Q: What is pathological gambling? Is there any effective treatment?
A: The newest edition of psychiatry’s diagnostic manual classifies pathological gambling as an addiction. People addicted to alcohol or drugs are at increased risk to develop gambling problems. The reverse is also true. Problem gamblers are more likely to become addicted to substances than people who don’t gamble.
Gambling may be an escape, either from personal problems or dark moods. Problem gamblers become preoccupied. They bet increasing amounts of money. They try to make up for losses by gambling – and losing – more.
Attempts to control the behavior fail. Problem gamblers get irritated if they try to cut back. But they may have to turn to friends and family to rescue them from debts that pile up.
For many, the losses go beyond money. They lose relationships, jobs and opportunities.
There is not a lot of evidence about what treatment is best. But some treatments are promising:
1. Gamblers Anonymous: This 12-step program is modeled on Alcoholics Anonymous. Members acknowledge they are powerless over gambling. Fellow members support each other in giving up the behavior. (Find a WNY group at gamblersanonymous.org.)
2. Cognitive behavioral therapy: Therapists help gamblers recognize distorted thinking about gambling. Gamblers learn to change how they think about it. They learn to avoid gambling triggers and develop other activities.
3. Motivational Interviewing: This therapy aims both to promote readiness to change and commitment to treatment. The therapist helps a patient explore and resolve feelings about giving up gambling.
Drug treatment is limited. Some doctors prescribe so-called “opioid antagonists” that have been used to treat alcohol dependence. Two examples are naltrexone (ReVia) and nalmefene (Revex). By blocking opioid receptors, these drugs modify reward circuits in the brain. The rationale is that these drugs will help subdue the desire, or “craving,” that contributes to gambling.
Dr. Michael Craig Miller is an assistant professor of psychiatry at Harvard Medical School.
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