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gambling discussion questions A service of the National Library of Medicine, National Institutes of Health.
National Research Council US Committee on the Social and Economic Impact of Pathological Gambling.
Pathological Gambling: A Critical Review.
Washington DC : National Academies Press US ; 1999.
click at this page used to describe behaviors in similar contexts or venues have an influence on how those behaviors are defined and viewed.
Understanding the extent and nature of pathological gambling, as well as its social and economic impact, requires as clear a definition as possible.
A discrete, acceptable, and useful definition of pathological gambling would be based on a nomenclature applicable in a wide diversity of contexts American Psychiatric Association, 1994.
Nomenclature refers to a system of names used in an art or science and is critical in conceptualizing, discussing, and making judgments about pathological gambling and related behaviors.
A nomenclature inclusive of pathological gambling must be suitable for use in scholarly research, clinical diagnosis and treatment, and community and other social contexts.
The nomenclature must also reflect a variety of perspectives because research scientists, psychiatrists, other treatment care clinicians, and public policy makers tend to frame questions about gambling differently, depending on their disciplinary training, experience, and special interests.
In the absence of an agreed-upon nomenclature, these and other groups interested in gambling and gambling problems have developed different paradigms or world views from which to consider these matters.
Consequently, the act of gambling has been considered by various observers to provide evidence of recreational interest, diminished mathematical skills, poor judgment, cognitive distortions, mental illness, and moral turpitude.
These varied views have stimulated debate and controversy.
Historically, the word ''gambling" referred to playing unfairly or cheating at play.
A gambler was defined as a fraudulent gamester, sharper, or rook who habitually plays for money, especially extravagantly high stakes Oxford English Dictionary, second edition, 1989.
In modern times, gambling has come to mean wagering money or other belongings on chance activities or events with random or uncertain outcomes Devereux, 1979.
Gambling in this sense implies an act whereby the participant pursues a monetary gain without using his or her skills Brenner and Brenner, 1990.
This is the dictionary definition of gambling as well Oxford English Dictionary, second edition, 1989.
Throughout history, however, gambling also has involved activities requiring skill.
For example, a bettor's knowledge of playing strategies can improve his or her chances of winning in certain card games; knowledge of horses and jockeys may improve predictions of probable outcomes in a horse race Bruce and Johnson, 1996.
The use of such skills may reduce the randomness of the outcome but, because of other factors that cannot be predicted or analyzed, the outcome remains uncertain.
As used in this report, the term "gambling" refers both to games of chance that are truly random and involve little or no skill that can improve the odds of winning, and to activities that require the use of skills that can improve the chance of winning.
By its very nature, gambling involves a voluntary, deliberate assumption of risk, often with a negative expectable value.
For example, in casino gambling the odds are against the gambler because the house takes its cut; thus, the more people gamble, the more likely they are to lose.
Role of Risk-Taking in the Gambling Experience Throughout history, scholars and writers have theorized about why human beings gamble.
These explanations have encompassed evolutionary, cultural, religious, financial, recreational, psychological, and sociological perspectives Wildman, 1998.
A current and widely disseminated theory is that people engage in gambling because it has the capacity to create excitement Boyd, 1976; Steiner, 1970.
People seek stimulation and try to optimize their subjective experience by shifting sensations.
Sensation-seeking and shifting these experiences, as a basic and enduring human drive, can be compared to a child's exploration of his or her environment to develop fundamental mastery of skills and satisfy curiosity.
The experiences that humans regularly seek include novelty, recreation, and adventure Zuckerman, 1979; Ebstein et al.
To paraphrase William Arthur Ward, a 20th century American philosopher, the person who risks nothing, has nothing.
Indeed, it is common for individuals to take risks in life.
Risk-taking underlies many human traits that have high significance for evolutionary survival, such as wanting and seeking food Neese and Berridge, 1997.
Moreover, risk-taking is reinforced by the emotional experiences that follow, such as relief from boredom, feelings of accomplishment, and the "rush" associated with seeking excitement.
Individuals vary considerably in the extent to which they take risks.
Some limit their risk-taking to driving a few miles over the posted speed limit, whereas others actively pursue mountain climbing, skydiving, or other exciting sports with a high risk of harm.
Gambling is neither a financially nor a psychologically risk-free experience.
In addition to the possibility that gamblers will lose their money, they also risk experiencing a variety of adverse biological, psychological, and social consequences from gambling American Psychiatric Association, 1994.
Personal aspirations and the social setting, however, can affect the likelihood of an individual's engaging in risky behavior, since aspirations will influence the perceived benefits and constraints of the risky situation.
The potential payoff of betting stimulates innate risk-taking tendencies.
Although exceptions exist, games with the highest "action," such as high-stakes poker and dice games, serve as more powerful stimuli to accelerate a player's risk-taking by increasing the payoff if the bet is won.
Even those not normally inclined to buy a lottery ticket, for example, often may do so when several million dollars in winnings are at stake Clotfelter and Cook, 1989.
The simple association between gambling and action, including the prospects of "winning big," which characterizes most popular gambling activities, can maintain stable gambling behaviors despite incredible odds against winning Lopes, 1987.
Medicalization of Pathological Gambling Understanding of the adverse consequences of excessive gambling has undergone profound change.
For most of history, individuals who experienced adverse consequences from gambling were viewed as gamblers with problems; today, we consider them to have psychological problems.
This change is analogous to the change in the understanding of alcoholics and alcoholism, and it has been reflected in, or stimulated by, the evolving clinical classification and description of pathological gambling in the various editions, between 1980 and 1994, of the Diagnostic and Statistical Manual of Mental Disorders called DSM published by the American Psychiatric Association.
