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Conceptualization of Gambling and the DSM

In the earlier editions of the the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM ) “Pathological Gambling” (now called “Gambling Disorder”) was categorized under impulse-control disorders (ICDs) and conceptualized as either addictive or compulsive behavior, but in the latest edition (DSM-5) Gambling Disorder is moved to the category Substance-Related and Addictive Disorders as a Non-Substance-Related Disorder.

Many researchers and clinicians believe that problem gamblers closely resemble alcoholics and drug addicts, not only from the external consequences of  the addiction, but also from the internal brain chemistry side as well.

Brain imaging studies and neurochemical tests have shown that gambling activates the reward circuitry in the same way as an addictive drug does.  For example, pathological gamblers report cravings and “highs” in response to gambling similar to drug addicts.

Many people expressed concern that the label “pathological” is a pejorative term that only reinforces the social stigma of being a problem gambler, and over such concerns the DSM-5 renamed the disorder “Gambling Disorder.” However, it is not gambling that is the problem, it is pathological gambling, and politically incorrect or not, it is a more descriptive term.

As does substance abuse, pathological gambling runs in families (is genetic), is often co-morbid with other addictions, and up to half of the people being treated for Gambling Disorder have suicidal thoughts.

PathologicalGambling.info

Gambling Disorders and Brain Neurochemistry

Clinical research suggests there are several neurotransmitter system dysfunctions involved in the the addiction to gambling.

The systems in particular are the, serotonergic, dopaminergic, glutamatergic and opioidergic functioning.

Of these, the opioidergic system appears to be the most promising target currently. Reseach data suggest that the drug naltrexone, that works by blocking the opioid system, may be the most effective form of current therapy for the treatment of gambling disorder –particularly for individuals with a co-occurring substance-use disorder or with a family history of alcoholism.

On the other hand, lithium or other mood stabilizers may be most effective for people with gambling disorders presenting with a co-occurring bipolar-spectrum disorder.

In addition, serotonin reuptake inhibitors (like Prozac) may be very effective in reducing gambling disorder symptoms for people also presenting with a non-bipolar-spectrum disorder-type of  mood or anxiety disorder.

Finally, elevated rates of gambling disorder (and other types of what are called Impulse Control Disorders) have been seen commonly among people with Parkinson’s Disease. Healthcare providers should look for tendencies to have gambling disorder symptoms when considering treatment for Parkinson’s Disease. Reducing the dose of medications such as  Sinemet or dopamine agonist drugs may partially reduce gambling disorder  symptoms among people with co-occurring Parkinson’s Disease treatment.

People who are not willing to try pharmaceutical agents, n-acetyl cysteine or behavioral therapies may be effective treatment for gambling disorders.

The effectiveness of combining behavioral therapies and anti-gambling disorder medications is not as well studied, but the combined treatments should be considered.

PathologicalGambling.info