Gambling Disorder

• The prevalence of gambling disorder is between 0.2 to 0.3%.^[2]
• Males are at higher risk for gambling disorder (3:1)
• Gambling is a cultural construct, and individuals gamble on games and events, and most do so without experiencing problems.
  • However, some individuals develop substantial impairment with gambling behaviours.

• It usually develops over the course of years, although the progression may be more rapid in females than in males.
• Gambling patterns may be regular or episodic, and the diagnosis of gambling disorder can be persistent or in remission.
• Gambling disorder can also spontaneously remit, with long-term remission.
• Employment or educational activities can be impacted by gambling disorder.
  • There can be absenteeism as individuals may gamble during work or school hours or be preoccupied with gambling when they should be working or studying.^[3]
• Many high school and college students with gambling disorder grow out of the disorder over time.
• Younger individuals may prefer online gambling (e.g. - sports betting), while older adults are more likely to develop problems with slot machines and bingo gambling.^[4]

• Up to 50% of individuals in treatment for gambling disorder have experienced suicidal ideation, and about 17% have attempted suicide.^[5]
• Females with gambling disorder are more likely to have depressive disorders, bipolar disorders, and anxiety disorders.^[6]
• Other mental disorders, such as substance use disorders, depressive disorders, anxiety disorders, and personality disorders are comorbid.^[7]

• Gambling can increase during periods of high stress, depressive episodes, and/or during substance use or abstinence.^[8]
• Gambling that begins in childhood or adolescence is associated with increased risk for gambling disorder.
• Gambling disorder can be common within in families, and relates to both environmental and genetic factors
  • For example, gambling disorder is more frequent in monozygotic than in dizygotic twins, suggesting a genetic contribution.^[9]

Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress, as indicated by the individual exhibiting at least 4 of the following in a 12-month period:

1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
2. Is restless or irritable when attempting to cut down or stop gambling.
3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
4. Is often preoccupied with gambling (e.g. - having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
5. Often gambles when feeling distressed (e.g. - helpless, guilty, anxious, depressed).
6. After losing money gambling, often returns another day to get even (“chasing” one's losses).
7. Lies to conceal the extent of involvement with gambling.
8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

The gambling behavior is not better explained by a manic episode.

• A pattern of “chasing one's losses” may develop, with an urgent need to keep gambling (e.g. - placing larger bets or taking greater risks) to undo a loss or series of losses.
• Distortions in thinking (e.g. - denial, superstitions, a sense of power and control over the outcome/chance of events, and/or overconfidence) may be present
• Individuals may believe that money is both the cause of and the solution to their problems.^[10]

• Brief Problem Gambling Screen (BPGS)^[11]

• Like with all substance use disorders, there is a complex interplay between biological, social, psychological, and cultural factors.

• Non-disordered gambling
  • Gambling disorder must be distinguished from professional and social gambling. In professional gambling, risks are limited and discipline is present. Social gambling usually occurs with friends or colleagues, and only lasts for discrete periods of time, with reasonable or acceptable losses. Some individuals can experience problems (e.g. - short-term chasing behavior and loss of control) but still do not meet the full criteria for gambling disorder.
• Manic episode
  • Reckless behaviours, poor judgment, and excessive gambling may occur during a manic episode. An additional diagnosis of gambling disorder should be given only if the gambling behavior is not better explained by a manic episode (e.g. - a history of maladaptive gambling behaviour at times other than a manic episode). Alternatively, an individual with gambling disorder may, during a period of gambling, exhibit behaviour that looks like a manic episode, but once the individual is away from the gambling, these manic-like features dissipate.
• Personality disorders
  • Problems with gambling may be common in those with antisocial personality disorder and other personality disorders. If the criteria are met for both disorders, both can be diagnosed.
• Other medical conditions or medication-induced
  • Some patients taking dopaminergic medications (e.g. - Levodopa for Parkinson's disease) may experience urges to gamble. If these symptoms stop when dopaminergic medications are reduced in dosage or ceased, then gambling disorder is not diagnosed.^[12]
  • Partial dopamine agonists (e.g. - aripiprazole) have also been documented to cause impulse-control disorders.