Changes over time in the DSM reflect a desire to be more scientific in determining appropriate criteria for pathological gambling by accounting for its similarities to other addictions, especially substance dependence American Psychiatric Association, 1980, 1987, 1994; Lesieur, 1988; Rosenthal, 1989; Lesieur and Rosenthal, 1991.
Today pathological gambling is understood to be a disorder characterized by a continuous or periodic loss of control over gambling, a preoccupation with gambling and with obtaining money with which to gamble, irrational thinking, and a continuation of the behavior despite adverse consequences.
The official medicalization of excessive gambling is marked by its inclusion in the DSM American Psychiatric Association, 1980, 1987, 1994.
It is not surprising, however, that some scholars e.
Nevertheless, in the United States and elsewhere, although not in all nations or cultures, people with serious gambling problems are now described as suffering from a disorder that reflects a psychiatric illness or disease state.
And despite significant gaps in research and a generally deficient state of scholarly literature, pathological gambling is known to be a robust phenomenon Shaffer et al.
Moreover, all these factors can be affected by traditional, contemporary, and constantly emerging gambling-related technologies.
Conceptualizing gambling behavior on a simple continuum ranging from no gambling to pathological gambling may provide a useful model for developing a public health system of treatment, but it is insufficiently detailed to provide a scientific explanation of the emergence of pathological gambling.
The list of important terms used in this report for gambling behaviors suggests that they cover a wide range see.
These terms are important to the discussion of prevalence in.
Important Gambling Terms Used by the Committee.
Compulsive gambling: The original lay term for pathological gambling, it is still used by Gamblers Anonymous and throughout much of the self-help treatment community.
Disordered gambling: Inspired by language When considering the range of gambling involvement, it is important to note that today about 20 percent of Americans do not gamble at all; that most gamblers do so for social or recreational reasons without experiencing any negative consequences; and that cooccurrences with other types of problems, as well as negative social and economic effects experienced by individual gamblers and their families, theoretically increase with the level, chronicity, and severity of gambling problems.
In other words, once gamblers cross the threshold and enter into the range of problem gambling described as Level 2 in they begin to manifest adverse effects; since there are far more problem gamblers than pathological gamblers, most adverse affects are believed to be experienced or caused by problem gamblers.
Although this increasing relationship is often asserted or implied in the literature, neither an increasing association nor a progressive gambling behavior continuum is supported by available research.
Moreover, the range of different gambling behaviors is believed to be dynamic: for example, social or recreational gamblers can become problem gamblers; problem gamblers can become pathological gamblers, return to a level of social or recreational gambling, or even discontinue gambling.
In addition, the time involved in shifting from one level to another is commonly believed to be https://bannerven.com/gambling/colorado-laws-on-gambling.html to extreme variance, although this has not been empirically demonstrated.
Contemporary Pathological Gambling The assumption underlying the existing research is that gambling problems exist and can be measured Volberg, 1998.
Despite agreement among researchers at this fundamental level and a widely recognized and accepted definition of Level 3 pathological gambling as described inthere is widespread disagreement about the conceptualization, definition, and measurement of Level 2 problem gambling.
Conceptual and methodological confusion is common in emerging scientific fields Shaffer, 1986, 1997bbut debate about problem gambling creates public confusion and uncertainty about gambling problems and their effects on chargeback paypal gambling Volberg, 1998.
For example, in considering excessive gambling behavior, clinicians and the majority of researchers in the United States and abroad rely on well-established psychiatric classifications nosologies and descriptions nosographies of pathological gambling that have evolved over the past 20 years American Psychiatric Association, 1980, 1987, 1994.
However, debate is ongoing as to their validity, as well as about broader conceptualizations of excessive gambling ranging from problem to pathological Rosenthal, 1989; Shaffer et al.
A number of competing conceptual models and definitions have arisen to explain the origins of these behaviors.
Compounding this classification difficulty is the wide variety of labels or terms found in the literature to describe people with gambling problems.
For these reasons it can be useful to conceptualize progressively harmful gambling behaviors on a continuum similar to the progressive stages and harmful effects of alcoholism, including: abstinence, social or controlled drinking, problem drinking with loss of control disruption of work and social functions but minimal organ damageand severe problem drinking with organ damage.
To ensure clarity and consistency in our use of such labels and terms in this report, they are defined in.
The following section focuses on the medical conceptualization of pathological gambling, beginning with a discussion of how it differs from problem gambling.
Pathological Gambling Versus Problem Gambling Although clinicians and researchers concur that understanding the nature, scope, and severity of gambling-related problems is important, there is much variation in the language used to designate various levels of gambling involvement and their consequences.
For example, investigators often use the terms "problem gambling," "at-risk gambling," "potential pathological gambling," "probable pathological gambling," "disordered gambling,'' and "pathological gambling.
The labeling difficulty arises in part because epidemiologists and clinical researchers do not use the same terminology.
Also, various terms arise when investigators characterize broadly defined samples of extreme gamblers.
Nevertheless, the frequency and intensity of problems associated with gambling can range from none to a lot.
Thus, in the absence of rigorously achieved and convincing validity data, any classification label is inherently arbitrary to some degree and may be too simple to describe such a complex and multidimensional concept as gambling severity Walker and Dickerson, 1996.
This issue, however, is encountered in all psychiatric classifications, not just pathological gambling.
The challenge is to establish agreed-on terminology so that researchers, clinicians, and others in the field can communicate precisely.
Imprecise terms, such as "potential pathological gamblers" or "probable pathological gamblers," among other terms, have been promulgated by research relying on a variety of instruments.
Use of various terms has contributed substantially to confusion about what constitutes Level 2 problem gambling.
Some people have criticized the fact that the American Psychiatric Association's DSM-IV designates only one term to connote a gambling disorder pathological gamblingbecause it does not adequately serve investigations that need to describe individuals who are experiencing less extreme difficulties.
