2. Change diagnostic category from Substance-
Related Disorders to Substance Use and
Addictive Disorders
The addition of Addictive Disorders indicate
acceptance of process or behavioral
addictions as a concept by the APA
workgroup that worked on this category.
3. Acknowledges behavioral processes can activate the
reward system and produce behavioral symptoms
similar to SUDS.
Includes Gambling Use Disorder as a diagnosis in
Section II under the Substance-Related and Addictive
Disorders category.
Includes Internet Gaming Disorder (p. 795) in Section
III.
Other process addictions must be categorized under
other diagnostic categories such as Feeding and Eating
Disorders, Impulse Control Disorders, Obsessive
Compulsive Disorders, and Sexual Disorders or
Paraphilias.
5. ◦ Clinically significant impairment or distress
◦ 4 or more criteria in 12 month period
More money to achieve desired excitement (tolerance)
Restless or irritable when tries to cut down/stop (withdrawal)
Can’t control behavior (compulsion)
Preoccupied with gambling (obsession)
Gambles when feeling distressed (emotion regulation)
Lies to conceal extent of gambling
Impaired functioning
Relies on others to provide money to continue gambling
◦ Not better explained by a manic episode
7. Distorted Thinking:
◦ Denial
◦ Superstitions
◦ Sense of power & control over the outcome of chance
events
◦ Overconfidence
“Some are impulsive, competitive, energetic,
restless, and easily bored” (p. 587).
8. “May be overly concerned with the approval of
others and may be generous to the point of
extravagance when winning.”
“Others may be depressed and lonely, and they
gamble when feeling helpless, guilty, or
depressed.”
About 50% in treatment have suicidal
ideation & about 17% have attempted
suicide.
9. Prevalence
◦ Last 12 months .2%-.3% of the general population
◦ Lifetime prevalence rate gender & ethnicity
Males: .6%
Females: .2%
African Am .9%
Whites .4%
Hispanics .3%
◦ More common among young & mid-life
◦ Risk & Prognostic Factors:
Temperament
Genetic
Course Modifiers
10. Earlier onset:
More common with males
Often begin with family & friends
Associated with impulsivity & substance abuse
HS & college students who have the disorder may grow out of it
Younger prefer sports betting
Older: Machine/bingo gambling more likely
Females: mid-late adult onset is typical
more rapid development in females
more likely than males to have depression, bipolar, &
anxiety
Low rate of treatment seeking in general <10%, but more older onset females
present for treatment than other populations
Frequency gambling can be more associated with the type of gambling than
the severity of gambling. (scratch ticket vs. casino)
Amount of money isn’t necessarily an indicator of a gambling problem.
11. Poor general health & utilize medical services at a high rates
◦ Tachycardia & angina more common in GD population even when other
substance use disorders are controlled for.
Jeopardize or loss of important relationships
Repeated lying to cover up the extent of gambling
May request money used for gambling or to pay off gambling
debts
Employment/educational activities may be adversely impacted
◦ Absenteeism
◦ Poor work/school performance
13. Genetics: research “suggests that the possession of
the dopamine D2A1 allele receptor gene may result in
deficits in the dopamine reward pathways” (Ashley &
Boehlke, p. 56).
Trauma History: Kausch et al. found 64.4%
Cognitive Distortions (next slide)
Accessibility: Gerstein et al. double risk if within 50
miles of a casino - controversial
Co-morbid SUDs, mood, ADHD
Criminal behavior, Bankruptcy
Suicidal Thinking
Notas del editor
Leigh
Leigh
Gambling Disorder:
Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period:
Needs to gamble with increasing amounts of money in order to achieve the desired excitement. (tolerance)
Is restless or irritable when attempting to cut down or stop gambling. (withdrawal)
Has made repeated unsuccessful efforts to control, cut back, or stop gambling. (Loss of control/compulsion)
Is often preoccupied with gambling (e.g., having persistent thoughts of relieving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). (obsession)
Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). (emotion regulation)
Impaired Functioning
6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
7. Lies to conceal the extent of involvement with gambling.
(Criteria 8 and 9 are least endorsed – usually most severe cases)
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.
B. The Gambling Behavior is not better explained by a manic episode.
Episodic:
Meets Diagnostic Criteria at more than one time point
Symptoms subsiding between episodes for several months
Or Persistent:
Continuous symptoms for multiple years
In Early Remission
After diagnosis, none of the criteria have been met between 3 and 12 months
or In Sustained Remission
After diagnosis, none of the criteria met 1 year or longer
Severity Level
Mild: 4-5 criteria met
Moderate:6/7 criteria met
Severe:8/9 criteria met
“Those presenting for treatment most often are at the moderate to severe level of severity” (p. 586).
Prevalence –
Last 12 months .2%-.3% in general population.
Lifetime prevalence rate
Males: .6%
Females: .2%
African Am.9%
Whites.4%
Hispanics.3%
More common among young & mid-life
Risk & Prognostic Factors
Temperamental:
Gambling beginning in childhood or early adolescence is associated with increased rates of gambling disorder.
GD appears to aggregate with antisocial PD, depressive & bipolar disorders, and other substance use disorders (particularly alcohol)
Genetic
Can aggregate in families related to both genetic & environmental factors
More frequent in monozygotic than dizygotic twins
More frequent among first degree relatives of individuals with moderate-severe alcohol use disorder
Development
Earlier onset:
more common with males
Youth – often begin with family & friends
associated with impulsivity & substance abuse
HS & college students who have the disorder may grow out of it
Younger prefer sports betting
OlderMachine/bingo gambling more likely
Females:mid-late adult onset is typical
more rapid development in females
more likely than males to have depression, bipolar, and anxiety
Low rate of treatment seeking in general &lt;10%, but more older onset females present for treatment than other populations
Course Modifiers
Many individuals are likely to resolve gambling disorder problems over time
Strong predictor of future gambling problems is prior gambling problems
Frequency gambling can be more associated with the type of gambling than the severity of gambling. (scratch ticket vs. casino)
Amount of money isn’t necessarily an indicator of a gambling problem.
Differential Diagnosis:
Non-disordered Gambling:
Professional gambling – risks are limited & discipline is central
Social gambling typically occurs with friends or colleagues & lasts for a limited period of time, with acceptable losses.
Manic Episode:
Loss of judgment associated with excessive gambling may occur during a manic episode.
Only give GD if the behavior isn’t better explained by mania.
Similarly, a person with GD may exhibit behavior consistent with mania when gambling but does not exhibit this behavior away from gambling.
Personality Disorders:
Antisocial PD & some other personality disorders may be more prone to GD.
Full criteria for both disorders must be met in order to diagnose both.
Other Medical Conditions:
Determine if dopaminergic medications (i.e. for Parkinson’s disease) are resulting in experiencing urges to gamble. – don’t give GD if so
Comorbidity:
Poor general health
Tachycardia & angina more common in GD population even when other substance use disorders are controlled for.
Substance us disorders
Depressive disorders
Anxiety disorders
Personality disorders