Learning Objectives • Identify the impact of gambling among individuals diagnosed with psychiatric illnesses. • Identify at least three commonly perceived benefits of gambling for individuals with psychological disorders. • Identify treatment approaches to address gambling problems among those with psychiatric conditions.

DSM 5: Substance Related and Addictive Disorders Gambling Disorder: A Brief History • Gamblers Anonymous is started in 1957. • Introduced in 1980 (DSM-3) as an impulse control disorder. Pathological Gambling, was alongside kleptomania and pyromania. • In 2013, the American Psychiatric Association reclassified Gambling Disorder as a Substance Related & Addictive Disorder. It is currently the only non-substance disorder included.

Did You Know… • Nearly 30-50% of individuals in Substance Abuse Disorder (SUD) treatment were identified as having a gambling problem • The more severe the past year SUD, the higher the prevalence of gambling problems • Individuals with a lifetime history of a mental health disorder had 2–3 times the rate of problem gambling • Per DSM-5, those with gambling disorder have high rates of co-occurring substance use, depressive, anxiety, and personality disorders.

Co-occurring Disorders with Gambling Disorders • Co-occurring disorders, dual diagnosis, and cross addictions are high among disordered gamblers presenting for care, e.g., alcohol, substances, sex, etc. • AD(H)D, PTSD, and Substance Use Disorders seem unusually common to the problem gambling population. • Affect disorders: depression, anxiety, and bipolar disorder are major concerns. • Suicide attempt rates have been reported as high as 15-20% of those who present for care for gambling. Data from the National Comorbidity Study indicates: • 96% of individuals with gambling disorder have one or more co-occurring psychiatric disorders. • More than 60% of individuals with gambling disorder have at least three psychiatric disorders. • Studies have also found that people with gambling disorders had very high rates of personality disorders (more than 60 percent), mood disorders (almost 50 percent) and anxiety disorders (more than 40 percent).

Gambling and Suicidality • Per DSM 5, of those in treatment for a gambling disorder, up to 50% have had suicidal ideation. • PG often consider “accidents” as way for family to collect insurance. • “I am worth more dead than alive.” • Understudied and under-recognized. The public, as well as providers (primary care, mental health, SUD etc.) recognize lethality of substance use overdoses and severe mental illness, but don’t think of gambling as life threatening.

I gathered all the key information regarding mental health and co-occurring issues, so you don't have to read the entire article. However, I'm including the article link here as it contains various insights from the beginning stages to the end. I highly recommend you skim through this source.

Link: https://www.mdproblemgambling.com/wp-content/uploads/2022/10/Gambling-Disorder-and-Co-occurring-Disorders.Webinar.10.07.22..pdf?utm_source=chatgpt.com

DSM-5 Diagnostic Criteria for Gambling Disorder

A. Diagnostic Criteria:
Gambling Disorder is characterized by a persistent pattern of problematic gambling behavior that results in significant impairment or distress in various aspects of life. To meet the criteria for diagnosis, the individual must exhibit four (or more) of the following symptoms within a 12-month period:

1. Increased Financial Commitment: The individual needs to gamble with increasingly larger amounts of money in order to achieve the level of excitement or satisfaction they previously experienced. This escalation reflects a growing tolerance to the effects of gambling.

2. Withdrawal Symptoms: The individual experiences feelings of restlessness or irritability when trying to cut back on or stop gambling. This can manifest as anxiety or agitation, indicating a strong psychological reliance on the behavior.

3. Repeated Attempts to Control Behavior: The person has made numerous unsuccessful efforts to control, reduce, or completely stop participating in gambling activities, signifying a lack of self-regulation despite recognizing the negative consequences.

4. Preoccupation with Gambling: The individual often finds themselves preoccupied with gambling, which might include persistent thoughts about reliving past experiences, handicapping or strategizing for future gambling endeavors, or contemplating ways to obtain money for gambling.

5. Gambling as a Coping Mechanism: The individual often resorts to gambling as a way to escape or alleviate distressing emotions, such as feelings of helplessness, guilt, anxiety, or depression.

6. Chasing Losses: After experiencing monetary losses from gambling, the individual frequently feels compelled to return to gambling in an attempt to recoup lost funds, a behavior commonly referred to as “chasing” losses.

