Pathological gambling: an increasing and underestimated disorder

Abstract

Pathological gambling, which has recently been proposed to be one of the related conditions belonging to the obsessive-compulsive spectrum disorders, is classified as a disorder of impulse control in the DSM-IV. The more significant characteristics among the diagnostic criteria are: preoccupation with gambling, restlessness or irritability when attempting to cut down or stop gambling, tendency to lie to conceal the extent of involvement with gambling, antisocial behaviour such as forgery, fraud, theft or embezzlement and loss of significant relationships, job, educational or career opportunities. Pathological gambling is a progressive, chronic disorder which coexists with several comorbid psychiatric conditions. Up to 50% of gamblers have substance use disorders, Depressive disorders, anxiety disorders, obsessive-compulsive disorder and attention-deficit disorder frequently occur in pathological gamblers and some reports suggest that these conditions share a physiological substrate with pathological gambling. The impulsive nature of the condition, coupled with these comorbidities, leads to a high rate (13-20%) of suicide attempts. Several casinos will open in Switzerland in the near future. As no available data on the prevalence of pathological gambling were available, we have conducted a survey to evaluate the prevalence of pathological gambling in the Swiss adult population before the introduction of new gambling activities and the link between pathological gambling and alcohol abuse. The current prevalence of probable and potential pathological gamblers were estimated to be 0.8 and 2.2% respectively. This means that in Switzerland the number of probable pathological gamblers is between 32712 and 77768 (confidence level 95%) and of potential pathological gamblers between 107090 and 179759. In this survey, a clear relationship between alcohol abuse and gambling behaviour was found. This correlation has repeatedly been noted in literature regarding studies focusing on treatment populations (i.e. substance abusers or problem gamblers) whereas our study addressed a general population. In the present article, we focus on the characteristics of the pathological gamblers compared to occasional gamblers and non-gamblers of this study population. Moreover, we consider the correlation between four regions of the country offering different gambling possibilities and the current prevalence rate. The findings of our study show that in cantons (such as Fribourg and Tessin) and regions (Western Lemanic) where availability is higher, so are probable and potential pathological gamblers. In terms of general treatment strategy, reductions in gambling may be a more viable goal for problem gamblers than abstinence. Options for therapy of pathological gambling include self-help groups, psychodynamic treatments, family therapy, cognitive-behavioural approaches and pharmacotherapy (selective serotonin reuptake inhibitors). However, cognitive-behavioural therapy is the only approach that has been shown to be effective in controlled trials, so far. Switzerland will see the development of legal gambling and as a consequence, a probable increase in pathological gambling. The results of our study show that pathological gambling is already high and directly influenced by availability. Although pathological gambling is becoming a major health concern, this psychiatric disorder remains largely undiagnosed and untreated in clinical practice.