Since people who meet at least one but less than five of the DSM-IV criteria suggested for a diagnosis of click at this page gambling have experienced some level of difficulty, they also warrant attention.
However, their problems are extremely variable and range from trivial to serious.
Furthermore, these individuals may be progressing toward a pathological state, or they may be pathological gamblers in remission who are recovering i.
The term "pathological" is defined in the Oxford English Dictionary as "caused by or evidencing a mentally disturbed condition.
Sometimes the terms ''pathological" and "compulsive" are used interchangeably; however, "compulsive" is the historical and lay term and the one used by Gamblers Anonymous 1997.
But for most researchers and many clinicians, the notion of compulsive gambling as a description of pathological gamblers is a technical misnomer Lesieur and Rosenthal, 1991.
In the psychiatric lexicon, a compulsive behavior is involuntary and "ego-dystonic"—that is, external or foreign to the self.
The DSM-IV defines compulsions as "repetitive behaviors or mental acts, the goal of which is to prevent or reduce anxiety or stress, not to provide pleasure or gratification" American Psychiatric Association, 1994:418.
It is an "unwilling" attempt to rid oneself of discomfort and pain.
In some cases, individuals perform rigid, stereotyped acts according to idiosyncratically elaborated rules without being able to indicate why they are doing them.
Examples of a compulsion would include repetitive hand washing or the irresistible urge to shout an obscenity see American Psychiatric Association, 1980, 1987, 1994.
Pathological gamblers, in contrast, typically experience gambling as ego-syntonic and pleasurable until late in the disorder.
The DSM-IV provides a widely accepted definition of and diagnostic criteria for pathological gambling, but the term "problem gambling" is somewhat more difficult to conceptualize and define.
In much of the research literature, problem gambling is used as an overlay to include pathological gambling Shaffer et al.
In fact, the concepts are inextricable, because on the continuum of gambling behaviors pathological gambling encompasses problem gambling i.
Moreover, pathological and problem gamblers can experience varying levels of problem chronicity over time.
However, problem gambling is most commonly characterized as describing those individuals who meet less than five DSM-IV criteria for a diagnosis of pathological gambling Lesieur and Rosenthal, 1998.
Shaffer and his colleagues considered these as cases that could be "in-transition" and described in-transition gamblers as moving either toward or away from pathological states; however, they also noted that in-transition gamblers may not necessarily be in an earlier stage of the disorder.
It is important to note that these authors observed that in-transition gamblers may never develop the attributes of pathological gambling; in-transition gamblers may languish in this state or begin to move toward recovery.
The click the following article of a continuum of problem severity implies that people can be located at a point on a continuum.
They can move from that point, developing more or less serious difficulties.
This analysis suggests that gambling problems reflect an underlying unidimensional construct.
Although individuals can theoretically move across a continuum of problem severity and some scholars believe that gambling problems may best be conceptualized as a developmental continuum of gambling behaviors with respect to frequency and intensity, there is no empirical evidence that actual progression of go here illness is linear Shaffer et al.
Moreover, clinicians and the self-help treatment community believe that pathological gamblers cannot successfully return to a level of social or recreational gambling.
Development of the DSM Criteria Largely through the efforts of Robert Custer, pathological gambling was first included in the DSM in 1980 see DSM-III in.
Custer had treated pathological gamblers and written about their illness for several years Custer, 1980; Custer and Custer, 1978.
For the first inclusion in DSM-III, there was no testing of criteria beforehand.
Instead, inclusion was based on his clinical experience and those of other treatment professionals.
The original DSM-III criteria started with a statement about progressive loss of control and then listed seven items.
Three or more had to be met for a diagnosis of pathological gambling.
The emphasis was on damage and disruption to the individual's family, personal, or vocational pursuits and issues https://bannerven.com/gambling/tax-rate-on-gambling-winnings.html had to do with money five of the seven original criteria fell into this latter category.
There also was added an exclusion criterion: "not caused by antisocial personality disorder.
With the revision of the diagnostic manual in 1987 DSM-III-Rit was decided to emphasize the similarity to substance dependence, literally by see more the criteria, substituting "gambling" for "use of a substance.
The only item that appears different, item 5 in the finalized version, seems less so if one considers the symptom of "chasing" one's losses as an attempt to negate or reverse the progressive dysphoria—the shame and guilt—consequent to the gambling see.
Thus it resembles the taking of a substance to relieve or avoid link symptoms gambling discussion questions />A year after the publication of the new criteria, a group of treatment professionals found considerable dissatisfaction with them, with some preference expressed for a compromise between the old DSM-III and the newer DSM-III-R criteria Rosenthal, 1989.
On the basis of these complaints, a questionnaire was constructed and administered to 222 self-identified compulsive link and 104 substance-abusing controls who gambled at least socially Lesieur and Rosenthal, 1991; Bradford et al.
The results were analyzed to determine which items best discriminated between the two groups.
A new set of nine criteria emerged that combined DSM-III and DSM-III-R, with the addition of one new on line gambling companies "gambles as a way of escaping from problems or intolerable feeling states.
For example, the item pertaining to being preoccupied with gambling was selected by 97 percent of the compulsive gamblers and just 3 percent of the social gamblers Bradford et al.
Following a presentation of these findings to gambling research and treatment professionals at several national and international conferences, it was decided that one additional item—"repeated unsuccessful attempts to control, cut back or stop gambling"—should be added.
The final phase was a field trial using 453 subjects Lesieur and Rosenthal, 1998 to test this additional item representing loss of control.
The analysis found that adding or deleting it did not affect the threshold for diagnosis, and that it was highly correlated with other criteria.
Based on these findings and the preference sport gambling usa clinicians in the United States and abroad that it be included, "loss of control" was reinstated as a diagnostic criterion, but with the wording improved from DSM-III-R.
The resulting definition click the following article pathological gambling was published in 1994 in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV.
