[Special Topic on Gambling Disorders]Addiction and inability to extricate oneself become mental illness. Gambling disorder damages the brain like drug addiction

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(Kuala Lumpur News) The Chinese often say “small gambling is fun”, but if you are addicted to gambling and cannot extricate yourself, it becomes a mental illness, called gambling disorder.

A research institute in the United States compared the brain functions of people with gambling disorders and ice addicts, and found that the brains of the two are almost the same and have similar damage, which shows that gambling is also a chronic brain disease.

Is Gambling Addiction a Mental Illness? First of all, psychiatry cannot diagnose the condition through blood tests or scans, generally according to the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders Fifth Edition” (DSM-5) or the World Health Organization’s “International Classification of Diseases Eleventh” Revision” (ICD-11) as a guideline for diagnosis.

Winning money feels like taking drugs

Addiction refers to a person’s uncontrollable repeated desire to abuse a certain substance or engage in a certain activity. It can be divided into two types: substance addiction and behavioral addiction. The former is like smoking, alcohol or drugs; the latter includes food addiction, shopaholics (shopaholic), trichotillomania, cleptomania, etc.

However, none of these examples of behavioral addictions are included in the DSM-5, and gambling disorder (gambling disorder, or gambling disorder) is the only behavioral addiction disorder in it. Considering that ICD-11 has officially included gaming disorder (gaming addiction), perhaps the number of behavioral addiction diseases in DSM may increase in the future.

Assoc Prof Anne Yee Hway Ann, Consultant of Psychiatry and Addiction Medicine at the University of Malaya Medical Center, pointed out that there have been many names for gambling addiction in clinical practice, such as pathological gambling and ludomania. etc., is now uniformly used for gambling disorder.

Gambling disorder was first discussed as impulsive control disorder or obsessive-compulsive disorder, etc., but it was first classified as “non-substance-related disorder” in addictive diseases in DSM-5, which is also the psychiatric text for The first formal recognition of behavioral addictions.

Gambling disorder was ultimately brought under the “flagship” of addiction, she said, because it shares many similarities with other addiction problems, including loss of self-control and denial of a problem, like a drunk who perpetually says he doesn’t have a problem. Drunk in general, also often have depression or mood swings.

“Just like drugs are addictive, it takes a while for gambling addiction to form, but this is why ‘never take the first sip’ is so important, because the brain will find that this behavior can produce a refreshing and enjoyable feeling, Little by little it started to change.”

In addition, the reason for most addictions is to escape reality and relieve stress. “Addicts also have cravings. For example, a gambler’s life eventually revolves around gambling. While working, he already wants to gamble with the money he earns.”

Not only that, all kinds of addicts will have a similar “high” (high, with a stimulating feeling of excitement), which means that the “cool feeling” of winning money is the same as the “cool feeling” of taking drugs.

Gambling pathways are easier to cover up

She noted that gambling disorder differs from other addictions in that gamblers are more likely to “high” because exposure to gambling is relatively easy and easy to mask. It is also difficult to distinguish people with gambling disorders, unless they experience significant financial losses, otherwise it will not be apparent on the surface. Unlike alcoholics who may experience shaking hands, insomnia, or cold sweats when they stop drinking, gambling disorders have no physical response.

“Furthermore, the gamblers did not take any substances, and there are no clinical tests or scans that can detect gambling disorders.”

More importantly, the society’s view on gambling is different from other addictions, especially the Chinese society is accustomed to gambling, and thinks it’s fun to gamble a little. Such behaviors, in fact, ignore, underestimate and normalize the negative impact that gambling can have on individuals and society.

Stimulate the brain to secrete dopamine, bet more and seek greater stimulation

The human brain is not fully developed until around the age of 25, so an 18- or 21-year-old adult’s brain is still growing.

Yu Anzhen said that people under the age of 25 are particularly sensitive to the effects of dopamine. At this time, their decision-making ability is still developing, and it takes more time to make the right decision, so they often do it first.

