Pathological gambling
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1593 (Published 05 April 2017) Cite this as: BMJ 2017;357:j1593All rapid responses
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Some facts should be added to the Editorial of H. Bowden-Jones[1]. There is a strong difference between casino games with the special casino setting, non-casino gambling games like card games and an increasing number of electronic games on the internet. The DSM-V has classified pathological gambling as "gambling disorder" and listed this disorder under substance-related and addictive disorders rather than impulse-control disorders. This is due to the symptomatology of the disorder resembling an addiction not dissimilar to that of substance-abuse [2].
Pathological gambling shows similarities with substance abuse, but there is only a partial overlap in diagnostic criteria. However, the etiology of this behavior is poorly understood. Genetic, environmental and biological factors can cause some different types of addiction. Deficiencies in norepinephrine, serotonin and dopamine dysregulation might also contribute [3]. Dopamine agonist treatment was associated with pathological gambling, may relate to stimulation of dopamine receptors in the limbic system[4]. There is a high comorbidity with affective, anxiety and personality disorders. This highlights the importance of integrated treatments of gambling disorders and its comorbidity [5]. In Europe, the rate of problem gambling is typically 0.5 to 3 percent.
Gambling disorder is associated with various adverse effects. One risk is a high rate of suicides and dramatic economic costs for the patients and the community (“problem gamblers are associated with between £260 million and £1.2 billion a year of extra cost to government”). Cognitive behavioral therapy (CBT) may be a possible treatment to reduce symptoms, but new and important modifications [6] are necessary, especially under the aspect of increasing electronic gambling[7]. Müller KW demonstrated in a new study, that one year after treatment, a considerable percentage of patients kept on gambling[8].
References:
1) Bowden-Jones H, Pathological gambling. BMJ 2017;357:j1593
2) Christensen, DR et al. An Examination of a Proposed DSM-IV Pathological Gambling Hierarchy in a Treatment Seeking Population: Similarities with Substance Dependence and Evidence for Three Classification Systems". J Gambl Stud 2014; 1–20
3) Roy, A. et al. Pathological Gambling: A Psychobiological Study. Arch Gen Psychiat. 1988;45 (4): 369–373
4) Dodd ML et al. Pathological gambling caused by drugs used to treat Parkinson disease. Arch Neurol. 2005;62(9):1377-81
5)Linnet J et al. Treatment of gambling disorder patients with comorbid depression. Acta Neuropsychiatr. 2017; 27:1-7
6) Abbott M.Effectiveness of problem gambling interventions in a service setting: a protocol for a pragmatic randomised controlled clinical trial. BMJ Open. 2017 Mar 2;7(3):e013490. doi: 10.1136/bmjopen-2016-013490
7) Bouchard S et al. Using Virtual Reality in the Treatment of Gambling Disorder: The Development of a New Tool for Cognitive Behavior Therapy. Front Psychiatry. 2017 Feb 24;8:27. doi: 10.3389/fpsyt.2017.00027. eCollection 2017
8) Müller KW et al.. Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study. Eur Psychiatry. 2017 Feb 7;43:28-34
Competing interests: No competing interests
Gambling is an addictive behavior and social lubricant that tricks and traps us by creating the fleeting euphoria of feeling lucky and rich, but the sustained sickness of being unlucky and poor. The euphoria of feeling lucky and rich, and the sickness of being unlucky and poor, are opposites that reinforce each other: the euphoria blinds us to the sickness; and the sickness makes us crave the euphoria. Perversely but predictably, gambling creates, aggravates, and perpetuates the very sickness of being unlucky and poor that it falsely seems to cure, thus placing lotteries and casinos, and their owners/sponsors, in a very bad light.
Competing interests: No competing interests
Re: Pathological gambling
Sports gambling industry has become huge, transacting $4 trillion annually. [1]
Total underground illegal gambling cannot be precisely calculated.
Brief contracts trading currencies is a form of legalized financial gambling, transacting $5 trillion daily. [2]
The total notional derivatives value, futures betting, is about $1.5 quadrillion. [3]
Governments earn considerable sums by taxing gambling activities.
References
[1] http://www.stuff.co.nz/sport/other-sports/67786452/illegal-gambling-push...
[2] http://www.businessinsider.com/heres-how-much-currency-is-traded-every-d...
[3] http://www.globalresearch.ca/global-derivatives-1-5-quadrillion-time-bom...
Competing interests: No competing interests