambling

Gambling can become addictive and progressive; the process become more important than the winning or the money. It also takes more and more to achieve a "fix", and eventually no amount is enough. Pathologic gambling is considered a major psychiatric disorder. Compulsive gamblers use their addiction to keep them unaware of their internal feelings. Their lives become progressively more unmanageable. Gambling can be just as addictive as alcohol; although it does not destroy the body, as alcohol does, it is equally capable of destroying a life and of wreaking havoc with relationships.

The problem gambler experiences adverse consequences in personal, social, and occupational functioning, and he or she continues to gamble despite the clearly negative outcomes and even loss of enjoyment of the activity. Pathologic gambling represents a significant public health problem, and problem gambling is clearly associated with crime, incarceration, financial ruin, alcohol and drug addiction, suicide, and psychiatric disturbance.

The Diagnostic and Statistical Manual of Mental Disorders defines pathologic gambling as "persistent and recurrent maladaptive gambling behaviour that is not better accounted for by a manic episode." Three elements are central to the diagnosis: loss of control; increasing investment in frequency, amount gambled, time spent gambling, and obtaining money with which to gamble; and continued gambling despite negative repercussions.

The prevalence of problem gambling is estimated at less than 3% of the general population, with a male to female ratio of 2:1. The group with the highest prevalence of gambling problems is the 18- to 25-year-old age group, and among adolescents, the percentage approaches 6% in some studies and almost 15% in others.

The gambler who has legal problems is likely to be male, unemployed, single and abusing drugs or alcohol. Pathologic gamblers who have not been arrested tend to be female, and they tend to be involved in what are called non-strategic forms of gambling such as lotteries or slot machines.

The diagnosis of pathologic gambling generally occurs as the gambler gets older, because gambling skill often deteriorates over time -- perhaps as long as 2 or 3 decades. Females tend to get involved later in life, in their thirties or forties, whereas males often begin during adolescence. Women seem to deteriorate more rapidly and seek help after only a few years; whereas with men, the problem may persist for many years.

About half of pathologic gamblers are alcohol or substance abusers, and this is particularly true among adolescents. Teen gamblers have higher rates of alcohol, tobacco, and marijuana use than non-gambling peers, and among teen substance abusers, the rates of problem gambling have been estimated as high as 10% to 30% in different studies. Problem gamblers have exceedingly high rates of mood problems: depression (32% to 76%), mania and hypomania (46%) and suicide attempts (12%). The co-occurrence of attention-deficit hyperactivity disorder (ADHD) is estimated at about 20%; when adult problem gamblers are compared with controls, the gamblers are significantly more likely to have childhood behaviour problems.