“Therefore, there is a scientific basis for the constant claim that teens are impulsive, that they are more likely to be excited by stimuli such as the media, gambling, food and sex.”

chronic relapsing brain disease

“When you gamble, dopamine is released in the brain, which gives people a sense of euphoria. When they are exposed to large amounts of dopamine prematurely, the brain changes, and this is the same as drug use that changes the shape and function of brain cells.”

She pointed out that Dr. Timothy Fong of the University of California, Los Angeles (UCLA) used functional magnetic resonance imaging (FMRI) to compare the brain functions of people with gambling disorders and those who use methamphetamine, and found that the brains of the two were almost the same. With similar damage, it can be seen that gambling is also a chronic brain disease.

To put it simply, when a person is constantly stimulated by gambling to produce dopamine, the brain needs to make adjustments to maintain a balanced state, including lowering the sensitivity and not releasing dopamine so easily.

“In the end, he needs greater stimulation (gambling more, a larger amount) to secrete more dopamine to achieve stimulation, resulting in deviations in brain function.”

Does Gambling Disorder Need Treatment? Yu Anyu said, this is for sure.

“Be aware that gambling addiction is a chronic, recurrent brain disease. Although gamblers can stop gambling on their own, they will experience psychological withdrawal and tolerance reactions like quitting smoking, such as upset, nervousness, sitting Sleep restless, restless, irritable and uncomfortable, eager to gamble, etc., and psychiatrists will mainly help them through this difficult time.”

The problem is that our society normalizes gambling as a normal recreational activity; gamblers may feel that although they gamble a lot and a little too much, they are not serious enough to need to see a doctor or take medicine . As a result, less than 10% of people with gambling disorder seek treatment.

Antidepressants for Gambling Disorder

She pointed out that there are 3 types of treatment for gambling disorder, the first being medication. Opioid receptor antagonists (opioid receptor antagonists) used to treat alcohol or opiate addiction, such as naltrexone (naltrexone) and nalmefene (nalmefene), have good effects on gambling disorders, greatly reducing the patient’s desire for gambling. crave.

Doctors may also prescribe bupropion slow release, an antidepressant that has been found to be effective for smoking cessation and, more recently, for gambling disorders.

“If there are comorbidities, the doctor will also give corresponding antidepressant or anti-anxiety drugs. For example, for a gambling disorder patient with bipolar disorder, the doctor will prescribe mood stabilizers (mood stabilizers) such as lithium Wait.”

She said that as patients’ drug compliance needs to be strengthened, patients with alcohol addiction may stop taking their own drugs to ensure that they have a good drink at the wedding reception. therefore. No matter what kind of addiction you are quitting, the road to treatment will not be straight, and it will not be that if you decide to quit addiction today and take medicine, you will succeed tomorrow.

“Many times patients are going around in circles and successfully move forward, but after a period of time they can’t resist the temptation and start to go around in circles, so family members need to be very patient.”

The second treatment method is psychotherapy, commonly used behavioral therapy or cognitive behavioral therapy (Cognitive Behavioral Therapy, CBT), which requires the professional guidance of a psychiatrist. The third is a combination of drugs and psychotherapy, which is also the best treatment.

She said most people with gambling disorders turn to support groups, usually involving someone who has been there to help another person quit gambling. Sometimes people who join a support group and don’t see results still don’t come to the doctor. When a person with a gambling disorder seeks medical attention, it is often a doctor’s letter to resolve gambling debts or a bank negotiation.

“We often find that after helping to solve their ‘worries’, their determination to quit gambling will weaken. This is also a wrong decision that family members often make, that is, repeatedly helping to pay off debts.”

Perhaps the family members will ask, how can the “big ears” say they are going to kill someone? But Yu Anzhen would ask his family members: What is the benefit to the patient by helping to pay off the debt? Not at all, not only did he not get help, but he felt that he could continue to gamble because his family would help fill the hole.

