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Pathological Gambling: Diagnosis & Treatment
Gambling continuing education psychologist CEUs

Section 16
Action Gamblers and Escape Gamblers

CEU Question 16 | CEU Answer Booklet | Table of Contents | Gambling
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Gambling has become increasingly legitimate and socially acceptable. Most states have legalized it in some form, and it’s one of the nation’s fastest growing industries, already attracting more customers than baseball or movies. Credit requirements have been relaxed and facilities are more accessible. Gambling expenditures have more than doubled since 1975.

One in two adults bought a lottery ticket and nearly a third visited a casino during the last year. States depend on lotteries to fill their treasuries, and casinos are the main source of income on some Native American reservations. Technological advances continually supply easier and more enticing ways to play; the latest is the Internet. Inevitably, out-of-control gambling is on the rise. It’s now recognized as a psychiatric disorder and a challenge for mental health treatment.

Compulsive gamblers are constantly thinking about past bets, planning the next one, and finding the money to support the habit. They increase the size of their wagers and struggle to quit or cut back. Unable to tolerate losing, they immediately try to recoup. They gamble when they are disappointed or frustrated; neglect their families; lose jobs, careers, and marriages to the habit; sell personal property, borrow, beg, lie, steal, and write bad checks to finance gambling or pay their debts.

Often they are repeatedly bailed out by their families. The American Insurance Institute has called gambling the main cause of white-collar crime.

According to the National Council on Problem Gambling, about 1% of American adults—nearly 3 million people—are pathological gamblers. Another 2%–3% have less serious but still significant problems, and as many as 15 million are at risk, with at least two of the symptoms described by the American Psychiatric Association.

Most compulsive gamblers are men, but the problem is growing among women. African Americans have a higher rate of compulsive gambling than whites, and the rate is about twice the average among those living within 50 miles of a casino. The poor and people with limited education, exposed to tempting visions of unattainable wealth, are particularly susceptible.

Experts often distinguish gambling for action from gambling to escape. Action gamblers, highly competitive and easily bored, tend to take unnecessary risks and make impulsive decisions. They often prefer poker and blackjack, horse races, professional and college sports, and stock market speculation — where they can exercise some skill, or at least the appearance of skill. Escape gamblers are more likely to play passive games of pure chance—slot machines, bingo, and lotteries. They are often depressed or anxious and use gambling to numb or cheer themselves. A biological predisposition could be involved. Twin studies indicate that heredity may account for up to 35% of individual differences in susceptibility to gambling problems. Some research suggests that pathological gamblers have abnormal activity in areas of the frontal lobes that are centers of judgment and decision-making. But gambling problems cannot be reduced to genetics or neurochemistry. Biological research is still scarce, and the results have to be corrected for the presence of other psychiatric disorders.

Such disorders are common. Compulsive gamblers have high rates of depression, mania, alcohol and drug abuse, and some personality disorders. In a survey of Gamblers Anonymous members, 22% reported panic attacks, 72% reported an episode of major depression, and 52% reported alcohol abuse. As in all such situations, it’s difficult to distinguish between causes and effects. The results of irrational betting while intoxicated lead to more drinking. Gambling losses cause depression, which leads to more gambling. Eventually, whatever the origin of the problem, the pattern becomes self-perpetuating.

It’s a pattern typical of addiction, and that’s how most experts now regard pathological gambling. Although the American Psychiatric Association formally classifies it as an impulse control disorder, the description closely parallels alcoholism and drug dependence. The thrill of the wager corresponds to intoxication. Increasing the size of bets corresponds to tolerance and taking more than intended. The restlessness and irritability of abstaining gamblers are a kind of withdrawal reaction. The bailout—a loan or gift to pay debts in return for a promise to quit — corresponds to detoxification without further treatment. The origin of the word "addict" fits this picture; it’s an ancient Roman term referring to persons legally enslaved for defaulting on debts.

- Problem gambling. Harvard Mental Health Letter, Mar2004, Vol. 20 Issue 9, p1-4
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #9
The preceding section contained information regarding action gamblers and escape gamblers.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 16
What is are the difference between an ‘action gambler’ and an ‘escape gambler’? Record the letter of the correct answer the CEU Answer Booklet

 
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The article above contains foundational information. Articles below contain optional updates.
Study provides vital clues into biology of gambling addiction - January 03, 2017
Gambling addiction activates the same brain pathways as drug and alcohol cravings, suggests new research.
Study sheds light on neuronal circuits during risky behavior - July 27, 2016
New research sheds light on what's going on inside our heads as we decide whether to take a risk or play it safe. Scientists at Washington University School of Medicine in St. Louis located a region of the brain involved in decisions made under conditions of uncertainty, and identified some of the cells involved in the decision-making process.
New survey shows one-third of students experience high levels of psychological distress - July 21, 2016
More than one in three - an estimated 328,000 -- Ontario students in grades seven to 12 report moderate-to-serious psychological distress, according to new survey results from the Centre for Addiction and Mental Health. Girls are twice as likely as boys to experience psychological distress.
Most gamblers who play responsibly enjoy experience and exhibit no problems - September 10, 2014
People who are in control of their gambling habits play for fun and like the idea of possibly winning big. They set limits on how much money and time they can spend, and they are likely to gamble on the internet.
Brain changes in problem gamblers make it hard to quit habit - June 19, 2014
People who gamble frequently may experience brain changes that make it extremely difficult for them to give up the habit.

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