How to help a gambler?

Games of chance and bets turn out to be activities that many of us have participated in at some point and have turned out to be entertaining to have fun with friends.

However, addiction to these games of chance represents a source of conflict with family, friends and, above all, with oneself, as it is distorted by an obsessive and pathological need to continue gambling without weighing the consequences that it entails. In this article, I'm going to explain how to help a gambler.

What is pathological gambling?

Gambling is a disorder consisting of the progressive alteration of behavior in which the subject experiences an uncontrollable need to play, despite the consequences it causes.

1. Symptoms

It is considered by the Diagnostic and Statistical Manual of Mental Disorders, DSM 5 (2013) as a disorder called pathological gambling if it meets four or more of the following symptoms:

1. Need to play bets with larger amounts of money or goods to achieve the desired excitement.
2. Has made repeated efforts to control, quit, or reduce gambling without success.
3. Most of the time, he is irritable or anxious, especially when trying to cut down or quit gambling.
4. When he loses money on bets, he usually comes back another day to try to win or recoup his losses.
5. You are frequently thinking about gambling (remembering past gambling experiences, planning your next bet).
6. Generally, he bets when he presents some discomfort or vicissitude (anxiety, depression, guilt, abandonment).
7. He lies in order to hide how involved he is in the game.
8. He often counts on others to give him the money to ease his financial situation.
9. You have jeopardized or even lost a job, an important relationship, an academic or professional career because of gambling.

2. Types

Gambling can present itself in two ways: episodically or recurrently:

• It is considered episodic when it meets the above symptoms on more than one occasion, but they decrease for several months.
• It is recurrent when symptoms occur continuously for several years.

Three forms of gravity are also recognized:

• Mild: meets 4-5 symptoms
• Moderate: meets 6-7 symptoms
• Serious: meets 8-9 symptoms

How gambling disorder is treated

The treatment of pathological gambling, being a disorder with an addictive characteristic, is oriented in a very similar way to that of substance addictions.

Here are some of the treatments for pathological gambling:

1. Psychotherapy

Since gambling addiction has been considered an addiction, therapeutic techniques have been used that have shown their usefulness in controlling alcoholism and drug addiction.

Cognitive behavioral therapy focuses on the identification of pathological beliefs or cognitive errors in order to replace them with those that turn out to be beneficial to the health of patients.

Familiarity with gambling develops an illusion of control on the part of the sick subject, as well as a perceived self-efficacy related to the greater probability of winnings.

For this reason, heavy gamblers have more pathological (irrational) thoughts than casual gamblers, leading them to engage in more risky behaviors.

On the other hand, these subjects also tend to evaluate the results of the game in a biased way: with a belief that continuous losses predict the arrival of an imminent big win that will allow them to recover, even obtain more winnings.

Cognitive-behavioural therapy emphasizes the importance of changing cognitive distortions to reduce the urge to gamble and, in turn, gambling behaviors. The goal of cognitive-behavioural therapy is to help the patient manage irrational thoughts and establish a relationship between thoughts, emotions and behaviors, as well as to locate the self-verbalizations used in connection with gambling.

2. Pharmacotherapy

The interest of pharmacological intervention in pathological gambling arises from the involvement or function of some neurotransmitters, such as serotonin, dopamine and norepinephrine, in brain reward mechanisms.

In general, dopamine is associated with the reward and motivation system, norepinephrine with activation and search for rewards (novelties), serotonin is associated with compulsion.

• The drugs that have been proven to have positive results in pathological gambling act on these neurotransmission systems and these are serotonin reuptake inhibitors (SSRIs), mood stabilizers, atypical neuroleptics and opiate antagonists. SSRIs have shown a significant decrease in the desire to gamble and compulsive behaviors, and especially when there is comorbidity of some other pathologies of anxiety or depression.
• Mood stabilizers such as lithium or topiramate can have quite positive results in the treatment of compulsive gambling when used as negative mood regulators.
• Opioid antagonists such as naltrexone can inhibit feelings of euphoria associated with gambling, which may reduce cravings and thoughts of gambling (pleasure) and thus improve social functioning; Above all, they are indicated when the desire to gamble at the start of treatment is very strong or when there is a family history of alcoholism.

• Internment: Admitting subjects to a hospital center is recommended in cases with severe acute crises, with repeated therapeutic failures and with comorbid disorders, especially depression and suicide attempts.

Can you get out of gambling addiction without help?

Gambling is one of the disorders recognized by the American Psychiatric Association, and like many of the pathologies categorized in DSM5, it primarily requires professional intervention.

Undoubtedly, social and family support contributes considerably to the recovery of health, in the same way that one is aware of the problem and per se there is a need to correct compulsive habits or behaviors.

However, these attempts at a solution on their own and with the help of those close to them are limited by clinical issues that are often unknown. These attempts are also diminished by the concomitant symptoms themselves (for example, depression or an anxiety disorder), causing abandonment of the recovery processes that have been started.

How to help someone with gambling problem?

How to help a person with gambling problems? These are the most important tips to help a friend or family member who presents pathological gambling:

1. Get informed

Find information about the symptoms of the person with problem gambling you want to help. Finding out about the pathology that has damaged the relationship with the sick person will allow us to understand not only the behavioral presentation, but also its cognitive and emotional characteristics.

2. Analyze the emotional world

People who show symptoms of compulsive gambling frequently present underlying emotional conflicts that operate as the etiology of this disease.

Observe at what times in the patient's life the symptoms manifest or are exacerbated (for example, there may be social or family conflicts, such as a disagreement or argument, that trigger the symptoms).

Sometimes, patients learn to use the game as a mechanism to avoid emotional pain.

How to help a gambler who does not recognize him? Supporting, guiding and accompanying the sick person at this time can be effective in recovering their health.

3. Don't keep contributing to symptoms

What to do when a gambler does not want help? Sometimes, to alleviate the sick person's discomfort, we prefer to give them what they are asking for (many times they are financial resources, sometimes support for activities), but it is necessary to address the problem and not make it easier for them to avoid it.

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