This is the latest in an evolving effort by the American Psychiatric Association to operationally define the disorder.
The definition includes 10 criteria, which describe both the individual attributes of sufferers and the social consequences that result from their behavior.
Also described are associated features and disorders, specific culture and gender features, prevalence, course, familial pattern, differential diagnosis, and exclusion criteria.
As such, the criteria are intended to provide guidance for clinically diagnosing pathological gambling as a disorder of impulse control.
To be diagnosed as a pathological gambler, an individual must meet at least five criteria Bradford et al.
For the criteria and full text of the DSM-IV definition, see.
The 10 criteria that resulted from this process represent three clusters or dimensions: damage or disruption, loss of control, and dependence.
In the category of dependence are tolerance needs to gamble with increasing amounts of money in order to achieve desired excitementwithdrawal restless or irritable when attempting to cut down or stoppreoccupation with gambling, and gambling as a way to escape from problems.
The wording and selection of items and the diagnostic cut-off point of five or more were based on clinical data; a partial exclusion criterion was then added: "The gambling behavior is not better accounted for by a Manic Episode.
The current description of pathological gambling in DSM-IV has been found to characterize pathological gambling in relatively precise operational terms; to provide the basis for measures that are reliable, replicable, and sensitive to regional and local variation; to distinguish gambling behavior from other impulse disorders; and to suggest the utility of applying specific types of clinical treatments Shaffer et al.
Moreover, the DSM-IV criteria appear to have worked well for clinicians for the past five years.
However, because it is a clinical description with little empirical support beyond treatment populations, there still are problems with its use to define the nature and origins of pathological gambling, and when trying to estimate prevalence.
The Clinical Picture Descriptions of the clinical course of pathological gambling date back to 1892 Quinn, 1892.
The traditional description of the disorder has included four phases: the reaction to winning, losing, desperation, and hopelessness Custer, 1982; Custer and Milt, 1985; Lesieur and Rosenthal, 1991.
Recent research has suggested an alternative model, with as many as six phases of development into and out of a gambling addiction: initiation, positive consequences, negative consequences, turning points, active quitting, and relapse prevention Shaffer and Jones, 1989; Shaffer, 1997; Prochaska et al.
Clinical studies suggest that, as gambling progresses toward a pathological state, there is frequently an increase in the amounts wagered and the time devoted to gambling and a corresponding increase in depression, shame, and guilt Rosenthal, 1992.
Studies primarily of gamblers seeking help suggest that as many as 20 percent will attempt suicide Moran, 1969; Livingston, 1974; Custer and Custer, 1978; McCormick et al.
Pathological gambling can exacerbate other mental disorders, and stress-related physical illnesses are common Lorenz and Yaffee, 1986.
Chapters and discuss these issues in more detail.
Pathological gambling differs from the social and recreational gambling of most adults.
Social or recreational gamblers are those who gamble for entertainment and typically do not risk more than they can afford Custer and Milt, 1985; Shaffer et al.
In pathological gambling, however, players generate adverse consequences for themselves and others involved in their life.
Clinicians report that, although money is important, male pathological gamblers often say they are seeking action, an aroused euphoric state that may be similar pity, gambling money islam idea the high from cocaine or other stimulating drugs.
Pathological gamblers report a "rush" characterized by sweaty palms, rapid heartbeat, and nausea or queasiness.
This can be experienced while gambling, in anticipation of gambling, or source response to any situation or feeling that reminds them of gambling Rosenthal and Lesieur, 1992.
Pathological gamblers may go for days without sleep, and for extended periods without eating or taking care of other bodily needs.
Clinicians have described the go here of cravings, tolerance—the need to make increasingly larger bets or take greater risks to produce the desired level of excitement Lesieur, 1994 —and withdrawal symptoms Wray and Dickerson, 1981; Meyer, 1989; Rosenthal and Lesieur, 1992.
Although there are other kinds of intense physiological reactions, clinicians also report that some pathological gamblers are less interested in the excitement or action and more interested in escape.
They are seeking to numb themselves and report a quest for oblivion.
This motivation for escape may be understood as a quest to reduce psychological discomfort and as an attempt to attain a more normal state—a self-medication Khantzian, 1975, 1977.
These reactions are reported by many women gamblers Lesieur and Blume, 1991as well as many slot and video poker machine players.
Many pathological gamblers, both male and female, report experiencing amnesic episodes, trances, and dissociative states Jacobs, 1988; Kuley and Jacobs, 1988; Lesieur and Rosenthal, 1994; Brown, 1996; O'Donnell and Rugle, 1996.
Pathological gamblers also evidence distortions in their thinking Gaboury and Ladouceur, rehab singapore Walker, 1992.
These cognitive distortions include denial, fixed beliefs, superstition and other kinds of magical thinking, and notably omnipotence.
Pathological gamblers experiencing cognitive distortions deny the reality of their gambling situation, including their odds of winning or losing e.
They may fixate on particular numbers, days of the week, https://bannerven.com/gambling/gambling-boat-long-island-ny.html of clothing, or a particular slot machine or may possess other magical objects that for them signify or enhance luck Toneatto, personal communication to the committee, June 2, 1998.
Rosenthal 1986 contends that such feelings of omnipotence are born out of desperation: the more helpless the situation, the greater their sense of certainty that they know what will happen next, and that they will achieve a positive outcome.
Bad luck, greed, or poor money management are not sufficient for someone to be a pathological gambler—although these factors do exert influence on the mental state of a gambler.
For example, some individuals seek help during the early phase of their gambling career, even while they are still winning.
They are astute enough to become concerned about their intense physical or psychological reactions, or about the effect their preoccupation with gambling is having on other aspects of their lives Rosenthal, 1992; Rosenthal and Lorenz, 1992.
