Mood Disorders And Gambling
- Mood Disorders And Gambling Disorders
- Affective Mood Disorder
- Mood Disorder Medications
- Mood Disorder Criteria
- Mood Disorders Symptoms In Adults
- Mood Disorders And Gambling Rehab Centers
- Mood Disorders And Gambling Addiction
Compulsive gambling, known formally as pathological gambling, is a psychiatric disorder that involves a persistent fixation with gambling that continues in the face of seriously negative personal or social consequences. Along with a varied range of other conditions that feature impulsive behavior, it’s officially categorized as an “impulse disorder not otherwise specified.” Current guidelines group all compulsive gamblers together. However, according to the results of a study published in 2010 in the Canadian Journal of Psychiatry, compulsive gamblers actually belong to one of four different sub-types, two of which include features of certain personality-based mental illnesses called personality disorders.
Compulsive Gambling Basics
It’s important to consider both your depression and gambling addiction when seeking treatment because each disorder can intensify the symptoms of the other. If you’re feeling depressed, you’ll be looking for ways to boost your mood and the thought of winning at gambling may seem like a good solution.
- SCID based study results show a close link between gambling and mood disorders. The prevalence of manic disorder reaches to approximately one fourth of the pathological gambling disorder population. The prevalence of depression is much higher, reaching to over half of the population in some studies.
- With respect to specific disorders, most of them reported the onset of any substance use disorders (74.6%) and anxiety disorders (57.9%) prior to the onset of pathological gambling, whereas the onset of mood disorders (62.7%) and adjustment disorders (64.3%) was later than the onset of pathological gambling.
- Problem gambling is often associated with mental health problems, including depression, anxiety, and mood disorders. Gambling problems don’t just affect mental health. People who have struggled with gambling benefit greatly from treatment and often also need family counseling and financial coaching to fully recover.
- Jul 08, 2020 Gambling addiction, also known as compulsive gambling, may be a type of impulse-control disorder. Compulsive gamblers keep gambling whether they’re up or down, broke or flush, happy or depressed.
The American Psychiatric Association, a professional organization responsible for creating the standard definitions for mental illness in the United States, recognizes 10 distinct symptoms in compulsive or pathological gamblers. These symptoms include a fixation on gambling that persists outside of actual gambling situations, a repeated inability to control one’s gambling behaviors, increased moodiness when not involved in gambling, repeated lying about gambling activities, increased excitement when betting higher and higher amounts of money, a recurring need for help to recover from gambling debts, a rapid return to gambling after a big loss, use of gambling as a “mood lifter,” commission of crimes to sustain gambling activities and levels of gambling involvement that permanently damage one’s social or personal standing. In order to receive a diagnosis, any given individual must have a minimum of five of these symptoms.
As is true with a number of other non-substance-based impulsive or compulsive behaviors, mental health professionals increasingly view pathological gambling through the lens of mental/biological addiction. In the initial stages of his or her involvement, a given individual may feel entirely free to choose how he or she behaves in response to the gambling urge. However, over time, that sense of freedom and voluntary action starts to fade and gets replaced by an involuntary need for gambling that gradually supersedes all other relevant priorities. Specific problems that can increase the probability of a shift from voluntary to pathological gambling behaviors include substance addiction and the presence of antisocial personality disorder or various forms of schizophrenia.
Types of Compulsive Gamblers
Since the introduction of pathological gambling as a form of defined mental illness, a key feature of diagnosing the condition has been the identification of an inability to control the gambling impulse. However, according to the authors of the study published in the Canadian Journal of Psychiatry, this criterion does not accurately reflect the mental status of all people who otherwise meet the criteria for a pathological gambling diagnosis. Instead, after examining the psychological profiles of more than 1,100 compulsive gamblers, they concluded that people affected by the disorder actually fall into one of four separate personality-based sub-types.
According to the study authors’ classifications, people with Type 1 pathological gambling have personality traits that resemble the traits in people who have a condition called schizotypal personality disorder. People with this disorder are well oriented toward reality, but exhibit dysfunctional degrees of emotional disorganization, emotional instability and impulsivity; typically these traits first arise early on in life. People with Type 2 pathological gambling have personality traits associated with another condition called schizoid personality disorder. This condition closely resembles schizotypal personality disorder; however, unlike schizotypal individuals, schizoid individuals are not bothered by any personal or social disruptions caused by their illness.
People with Type 3 pathological gambling (as defined by the scheme presented in the Canadian Journal of Psychiatry) gamble out of an impulsive desire/need for a “rush” of sensation; typically, they don’t have symptoms of any particular sort of personality disorder. People with Type 4 pathological gambling also have no traits that correspond with a specific personality disorder; instead, they have what’s known as a “globally adaptive” personality, which allows them to change their behaviors according to their local surroundings.
