Transcript Revision Seminar Part 5 BPS Gamblingm

Kardinia International College
Unit 4 Psychology Final Review Series
AOS 2: Applications of a Biopsychosocial
Framework
3. Addictive Disorder
Main Characteristics of Addictive
Disorder: Gambling
• Gambling Addiction, also known as compulsive or
pathological gambling is classified by the DSM-IVTR as a type of Impulse Control Disorder
Symptoms / Diagnosis
• Chronic and progressive failure to resist impulses to gamble –
it becomes uncontrollable the gambler starts to ‘chase losses’
and becomes irritable when forcibly stopped.
• Gambling behaviour that compromises or disrupts the
gambler’s life: it disrupts family, work or social functioning.
• Tolerance to gambling emerges, ie increasing amounts of time
and money are required to be gambled to experience pleasure
• Gambling dominates their thoughts and drives their behaviour
– even when they know their gambling has serious
consequences for themselves and their loved ones.
• Being Bailed Out of financial issues
• Lying to cover up gambling behaviour
• Illegal Activity to cover the costs of their gambling
Biological Contributing Factors:
• Behavioural Disinhibition: Where an
individual is unable to restrain themselves
from acting on their impulses.
• Imbalances of the following brain chemicals
have been found in pathological gamblers:
– Serotonin
– Noradrenaline
– Dopamine
Serotonin:
• a monoamine neurotransmitter in the Central
Nervous System. It has been implicated in a
wide variety of biological functions including
sleep, appetite, sex, aggression and mood.
• Deficiencies of serotonin have been linked to
compulsive behaviour – including gambling.
Noradrenaline:
• The neurotransmitter that mediates
physiological symptoms of anxiety and fear.
Pathological gamblers have been found to
have reduced levels of noradrenaline.
• It is released when one is under stress,
arousal, or thrill associated with risk-taking,
pathological gamblers gamble to make up for
under-dosage of the hormone.
Dopamine
• The brain chemical commonly associated with
the reward seeking system of the brain,
providing feeling of pleasure and
reinforcement to motivate a person to
perform certain activities.
Role of the Dopamine Reward System
and as a Target for Treatment
• When dopamine is released in the brain it creates a feeling of
enjoyment or satisfaction.
• These feelings are desired and the person will repeat
behaviours that cause the release of dopamine to satisfy that
desire.
• This ‘desire’ can lead to addiction.
As a target for Treatment:
• Naltrexone has been used as an antagonist inhibiting the
neurotransmitter dopamine at the synapse.
• It does not cause physical dependence and can be stopped
without withdrawal symptoms at any time. It is also used to
treat alcohol dependency and addiction to heroin.
• A study conducted by Kim and Grant (2001) showed
naltrexone to be very effective in treating participants
gambling addiction.
• Limitation is side effects that naltrexone causes, which is
predominately nausea but also can have toxic effects on
the liver.
Psychological contributing factors:
• Social Learning Theory
• Schedules of Reinforcement
Social Learning Theory:
Defines gambling as being on a continuum and that gambling
is due to interactions between social and environmental and
individual internal factors.
• Friends or peers are the most common sources of
introducing one to gambling
• Expectancy and Reinforcement become critical in the
development of the pathological behaviour.
• A large early win has been shown as an indicator of people
who become problem gamblers.
Social Learning Theory and Gambling
• Brown (1988) proposes the following elements in
continuation or escalation of gambling:
• The reinforcement of gambling behaviour
• Arousal is regulated
• There is relief from anxiety/depressive symptoms
• Internal fantasies and cognitive distortions exist
• Social approval is present
Schedules of Reinforcement &
Gambling
• It is commonly known that a variable schedule of
reinforcement promotes a steady response rate
over a longer period of time and is much more
resistant to extinction in comparison to a fixed
schedule
• Gambling and in particular poker machines are
often described as using a variable ratio
reinforcement (VR) schedule however they
actually use a schedule known as random ratio
(RR) (Haw, 2008).
Variable Ratio vs Random Ratio
• If you had a variable ratio of 20 (VR20) that would
mean that although unpredictable over a large number
of correct responses say 100 would equal 20 payouts
• This is not truly random as there is an upper limit on
the maximum number of responses given before
reinforcement occurs
• In contrast in a random ratio schedule there is no
predetermined upper limit before reinforcement is
given
• Each spin is completely independent of the next and it
may take 100 0r 1 000 000 responses before the RR20
is achieved
It gets worse!
• A RR schedule of reinforcement leads the
gambler to respond at high rates for relatively
little reinforcement, and to persist in long periods
of responding even when no payout is
forthcoming
• This is because the gambler thinks that each
response brings them closer to a response that
will be reinforced however this is false belief
when the RR schedule is used
The use of Psychotherapies in
treatment of Gambling Addiction
• Cognitive Behavioural Therapy
• Psychodynamic Therapies
Cognitive Behaviour Therapy &
Addiction
• CBT treatment aims to assist the individual to
examine their thought processes and examine
other alternatives when looking at their
situation
• Many gambling addicts have cognitive
distortions with two of the most common
being:
1. Illusions of control
2. Gambler’s fallacy
I Illusions of Control
• Illusions of control occurs when the gambler
thinks they can beat the odds using their
knowledge or skills
• The gambler would attribute wins due to their
personal actions and losses to factors outside
their control
• By using this thought process the gambler will be
able to maintain their false belief that their
gambling strategies are effective
Gambler’s Fallacy
• Gambler’s fallacy refers to the belief that future
events can be predicted by past events in a series
of independent chance events
• This is evident in coin tosses or ‘hot streaks’
• Most people with gambling problems are
unaware that they have cognitive distortions
• The first step of the cognitive component when
using CBT is to obtain information of the
individuals gambling patterns and distortions.