One need not lose everything to be a pathological gambler, nor is it necessary to think about gambling every day.
Some sufferers are binge gamblers, who sporadically experience consequences or cause damage in their lives or the lives of others.
And some pathological gamblers may gamble excessively only at one type of game and are not interested in other types of gambling, whereas other pathological gamblers may play other games in order to support their game of choice Lesieur, 1984.
Pathological Gambling as an Exculpatory Condition As noted by Rachlin et al.
With this new class articles gambling disorders came the opportunity for lawyers to use this kind of disorder as the foundation for the application of the insanity defense for criminal offenses.
The insanity defense, however, rests in part on the distinction between an overwhelming uncontrollable impulse and the inability or unwillingness to control an impulse.
They observe that impulse disorders consist of the failure to resist impulses rather than an overwhelming uncontrollable impulse.
The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments, for example, that take into account such issues as individual responsibility, disability determination, and competency" American Psychiatric Association, 1994:xxvii.
For additional information and examples of legal case rulings, see Morse 1994, 1998 ; U.
Classifications and Controversies The American Psychiatric Association 1994 classifies pathological gambling as one of five different impulse disorders under a category called "Impulse-Control Disorders Not Elsewhere Classified.
There are many other psychiatric disorders that involve problems of impulse control e.
However, these other disorders have other features, beyond difficulty regulating impulses, that better classify them.
This cluster of impulse disorders suggests that there may be an important relationship between pathological gambling and the other impulse control disorders e.
For example, these phenotypically different conditions could represent alternative manifestations of a shared predisposition toward impulsivity.
Since there is no agreement in the field on the precise meaning of mental disorder, Wakefield 1992 suggests that a disorder is better thought of as a "harmful dysfunction," an idea that integrates social values harmful and scientific concepts dysfunction : "dysfunction is a scientific term referring to the failure of a mental mechanism to perform a natural function for which it was designed by evolution" Wakefield, 1992:373.
The class of impulse disorders in which pathological gambling has been placed represents a set of behaviors that are violations of social mores and customs and therefore considered harmful.
The dysfunctional nature of these disorders in general and pathological gambling in particular, however, remains to be determined.
As we have previously indicated, mental disorders with impulsive features often have failed to satisfy the legal system's need for exculpatory conditions.
These disorders have not been considered as "causal" in the scientific sense and have therefore not withstood courtroom challenges.
This matter becomes even more complicated when considering the matter of comorbidity from the perspective of DSM-IV classification.
Comorbidity is the medical term used to describe the cooccurrence of two or more disorders in a single individual; comorbidity is extremely common among pathological gamblers Crockford and el-Guebaly, 1998.
The problem of conceptually distinct multiple diagnoses can be taken to suggest that pathological gamblers suffer from a variety of interactive disorders.
However, there is an alternative possibility that has gained considerable support among clinicians: multiple diagnoses reflect an underlying problem with the constructs of mental disorders.
The frequency of cooccurring disorders as described in the DSM suggests that these categorical distinctions exhibit "extraordinary and obstinate heterogeneity" Carson, 1991, cited in Blatt and Levy, 1998: 83-84.
Given this conceptual difficulty, although we describe comorbidity issues and pathological gambling more inwe do not emphasize this aspect of the disorder in the report.
Nevertheless the reader is encouraged to keep comorbidity issues in mind when reading the discussions that follow of pathological gambling as an impulse disorder, as an addiction, and as considered by other theories and conceptualizations.
Pathological Gambling as an Impulse Disorder An impulse refers to incitement to action arising from a state of mind or some external stimulus; or a sudden inclination to act, without conscious thought; or a motive or tendency coming from within Oxford English Dictionary, 2nd edition, 1989.
The essential feature of an impulse control disorder, as defined by DSM-IV, is ''the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others" American Psychiatric Association, 1994:609.
This implies a loss of control over behavior.
There go here be a sense of tension prior to committing the act, in which case committing it brings relief.
The act is often pleasurable, though it may be followed by guilt and regret.
Existing literature on pathological and problem gambling uses many terms to describe impulsive behaviors from a variety of important perspectives, including "sensation-seeking," "behavioral disinhibition," and "risk-taking" Lopes, 1987; Monroe, 1970; Zuckerman, 1979, 1983; Zuckerman et al.
There is substantial literature suggesting that the descriptions are correct and contribute to both the origins and the maintenance of gambling involvement and problem gambling Davis and Brisset, 1995.
For example, indicators of behavioral disinhibition—the inability or unwillingness to inhibit behavioral impulses—have been associated with gambling involvement Ciarrochi et al.
In a study of cocaine treatment-seekers Steinberg et al.
In a study comparing a group of pathological gamblers in treatment to controls from the community, Specker and colleagues 1996 found that a significantly higher proportion of pathological gamblers had at least one other impulse control disorder 35 versus 3 percent.
Similarly, the findings of increased antisocial behaviors and a history of criminal offenses among pathological gamblers also suggest disinhibitory tendencies Cunningham-Williams et al.
Also, elevated rates of childhood attention-deficit hyperactivity disorder ADHD Carlton et al.
Despite this evidence, this body of research may be misleading.
The very few prospective studies of these addictions e.
The experience of alcoholism or pathological gambling may shift personality attributes so that, when researchers examine subjects who already have experienced alcoholism or pathological gambling patterns, they seem to have personality traits that are different from nondrinkers or nonpathological gamblers.
Thus, it is possible that pathological gambling causes the development of these abnormal personality attributes, rather than that these attributes lead to pathological gambling.
Research suggests that the construct of behavioral disinhibition also relates to the risk for alcoholism McGue et al.
The presence of this trait may contribute to the high rate of alcoholism, estimated to be 33 percent, among pathological gamblers Stinchfield and Winters, 1996.
