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Gambling addiction

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Gambling addiction access

Postby Shakamuro В» 26.05.2019


This chapter contains a brief history of gambling and a brief description of gambling disorders, followed by the risks that this behavior would become compulsive and the negative consequences that the gambler and the members of this family would experience.

Thereafter, the psychological characteristics of the compulsive gambler will be specified, as results from the recent international researches, and we will also describe the psychological profile of the Romanian compulsive gambler.

Next, we will approach the various methods of treatment of gambling addiction, focusing on the forms of psychotherapy that proved to be effective in treating this mental disorder, and listing of certain studies that have demonstrated their effectiveness.

Cognitive Behavioral Therapy and Clinical Applications. Gambling has been around since the oldest times, as the desire to win, to gain welfare and prestige by taking risks continuously is an instinctual force, which continues to exist in the human gene.

There has been, throughout history, a plethora of personalities of different times preoccupied with gambling: Roman Emperors Nero and Claudius were recognized as great gamblers, while Lord Halifax, Marie Antoinette, the Duke of Wellington, and Dostoyevsky could belong in the modern definition of a compulsive gambler [ 2 ].

When a person is gambling more and more and is allocating more and more money to gambling to the detriment of other daily activities, a compulsive disorder may be seen as emerging and developing, which risks becoming a gambling disorder.

The consequences of compulsive gambling are many, ranging from financial problems to intensified or prolonged stress, from dismantled families to lost fortunes, academic abandonment, and more. It is becoming more and more important that the young population especially, but also the rest of the population seen entering casinos on an increasing larger scale, should understand what it means to gamble responsibly and how to avoid the slippery slope to gambling disorder [ 5 ].

Raylu and Oei [ 6 ] consider that there are three categories of factors that can contribute to the emergence and development of gambling disorder: family-related factors, individual factors, and sociological factors. In terms of family factors , specialized studies in the field have demonstrated that both parental models of behavior and genetic factors represent for any gambler at the risk to develop a compulsive gambling behavior [ 7 , 8 ].

Sociological factors which are tied to the emergence of gambling disorder refer to the existence of a socio-economic status of the gamblers, unemployment, and a lower education level. The practice of excessive gambling has negative consequences on the gamblers as well as on the society per se, starting with poverty, family dismantling, and illegal behavior in terms of obtaining the necessary money gamble.

Financial problems: one borrows, sells goods, and builds up debt in order to finance this addiction;. Stress-related afflictions: insomnia, nervousness, depression, anxiety, culminating in suicide attempts.

Studies conducted by Blaszczynsky [ 10 ] have revealed that gambling disorder determines the following negative effects on gamblers: depression, suicidal thoughts, anxiety, alcohol and drug consumption, difficulties in keeping a work-place, lies and deceits, the decrease of cognitive performance, and physical symptoms. Is often preoccupied with gambling e. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.

Relies on others to provide money to relieve desperate financial situations caused by gambling. South Oaks Gambling Screen SOGS was developed by Lesieur and Blume [ 18 ], and it contains 20 items which correlate with the criteria of the diagnostic for the pathological gambling from DSM-IV; the advantage of SOGS is the ease with which it is administered and the way of scoring, as well as the fact that proved useful with diagnosing the pathological gambling for both teenagers and adults.

Massachusetts Gambling Screen MAGS [ 19 ] is an easily administrable and markable questionnaire that can be used for both teenagers and adults, and it utilizes the criteria of DSM IV for the diagnosis of the pathological gambling; a score of minimum 5 permits the adjustment in the pathological game of chance.

Gamblers Anonymous 20 Questionnaire [ 20 ] is a more extensive questionnaire with 20 questions, which the gamblers can self-manage in order to establish whether they possess an addiction problem or not.

The Problem Gambling Severity Index PGSI [ 21 ] represents an instrument which comprises a number of nine items with whose help any person can self-evaluate the severity of their pathological gambling. The Inventory of Gambling Situations IGS [ 22 ] represents an identifying instrument identify for the situations, where a person presents a risk of compulsive gambling and comprises a number of 63 items, which represent just as many possible situations in which someone could gamble excessively.

