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May 2017
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Pathological gambling was one of the first non-drug addictions to be studied and quickly attracted the interests of psychologists and psychiatrists, as well as means of mass communication, writers and directors, to the point where it is often talked about with regards to the serious health effects it has, especially those related to the mental imbalance that this addiction can cause. With gambling addictions, the true sense of the game, through which you can create and explore yourself experiencing freedom, creativity, learning of rules and roles and suspending real consequences, is completely reversed to transform the so called "oasis of happiness" inside a "cage of yourself”, made out of bondage, obsession and repetition.

Gambling in the history of mankind and civilisation

Playful activities which concern the manipulation of random elements, ranging from numbers to symbols, represents a human tradition which man is inclined towards due to our heritage of magical thinking (which has never been completely abandoned) which often pushes mankind to risk their own goods and money in a game. It is precisely due to this nature inclined towards gambling that, in the history of mankind, many types of games of risk have been developed which are based on arbitrariness. There are traces of this in archaeology (dices and similar objects), antique manuscripts relating to the Eastern populations of Ancient Egypt, China, Japan and India and in narratives about Ancient Greece related to betting on the results of the Olympic Games and Ancient Rome, where people could bet on gladiator fights in the so called ‘munera’. Popularity of gambling is further confirmed by the etymology of the word ‘risk’ which comes from the French word hazard, a word that has Arabic origins and comes from the word az-zahr which means ‘die’, one of the oldest objects used for social betting. The increase in gambling problems has partly been fuelled by the growing possibility to choose from a large range of games which were continually being legalised and which are able to respond to players’ various preferences and different personalities. This is the reason why gambling addicts can range from rule breakers in casinos and on slot machines to lovers of videogames who they let themselves be enticed by the ever popular video poker, or to lovers of popular games of chance, like the lottery, number games and scratch cards, including bingo, which can entice huge groups of people thanks to its deep connection to traditional personal experiences during holiday breaks.

From a vice to an addiction: characteristics of pathological gambling

To begin identifying the symptoms of pathological gambling, it is extremely important to explain the need to distinguish between gamblers and pathological gamblers. For many people, gambling games are very enjoyable pastimes which they play occasionally or habitually, yet this latter case does not necessarily mean that the game has become pathological as the amount of time spent playing is not the problem. A compulsive player can be placed on a continuum which distinguishes the various stages of the blurred boundaries ranging from the occasional game to a habitual game, a game of risk or even a compulsive game. Consequently, pathological gambling begins when the player loses the ability to control him/herself when playing and this eventually, directly and indirectly, starts to take up his/her time, creating serious secondary problems which involve different areas of the addict’s life. 

Along the continuum, which ranges from recreational gambling to pathological gambling in relation to the motivations that determine and accompany gambling, the following types of players have been distinguished:

  1. the social player, who is motivated by recreational participation, considers the games to be an occasion to socialise and enjoy him/herself and knows how to control destructive impulses;
  2. the problematic player who, although signs of a true and active pathology are not yet present, does have social problems which he/she is running away from or trying to find a solution to through the game;
  3. the pathological player, whose behaviour is destructive, whose idea of the game is distorted and whose problem is also fostered by psychical problems,
  4. the addicted/impulsive pathological player who shows serious symptoms which prove that his/her relationship with gambling is sometimes based on addiction and sometimes based on impulsiveness. 

A player who is really and truly addicted to gambling is someone whose impulse for the game becomes an overwhelming and uncontrollable need which is accompanied by strong, emotional tension and the inability, either partially or totally, to use reflective or logical thought. Self-deception and the use of seemingly rational reasoning take on the functions of control instruments to deal with the sense of guilt felt. They also create and nourish a self-destructive circle (Fig. 1) in which, if an addicted player loses, he/she justifies the following games with the idea that he/she needs to at least win back the lost money, and if he/she wins, it is justified by saying that "it is my lucky day and so I must take advantage of it" because of a temporary victory which supports, through a reality which is true but is equally rather unstable and temporary, this statement, which may either be said out loud or inside the gambler’s mind. 

 Figure 1: the vicious circle of a pathological gambler

The mental state of a pathological player is therefore different from that of a regular but not pathological player and they (gambling addicts) appear to be in a state of drunkenness with a modified perception of time, which might slow down or even appear to stop and which is born out of the tendency to reach an altered state of completely absorbed consciousness, even getting to a state of hypnotic ecstasy, both of which are caused by the game. Sometimes, this mental condition is fostered by the consumption of alcohol or other substances associated with the game, which encourages the loss of control of the player’s conduct.

To clarify the diagnostic features of addictive gambling, it is also very important to distinguish between the "vice of gambling" and "addiction to the game" by emphasising that there is often a tendency to use the first term to incorrectly describe addictive behaviour. The distinction is extremely important because it allows you to identify one of the key features of addictive gambling, called I.C.D. (impulsive control disorder) in psychiatry: the loss of control over one’s behaviour, which, regarding the ‘vice of the game’, is voluntary and which can be controlled and even interrupted by the person because he/she is behaving like this voluntarily and is also aware of the negative connotations attributed to him/her from a moral point of view.