Moreover, relatively high levels of behavioral disinhibition differentiate the offspring of alcoholics from the offspring of nonalcoholics Sher et al.
By inference, the development of pathological gambling may be similarly affected by this behavioral trait.
Other dimensions of impulse control that have been examined in the gambling literature are sensation-seeking, novelty-seeking, and arousal.
Zuckerman's theory click here sensation-seeking as applied to gambling suggests that "individuals entertain the risk of monetary loss for the positive reinforcement produced by states of high arousal during periods of uncertainty, as well as the positive arousal produced by winning" Zuckerman, 1979.
Cloninger 1987 suggests a relationship between a desire for diverse sensations and alcohol consumption.
Both Zuckerman and Cloninger's theories are relevant to gambling, in that they imply that gambling behaviors reflect tendencies to take risks and enjoy complex or varied stimulation.
The empirical literature in this area of gambling is inconclusive.
Some investigations have found that pathological gamblers score higher on sensation-seeking scales than controls Kuley and Jacobs, 1988; Stoltz, 1989 ; others have not found strong associations Blaszczynski et al.
Similarly, researchers have not found elevated heart rates among gamblers in the laboratory setting Anderson and Brown, 1984; Rule and Fischer, 1970; Rule et al.
The lack of elevated heart rate in the laboratory may reflect a real difference in reaction—that simulated action is different from the real action of gambling.
It also could mean a poor simulation, other characteristics of the laboratory setting, or a variety of other influences that remain difficult to identify.
Coventry and Norman 1997 summarized several problems specifically with studies of arousal and gambling.
One example is heart rate fluctuation as a function of relaxation, frequent movement, or being in a simulated environment.
The inherent unreliability of averaging heart rate measures, since gambling activity for certain games like slot machines is intermittent, is also a problem with such studies.
Coventry and Norman also attempted to account for some of these methodological problems in their study of offtrack horse bettors and found significant increases in heart rate compared to baseline nongambling conditions, as bettors placed their bets.
Unfortunately, as the authors point out, in order to be unobtrusive, this link used a less than ideal measure of heart rate photo-plethysmography and measured bettors' heart rate for only one race.
Gambling problems also may originate from attempts to relieve or change subjective states e.
It is therefore not surprising that negative emotionality, that is, the tendency to experience psychological distress and a negative mood state, is a personality construct frequently associated with gambling severity.
Supporting evidence includes high rates of depressive-like thinking patterns among frequent gamblers McCormick et al.
Whereas gambling involvement may serve to manage or attenuate highly uncomfortable emotions, alternatively, gambling may also reflect attempts to regulate or shift emotions from one state to another to satisfy a need for novel experiences or entertainment.
The experience of altered emotional states may not predate the onset of gambling problems.
It is possible that people shift their emotional states using gambling, and then fall into a gambling pattern that stimulates problems.
There is considerable consensus that gambling involves impulsiveness.
In some studies, data do not systematically address the extent to which risk-taking and other dimensions of impulse control i.
The established relationship between behavioral disinhibition and gambling may be the result of the correlation of each variable with sensation-seeking.
Increased heart rates may be more attributable to other causes, like the anticipated outcome of a future event, not the response to an immediate event, such as the excitement of a race Coventry and Norman, 1997or verbalizations made by the gambler during gambling Coulombe et al.
And gambling discussion questions the retrospective study by Rugle and Rosenthal 1993 suggests that, at least in a subgroup of pathological gamblers with high impulsivity, the impulsivity preceded the onset of gambling problems, longitudinal studies have not been conducted to establish that differences in impulse control characteristics predate the onset of gambling disorders, a necessary condition to establish a causal relationship.
Interestingly, however, prospective studies are beginning to emerge suggesting that these traits may be transmitted genetically Comings, 1998.
Pathological Gambling as an Addiction Preoccupation, tolerance, and other DSM-IV criteria for pathological gambling, such as repeated unsuccessful efforts to stop gambling and becoming restless or irritable when attempting to stop, are indicative of physiological dependence Wray and Dickerson, 1981; Meyer, 1989; Rosenthal and Lesieur, 1992.
In addition, the self-help community has thought of what it terms compulsive gambling as an uncontrollable emotional illness Gamblers Anonymous, 1997.
As such, many researchers have turned their attention to the extensive body of literature on addictions to explain pathological and problem gambling behavior.
For example, research has begun to explore the possible biochemical basis of excessive gambling and its effects on the brains of pathological gamblers Hickey et al.
Although intriguing, these studies are primarily of persons in treatment with no control groups.
Moreover, the basis for believing that pathological gambling should be classified as an addiction is almost entirely theoretical.
As indicated above, DSM nomenclature has highlighted the similarity of pathological gambling to substance abuse since its third edition in 1987 American Psychiatric Association, 1980, 1987, 1994but it uses only the terms "abuse" or "dependence," not addiction.
To test the hypothesis that pathological gambling is a dependent state, studies such as those recently reviewed by Comings 1998 must further address associated genetic, molecular, and environmental factors taking into account other cooccurring conditions and an array of risk factors—all among a diverse population i.
Research also should explore the possibility that pathological gambling is a spectrum disorder, which means it shares the underlying genes and observable behavior with other psychiatric disorders.
Finally, research in this area should also consider the possibility of gambling as an addiction with respect to: 1 behavioral signs, 2 psychophysiological signs e.
Other Theories and Conceptualizations of Pathological Gambling The committee was charged to review excessive gambling as "pathological" as determined by the American Psychiatric Association.
We were not charged with the task of determining the impact of excessive gambling caused by poor judgment untainted by illness.
Although this report focuses on a medical model of gambling problems, readers should note that other models can also illuminate gambling discussion questions excesses.
For example, gambling can be understood as one aspect of a much larger problem, namely that a large and increasing number of households have trouble living within their means.