The Gambling Related Cognition Scale [ 7 ] is a questionnaire with 23 items, which help the participant to self-evaluate their irrational beliefs related to games of chance, and the items are divided in five subsections: interpretative biases referring to the capacity of controlling the game; the illusion of control; the prediction of control; nonrealistic expectations tied to gambling; and the inability to stop gambling. Gambling disorder is best described as being a syndrome, and from this perspective, the most efficient treatment reflects a multimodal approach, which bases itself upon a personalized and complex treatment plan.

Multidimensional treatments thus include different combinations of therapeutic, financial, and educational counseling, as well as self-help, psychotherapy, and psychopharmacology in the case of intervention. There is a wide range of treatment programs for compulsive gambling, based on the specific professional expertise of the therapist and the existing therapeutic resources.

Primary medical care programs tend to offer more screening, short-term pharmacological treatment, and guidance for follow-up counseling. The problems faced by specialists when starting treatment with compulsive gamblers mainly relate to the fact that they deny that they have an addiction problem, they are not informed on the fact that there are qualified professionals in this field, they are fearful of the fact that they could be stigmatized, often they do not want to give up gambling, their partner does now want to get involved, and their family is not supportive.

The treatment for the gambling disorder shares many similarities with the treatment for drug addiction, and it involves the development and techniques and measures to cope with the phenomenology of craving that characterizes any addiction and has a neurophysiological substrate.

In drug and alcohol addiction and even in gambling disorder, we find the following aspects [ 23 ]: An increased desire to gamble or to ingest substances ;. Until the present day, there have been relatively few studies on checking the efficiency of the different forms of treatment for gambling disorder [ 24 , 25 , 26 , 6 , 7 , 27 ].

Pharmacological treatment has some promising results in ameliorating some comorbidities, such as impulsivity and mood disorders, but the results of the efficiency studies for this type of treatment are limited due to the fact that there were smaller lots of people used, high drop-out rates recorded, and big variations in terms of the placebo effect [ 28 , 29 , 30 ].

Psychological treatment for gambling disorder includes numerous approaches, such as psychodynamic therapy and analytic therapy [ 31 ], multimodal therapy, the Gamblers Anonymous group [ 20 ], the motivational interview [ 32 ], online counseling [ 33 ], behavioral therapy [ 34 ], and cognitive-behavioral therapy [ 6 , 15 , 23 , 24 , 35 , 36 , 37 ].

Chambles and Ollendick [ 38 ] have analyzed the efficiency of various approaches to treat gambling disorder; based on the scientifically validated evidence and the research that has been carried out, following classification has been established: Cognitive-behavioral therapy together with behavioral therapy represents the most efficient forms of scientifically validated treatment;. Psychodynamic therapy, aversive therapy, auto exclusion, and the Gamblers Anonymous groups present a reduced efficiency in treating this pathology.

Authors mention the fact that it is possible that cognitive-behavioral therapy has no direct effect on game behavior; however, its effect relates to reducing symptoms of depression and anxiety, which will then influence in their turn the improvement of game behavior. Cognitive-behavioral therapy is currently considered the most efficient method of treatment for gambling disorder; this type of therapy postulates the fact that the irrational thoughts tied to the ability of a person to control the game and predict the win represent the main factors which determine the development and the maintenance of this pathology [ 39 , 40 , 41 , 42 , 43 , 44 , 45 ].

Petry and his associates [ 51 ] conducted a comparative study on a lot of compulsive gamblers which they split into three groups: the first group was treated using the Gamblers Anonymous method, the second group using GA combined with the help of the cognitive-behavioral therapy guiding exercises, and the third group participated at the GA groups plus eight individual sessions of CBT. Ladouceur and others [ 52 ] proposed a model of therapy for treating the gambling disorder which comprises the following five steps: Informing in terms of the general aspects of the game;.

Modifying the irrational beliefs of the gambler with how the activities in gambling are carried out;. Learning some coping methods in terms of maintenance the positive changes in game behavior;. Learning of maintenance strategies of the therapeutic wins obtained and preventing relapse.

Blaszczynsky [ 10 ] introduced a complete self-help program for compulsive gamblers which comprises the following steps: Increasing the motivation to stop the game;. Wulfert, Blanchard, and Martell [ 54 ] used for the treatment for gambling disorder an alternative of cognitive-behavioral therapy which comprises techniques of the motivational interview, cognitive-behavioral therapy, and techniques for relapse prevention, while Miller and Rollnick [ 55 ] proposed a model of raising motivation where the key concepts are the following: raising the motivation of the client is essential in observing the product of change; motivation is a dynamic feature; and motivation is influenced by external factors, including the behavior and attitude of the counselor.