“Therefore, I often tell family members that one of the key points of treatment is to let patients know that gambling is a problem, and blindly helping is not helping and making things worse.”

What should family members do in the face of a person with gambling disorder? Seek professional help and advise patients to come to specialist treatment. Sometimes family members may also need to receive counseling, because gambling affects not only yourself, but people around you may also be anxious or depressed.

The first 3 months of quitting gambling are the worst

She reminded that please do not help to cover up the gambling behavior of patients, and understand that treatment is necessary and long-term. Bring the patient to see the doctor, thinking that it is impossible to solve the gambling addiction after one visit. Rehab usually comes and goes, back and forth, but as long as there is determination, even if it takes a long time, it will eventually succeed.

For ex-gamblers, withdrawal and tolerance reactions appear, which means that the most uncomfortable time is the first 3 months after stopping gambling. During this period, the symptoms can be relieved by drugs, and it will be better after passing through.

Third, ask the family members to be responsible for controlling the financial power, and even collect the bank card or suspend the credit card if necessary. It is conceivable that the patient’s brain function has deviated, and he has lost self-control and judgment, so the family needs to help make decisions.

Finally, it is a pity that there is no structured gambling treatment service in the Malaysian public medical system. Although some private medical centers provide treatment, the cost will be higher.

Still, “investing” money in treatment is better than helping to pay off debt forever. In addition, although there are many non-governmental gambling rehabilitation centers in the local area or they have switched to online activities, the effect of gambling rehabilitation will be less.

17% of people with gambling disorder and depression have suicidal tendencies

Up to 76% of people with gambling disorder suffer from depression or bipolar disorder!

Foreign studies have found that 17% of patients with gambling disorder and depression would choose to commit suicide as a solution. To prevent gambling behavior from getting out of control and causing serious consequences, it is best to detect and take precautions early.

Which groups of people are more likely to develop gambling disorder? Basically gambling is a potentially addictive behavior that anyone is at risk for. Trauma such as childhood abuse, high work stress, mood swings and loneliness are risk factors for gambling disorder.

This also explains why many people have become online gamblers during the epidemic.

Men more likely than women to suffer from gambling disorder

When a person stays at home for an extended period of time, there may be feelings of loneliness, mood swings, or depression. “Sometimes it’s the stress of work or financial difficulties that they try to find a way to relieve, and they go astray and choose to gamble.”

Yu revealed that when a person has other addictions, such as alcohol and drug abuse, the risk of developing a gambling disorder is also higher. “Another point is environmental factors. When friends and relatives are gambling, he will naturally also. Generally speaking, men are more likely to suffer from gambling disorders than women. Because of the different brain structures, men are more impulsive and slower to mature.”

Another group that is often overlooked, she points out, are retirees who, with a sudden and lucrative pension, may not have children around, feel lonely, have little entertainment, and start gambling.

In recent years, it is very common for elderly people to suffer from gambling disorder. Some even gambled away their retirement funds, and they were too ashamed to tell their children and went to a dead end, thinking that this would solve all problems.

Attempted suicide is a criminal offense in our country. Anyone who attempts suicide or attempts suicide can be jailed for up to one year, fined, or both. It can be seen that the consequences of gambling addiction are great.

In any case, suicide is just an escape from the problem, not a solution. If you find someone around you addicted to gambling, you must persuade them to seek professional help as soon as possible.

2% of gamblers are problem gambling

Q1: Does gambling necessarily lead to addiction?

A1: Actually not. About 2% of gamblers have problem gambling or gambling disorder, and this also takes into account race or religion.

Problem gamblers are more likely to develop a gambling disorder than non-gamblers. If the full score is 10 points for gambling disorder, and the Muslim group is 0 points for non-gambling, the risk of gambling disorder is very low.