This may involve role plays, diaries or simulations
CBT in Action
• The next step involves educating the person to develop an
awareness of concepts such as probability, random and chance
events
• An important aspect of the cognitive component of CBT is to
encourage the individual to directly challenge and correct their
distorted thoughts and provide problem solving strategies to gain
control over their impulses
• The behavioural component of CBT assists the individual to manage
the arousal, anxiety or tension that is associated with the urges to
gamble
• A common method of achieving this is using imaginal
desensitisation. In this technique the gambler is asked to imagine
being in a typical gambling situation while in a state of relaxation
• The goal being to extinguish the arousal and gambling and replace it
with relaxation
Psychodynamic Therapy:
• Psychodynamic psychotherapy is based on the theories proposed
by Freud and was widely used in treating people with problem
gambling prior to the development of CBT
• It is a type of psychological treatment that aims to help people
understand the roots of emotional distress by exploring
unconscious conflicts, motives, needs and defences
• Based on Freud’s theory that all mental disorders are caused by
unresolved psychological conflicts that occur in the unconscious
with their origins being in early childhood
• The aim of this treatment is to help people to understand the cause
of the emotional distress which for problem gambling revolves
around the Oedipal complex (Freud, 1928)
• When using the psychodynamic approach the therapist will try to
achieve abstinence from gambling which can be a lengthy process
thus it is important that the client is an active participant
Psychodynamic Treatments
• When treating problem gambling therapists use a range of
techniques such as free association, dream interpretation,
identification of defence mechanisms and displays of
transference
– Free association is when the client is encouraged to say
whatever comes to their minds in order to identify the themes
involved in their gambling
– Dream interpretation involves clients sharing their dreams as
the psychodynamic perspective has the belief that dreams
symbolically represent information stored in the unconscious
mind
Psychodynamic Treatments
– Identification of defence mechanisms is essential for
treatment to work as it prevents the unconscious conflicts
from being explored and resolved. Denial and
omnipotence are two common defence mechanisms that
gamblers use
– Denial is the refusal to believe whatever it is that may be
causing ones anxiety or emotional conflict;
– Omnipotence refers to the feeling of being ‘all powerful’
and is a direct defence against feelings of inadequacy and
helplessness
– Transference provides a valuable source of information by
the client unconsciously responding to the therapist as
though they are a significant person in their life
Socio-cultural Contributing Factors:
• social permission of gambling opportunities
• Management including social network and
recovery groups
Social Permission of Gambling
Opportunities
Gambling is regarded by
many Australians as part of
their cultural heritage.
• Around three in four Australians gamble at some time in the year
• There is the Melbourne Cup, two-up during Anzac day and constant
advertising that provides and reinforces a positive image of
gambling in our society
• Research indicates that when there is a perception that gambling is
socially acceptable younger people are more likely to try gambling
and less likely to associate negative consequences with it
(Australian Psychological Society, 1997)
Management of Pathological
Gambling
Support Networks
and
Recovery Groups
Social Networks
• Social psychologists have defined a social
network in terms of the social structure that
maps out the relationships between individuals
• These relationships usually have some kind of
significance or importance to the individual –
immediate family, friends, colleagues
• Another characteristic of the social network is
that people within the network may also have
some kind of connection with each other, as well
as the individual
The Main Benefit of a Social network
• is that it gives access to social support – help or
assistance from other people during a recovery
process, this can take different forms
– Appraisal support – such as having access to someone
with whom to talk and obtain feedback from
– Tangible assistance – such as help with a bill payment
or a meal
– Information support – such as providing the website
of a social network or a recovery group in the
community
– Emotional support – such as help in coping with
problems experienced
A Limitation of Social Networks
• is that the network of someone with a
gambling problem usually includes others with
a gambling problem.
– This seems to be especially true for females who
have gambling problems with poker machines
– This continued association with other problem
gamblers may cause the cues that promote or
initiate gambling to re-emerge
Social Networks
• Gamblers are more likely to abstain from
gambling when they associate with individuals
who support their abstinence
Recovery Groups for Gambling
• A recovery group or support group is a not for
profit group run by and for people who interact
on the basis of common interests or experiences
to support one another
• One of the best known recovery groups for
people experiencing problem gambling is
Gamblers Anonymous (GA)
Gamblers Anonymous
• GA is based on the principles of peer support and the
power of relating to people whose gambling has left them
with feelings of emptiness, isolation, guilt and shame
• GA sessions run for 90 minutes, there are no fees with the
only requirement for membership being a desire to stop
gambling
• The initial process in recovery for the problem gambler is
admitting they are powerless in controlling their gambling
and surrendering to a ‘higher power’
• Another key feature of GA is having a sponsor who is a
former problem gambler who has remained abstinent and
can provide support and guidance through the recovery
process
GA although social in its structure does
use some psychological theories:
– Positive reinforcement when the gambler is given
rewards from not gambling for a period of time
– Behavioural techniques that provide different
social activities other then gambling
– Cognitive approaches encourage problem
gamblers to take one day at a time thus decisions
are more likely to be rational and self-controlling
(Grant, 2007)
Some of the limitations of GA is that:
– It believes that abstinence is the only solution for
problem gambling. There has been empirical
research to show a reduced and responsible
gambling behaviour for some people can be a
realistic goal
• GA is more likely to be effective when used in
combination with psychological therapy.