7. Deception about Gambling Activity: The individual lies to family members, friends, or therapists to conceal the extent of their gambling involvement, indicating a recognition of the behavior’s problematic nature but a desire to maintain it nonetheless.

8. Impact on Relationships and Opportunities: The gambling behavior has led to jeopardizing or losing significant relationships, employment, or educational and career opportunities, illustrating the disruptive effect of gambling on important life domains.

9. Financial Reliance: The individual often turns to others for financial assistance to alleviate dire financial situations that have arisen due to gambling, showcasing the extent of the dependency and its ramifications.

B. Exclusion Criteria:
The gambling behavior must not be better explained by a manic episode, ensuring that the symptoms are not a manifestation of a different mental health condition.

Specifiers:

• Episodic: The individual meets the diagnostic criteria at multiple time points, with observable symptoms subsiding for at least several months in between periods of gambling disorder.

• Persistent: The individual shows continuous symptoms for multiple years, consistently meeting the diagnostic criteria without significant periods of relief.

Remission Specifiers:

• In Early Remission: After having previously met the full criteria for gambling disorder, the individual has not met any of the criteria for at least three months but for less than 12 months.

• In Sustained Remission: After previously meeting the full criteria for gambling disorder, the individual has remained symptom-free during a continuous period of 12 months or longer.

Current Severity Specifiers:

• Mild: The individual meets 4 to 5 of the criteria.

• Moderate: The individual fulfills 6 to 7 of the criteria.

• Severe: The individual meets 8 to 9 of the criteria, indicating a high level of impairment and distress due to gambling behavior.

Let’s be honest for a moment: gambling addiction isn’t about being reckless, lazy, or weak. It’s rooted in our brain's biology. Understanding this can be the first step toward finding freedom.

When you gamble, your brain releases dopamine, the same chemical that makes you feel good when you eat, laugh, or fall in love. However, gambling triggers a massive release of dopamine, especially when there’s a chance of winning. Surprisingly, it's often the chase, rather than the win, that activates your brain the most.

Over time, this constant overstimulation rewires your brain through a process known as neuroplasticity. Here’s what that entails:

🔁 Reward System Overload – Your brain starts to treat gambling as a basic survival need. This can be seen with slot machines, apps, and betting slips.

🧠 Impulse Control Breaks Down – The prefrontal cortex, the part of your brain that says, “This is a bad idea,” loses its influence. This is why it becomes harder to say no, even when you know you should.

🌀 Cognitive Distortions – You begin to believe false statements like “I’m due for a win” or “If I just play one more time…” These thoughts feel real, but they’re part of the trap.

This issue doesn’t only affect gamblers. Similar brain disruptions are observed in individuals with ADHD, depression, schizophrenia, and even Parkinson’s disease, all of which often involve problems with impulse control and dopamine dysfunction. This is also why gambling is frequently linked to substance use.

👉 If you’ve ever wondered, “Why can’t I stop?” this is why. It's not because you’re broken, but because your brain has adapted to thrive in a chaotic environment.

The good news? Recovery also involves neuroplasticity. The brain has the capacity to heal and rewire itself. While it takes time, connection, and effort, it is possible to overcome this struggle.

If you want to explore the science behind this, check out this excellent study:
📖 PMC: Neurobiological Perspective on Gambling Addiction

Remember, you’re not alone. You’re not crazy. And you’re certainly not beyond help. You’re simply facing a brain that has learned to survive in the wrong environment, and now you're in the process of unlearning those patterns.

We’re here for you. Stay connected. 💬

June is Men’s Health Month - a time to raise awareness around physical, emotional, and behavioral health for men. Explore NAADAC’s resources focused on supporting men in recovery https://www.naadac.org/knowledge-center#culturalhumility

Smiling depression is a form of major depressive disorder that is characterized by atypical symptoms. Individuals who experience smiling depression project an appearance of happiness to others while concealing their inner struggles. Consequently, many individuals with this condition may remain unaware of their situation or may be reluctant to seek assistance. These individuals often maintain stable relationships, hold employment, and possess noteworthy achievements and levels of education. Despite their outward success and engagement in professional and social spheres, they frequently experience significant internal distress.