For some households, the array of temptations to spend more than they can afford and the pressures to do so from advertising and a culture of conspicuous consumption may overwhelm self-control and skill in managing money.
Those who cannot resist the temptation to spend beyond their means tend to be constantly in debt and constantly dealing with the consequences of their improvidence through legal and even illegal means.
For some, the problem is credit cards and the Home Shopping Channel.
For others, it's gambling or speculating in investments.
At-risk people may differ with respect to which type of temptation is most alluring, but the consequences and the social costs to themselves and their friends, family, employers, and creditors are the same regardless.
The primary strategy for dealing with the problem of temptation has usually been to limit the availability of stimulants and opportunities.
Excessive click here may be intemperate because they fail to resist temptation or fail to regulate impulses to act.
Besides the medical model, several other conceptual models and theories have been advanced to explain pathological gambling.
These include a general theory of addictions, the reward deficiency syndrome, behavioral-environmental reasons, the biopsychosocial model, and the moral model, among others.
Although these models are not directly comparable, according to Rugle 1998"the importance of such models is their potential for determining intervention and research strategies, public opinion and policy decisions, and the self-perceptions of pathological gamblers themselves.
For detailed discussion of biogenetic and medical explanations of pathological gambling, see.
Behavioral-Environmental Reasons Gambling may be viewed as a behavior that has been shaped in part by the environment, that is, pathological gamblers are people who have been susceptible to conditioning.
The sequence of outcomes in some forms of gambling e.
Winning, for example, represents a positive reinforcement.
With partial reinforcement, rewards occur with some wagers, but not all.
Gamblers are uncertain about which bets will produce rewards.
In some forms of partial reinforcement, rewards come only after a certain number of responses betsbut the number of responses is always changing.
This is called a variable ratio schedule of reinforcement Skinner, 1969.
Variable ratio schedules of reinforcement do not produce learning as quickly as fixed ratio schedules of positive reinforcement e.
This phenomenon may explain people's persistence in gambling despite large losses Skinner, 1969.
Furthermore, the greater the size of the rewards, the more resistant the behavior is to extinction, a result that suggests gamblers who experience large wins early in their gambling careers may be most susceptible to addiction.
Some theorists have pointed out that gambling can provide reinforcement even in the absence of a win.
Reid 1986 noted that near misses or losses that were "close" to being wins also encouraged gambling.
For example, when two same-type fruits appear in a slot machine, there is a brief period of excitement and thrill as one hopes for the third needed to win the jackpot.
Even if the third fruit does not quite line up with the other two, there is still some thrill from the thought of nearly winning.
Not surprisingly, some slot machines are designed to ensure a higher than chance frequency of near misses.
Such reinforcement can occur at no expense to the casino.
Finally, the casino environment itself provides reinforcing effects, such as flashing lights, ringing bells, bright lighting and color schemes, and the clanging of coins as they fall into the winning collection bins of slot machines Knapp, 1976.
People are often "primed" when casinos give away rolls of free coins, or allow people to gamble without charge for limited periods of time.
For all of these reasons, excessive gambling may be viewed as a conditioned response to powerful reinforcers.
General Theory of Addictions In response to the conceptual confusion affecting understanding of addictive and impulse disorders generally, Jacobs and others have emphasized the need for an overriding conceptual framework—a credible and testable theory, supported by an empirically derived database—that could clearly address the causes and the gambling protection of customer funds of addictive behaviors Jacobs, 1987, 1988; Shaffer et al.
Jacobs has proposed an interactive model of addiction, defining it as a dependent state that is acquired over time by a predisposed person in an attempt to relieve a chronic stress condition.
Using pathological gambling as the prototype addiction, he posited that two interacting sets of factors an abnormal physiological arousal state and childhood experiences resulting in a deep sense of personal inadequacy and rejection in a conducive environment may produce addiction to any activity or substance that possesses three attributes: 1 it blurs reality by temporarily diverting the person's attention from the chronic aversive arousal state, 2 it lowers self-criticism and self-consciousness through an internal cognitive shift that deflects preoccupation from one's perceived inadequacies, and 3 it permits complimentary daydreams about oneself through a self-induced dissociative process.
The general theory holds that a given individual's addictive pattern of behavior represents that person's deliberately chosen means for entering and maintaining a dissociative-like state while indulging.
Jacobs also characterizes this feature as a type of self-management or self-medicating strategy Khantzian, 1985 ; that is, the person's addictive behavior represents the best solution to the stresses generated by longstanding underlying problems.
Testing this theory on pathological gamblers, persons with other kinds of addictions, and normal control subjects, Jacobs and others have found principally through self-report research, that similar dissociative states are reported by pathological gamblers, alcoholics, and compulsive overeaters Kuley and Jacobs, 1988; Marston et al.
However, others have found that, although his work represents an important step toward the development of multidimensional models, Jacobs has largely ignored the importance of the social setting factors Lesieur and Klein, 1987; Rosecrance, 1988; Zinberg, 1984 that influence the development, maintenance, and recovery from addictive behaviors Shaffer et al.
Reward Deficiency Syndrome Kenneth Blum and his colleagues adopted the concept of a reward deficiency syndrome to refer to alterations in brain chemistry that can interfere with the brain's reward process.
This theory holds that genetic commonalties in a spectrum of behavioral disorders including alcoholism, substance abuse, smoking, compulsive overeating and obesity, attention-deficit disorder, and pathological gambling may be the underlying cause of a chemical imbalance that alters the signaling in the brain's reward process.
The chemical imbalance appears to supplant normal feelings of well-being with negative feelings.
A recent study found that the genetic anomaly that interferes with the brain's reward process was present in more than 50 percent of a sample of white pathological gamblers Comings et al.
This research and related issues are discussed in in the section on biology-based studies of pathological gambling.