For the Chinese, there are risks, because most parents have small gambling habits, or play mahjong for entertainment, making family members believe that gambling is a normal thing, which is exactly the problem. Having such thoughts is somewhere between social gambling and being at risk, about a 5.

Electronic gambling is the most addictive

Q2: Is online gambling more dangerous to teenagers?

A2: The study found that the most addictive type of gambling is electronic gambling, including video lottery and Internet gambling.

Because traditional forms of gambling, such as horse racing or casinos, can be regulated by law to avoid contact with young people, for example, ID cards are required; online gambling is difficult to control, even if “If you are not over 18 years old, please click to leave” pops up Waiting for the page, just press “I am over 18 years old to browse” to enter.

Secondly, online gambling has no real feeling of “paying money”, unlike putting a stack of banknotes in front of the gaming table and watching it disappear or feel heartache. Just like the new cases of COVID-19, from 300 cases to 2,3000 cases, people have gradually become insensitive to numbers, and the same is true for online gambling, which is easier to be numb than comparison.

Third, online gambling is too easy and convenient. They don’t have to go out, such as going to betting shops, watching horses, grabbing numbers, etc. They don’t need any mental and physical strength at all. It is easy to gamble on the Internet, and it is more addictive.

co-existence of emotional disorders

Q3: What are the comorbidities of gambling disorder?

A3: Mental diseases that often coexist with gambling include mood disorders, accounting for about 34% to 76%, such as depression and bipolar disorder. As for anxiety disorders, it ranged from 13% to 40%.

Substance use disorder (substance use disorder) such as alcohol, tobacco or drugs is between 25% and 63%. Other potential problems include attention deficit hyperactivity disorder (ADHD), personality disorders, and other impulse control disorders such as shopaholics.

The most common, however, is depression or bipolar disorder. When they are “irritated” (emotionally high), they may ignore their abilities and take a big gamble.

12 months of continuous and repeated gambling, 4 of the 9 conditions are met

According to DSM-5, the diagnostic criteria for a gambling disorder is that a person has persistent and recurrent problem gambling behavior within 12 months, resulting in impairment or distress (such as life or interpersonal injury), must meet the following 9 conditions 4 counts.

1/Increased tolerance

It takes more money to gamble to get the same excitement from gambling as it used to. This is the same as alcohol addiction. It is like a person who used to drink 3 glasses of wine to be high, but then needs 10 glasses to “high”.

2/ withdrawal reaction

Psychological restlessness or irritability when trying to reduce or stop gambling. There is no physical reaction to gambling, but there will be a psychological withdrawal reaction. As long as you take money to gamble, these feelings will completely disappear.

3/ He has tried unsuccessfully to reduce or stop gambling.

4/ Having a craving to gamble

Gambling is often in the mind, including reviewing past gambling experiences and planning future gambling events.

5/ Gambling when feeling depressed, guilty or anxious

Use gambling to escape some problems, or temporarily relieve bad emotions.

6/ Trying to win back gambling losses

Especially after losing money, you want to gamble for another round in order to get back or make money.

7/ Want to hide the extent of their gambling

When asked, he would say that he rarely gambles or gambles not much.

8/ Losing money, relationships, jobs, or significant career opportunities due to gambling.

9/ End up relying on others for money to deal with financial problems caused by gambling.

Just like the Internet celebrity Yang Baobao who made a lot of noise in the city the year before last, he actually already belongs to the level of gambling disorder.

According to her, she got the benefit of winning 30,000 ringgits for 300 ringgits and started to gamble heavily. After losing the bet, she borrowed usury loans in order to pay back her capital. During this period, she also had emotional problems that led her to give up on herself. Wait, keep digging one hole to fill another, eventually forming a vicious circle.

These people with gambling disorders tend to hide the extent of their gambling and keep the problem hidden for a long time. I believe that Baby Yang’s gambling addiction has been going on for several years. If he had noticed it at the beginning, the following things would not have happened.

Reported by Yang Qianni and edited by Liang Yingxiu

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