Magazine article Clinical Psychiatry News

Screening Tools Can Identify Gambling Disorder

Magazine article Clinical Psychiatry News

Screening Tools Can Identify Gambling Disorder

Article excerpt

EXPERT ANALYSIS FROM THE AAAP ANNUAL MEETING

AVENTURA, FLA. -- People with unrecognized gambling disorders may present with depression, anxiety, substance abuse, or other psychiatric symptoms, and screening patients with these symptoms can help make this connection, Dr. Timothy Fong said during a workshop at the annual meeting of the American Academy of Addiction Psychiatry.

Screening tools are essential in helping identify patients with a gambling disorder or subthreshold disorder, who typically do not bring up these problems with their physicians and often suffer in private, said Dr. Fong, a psychiatrist at the University of California, Los Angeles, and codirector of the UCLA Gambling Studies Program.

"By the time I see them, the screening has already happened; they have self-identified as having a problem," he said. "But when they're coming to see the general psychiatrist," problems like depression, difficulty sleeping, or problems with a spouse or family, "are the chief complaints, it's not 'I have a gambling problem.'"

Screening can help identify patients before they develop a full-blown gambling disorder, at an earlier stage, when it is simpler to treat and interventions are more effective "and you can prevent the progression to a more severe disorder," he noted.

Watch for hidden addictions

Another sign someone might have a gambling problem is failure to respond to medication, an indication that problem gambling "may be a hidden addiction that is driving the stress [or] depression," Dr. Fong said, citing a patient with depression who does not respond to courses of selective serotonin reuptake inhibitors or other categories of antidepressants as an example.

During a workshop on gambling disorders held during the meeting, Dr. Fong and Dr. Iman Parhami, who is affiliated with the Delaware Division of Substance Abuse and Mental Health, New Castle, referred to one such resource, a brief three-question screening tool available on the National Center for Responsible Gaming website.

Gambling behavior can be considered in three levels: recreational gambling, where there are no repercussions related to gambling; subthreshold gambling disorder, where the individual encounters gambling-related problems but does not meet the diagnostic threshold for a disorder, although is at an increased risk of developing a gambling disorder at some point in the future; and gambling disorder. A gambling disorder is characterized by "persistent, recurring and sometimes progressive maladaptive gambling behavior despite the negative consequences," with behavior that has the greatest social, psychological, and medical impact. Those with a subthreshold gambling disorder are at a higher risk, but whether recreational gamblers are at increased risk is less clear, said Dr. Parhami, who formerly was affiliated with the UCLA gambling studies program.

In the DSM-5, gambling disorder now appears under "non substance-related disorders" in the substance-related and addictive disorders section, and is defined as "persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress," as indicated by the individual exhibiting at least four of nine symptoms over a 12-month period: preoccupation, tolerance, withdrawal (developing symptoms like anxiety when they do not gamble), loss of control, escapism, dishonesty, risk-taking behaviors related to gambling, chasing (returning another day to get even after losing money gambling), and bailouts (relying on others to provide money to relieve a desperate financial situation caused by gambling). …

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