ÓÈ{Ê UÊ Gambling addiction
does not specifically endorse GA, it has been publi-
cizing the signs and symptoms of compulsive gam-
bling, thus helping to reduce the stigma.
An outcome study of GA conducted in 1988
found that less than 8 percent of people who begin
attending GA meetings continue to work the pro-
gram and stay away from gambling for more than
one year. One reason may be that the stress of ac-
cepting responsibility for financial, legal, and em-
ployment problems in spite of abstinence from gam-
bling is overwhelming. Another possible reason is
that compulsive gambling also may be compounded
by substance abuse: When the concomitant addic-
tion is not addressed, relapse into gambling is easily
triggered.
In addition, the recovery rate of GA members is
still lower than that of AA members because the med-
ical model of compulsive behavior as a progressive
illness is less accepted by society for compulsive gam-
blers than for alcoholics. The medical community has
labeled compulsive (pathological) gambling as an im-
pulse control disorder similar to compulsive eating,
kleptomania, and hypersexuality. The increasing in-
cidence of compulsive gambling in persons with Par-
kinson’s disease, for example, has prompted research
that has discovered an associated dysfunction in the
frontal lobe of the brain. Rat models of impulsivity
are being developed to identify potential pharma-
cological targets and treatments for impulse control
disorders.
Bethany Thivierge, MPH
Further Reading
A Day at a Time: Gamblers Anonymous. Center City, MN:
Hazelden, 1994. Daily affirmations and readings to
inspire compulsive gamblers to pursue recovery.
Gamblers Anonymous. GA Red Book: A New Beginning.
3rd ed. Los Angeles: Author, 1998. Inspirational sto-
ries about persons who have successfully worked
GA.
- - -. Sharing Recovery through Gamblers Anonymous. Los
Angeles: Author, 1984. Handbook for compulsive
gamblers following the twelve-step recovery pro-
gram.
Sanders, Elizabeth. Gambling Recovery: Working the
Gamblers Anonymous Recovery Program. Tucson, AZ:
Wheatmark, 2010. A guidebook to working the
twelve steps of the GA recovery program. Includes
exercises at the end of each step.
Salem Health
Websites of Interest
Gamblers Anonymous
http://gamblersanonymous.org
National Council on Problem Gambling
http://www.ncpgambling.org
See also: Behavioral addictions: Treatment; Gambling
addiction; Group therapy for behavioral addictions;
Support groups; Twelve-step programs for addicts
Gambling addiction
Category: Psychological issues and behaviors
Also known as: Compulsive gambling; disordered
gambling; pathological gambling; problem gam-
bling
Definition: Gambling is an activity that involves a de-
gree of risk and an expenditure of money or goods
with the hope of an increased return but with the
possibility of a total loss. Some people gamble for
pleasure, in a nonaddictive fashion, and suffer
no ill effects from gaming activities. Others have
a problem with gambling, which is manifested by
their increasing desire to gamble, even if doing so
creates hardships. These hardships include money
and debt problems, difficulties at work, relation-
ship problems, and legal sanctions.
Causes
Problem gambling has a familial component because
parents with a gambling addiction tend to socialize
their children into the gambling world. Many of these
young people, in turn, develop disordered gambling
behavior. Research with twins suggests that there may
be a genetic component underlying gambling ad-
diction, which may be reinforced by cultural norms.
Cultural components have also been associated with
problem gambling, as have games that can be played
without a gambling component, such as mahjongg
and bingo.
Risk Factors
Greater numbers of men typically experience gam-
bling addiction, although women are also at risk.
People with gambling addictions often have other
Addictions and Substance Abuse
mental health issues (including personality disorders,
mood disorders, and anxiety ailments) and other ad-
dictive disorders, which increase the challenge in de-
termining what effects were caused by gambling and
what were caused by other comorbidities. Problem
gamblers often consume alcohol, nonprescription
drugs, and tobacco in unhealthy ways, which also con-
tributes to dysfunctional behavior.
Prevalence research in much of the developed
world suggests that approximately 1 percent of the
world’s population may experience gambling prob-
lems. The disordered gambling figures for adoles-
cents, in locations where such research has been com-
pleted, are much higher, with the implication that
gambling-addiction numbers will rise as adolescents
age and as increasing means to gamble become avail-
able. The growth of Internet gambling is particularly
challenging for local authorities to license, control,
or measure. Particular concerns with these web-based
services are that young players are difficult to identify
and, thus, cannot be prevented from accessing these
sites, even when local laws do not permit children to
gamble.
Symptoms
According to the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV), published in 1994 by the
American Psychiatric Association (APA), pathological
gambling is considered to be an impulse-control dis-
order. A text revision of this manual, called DSM-IV-
TR, appeared in 2000, but this revision did not fun-
damentally change the definition of pathological
gambling. The DSM volumes do not use the term ad-
diction in connection with gambling, although other
APA publications highlight the similarities to sub-
stance addictions.
