Final presentation for the Scaife Advanced Student Medical Seminar by Joshua Altman

1. Josh Altman

4. Gambling Statistics
 2009: Legal Gambling market alone
generated approximately $335 Billion globally
 It has been estimated that approximately
85% of Americans have gambled at least one
time during their life
 Between ~65-80% reported having gambled
in the past year

5. When Gambling Becomes a
Problem
 What are some of the beliefs and concepts that
lead to a gambling problem?
-Gambler’s Fallacy
-Idea that continuing to play is the only way to win
back money lost
-Variable reinforcement schedule

6. Gambling Addiction
 Problem Gambling = “an urge to continuously
gamble despite harmful negative
consequences”
 The most severe form can be clinically
diagnosed as Pathological Gambling

7. Pathological Gambling
 Classified as an impulse control disorder by
DSM-IV
 It has been suggested that it be reclassified in
a new category “Addiction and Related
Disorders” in the new DSM-V

8. DSM-IV Diagnostic Criteria
Five or more of the following:
 preoccupied with gambling
 Needs to gamble with increasing amounts of money in order to achieve the
desired excitement
 Has repeated unsuccessful efforts to control, cut back, or stop gambling
 Restless or irritable when attempting to cut down or stop gambling
 Gambles as a way of escaping from problems
 After losing money gambling, often returns another day to get even
 Lies about the extent of involvement with gambling
 Has committed illegal acts such as forgery, fraud, theft, or embezzlement
to finance gambling
 Has jeopardized or lost a significant relationship, job, or educational or
career opportunity because of gambling
 Relies on others to provide money to relieve a desperate financial situation
caused by gambling

9. Biology behind Pathological
Gambling
 Brain Regions implicated:
 Nucleus Accumbens and Ventral Tegmental Area
(Reward and Pleasure areas)
 Orbitofronal Cortex (decision making)

10. Brain regions cont.
 Hippocampus and Amygdala (Limbic System –
Memory, learning, and emotions)

11. Neurotransmitters
 Hypothesis: Chemical Imbalances of
 Noradrinergic
 Serotonergic
 Dopaminergic
-Arousal, reward, and mood regulation
-Chemical imbalances of these systems may lead to
problems with impulsivity, difficulty with control,
and mood disorders

12. Genetic Factors
 Studies have shown a likely genetic link to
pathological gambling
 Twin study (2012): Differences in number of
times gambling could be accounted for both
by familial environment (42%) and genetic
differences (32%)
 Disordered gambling differences resulted
primarily from genetic factors

13. Specific Genes
 Dopamine Receptor Gene: D2A1 allele
 May result in deficits in dopamine reward
pathways
 Hypothesis: Leads to increased pursuing of
pleasure generating activities

14. Specific Genes: Cont.
 Serotonin Receptor Polymorphisms
 Study found that a certain genotype of the
serotonin receptor 2A (“C/C Genotype”) was
significantly associated with pathological
gambling

15. Co-Morbid Conditions
 ~64% of Pathological Gamblers have had some form of co-
morbid psychiatric disorder
 Substance Use Disorders
 Personality disorders (antisocial, borderline, narcissistic
most commonly)
 Depression
 Bipolar Disorder
 Suicide Risk
 Pathological gamblers with co-occuring mental illness were
significantly more severe with their gambling problems

16. Treatments
 12-step based programs – GA
 CBT and Counseling
 Online Peer Support Groups
 Medication
 Self-Help

17. Medication Research
 No drug currently approved specifically for
use for pathological gambling
 SSRI Paroxetine: studies have shown it is
efficient in treating people with pathological
gambling
 Nalmefene: Opiate Antagonist – Also shown
effective in reducing problematic gambling

18. Thank You!
 Questions?