What is Pathological Gambling?

In a treatise on pathological gambling published in 1561, Belgian-born doctor Juste Pâquier linked gambling addiction and disease and described a pathological gambler as a prodigy who believed that he could control chance. Originally considered as an impulse control disorder, gambling disorder (commonly referred to as pathological gambling or compulsive gambling) is now understood and seen as an addictive disorder.

Pathological gambling is defined as frequent and recurrent maladaptive gambling behaviour causing clinically significant distress in the person who presents with it. Pathological gamblers commonly have a tendency to lie to hide the problem from the people around them. Some gamblers also have a tendency to borrow or steal money, to constantly increase their wagers, to be preoccupied by gambling and to not want to stop gambling. When they try to reduce or stop their excessive gambling, gamblers demonstrate psychological withdrawal symptoms similar to those experienced by people who have alcohol or drug problems, becoming irritable, impatient, agitated or tense. Some gamblers often demonstrate distortions in their way of thinking, mentioning that they are going to start gambling again in order to win back the money that they have lost. They tell themselves that maybe when they manage to win a large sum of money, they will stop gambling. All in all, gambling becomes more important than everything else. The gambler’s entire life revolves around his gambling and all aspects of his life are gradually impacted by it.

This chronic, progressive and potentially fatal condition affects the person physically, professionally, legally, emotionally, financially and spiritually. It also affects the people close to the pathological gambler.

In Quebec, pathological gambling affects approximately 1% of the population. Gambling is two to four times more prevalent in teens than in adults, especially with gambling being so accessible on the internet.

According to the Centre for Addiction and Mental Health, pathological gambling, like any addictive behaviour, results from the interaction between risk and vulnerability factors related to the individual, the social-environmental context and the object of the addiction. According to scientific studies, being male and early introduction to behaviours related to games of chance and betting games are significant risk factors. In the family history of pathological gamblers there is often a parent who had a gambling problem or who was absent, negligent or abusive. People with gambling problems generally have poorer coping and problem-solving skills. The stimulation of gambling provides them a retreat where they can go to escape their immediate problems and, often, alleviate their deeper mental suffering. They believe that most of the time they are able to influence, predict or control the outcome of a game. Other factors also have an impact on gambling problems, namely: easy access to gambling; access to state-run gambling activities (including video lotteries, slot machines, the internet, etc.); the quest for meaning and happiness through money; the quest for a living environment in which prestige, a feeling of belonging and group support are important.

Psychiatric comorbidities (the co-existence of another) are frequently tied to pathological gambling. Pathological gambling may precede the onset of comorbidities or result from them. Most of the time, the two coexist and it is difficult to establish the exact chronology. Among the comorbidities are depression, bipolar disease and a history of anxiety disorders. Furthermore, disorders related to the use of psychoactive substances are the comorbidities most frequently associated with pathological gambling. Lastly, attention deficit hyperactivity disorder, not well documented in gamblers, is a frequent comorbidity, associated with clinical characteristics that make for a less hopeful prognosis. In any event, as gamblers may feel cornered by the consequences of their behaviour, the risk of suicide should always be assessed (suicide occurring in 17% of cases).

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