Is Gambling Truly a Disorder?
The American Psychiatric Association, America’s experts on disorders identified gambling as an official disorder of impulse control. Their studies have shown that gambling corresponds with mental illnesses of uncontrollable desire. Gamblers with this illness are restless and impulsive and are “adrenaline junkies”, constantly seeking something new and exciting; normal life is boring to them. However, according to DSM-IV, the criteria for pathological gambling draws heavily upon the substance abuse model and includes a preoccupation with gambling, needing to gamble increasing amounts of money, inability to cut back, withdrawal symptoms, and a significant effect on ones life through loss of occupation, personal relationships, and resorting to illegal acts to obtain money for gambling . Therefore, in terms of clinical definition, pathological gambling is considered similar to other addictions, characterized by some form of emotional dependence, loss of control and interference with normal functioning. However, pathological gambling still occupies a marginal position within the addiction field, depending upon the model of addiction that is held and where the boundaries of that field are drawn. Thus, genetic research suggests that the need of the individual to participate in addictive behaviors is biologically determined, however, the individual determines the choice of behavior. This suggests that an individual with a biological vulnerability to addiction could chose any substance or activity, and through the rewarding effects it produces, either physiologically or psychologically, could ultimately lose control over their behavior. Others assert that there are many similarities between alcohol and drug addiction and pathological gambling, including the development of a euphoric state (a high), cravings (a need for more), tolerance (increasingly larger bets or greater risks needed to produce a desired level of excitement) and withdrawal like symptoms. It could therefore be argued that the addictive effects of any activity serve the same purpose for the person who is biologically predisposed to develop an addiction. Nonetheless, behavioral addictions do not fit the 'typical' framework for physiological addiction, which usually is applied to addictions that involve the ingestion of drugs and refers to the presence of physiological symptoms, such as tolerance, craving, and withdrawal. Tolerance refers to a condition of diminished responsiveness of a drug resulting from repeated exposure to it. Although it is reasonable to assert that tolerance is indicative of substance addiction, it has also been suggested that pathological gamblers develop tolerance over a period of time, whereby larger and more frequent 'bets' are needed to obtain the same pleasure or 'high' and to subsequently produce the initial rewarding effects experienced. Craving refers to an intense longing. In a study, 1,403 males were assessed via the Substance Use Disorder Diagnostic Schedule and the South Oaks Gambling Screen. It was found that in contrast to alcoholics and cocaine misusers, pathological gamblers scored significantly higher on impulsivity and the inability to resist craving, furthermore, research has also shown that gamblers often do experience withdrawal like effects when attempting to discontinue or reduce gambling. For example, Gambling Anonymous attendees, and found that 30-50% reported restlessness, irritability, depressed thoughts, poor concentration, and obsessional thoughts when attempting to discontinue gambling. Wray & Dickerson likened these findings to withdrawal symptoms reported by excessive drinkers. Primary factors are described as the individual's rewarding experience of the gambling activity itself, signified by arousal and excitement. These act as a positive incentive to continue to gamble. It has been acknowledged that variability and unpredictability of reinforcements strengthen learned behavior. Gambling is characterized by such an intermittent schedule of rewards, thus fostering the reinforcement of the gambling behavior further. Additionally, it has been shown that early 'big' wins for the gambler are characteristic of future gambling problems. Secondary factors are considered to be a powerful set of attachment promoting processes that could substitute neuro-adaptation and withdrawal, and are based on the increased drive to obtain money, characterized by chasing losses (repeated gamblers to 'win back' the money already lost), secrecy and cognitive defense. Cognitive defense takes several forms, namely ignoring the accumulation of escalating losses by believing that a big win is eminent, and the inability to accept that they are out of control financially. Tertiary factors refer to the loss of self- respect making further gambling more valuable as a psychological means of escaping bad feelings. Negative outcomes in their personal lives (e.g. job loss, divorce) are seen, from the pathological gambler's perspective, as positive, as restrictions are lessened, leaving more time for gambling. It has been acknowledged that pathological gamblers not only gamble for excitement, but also to escape, to alleviate depression, to promote relaxation and to cope with loneliness. This level of attachment can relate to both physiological and psychological dependence. Subsequently, asserts that it will always remain an open question whether gambling can be as addictive as a substance such as alcohol, when addiction is defined in terms of the strength of a person's psychological attachment to the activity or substance. To conclude, the available literature suggests that both biological and psychological factors are implicated in pathological gambling. However, the fundamental concept of addiction is challenged when establishing whether pathological gambling should be treated as an addiction. Although evidence is provided to demonstrate that pathological gamblers do show tolerance, craving, and withdrawal, it is still important to note that many 'addictive' drugs do not produce these symptoms (e.g. cocaine), also, dependence and withdrawal are often present when drug use is absent. Therefore, either drug use is not necessary to produce addiction, or gambling disorders are not representative of addictive behaviors. Pathological gambling, viewed as a psychological dependence reveals that addiction can exist without drug taking. Pathological gambling is a destructive influence on individuals, their families, and society in general. Hopefully, what the literature has demonstrated is that addictions are not just restricted to drug-ingested behaviors and that evidence is growing that addictive behaviors whether physiologically or psychologically based, have many commonalities.
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