Gambling Flashcards
(52 cards)
1
Q
Why do people persist in gambling despite negative consequences?
A
- to recoup losses (chasing)
- emotional escape
- for emotional reasons (narcissism, ego)
- manage dysfunctional affective states (depression, anxiety)
2
Q
When did gambling increase significantly?
A
- resurgence of gambling legislation since 1950s
- in USA (lotteries), Oz (Casinos in hotels and states 1973), Britain (Royal Commission into gambling 1978), Europe (1990s), Asia 2000s
- 2000s: technological advances leading to Internet and mobile interactive forms
3
Q
What is the prevalence of gambling in the general population?
A
- 60-85% of general population
4
Q
What are the rates of pathological gamblers vs. problem gamblers in the USA, Australia & Europe?
A
- 0.4-1.1% pathological gamblers
- 1-2% problem gamblers
5
Q
What is the prevalence of gambling in adolescence?
A
- 3-14% (median 5%)
6
Q
What is the prevalence of pathological gamblers among gaming venue patrons?
A
- 15-25% pathological gamblers
7
Q
What is gambling now classified under in the DSM -V compared to DSM-IV?
A
DSM - IV: was classified as an ‘impulse control disorder’ (alongside Kleptomania, Pyromania etc)
DSM- V : now classified under addictions and related disorders under NON SUBSTANCE RELATED ADDICTIONS
Criteria same from DSM-IV to DSM-V except cut out need for illegal activity (and only need 4/9 instead of 5/10)
8
Q
What classifies a gambling disorder (criterion a)?
A
CRITERION A: Four or more of:
- Preoccupation (PSYCHOLOGICAL DEPENDENCE)
- increased amount gambled (TOLERANCE)
- irritability/restlessness on cessation (WITHDRAWAL)
- escape from stress (-VE RFT & MOTIVATION)
- chasing losses (ERRONEOUS & DISTORTED COGNITIONS)
- lying
- repeating failure to cease (IMPAIRED CONTROL)
- ILLEGAL ACTS NOT ESSENTIAL
- risked significant r/s
- BAILOUT
9
Q
What percentage of pathological gamblers experienced a win prior to developing problems?
A
- 2/3
10
Q
What is a facilitative cognition?
A
e.g. “I can win the casino”, “this is easy”
11
Q
What happens in the early winning phase?
A
- facilitative cognitions
- gambling becomes a stronger influence on mood than other activities
- increased frequency and intensity
12
Q
What happens in the losing phase?
A
- heightened preoccupation with gambling
- growing losses & attempts to recoup (‘chasing losses’)
- increased stress, irritability, withdrawal
13
Q
What happens in the desperation phase of gambling?
A
- efforts to survive financially & psychologically become increasingly extreme (e.g. illegal activities, r/s manipulation)
- 60% have committed an offence to finance gambling
14
Q
What % of pathological gamblers have committed an offence to finance their gambling?
A
- 60%
15
Q
What is the age of onset in gambling?
A
- mostly in adolescence & young adults
(average 12-15 yrs) - females bimodal (youth and >45 yrs)
16
Q
What is the average age of seeking treatment in gambling?
A
- 35-39 years
17
Q
Do males/females tend to have more gambling problems?
A
- males: 2 to impulsivity, substance use, risk-taking behaviours
18
Q
What is a huge comorbidity related to pathological gambling?
A
Their risk of
- substance abuse times 5.5 increase (30-40% alcohol abuse/dependence)
- mood disorders by 3.7 times (75% dep.)
- anxiety 3.1 times (40% anxiety)
19
Q
What is the cause-effect r/s of gambling of comorbidities?
A
- pathological gambling often precedes comorbid conditions in 23% of cases.
20
Q
What percentage of problem gamblers seek formal treatment?
A
- <10%
21
Q
What is the integrated bio psych-social model of gambling?
A
- suggests that there are multiple interactive vulnerability factors including:
NEUROBIOLOGICAL/GENETIC: (meso-limbic/orbito-frontal reward systems (shared with substance use)
PERSONALITY TREATS
COPING STRATEGIES
PEER GROUP INTERACTIONS
BELIEF SCHEMAS
FAMILY HX (modeling, exposure/attitude, trauma/rejection
22
Q
what is the pathophysiology related to problem gambling in relation to serotonin
A
- problem gamblers show reduced concentrations of serotonin- metabolite (5 hydroxyindoleacetic acid) in CSF
- subjective ‘high’ can be produced through postsynaptic serotonin receptor stimulation with a mixed agonist
- SSRIs show therapeutic effects
23
Q
What is the pathophysiology of problem gambling in relation to dopamine?
A
- problem gamblers show reduced neurnal responses within dopaminergic midbrain while engaging in gambling behaviour
- admin of amphetamines can prime congitons about gambling in PG.
- DRD2 association
- d2 receptor antagonist (haloperidol) can enhance rewarding properties of gambling behaviour
- dopaminergic treatments are associated with pathological gambling in a minority of patients with Parkinson’s dx.
24
Q
What are the reinforcement schedules seen in PG? (OPERANT CONDITIONING)
A
- INTERMITTENT (occasional) and VARIABLE (unpredictable)
HIGHLY RESISTANT TO EXTINCTION
25
How does classical conditioning potentially lead to problem gambling?