Pathological gambling is defined operationally
by the presence of five of ten criteria. The measures
focus on the negative effects of gambling for an in-
dividual (such as preoccupation, desire to gamble,
and difficulty stopping) and the results for gam-
bler’s associates (such as lies, illegal actions, and loss
of relationships). It is possible that some of the cur-
rent criteria may be revised in updated editions of
the DSM.
A person may manifest a gambling addiction for a
period of time and then gain some control over his or
her behavior, only to relapse and begin the cycle yet
again. This is a common pattern for other addictive
Gambling addictionÊ UÊ ÓÈx
South Oaks Gambling Screen
The most common instrument used to screen for
probable pathological-gambling behavior is the
South Oaks Gambling Screen (SOGS), developed at
South Oaks Hospital in New York. South Oaks Hospi-
tal is located on Long Island and is well known for
work with psychiatric problems and addictions.
SOGS has become one of the most-cited screening
instruments in psychological research literature
involving the measurement of pathological gam-
bling.
Henry Lesieur, a psychiatrist and certified gam-
bling counselor, and Shelia Blume, medical director
at South Oaks Hospital, developed the twenty-item
SOGS in the late 1980s to produce a scale that would
be consistent and quantifiable. In use, responses to
the twenty items are recorded, and agreement with
five or more items is interpreted as evidence of the
presence of pathological gambling. In the years since
its development, SOGS has become the most com-
monly used scale to measure problem gambling in
both clinical and nonclinical settings.
disorders, and this cyclical progression is challenging
for persons in the gambler’s family and social circles,
and for the individual gambler.
Screening and Diagnosis
Several dozen screening and diagnostic devices
have been used to measure problem gambling.
Many of these are based on the DSM criteria for
measuring pathological gambling. Two commonly
used tools are the South Oaks gambling screen and
the modified NORC DSM-IV screen for gambling
problems.
Depending on the type of gambling screen used,
a diagnosis typically places the person along a con-
tinuum of increasingly disordered behavior. At the
lowest levels are people who have never gambled,
although few people fit into this category at most
locations, given the ubiquity of gaming activities in
contemporary society. People who do not gamble
excessively, or who cause no harm to themselves
or others, may be described as recreational or so-
cial gamblers. Gamblers who display symptoms
are termed compulsive gamblers, disordered gamblers,
excessive gamblers, intemperate gamblers, pathological
gamblers, or problematic gamblers. The term gambling
ÓÈÈÊ UÊ Gambling addiction
addiction is not used typically in the social or the
health sciences, although the general public uses
it. Some treatment centers use this nomenclature
as it is readily understood by clients.
Treatment and Therapy
Treatment traditionally involves talk therapy, al-
though more recent approaches have focused on
pharmacological interventions, especially antide-
pressants. A small number of studies have examined
the effects of mood stabilizers and opioid antagonists
(specifically naltrexone). Some of these medications
had unpleasant side effects for the research volun-
teers, especially the participants in clinical studies
using naltrexone.
Many people with gambling addictions have ac-
cess to psychological and therapeutic treatments,
including psychoanalytic approaches, psychody-
namic-based treatments, behavioral therapy, cogni-
tive approaches, addiction-based interventions, and
self-help. Much of the research on these types of
treatment relies on small sample sizes and no con-
trol groups, creating challenges in determining what
treatments are most successful.
An additional problem for gamblers is that most
treatments are offered at a cost, which can pose dif-
ficulties for this group given that, typically, gamblers
have little money by the time they need treatment.
Free Gamblers Anonymous groups are found in
most urban centers, which is helpful for this client
group.
In addition to methodological problems with
studies that make it difficult to identify the most
promising treatment options, there are conceptual
issues. Generally, people with gambling addictions
have been considered to be a fairly uniform subject
group by researchers; however, there are many dif-
ferences within the group in terms of comorbidity
and other factors, which might influence treatment
outcomes. Also, there are many problem gamblers
who manage to recover without treatment; it would
be useful to learn more about this group and what
factors account for their improvement.
Treatment efforts also have focused on spouses
and other family members of problem gamblers.
Because the addict also negatively affects others
with his or her addiction, therapists have suggested
that family members too could benefit from some
intervention.
Salem Health
Prevention
It can be argued that the best prevention for gambling
addiction is to avoid gambling, since most people do
not realize their propensity for unhealthy and prob-
lematic gambling until they have a problem. Gener-
ally, government dollars have been spent on treat-
ment rather than on prevention, but there are strong
public health arguments that support greater efforts
in prevention.
Susan J. Wurtzburg, PhD
Further Reading
Kaminer, Yifrah, and Oscar G. Bukstein, eds. Adoles-
cent Substance Abuse: Psychiatric Comorbidity and High-
Risk Behaviors. New York: Routledge, 2008. A broad
consideration of substance abuse among adoles-
cents.