Another distinction which must be made, also because of the different therapeutic approaches associated to it, is the difference between ‘addiction to the game’, that is, primary gambling disorder or compulsive gambling, and secondary pathological gaming, or symptoms of another psychical problem. In this latter case, pathological gaming can be considered as a side effect from a primary disorder which has become the main focus of therapy. With compulsive gambling, on the other hand, psychological or psychiatric problems which exist are the result of the vicious circle of the game.

In general, and according to traditional psychiatric classification criteria, we can summarise that someone is a gambling addict when he/she has persistent, reccurring and maladjusted behaviour regarding gambling and, in this case, the game can have very negative repercussions on his/her personal, social and professional life. Signs of such a problem can be behaviour such as that listed below which is not attributable to any other primary disorders:

  • excessive involvement in direct or indirect activities (game programmes, thoughts about how to make money, etcetera) related to gambling;
  • the need to increase the amount of money played with so as to reach the desired level of arousal;
  • repeated, unsuccessful attempts to stop, reduce or control one’s gambling behaviour;
  • anxiety or irritability when attempting to control or reduce gambling;
  • turning to gambling as a way to reduce or escape negative feelings (guilt, impotence, depression, etcetera);
  • tendency to return to the game to make up for previous losses;
  • tendency to lie about their behaviour towards the game;
  • actual loss or serious risk of losing important relationships and work or educational opportunities, caused by gambling;
  • illegal conduct, such as theft, fraud, cheating, forgery;
  • asking others for money to compensate for his/her current financial situation which will be quite dire because of gambling debts.

We can talk about a real and true gambling addiction if tolerance symptoms are present, such as the need to increase the amount of times the gambler plays the game, withdrawal symptoms, like discomfort related to anxiety and irritability associated to vegetative problems or impulsive, criminal behaviour, and symptoms of loss of control, which occur because of the inability to stop gambling. If other symptoms prevail which are related to the lack of control of one’s impulses, impulsive pathological behaviour can be attributed to a problem in this area, however it is not necessarily because of an addiction.

Some authors distinguish between the progressive phases of pathological gambling in which the player can move towards the slippery slope of addiction, or can move away from the problem. The following steps have been identified to be more precise:

  • WINNING PHASE: characterised by the occasional game and initial wins which motivate the player to play more often, usually thanks to the game’s ability to create pleasure and release tension and negative emotions;
  • LOSING PHASE: characterised by playing alone, an increase in the amount of money invested into the game, debts, an increase in thinking about the game and an increase in the time spent playing the game;
  • DESPERATION PHASE: the amount of time playing the game increases further and this causes social isolation and problems with work/school and friends and family (divorce, separation) which sometimes leads onto drastic behaviour, like attempted suicide;
  • CRITICAL PHASE: this is when help is wanted and the gambler hopes to be able to solve his/her problem and makes realistic attempts to do so by returning to work and patching up debts and social and family problems;
  • RECONSTRUCTION PHASE: this is when improvements in family life can be seen and the person starts planning new objectives and builds up his/her self-esteem;
  • GROWTH PHASE: this is when the ex-gambler develops insight and a new life which does not involving gambling at all.

From motivation to risk factors of the game

Numerous studies have tried to identify risk factors which cause people to become impulsive or addicted gamblers, drawing on three aspects which are generally considered to interact with one another:

  • BIOLOGICAL ASPECTS: these are mainly relative to neuro-physiological factors (which are still not extremely clear) or, more precisely, an imbalance which could affect the functioning of the cerebral neurotransmitter system which is needed to produce serotonin, a chemical cerebral substance responsible for our emotional-behavioural balance, which in pathological gamblers is lower than average levels;
  • ENVIRONMENTAL AND UPBRINGING ASPECTS: one’s upbringing and an environment which was characterised by problematic situations and a tendency to stimulate and overemphasise the possibility of happiness related to money, as well as financial difficulty related to unemployment, for example, seem to be risk factors which can lead onto pathological gambling;
  • PSYCHOLOGICAL ASPECTS: these sometimes seem more related to the presence of personal traits regarding luxury and greed for money, and other times they seem to be related to the need to be able to show that he/she (the gambler) can control fate and luck, as a symbol of control over things that are out of human control.

The games which seem to activate a bigger risk are those offering greater spatial-temporal proximity between challenge and reward, such as slot machines and casino games, but even video poker and bingo.  

The most vulnerable people seem to be, amongst women, housewives and self-employed females from 40-50 years old, and amongst men, unemployed and self-employed males who have regular contact with cash or are salesmen and are around 40 years old.

Dominating the desire to dominate fate

From the moment in which pathological gambling was recognised a real and true psychological disorder, which is different from other problems, various treatment programmes have been developed which are often carried out in rehabilitation communities. Group participation seems to have good results such as Gamblers Anonymous groups, which are based on various steps taken to solve the problem, from recognition and sharing to aims of abandoning the game, which are based on the analyses of common self-deception techniques which are often easier to see in others than in yourself. What must be underlined is that, through individual methods, therapeutic groups and self and group help, therapeutic objectives must always be centred around the possibility to change, including changing thoughts about how, eventually, the day will come when the game will change the player’s life by magically solving his/her problems.

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