Significance
The authors of the study in the Canadian Journal of Psychiatry believe that only people with Type 2 pathological gambling have a combination of personality disorder-related traits and impulsive or uncontrolled behavior that make them truly “pathological” (that is to say, extremely or excessively abnormal in some way). According to their findings, other people classified as pathological gamblers have definite, identifiable problems, but don’t rise to the same level of mental illness. Despite the results of this study, guidelines for compulsive or pathological gambling remain unchanged in 2013 and do not reflect the sort of symptom breakdown undertaken by the study’s authors.
By Colin Hodgen, Ph.D.
Gambling Disorder is recognized in the U.S. as an addictive disorder. Indeed, it is currently the only Addictive Disorder listed in the Diagnostic and Statistical Manual, 5th edition (DSM-5, 2013) published by the American Psychiatric Association (APA).
But, what is gambling disorder exactly? What drives a gambling behavior in problem gamblers? Expert Colin Hodgen explores more here in this article. Then, we invite your questions at the end. In fact, we try to respond to all questions personally and promptly.
What is a gambling disorder?
Previously classified as an Impulse Control Disorder, “Gambling Disorders” are now seen as a behavioral or process addiction with 4 core features. As explained by Dr. Jon Grant of the University of Chicago, these core features are:
- repetitive or compulsive engagement in a behavior despite adverse consequences;
- diminished control over the problematic behavior;
- an appetitive urge or craving state prior to engagement in the problematic behavior; and
- hedonic [pleasurable] quality during the performance of the problematic behavior.
The long term effects of gambling disorder are often observed as:
- Tolerance
- Withdrawal
- Repeated unsuccessful attempts to cut back or stop
- Impairment in major areas of life functioning
In other words, gambling is something we continue to do, over and over, even if it causes problems in our lives. We are no longer able to consistently decide when we will or will not gamble, and if we do gamble, we can’t consistently decide when we will or will not stop. Further, we experience sometimes overpowering urges or cravings to repeat the behavior, and that behavior provides a sense of pleasure, relief, or release in the moment, thereby reinforcing the behavior. This behavior must be repeated and completed to reduce chronic anxiety. Over time, we experience clinically significant impairment or distress in our daily lives at home, school, or work.
Why do people gamble?
Mood Disorders And Gambling Disorders
Gambling behavior is often separated into two categories: action and escape.
a) Action – Some people seem to gamble for the excitement.
b) Escape – Others tend to gamble to “get away from it all.”
The American Society of Addiction Medicine (ASAM) terms these behavior syndromes as “reward” and “relief.” If we focus on the “escape” or “relief” conditions, it becomes apparent that many gamblers are seeking some sort of pain relief, some reduction in the stress, pain, or anxiety in their lives, whether past or present.
- Numbing pain – Gambling activity becomes a way of “numbing” the acute/chronic pain and can lead into addiction. This numbed condition makes it very difficult for the individual or the treatment provider to connect with and/or resolve the underlying trauma and consequent pain.
- Relieving anxiety – In general, many gamblers engage in the behavior to reduce or relieve a cumulative condition of anxiety. This anxiety state can arise from or lead to chronic psychic pain and cognitive dissonance. Chronic anxiety can be a result of earlier life trauma or persistent excitation of the “fight-or-flight” response within the limbic system of the brain. A brain in chronic pain will often go to desperate measures to reduce or avoid continued pain.
- Coping with trauma – The brain pain is both acute and chronic. The acute state arises from the immediate circumstances of the gambler; the chronic state often is a residue of long-term, perhaps early childhood, trauma.
Over time, the gambler exhausts the repertoire of available coping responses, and is left with a dysfunctional, ineffective, and increasingly harmful set of behaviors and emotional responses. This history of trauma can lead to long-term effects on the brain and its function, through a process of adaptive learning or neuroplasticity.
The brain of gambling addicts
We need to understand brain function to address a gambler’s behavior and plan for recovery. Let’s take a brief look at what goes on in the brain, from the inside out, before taking a brief look at treatments that can be helpful in dealing with the immediate and long-term remediation of the effects of gambling disorder.
The brain is basically an electrochemical generator of the central nervous system and it regulates our thoughts, feelings, and actions. To do so, our brain generates and regulates various neurotransmitting chemicals. Here are five (5) primary neurotransmitters and their associated activities:
When the primary neurotransmitters Dopamine, Serotonin, and Norepinephrine are in balance, we see well-ordered mood and behavior:
Deficits in one or more of these chemicals (shown in italics) cause imbalances, and we see disordered mood and behavior:
Most of these mood states will be familiar to those with addictive behaviors.