Ladouceur, Robert, and Stella Lachance. Overcoming
Pathological Gambling: Therapist Guide. New York:
Oxford UP, 2006. Useful therapeutic information,
from a cognitive-behavioral therapy approach, for
the therapist, gambler, and affected family mem-
bers.
Nathan, Peter E., and Jack M. Gorman, eds. A Guide
to Treatments That Work. 3rd ed. New York: Oxford
UP, 2007.
National Research Council. Pathological Gambling: A
Critical Review. Washington, DC: National Academy,
1999. A clearly written overview of gambling tech-
nology, problem gambling, its effects on individ-
uals and communities, and treatment.
Newman, Stephen C., and Angus H. Thompson.
“The Association between Pathological Gambling
and Attempted Suicide: Findings from a National
Survey in Canada.” Canadian Journal of Psychiatry
52.9 (2007): 605–12. Print. Identifies an associa-
tion, although causality is unproven, between path-
ological gambling and attempted suicide.
Petry, Nancy M. Pathological Gambling: Etiology, Comor-
bidity, and Treatment. Washington, DC: American
Psychological Association, 2005. Examines patho-
logical gambling from a clinical perspective.
Wong, Irene Lai Kuen. “Internet Gambling: A
School-Based Survey among Macau Students.” So-
cial Behavior and Personality 38.3 (2010): 365–72.
Print. Discusses two growing gambling popu-
lations, each of which deserves more study: In-
ternet gambling and adolescent participation in
gambling.
Addictions and Substance Abuse
Websites of Interest
A.D.A.M. Medical Encyclopedia
http://www.ncbi.nlm.nih.gov/pubmedhealth/
PMH0002488
HelpGuide.org
http://www.helpguide.org/mental/gambling_
addiction.htm
National Council on Problem Gambling
http://www.ncpgambling.org
See also: Behavioral addictions: Overview; Compul-
sions; Gamblers Anonymous; Gaming addiction;
Impulse control disorders; Men and behavioral
addictions
Gaming addiction
Category: Psychological issues and behaviors
Also known as: Pathological video game use; prob-
lematic video gaming; video game addiction
Definition: Gaming addiction broadly refers to
excessive time playing games, particularly video
games. The gaming addict displays a pattern of
behavioral addiction (similar to gambling addic-
tion) whereby he or she ignores social, relational,
and occupational responsibilities and becomes
preoccupied with the game. In general, gaming
addiction has a greater connection to video games
than to board games, card games, or sports.
Causes
Gaming addiction can have several underlying causes.
In general, gaming addictions are triggered and cul-
tivated when unmet (or partially met) social and psy-
chological needs are fulfilled by playing games. It is
believed that one of the primary functions of playing
games is to rehearse real-life situations and circum-
stances to develop behavioral responses without risk.
Reasons for excessive gaming can include stress re-
lease, relaxation, anxiety reduction, escapism, au-
tonomy, social interaction, and competence and self-
esteem development.
Gaming addiction is considered to be similar to
pathological gambling in that it begins as rewarding
Gaming addictionÊ UÊ ÓÈÇ
entertainment. Video gaming, like gambling, activates
the brain’s reward pathways (and releases dopamine).
Another consideration in the cause of video game ad-
diction is the genre of the game. The massively mul-
tiplayer online role-playing games (MMORPGs) have
a significant mixture of social interaction and open-
ended game play that has drawn considerable atten-
tion for being addictive. The interactive nature of
video games and the increasing potential for realistic
depictions of environments that allow for complex
social interactions increase the potential that they be-
come salient to the person playing the game.
Risk Factors
Research indicates that adolescent and young adult
males are predominant users of video games and also
show a greater incidence of dependency. Gaming can
elicit a cognitive and affective state known as flow,
which is characterized by a rewarding, focused sense
of control and a loss of sense of time and place. Data
demonstrate that pathological gaming can persist
over time and is not a “phase.” Impulsivity, absence
of empathy, low social competence, and inability to
regulate emotion are correlated with pathological
gaming, although experts differ on the causal rela-
tionship of these factors in gaming development.
(The factors also may be in response to problematic
gaming.)
Addictive or pathological patterns of gaming also
appear to predict mental health issues such as depres-
sion, anxiety, and social phobias; however, the role of
these effects in developing and maintaining gaming
problems is unclear. Youth who play games more
than thirty hours per week are more likely to develop
gaming addiction than are those who game less than
twenty hours per week. Games such as MMORPGs,
which involve identifying with a gaming character
or avatar, are much more likely to become addictive.
Open-ended games or those that regularly add con-
tent to be mastered, also pose a risk of addiction. Per-
sons with a history of addictions (such as substance
abuse and gambling) and persons with extended pe-
riods of unstructured time are also considered to be
at risk for gaming addiction.
Symptoms
Symptoms for gaming addiction, which range from psy-
chological and social to physiological, include excessive
game-binging (gaming for more than six to eight hours