Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-01T18:44:11.588Z Has data issue: false hasContentIssue false
  • English
  • Français

Pathological Gambling: A Negative State Model and Its Implications for Behavioral Treatments

Published online by Cambridge University Press:  07 November 2014

Iver Hand
Get access Rights & Permissions [Opens in a new window]

Abstract

This article describes a new approach to the understanding and treatment of pathological gambling (PG). In order to foster an understanding of the pathological variations of gambling, gambling as a “normal,” widespread behavior that spans cultures and centuries is briefly reviewed, as is the current socioeconomic impact of gambling on society. PG is interpreted as an excessive exaggeration of a normal behavior (a behavioral excess disorder, or BED), similar to exaggerations of cleaning, grooming, loving, working, or shopping.

Particular developmental deficits in certain individuals and their resulting vulnerabilities make these persons prone to “getting lost” in excessive gambling activities. PG fulfills three important functions that serve to maintain these behaviors. Most frequently, it serves the intraindividual function of distraction from a cognitive, emotional, or physiologic negative state (NEST). A second, much less frequent intraindividual function is that of fast socioeconomic self-destruction in persons who develop presuicidal depression before they start gambling. In the worst disease course of this subtype, patients enter a dramatic “last game”; when they lose, “fate has decided” that they should kill themselves immediately thereafter. A third function fulfilled by PG is interactional, ie, in the “I can't be with or without you” type of relationship.

These gambling-related vulnerabilities are discussed against the background of recent studies from: (1) cognitive psychological and animal experiments regarding the prediction of future events; (2) functional brain imaging studies in obsessive-compulsive disorder; and (3) gambling experiments (prediction of future events) in patients with specific lesions in the orbitofrontal cortex. This article outlines the basics of strategic-systemic behavior therapy for these conditions, and summarizes results of the first outcome and follow-up studies.

Type
Feature Articles
Information
CNS Spectrums , Volume 3 , Issue 6: Pathological Gambling , June 1998 , pp. 58 - 71
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.France, CJ. The gambling impulse. Am J Psychol. 1902;13:364–407.CrossRefGoogle Scholar
2.Wildman, RW II.Gambling: An Attempt at an Integration. Edmonton, Alberta: Wynne Resources; 1997.Google Scholar
3.Thomas, WI. The gaming instinct. Am J Sociol. 1901;6:750–763.CrossRefGoogle Scholar
4.Stocking, C. Gambling: The Encyclopedia of the Social Sciences. Vol 6. New York, NY: McMillan; 1931.Google Scholar
5.Knapp, TJ. A functional analysis of gambling behavior. In: Eadington, WR, ed. Gambling and Society. Springfield, Ill: Charles C. Thomas Publisher Ltd; 1976:276–294.Google Scholar
6.Herman, RD. Motivation to gamble: the model of Roger Caillois. In: Eadington, WR, ed. Gambling and Society. Springfield, Ill: Charles C. Thomas Publisher Ltd; 1976:207–217.Google Scholar
7.Kusyszyn, I. Existence, effectance, esteem: from gambling to a new theory of human motivation. Int J Addict. 1990;25:159–177.Google Scholar
8.Smith, JF, Abt, V. Gambling as play. Ann Amer Acad Polit Soc Sci. 1984;474:122–132.Google Scholar
9.Freud, S. Dostoevsky and parricide. In: Starchey, I, ed. The Complete Works of Sigmund Freud. Vol 21. 1928:222–242.Google Scholar
10.Rosecrance, J. Gambling Without Guilt: The Legitimization of an American Past-Time. Los Angeles, Calif: Pacific Grove; 1988.Google Scholar
11.Boyd, WH. Excitement: the gambler's drug. In: Eadington, WR, ed. Gambling and Society. Springfield, Ill: Charles C. Thomas Publisher Ltd; 1976:371–375.Google Scholar
12.Piattelli-Palmarini, M. Inevitable Illusions: How Mistakes of Reason Rule Our Minds. New York, NY: John Wiley & Sons Inc; 1994.Google Scholar
13.Oford, J. Excessive Appetites: A Psychological View of Addictions. New York, NY: John Wiley & Sons Inc; 1985.Google Scholar
14.Zagorin, A. Gaming: all bets are off. How entrenched national monopolies are weakening Europe's chances of emerging with a single market for gambling in 1992. Time. 1991:40–41.Google Scholar
15.Brown, RIF. Dropouts and continuers in Gamblers Anonymous. Part 4: evaluation and summary. J Gambling Behav. 1987;3:202–210.Google Scholar
16.Hand, I. Outpatient, multimodal behaviour therapy for obsessive compulsive disorder. Br J Psychiatry. 1998;173(suppl 35):46–52.Google Scholar
17.Gazzaniga, MS. Nature's Mind: The Biological Roots of Thinking, Emotions, Sexuality, Language and Intelligence. New York, NY: Basis Books, Harper Collins; 1992.Google Scholar
18.Schwartz, J. Cognitive behavioral self-treatment for obsessive compulsive disorder systemically alters cerebral metabolism: a mind-brain interaction paradigm for psychotherapists. In: Hollander, E, Stein, D, eds. Obsessive Compulsive Disorders–Etiology, Diagnosis, Treatment. New York, NY: Marcel Dekker; 1997.Google Scholar
19.Baxter, L, Saxena, S, Brody, A, et al.Brain mediation of obsessive-compulsive symptoms: evidence from functional brain imaging studies in the human and nonhuman primate. Sem Clin Neuropsych. 1996;1:32–47.Google Scholar
20.Damasio, AR. Descartes' Error: Emotion, Reason and the Human Brain. New York, NY: Avon Books; 1994.Google Scholar
21.Peterson, CR, Beach, LR. Man as an intuitive statistician. Psychol Bull. 1967;68:29–46.Google Scholar
22.Hand, I. Obsessive-compulsive patients and their families. In: Falloon, IRH, ed. Handbook of Behavioral Family Therapy. New York, NY: The Guilford Press; 1988.Google Scholar
23.Custer, RL. Gambling and addiction. In: Craig, R, Baker, S, eds. Drug Dependent Patients: Treatment and Research. Springfield, Ill: Charles C. Thomas Publisher Ltd; 1982.Google Scholar
24.Miller, WR, Rollnick, ST. Motivational Interviewing: Preparing People to Change Addictive Behavior. New York, NY: The Guilford Press; 1991.Google Scholar
25.Klepsch, R, Hand, I, Wlazlo, Z. Long-term effects of multimodal behavior therapy for pathological gamblers. Suchtgefahren. 1989;35:35–49.Google Scholar