A particular combination of neurotransmitter deficits contributes to the distress of the gambler, specifically combined deficits in Dopamine and Serotonin which contribute to the hybrid state of Depression and Craving experienced by most individuals with Gambling Disorder.
Affective Mood Disorder
Impulsivity in the problem gambler
What may seem to be impulsivity in the compulsive gambling is often also a characteristic of both anxiety and a need for anxiety reduction. Problem gamblers will often present with symptoms of co-occurring Anxiety and/or Depression and will have concurrent difficulty with Impulse Control.
Glutamate and dopamine in the brain
Much of what we know about addictive behaviors relates to dopamine dysregulation, and is often associated with the effects of GABA and Glutamate on dopamine. Glutamate is an excitatory chemical and motivates behavior; GABA is an inhibitory chemical and deters or defers behavior.
Below we see two examples of the interaction of Glutamate and Dopamine, first where Glutamate from the PreFrontal Cortex motivates a pleasurable behavior associated with Dopamine. In the second example, Glutamate triggers GABA to inhibit disordered pleasurable behavior associated with Dopamine:
Psychotropics may not be the best gambling disorder treatment
Oftentimes, individuals, and the primary care physicians and mental health professionals who deal with them, attempt to diagnose and treat the mood/behavioral symptoms (anxiety, depression, sleep disturbance, etc.) without examining the underlying addictive conditions which produce these symptoms. Sadly, from a medication-based perspective, the use of psychotropics may cause more problems than they relieve.
Recently, in fact, the onset of troublesome compulsive behaviors such as compulsive gambling, compulsive shopping, and hypersexual behaviors have been associated with medications such as Mirapex and Abilify, side effects which were not anticipated or sometimes even associated with the medication. This is not to say that appropriate psychopharmacology cannot help reduce the distress of a problem gambler.
However, great care should be used when attempting to address addictive behaviors solely through use of psychotropic medications.
Well, then, what can we do?
Mood Disorder Medications
Treatments for gambling problems
Cognitive Behavioral Therapy (CBT) – This type of therapy is associated with good outcomes in treatment of addictive disorders and is also associated with better outcomes in long-term recovery. Generally, CBT targets improving the gambler’s “executive functioning,” that is, planning, cognitive flexibility, and inhibition responses. It involves a Functional Analysis of an individual’s Antecedents or triggers, the subsequent Behaviors, and the resultant Consequences. Over time, the gambler is better able to choose more appropriate and effective behaviors and begins to experience more positive Consequences.
Neurolinguistic Programming (NLP) – Another useful and effective approach involves Neurolinguistic Programming (see Dr. Janice Walton’s April 26,2016 article, “NLP Strategies Counselors Can Use When Treating Addictive Behavior” on Addiction Blog. This therapeutic approach also addresses thinking, behavior, and executive functioning. In the absence of co-occurring mental health disorders, this approach can be quite effective with behavioral/process disorders as well as substance-related disorders.
Alternative gambling treatments – For additional information on treatment alternatives, please see an earlier Addiction Blog entry, Jaime Costello’s article, “How to quit gambling: Alternatives for recovery” .
For additional insights into Gambling Disorder, please see any of the other Bybee Initiative posts on Addiction Blog under the Compulsive Gambling category. For more extensive examination of the neurobiology of addictive disorders, see Neurobiology of Addiction (Koob & Le Moal, 2005).
Mood Disorder Criteria
The nature of gambling disorder
Gambling Disorder, and similar process/behavioral disorders, can often resemble substance-related disorders. Many of the components of traditional substance-related disorders can be customized for use in treatment. After all, we’re dealing with the effects of chemicals on brain function. In the case of Gambling Disorder, these are Endogenous (internal source) chemicals (Dopamine, Serotonin, etc.) rather than Exogenous (external source) chemicals such as alcohol, opioids, or stimulants.
Whatever the source, and whatever the etiology of the disorder, individuals, families, and communities suffer the effects and consequences of Gambling Disorder. This disorder is uniquely insidious, a “hidden addiction,” since there are no immediate biochemical tests for the disorder. Oftentimes the disorder and the damage only become evident after some catastrophic event. Our challenge is to stay vigilant for early indicators and early intervention. Our task is Awareness, Education, and Advocacy.
Got any questions about the brain and gambling?
Mood Disorders Symptoms In Adults
Do you have any additional questions and would like to ask questions regarding the diagnosis, nature, and treatment of gambling disorder? We welcome you to post them in the comments section below. We try to answer all legitimate inquiries personally and promptly, or refer you to someone who can help.