Pathological Gambling Should be Viewed as Chronic Medical Condition, Say Yale Researchers

Like drug and alcohol abuse, pathological gambling should be viewed as a chronic medical condition, Yale researchers assert in an article published in the July 11 issue of the Journal of the American Medical Association (JAMA).

“Pathological gambling should be conceptualized as a chronic medical illness so that we can gain better understanding of the biological, genetic and environmental factors that contribute to the problem, develop better treatment strategies and treat individuals with the disorder within a medical context,” said principal investigator, Marc Potenza, M.D., assistant professor of psychiatry at Yale.

Potenza, who is also director of the Problem Gambling Clinic and the Women and Addictive Disorders Core of Women’s Health Research at Yale, said that as a nation, America has seen a robust increase in gambling. Studies show that with the rapid increase and availability of legalized gambling, there are a growing number of problem and pathological gamblers. In 1998, 86 percent of the general adult population was estimated to have gambled at some time in their lives, up from 68 percent in 1975.

Traditional forms of gambling include wagering in casinos or on lotteries or horse racing. Potenza said new gambling forms, such as video poker and Internet gambling, may be more habit-forming than traditional gambling, given their greater rapidity of action and ability to be used in isolation.

Potenza said less than 10 percent of adult gamblers develop a gambling problem. Problem gambling generally refers to gambling which interferes significantly with basic functioning in occupation, interpersonal relationships and finances. Pathological gambling is more severe and refers to a psychiatric disorder with specific diagnostic criteria.

“Gambling has gone from being considered a sin to being a vice to being just bad personal behavior and only recently has been conceptualized within a psychiatric or medical context,” said Potenza. “As with drug addiction, pathological gambling can have a devastating effect on family relationships, disrupting work, marriage and/or child care responsibilities. It is estimated that one of every five individuals with pathological gambling attempts suicide.”

Potenza said two prominent theories on gambling classify the condition as either an impulse control disorder or a non-substance-related addictive disorder. Some treatments for impulsive/compulsive disorders, such as selective serotonin reuptake inhibitors, appear effective in the short-term treatment of pathological gambling. Treatments for substance dependence, such as the opioid antagonist naltrexone, also appear effective.

“Primary care physicians should make questions about a patient’s gambling habits a routine part of a check-up, as are questions about alcohol and drug abuse,” said Potenza.

The article’s co-authors included Thomas R. Kosten, M.D. and Bruce Rounsaville, M.D., professors in the Department of Psychiatry at Yale.

The study was funded in part by the National Institute on Drug Abuse, American Psychiatric Association, National Alliance for Research on Schizophrenia and Depression, the National Center for Responsible Gaming and the VA-New England MIRECC.

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Karen N. Peart: karen.peart@yale.edu, 203-432-1326