[Slide1]

PathologicalGamblingPathological Gambling and Alcohol Use Disorders

Timothy Fong MD
First-Year AMSP Scholar

December 2005

I. Introduction (This lecture is important for medicalstudentsmedical students because) [Slide 2]

A. LifetimeriskLifetime risk of pathological gambling (PG) is ~ 2%(1)

B. LifetimeriskLifetime risk of alcohol use disorders (AUD) is ~ 13% (2)

C. LessresearchLess research on PG vs. AUD

1. PubMed References: PG ~ 1,600, AUD ~ 55,000

2. MostphysiciansMost physicians know little about pathological gambling (3)

3. MedicalschoolMedical school curricula do not cover pathological gambling

D. Co-occurring PG and AUD are associated with worse outcomes (4)

1. TwiceasTwice as likely to dropout of treatment (5-7)

2. ↓quality of life

E. ThislectureThis lecture will cover: [Slide 3]

1. PathologicalgamblingPathological gambling (PG)

a. GamblinginGambling in the United States

b. DSM-IV criteria

c. Epidemiology

d. Consequences

e. Screening

f. RiskfactorsRisk factors

g. Treatment

2. Alcohol usedisordersuse disorders (AUD)

a. AlcoholuseAlcohol use in the United States

b. DSM-IVcriteriaIV criteria

c. Epidemiology

d. Consequences

e. Screening

f. RiskFactorsRisk Factors

g. Treatment

3. AUD and PG [Slide 4]

a. Outcomes

b. Epidemiology

c. Similarities

d. Differences

e. TreatmentconsiderationsTreatment considerations

II. Pathological gambling

A. GamblinginGambling in the United States (8) [Slide 5]

1. 85% of Americans have gambled over the last 12 months

2. 48 states in the United States have legalized gambling

3. $72billion/year net revenue; more than amusement parks, movies and sporting eventscombinedevents combined

4. IncreasedculturalIncreased cultural acceptance (9)

a. IncreasedpopularityIncreased popularity of televised gambling

b. SchoolandSchool and churches use gambling for fund-raising

c. 80% of parents aware and not opposed to children gambling (10)

B. DSM-IV Criteria (11, 12)

1. SocialgamblingSocial gambling(13) [Slide6]

a. SimilarmeaningSimilar meaning to “social drinking”

b. GamblingdoesGambling does not meaningfully impact life

c. ~85% of gamblers

2. ProblemgamblingProblem gambling (1) [Slide 7]

a. SimilartoSimilar to “substance abuse”

b. GamblingbehaviorsGambling behaviors: problematic and beginning to interfere

c. ~5-6% of the general US population

3. PathologicalgamblingPathological gambling: [Slides8 and 9]

a. DSM-IVcriteriaIV criteria (5/10 criteria over last 12 months)(14)

i. PreoccupationwithPreoccupation with gambling

ii. GambleswithGambles with increasing money to achieve desired excitement

iii. RepeatedunsuccessfulRepeated unsuccessful efforts to control, cut back, or stop gambling

iv. Restless/irritablewhenirritable when attempts cutting down or stopping

v. GamblestoGambles to escape problems or to relieve dysphoria

vi. ReturnstoReturns to get even ("chasing" one's losses)

vii. LiestoLies to conceal the extent of involvement

viii. IllegalactsIllegal acts (e.g. forgery, fraud, theft, or embezzlement) to) to finance gambling

ix. LostrelationshipLost relationship, job, education, or career because of gambling

x. OthersprovideOthers provide money for desperate financial situation

b. GamblingisGambling is not better accounted for by a manic episode

C. EpidemiologyofEpidemiology of PG (8, 15, 16) [Slide10]

1. LifetimeprevalenceLifetime prevalence

a. ~1%of general population (15, 17, 18)

b. Higher within 50 miles of a casino

2. VulnerablepopulationsVulnerable populations (19) [Slide11]

a. Adolescents(20)

i. HardertoHarder to recoup financial losses

ii. EarlyexposureEarly exposure to gambling increases risk

b. Co-occurringsubstanceoccurring substance use disorder; impairs judgment (21)

c. CasinoworkersCasino workers: high access (22)

d. CurrentlyincarceratedCurrently incarcerated (17)

i. HighfrequencyHigh frequency of gambling in prisons/jails

ii. BoredomandBoredom and lack of activities

D. ConsequencesofConsequences of PG (23, 24) [Slide12]

. 1. Financial

a. Debt: average is ~ $45,000 (25)

b. BankruptcyratesBankruptcy rates: 4 times higher, 20% (26)

c. EconomicburdenEconomic burden: $35 billion per year (27)

2. Relationships

a. DivorceratesDivorce rates 54% (28)

b. DomesticviolenceDomestic violence: 10x more likely (29)

c. ChildabuseChild abuse and neglect: case reports of abandonment in several states (30)

3. LossofLoss of time and productivity: ~ 25 hours spent per week (31)

4. Medical

a. IncreasedfrequencyIncreased frequency of stress-related illnesses like peptic ulcer, hypertension (28)

b. 25% attempt suicide (32)

5. Crime: 21% of PG commitPG commit non-violent, financial crimes (33)

6. Substanceuse