NEUTRAL STIMULI e.g. sights, sounds, time of day, people) become associated with physiological arousal and subjective excitement
- subsequent exposure to such cues will elicit arousal/excitement and in turn anticipation of winning (experiences as gambling cravings)
26
What is the illusion of control?
- belief and over-magnification of one's skills and ability to influence or predict the outcome of an event
27
What is the Gambler's fallacy?
- a series of losses must be followed by a win, when in fact the chances are still 50/50 (e.g. with every toss of coin, probability of heads or tails is 50%)
28
What is biased evaluation?
- winnings attributed to one's skills, losses attributed to external, unrelated factors
29
How do neuro-cognitive and psychophysiological processes lead to problem gambling?
COGNTIVE SCHEMAS reinforce pre-existing beliefs,establish new cognitions (biased evaluation, cognitive regret, illusions of control), reward circuits
EXPOSURE TO GAMBLING CUES leads to
DECISION TO GAMBLE
- cost/benefit analysis
- impulsivitiy (neural substrates/personality)
- personality needs (ego, narcsissism)
- emotional escape
30
What is the premise of the Pathways model of pathological gambling?
```
- that pathological gamblers are not a homogenous population
THREE SUBTYPES:
- common phenomenology
- differ in aetiological factors
- differ in treatment requirements
```
31
What is an illusory correlation?
-misinterpretation of two mutually independent events being correlated
32
What does the Pathway 1 gambler look like?
- symptoms are causal outcomes of gambling- related problems
i. e. starts out participating from arousal/excitement, cognitive schemas -->leads to PG --> phenomenology: affective disturbance, criminality, substance abuse, impaired r.s
- responds well to psycho- education, brief interventions & brief CBT
33
What does a Pathway 2 gambler look like?
- affective disturbances, poor coping skills & substance use contribute to gambling
- used therefore as a means of dissociation & escape
34
What does a pathway 3 look like?
- deficits in reward pathways (dopaminergic) & impulsive
| - psychopharmacology & intensive interventions
35
What are some of the demographics of pathway 1?
- motivation to generate excitement, winning
- less dissociation and more absorption
- briefer history of excessive gambling
- childhood & family stability
- absence of psychopathology
- depression/ anxiety is secondary issue
- substance abuse secondary (usually minimal)
36
what are some factors leading to pathway 2 gamblers?
- childhood disturbance
- personality (seek sensation, escape, boredom proneness)
- arousal levels (hyper-arousal/anxious; hypo-arousal/depressed)
- poor coping/problem solving skills
- as well as ecological factors (conditioning - arousal and cognitive schemas)
- leads to PG for excitement/emotional escape
often comorbid conditions (addictions & mental health)
37
What are some factors leading to pathway 3 in PG?
- biological correlates (biochemical- serotonergic, noradrenergic, dopaminergic)
- neuropsychological (ADD, impulsivity)
- differential reward/punishment system
- leads to associated behaviours (criminality, substance abuse, impaired r/s_
- conditions
- vulnerability factors
38
What distinguishes pathway 3 from the other pathways of PG?
- early hx of family instability, abuse/neglect
- high levels of impulsivity, anti-social behaviour( involves in activities with high degree of stimulation, poorer performance at school)
- gambling pursued for its stimulation and capacity to generate excitement/arousal.
- substance-abuse, drugs & alcohol & broad spectrum of criminal behaviours
39
What are some of the earlier causative models of pathological gambling?
```
- psychodynamic
these all share some commonalities of biology
- behavioural
- cognitive- behavioural
- addictions
- biological
```
40
What are the functions of the dopamine pathways?
- reward
- pleasure, euphoria
- motor function
- compulsion
- perseveration
41
What are the functions of the serotonin pathways?
- mood, memory processing, sleep, cognition
42
What does the bio-psycho-social model suggest about treatment?
- different interventions for different areas e.g. schema therapy for disorted schema, psychpharmacology for neurophysiology etc
43
What learning mechanisms occur at the same time?
- operant conditioning
| - classical conditioning
44
What is cognitive regret?
- having invested considerable time and money in a session, a sense of regret at missing out on the next, potentially winning, gamble
45
What is selective recall?
- selectively recalling wins and forgetting losses
46
What are superstitious beliefs and luck charms?
- use of "lucky" charms, objects, prayers, or rituals to "improve" the chances of winning
47
What is luck as a personal quality?
- believing one has a special "lucky" quality. May have cultural association with reference to ancestors looking after one's wellbeing.
48
What is gambling as a source of income?
- the belief that one can win at gamblng- that is, that over the long term one can come out ahead.
49
Which type of gamblers participate in low skill games?
- hyper-aroused/anxious participants
50
Which type of gamblers participate in high skill games?
- hypo-aroused/depressed gamblers
51
What is the motivation for pathway 2 gamblers?
- gambling WITH money, not FOR MONEY: prolong sessions to allow continued emotional escape
- however, when loses, triggers downward depressive cycles
52
What suggests that pathway three gamblers may have some neurological component?
- correlation with ADHD
| - ?low levels of serotonin/dopamine/norepinephrine