The advantages of cognitive-behavioral therapy refers to the fact that it is a well-structured type of therapy, it is carried out on a limited period of time, it requires limited costs compared to the other types of therapy, and it produces long-term benefits and supposedly the fall off the risk of relapse [ 6 , 15 , 36 , 43 ]. The treatment of gambling disorder poses many problems, first of all, because pathological gambling has been only recently recognized as a disorder in its own right, not enough research has been done and there is a lack of professionals trained in offering psychological and psychiatric services in this field.

We have introduced a model of cognitive-behavioral therapy for gambling addiction in Romania, based mainly on cognitive restructuring techniques, with the following fundamental objectives: Reducing the consequences of gambling disorders which interfere in the everyday functioning of gamblers;.

Managing the negative emotionality associated with this disorder depression, anxiety, stress ;. Satisfying the need for entertainment and developing new and pleasant recreational and social activities, which do not pose the risk of having a destructive impact on the lives of the subjects. The model includes several stages, namely assessment and formulation, psycho-education and introduction to the ABCDE model, cognitive restructuring, problem-solving training, assertiveness skills training, and relapse prevention.

The degree to which the subjects have reached out for psychological support and the efficiency of the support they have received;. We will adopt an attitude of acceptance toward the subjects and their gambling experience, using techniques such as active listening, reflection, nonverbal communication maintaining visual contact, open body posture, nonevaluative facial expression, consistency of tone etc. John faced economic hardships his entire childhood and he remembers being the poorest child at his school.

When he got married, he vowed that his family would never suffer from poverty, but the company he started is not doing well and he believes that only his gambling activities will help them escape poverty. Because he is not able to support his wife financially, he experiences profound sadness, disappointment and discouragement.

The thought of suicide has crossed my mind, but then I started thinking: am I really such a coward? My family needs me, but they need me to be a strong and normal person, not the kind of person I am right now. For John, gambling is an escape. At the casino, he puts all his problems behind him and cuts himself off from the world.

In the case formulation, we will focus on the experiences, cognitions, emotions, and behavior of each client; the case formulation will help the client understand the factors that led to the development and maintenance of their compulsive gambling [ 58 ].

In the following stage, we will teach the client the ABCDE model designed by Albert Ellis [ 59 ] and we will familiarize him with the basic principles of cognitive-behavioral therapy [ 1 ]: Psychological issues represent learned maladaptive responses, supported by irrational cognitions;.

Dysfunctional cognitions can be identified and replaced, which takes effort and perseverance on the part of the subject. The goal of cognitive restructuring is to interrupt the vicious cycle of compulsive gambling and to help the subject have control over his behavior. Predictive control, which involves the belief that the gambler has the skill of making accurate predictions;.

A study carried out in Romania from to , involving compulsive gamblers with an average age of The participants had a Given that, whenever he goes to a casino, John is certain he will win a substantial sum of money that will get him out of poverty, I asked him where exactly such a huge win could come from, seeing how the casino where he gambles is basically just a small hall, in which approximately 10 gamblers try their luck.

When I lose, I get really mad, I yell at everybody, I turn into a monster. During the cognitive restructuring phase, we focus on changing gambling behaviors by correcting irrational beliefs, cognitions and dysfunctional attitudes about gambling, as seen in Table 1 [ 58 ]. Therefore, we will help the subject dispute each irrational belief we identify using the following type of questions [ 60 ]: What effect does this belief have on me?

Does it help me or not? We do not have the power to influence if or how much we win by gambling slot machines, as this is pre-determined by a computer system;. Slot machines are set up in such a way that what you win will always be less than what you spend;. You are not more valuable as a human being if you win and you are not less valuable as a human being if you lose when you gamble.

After the cognitive restructuring process, we will suggest to the gambler that he creates a list of alternative activities to replace his gambling behavior and as well as a schedule of daily activities which should leave him no spare time to gamble or identify the triggers for his gambling behavior. Studies have shown that involving compulsive gamblers in a large number of activities to fill up their spare time significantly reduces the risk of a relapse.

Preventing relapses is a psychoeducational approach targeting behavioral change, through which the gambler learns to identify and overcome risk situations that could make him return to his old compulsive gambling behavior [ 39 ].

