9 - Pathological gambling: an overview of assessment and treatment

Summary

Summary Pathological gambling has received scant attention in the psychiatric literature. It has a prevalence rate of about 1% in most countries, and with the deregulation of gambling in the UK the prevalence is set to rise here. Pathological gambling can adversely affect the individual, family and society, and also carries high rates of psychiatric comorbidity. Early identification and appropriate treatment can limit the long-term adverse consequences and improve outcome. This chapter reviews assessment techniques and tools, and treatment strategies.

Gambling is a common, socially acceptable and legal leisure activity in most cultures across the world. It involves wagering something of value (usually money) on a game or event whose outcome is unpredictable and determined by chance (Ladouceur et al, 2002). The various types of gambling activities commonly available in the UK are the national lottery, scratch cards, internet gambling, casino games, sports betting, bingo, slot machines and private betting. Results from the most recent British Gambling Prevalence Survey indicate that nearly three-quarters of the adult population had gambled in the previous year and that over half had gambled in the previous week (Sproston et al, 2000). For the large majority, gambling is a recreational activity with no adverse consequences. However, for a significant minority it progresses to pathological gambling, defined in DSM–IV as ‘a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family or vocational pursuits’ (American Psychiatric Association, 1994).

The wide array of choices available to the modern-day gambler, combined with the deregulation of gambling in the UK, is likely to result in an increase in the number of pathological gamblers and gambling-related problems (Griffiths, 2004). As it is an important public health issue, associated with high rates of psychiatric comorbidity and wide-ranging personal, family and societal problems, it is crucial that mental health professionals become familiar with this disorder, its assessment and treatment.

Epidemiology

Pathological gambling typically begins in early adolescence in males (later in females) and runs a chronic, progressive course, punctuated by periods of abstinence and relapses. Although gambling is currently more common among men, the prevalence among women is on the increase. Women are usually older than men when they take up gambling, but once started they develop gambling-related problems more rapidly.