Gambling within the Biopsychosocial framework Biological Factors Impulse Control Disorder • Currently in the DSM and ICD there is no category for an ‘addictive disorder’. Gambling comes under a type of impulse control disorder in the DSM-IV-TR. • In the DSM-IV-TR there are six different types of impulse control disorders such as pyromania and trichollomania (pulling one’s hair out for pleasure). • In the new DSM-V it has been proposed that ‘pathological gambling disorder’ will be replaced with the term ‘disordered gambling’ in a new category called addiction and related disorders within the subcategory behavioural addictions. According to the DSM-IV-TR a person must experience at least five of the following ten symptoms to be diagnosed as a pathological gambler: 1. Preoccupation with gambling (salience): At least two weeks or more thinking about gambling. 6. Chasing: A pathological gambler will chase their loses and not walk away. 2. Tolerance: Increasing size of bets or time spent gambling. 7. Lying: To conceal the extent of gambling. There are two types: a) Reactive lying-Being dishonest in response to questions that may expose one’s gambling. b) Deceptive lying: Dishonesty planned in advance. 3. Loss of control: Individual has tried several unsuccessful attempts to stop gambling. 8. Illegal activity: In order to obtain money for addiction. 4. Withdrawal: Unpleasant psychological and/or physical reactions when activity is reduced such as irritability or insomnia. 9. Risked relationships: Such as leaving a child in the car to place a bet. 5. Escape: Some psychologists propose that all gamblers do so for escape from the hassles that daily life creates. When the gambler is addicted, gambling then becomes an escape from the problems associated with it creating a ‘vicious cycle’. 10. Bailout: Receive money from family or friends to bail them out. The Biopsychosocial Model Biological Perspective: The dopamine reward system • The effects of dopamine on gambling addiction have become of interest to researchers due to Parkinson’s disease suffers who reported gambling addiction soon after treatment for the disease with dopamine. • Many sufferers of Parkinson’s disease however, have not reported gambling addictions despite taking dopamine. • Research has indicated however that dopamine although found in a few areas of the brain has a role in the development and maintenance of addictive gambling. The dopamine reward system • Dopamine is a neurotransmitter that is involved in pleasure, reward, motivation and emotional arousal. • The release of dopamine also contributes to planning and complex motor movements. • Researchers have identified a pathway in the brain where dopamine is concentrated producing a distinct sense of pleasure. • This pathway is known as the ‘dopamine reward system’. The dopamine reward system • Is located in the medial forebrain bundle that ascends from the midbrain through the hypothalamus into the nucleus accumbens. The dopamine reward system • Research by Gray 2007 has shown that dopamine is also released in anticipation of receiving a reward. • Research done on animals with the use of classical conditioning and schedules of reinforcement showed that dopamine was released at the presence of light without the UCS (food). • This creates an interaction between psychological and biological perspectives as it is conditioning and schedules of reinforcement that establishes the dopamine reward system. The dopamine reward system • • • In relation to gambling fMRI imaging has shown that chance monetary rewards activate the brain’s dopamine reward system. As the reward is never predictable the gambler receives a burst of dopamine into the brain every time they play. This is also reinforced by social environmental cues resulting in the development and maintenance of a strong response that is very resistant to extinction. Classical conditioning and Gambling. CS Gambling (anticipation of reward) UCS Receiving Reward UCR Dopamine released CR Dopamine released Biological Treatment for Gambling • 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.