Creating a decisional balance sheet for when he feels the urge to gamble again will help the subject to make the right decision about gambling. The decisional balance sheet is a technique which consists in creating a list of pros and cons of a certain behavior, as they appear to the subject at that particular moment in time. With the help of this balance sheet, the subject will weigh the long-term and short-term advantages and disadvantages of his gambling behavior, and based on the weight he gives to each advantage and disadvantage, he will make the decision to either cease or to continue to gamble, taking on the full responsibility for the consequences of his actions.

Among the disadvantages he includes losing large sums of money, addiction, wasting his time, neglecting his responsibilities, negative emotional states, heavy smoking while gambling, a permanent state of restlessness. During the process of cognitive restructuring, these cognitions will be replaced by rational alternatives: Nondogmatic preferences: I may want something, but I do not have to absolutely have it;.

Raylu and Oei [ 6 ] suggest using the following cognitive techniques when fighting the urge to gamble: Picture the negative consequences of the gambling;.

Redirect your focus from the urge to gamble to other external events, by using the STOP technique: as soon as you feel the urge to gamble, clearly tell yourself STOP in a silent voice, without saying it out loud, and focus on something else;. Identify your irrational beliefs about gambling, dispute them, and then replace them with rational beliefs. Specialists in the field of gambling disorder recommend regularly practicing guided imagery in a state of relaxation as a way of dealing with the urge to gamble [ 6 , 10 , 65 ].

The rationale for using relaxation techniques has to do with the fact that gambling disorders are caused or exacerbated by feelings of stress and anxiety, given that stress plays an important role in the development and maintenance of this pathology [ 37 , 66 ].

At the end of the therapeutic process, we will support the gambler in his efforts to adopt a well-balanced life style, by establishing the following intervention objectives: Overall improvement of coping strategies;. John has established the following objectives for himself: Make a change in myself;.

Take concrete actions to change for the better, without waiting for God to work a miracle in my life;. Put more effort into managing my company so that it yields a reasonable profit;. Dryden and Matweychuk believe that the maintenance of benefits that result from treatment requires developing coping skills with regard to risk situations and future temptations, insofar as addictive behavior relapse is concerned; the authors provide the following recommendations [ 67 ]: Develop several healthy convictions, such as give up the habit of pleasing others and put yourself first and the others second;.

Create or develop several social interests: understand that the people around you have their own wishes and goals in life, and they cannot always offer you their unconditional support, you must also think of how you can support them and be there for them when they need you;. Learn how to take control of your life; do not let your addictive behavior control your life;.

Develop a heightened tolerance to frustration so that you can achieve the goals you set for yourself;. Learn to accept uncertainty, because we live in a world of probabilities, in which nothing is absolutely certain;. Think logically, establish short- and long-term goals, and think about the possible consequences of your actions;.

Gambling on Addiction : How Governments Rely on Problem Gamblers - The Fifth Estate, time: 24:18
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Re: gambling addiction access

Postby Fenrigrel В» 26.05.2019

You are not more valuable as a human being if you win and you are not less valuable as a human being if you lose when you gamble. Type of gambling addiction availability as risk factors for problem gambling: a Tobit regression analysis access age and gender. However, when controlling for involvement in terms of frequency of participation, expenditure, and number gmabling forms used including land-basedInternet gambling participation does not uniquely addictoin gambling problems [ 2gambling161718games intersection games ].

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Re: gambling addiction access

Postby Vibei В» 26.05.2019

Consequences of gambling disorder The practice of excessive gambling has negative consequences on the gamblers as well as on the society per se, starting with poverty, family dismantling, and illegal behavior in terms gambling obtaining the necessary money gamble. Neither online or venue breadth of involvement were associated with K6 scores when addiction for EGM or casino game accsss. It access learn more here to note that associations between gambling activities and problem gambling severity are not necessarily fixed or stable over time. The sum K6 score was then used as addictkon count measure of psychological distress. Additional file 1.

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Re: gambling addiction access

Postby Grom В» 26.05.2019

First, acceds data are cross-sectional, and we cannot make any causal inferences. Live Chat. When controlling for overall gambling frequency, problem gambling was significantly positively associated with the frequency of online and venue-based gambling using electronic gaming machines EGMs and venue-based sports betting.

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