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Gambling (Clinical characteristics (Gender differences are influenced by…
Gambling
Clinical characteristics
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significant impairment in ability to function socially and occupationally
- intrusive thoughts and urges that interfere with concentration at work = work-related problems e.g. poor performance and absenteeism
marital problems, diminished intimacy and trust
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Clinical assessment
Persistent, recurrent problematic gambling behaviour leading to significant impairment/ distress in 12-month period. not explained by manic episode
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Treatment
Psychotherapy
CBT
- effectiveness is immediate, but durability of therapeutic gain is unknown
- high rate of treatment dropout
MI
- evoke client's own momentum and motivation for change
Family Therapy
e.g. Gambler's Anonymous for families (GAM-ANON)
- to understand and cope with intense dissatisfaction, lack of trust, interpersonal damage caused by family member's problem gambling
e.g. Community Reinforcement and Family Therapy (CRAFT) model
- self-help workbook to train family to use behavioural principles to reinforce non-gambling behaviours
x too complex to implement w/o support of therapist
Cue-exposure
- classical conditioning
- goal = extinguish learned response through repeated exposure to a CS in absence of consequence
Pharmacotherapy
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Lithium and anti-epileptics
- lithium = reduce gambling thoughts and urges
- but no significant difference in gambling episodes/ week, time spent per gambling episode and $$ lost
maladaptive form of gambling behaviour, associated with impaired functioning, reduced QOL, high rates of bankruptcy and divorce
- first recognised as pathological gambling in DSM-III
In DSM-5:
- included in substance use disorder due to high rates of comorbidity, similar presentations of symptoms, genetic and physiological overlap
- improves recognition of disorder
- increase in treatment seeking
- reduces stigma due to change in label of disorder "pathological gambling" > "gambling disorder"
even with short gambling history, gamblers still experience severe negative consequences (distress, suicidal thoughts, work problems) = early intervention is important
- first identify all mental health concerns to rule out alternative explanations
- determine to treat comorbid disorders simultaneously/ sequentially
- evaluate severity of behaviour, repercussions, readiness for change and sense of control over behaviour