Measuring Pathological Gambling As interest in pathological gambling increased during the 1990s, researchers have conducted an increasing number of epidemiological surveys and, to a lesser extent, clinical investigations.
Accordingly, scientists developed several screening and diagnostic instruments for this research.
The committee identified 25 different such assessment instruments that have been used to measure pathological and problem gambling Shaffer et al.
Of these, 12 were primarily used with adults and 3 were primarily used as adolescent measures.
These addictive behaviour gambling were used principally as screening tools.
As part of the Survey of American Gambling Attitudes and Behavior commissioned by the U.
Commission on a National Policy Toward Gambling, Kallick and her colleagues at the University of Michigan Survey Research Center developed the first instrument reported in the literature in 1975: the ISR Institute for Social Research Test Kallick et al.
Many of the recently developed tests are based on the DSM-III or subsequent DSM-based definitions to assess and measure pathological gambling.
As indicated in the table, many of the measures have not been evaluated and the others have received minimal psychometric evaluation.
The exception is the South Oaks Gambling Screen SOGSwhich has been widely used in numerous epidemiological studies see Shaffer et al.
The widespread use of the SOGS in population surveys did not occur without criticism.
The concern is that the use of screening instruments that were developed principally for use in clinical settings requires caution in studies of the general population.
In contrast to diagnostic interviews, the aim of screening tools is to identify the possible presence of the target problem.
Clinical screening measures typically yield conservative scoring decisions such as the SOGS designation of ''probable pathological gambler" that are designed to guard against false negatives—the mistake of claiming that there is no problem when in fact one exists.
Measures of Pathological and Problem Gambling.
A screening tool is most valuable when it is used to determine the need for conducting a more definitive assessment.
When screening measures are used in population surveys, they necessarily yield liberal estimates of the disorder.
Culleton 1989 has raised the question of the appropriateness of applying a screening test, such as the SOGS, to establish a prevalence rate in a general population.
He criticizes this method on the basis of the low predictive value of a test that screens for a disorder with a low base rate among the general population.
These concerns remind us more info, even when an instrument has high sensitivity and specificity, "the actual predictive value of the instrument could be much more limited, depending on the prevalence of the disorder of interest" Goldstein and Simpson, 1995:236.
This argument suggests that the use of any measure will result in an overestimation of the prevalence of pathological gambling in the general population, given the likelihood that the disorder is a relatively infrequent phenomenon Volberg and Boles, 1995.
However, future research cannot address whether the SOGS, or any other instrument, provides an overestimate or an underestimate of pathological gambling until the instrument's statistical association with independent and valid standards of the disorder is determined.
In this view, the use of screening instruments to estimate a "true" prevalence of a disorder is one of several important methods in the process of acquiring prevalence estimates.
Of course, all efforts to establish a prevalence estimate of pathological gambling rest on the assumption that a valid standard of the disorder exists.
However, it is not clear whether, in the field of psychiatry in general and for pathological gambling in particular, such standards exist Shaffer et al.
The process of establishing construct validity for disorders such as pathological gambling is complex and difficult; we take a brief but important digression into a more technical examination of this process in the next section.
The Process of Determining Construct Validity Scientific research inevitably involves measuring things.
The study of psychopathology involves measuring things that are not readily visible either to the naked eye or with contemporary technological instruments such as microscopes or neuroimaging equipment.
Even if we measure something consistently—that is, with reliability—scientists may remain uncertain of the thing that they are measuring.
The concept of validity refers to "the veracity or accuracy of some measurement of a construct" Malagady et al.
Construct validity refers to the idea that scientific instruments are measuring precisely what they claim to be measuring.
It is traditional to establish the construct validity of a clinical disorder by integrating evidence from many different sources e.
To establish the construct validity of pathological gambling, scientists will have to work through a rigorous and systematic process.
Malgady and colleagues 1992 suggest a classic three-part framework for validating a psychiatric diagnosis such as pathological gambling.
First, clinicians and scientists must establish content validity for the disorder, then conduct research on criterion-related validity, and finally arrive at construct validity.
Malagady and colleagues note that "the question of validity is whether or not the quantitative or qualitative values assigned to units under observation gambling discussion questions depict the units' variations in the construct or entity that is the intention of measurement" Malagady et al.
When two X measurements are rendered by different interviewers at the same time or at different times or even by different interviewers at different times, the correlation between the measurements is an estimate of reliability.
To qualify as a bona fide validity paradigm, the criterion-related indicator Y must be external to X, meaning that it was obtained by a different assessment technique, and must have relevance to the construct click to see more is the target of measurement" p.
To date, this paradigm has not been employed by any gambling researchers.
Thus, the scientific work plan to develop measures of pathological gambling would begin with identifying measurable behaviors and attitudes that theoretically reflect the underlying construct of pathological gambling.
For example, is pathological gambling best understood as an addictive disorder, an impulse disorder, or one of many problems associated with a more fundamental disorder, such as depression?
Individual and environmental factors that influence gambling class ii gambling license and the development of an excessive gambling pattern would be identified.
These factors could include player attributes e.
The measure would reflect the views of the onset, escalation, and maintenance of pathological gambling and be subjected to the rigors of validity testing so silent hill gambling, as evidence accumulates regarding the measure's validity, the underlying construct—that it is actually measuring pathological gambling—is affirmed.
Ultimately, establishing construct validity is an unending process.
Given the problems inherent in any discussion of the construct validity of pathological gambling, Bland et al.
In other words, although scientists and clinicians now may be able to measure and assess gambling-related problems reliably, this does not mean, nor should it imply, that either group knows exactly what it is that they are evaluating.
Validity as a Theory-Driven Construct Given the array of instruments that purport to identify gambling-related problems and pathology, and the potential pitfalls in their design and use gambling discussion questions the general population in particular, it is essential to sort through the psychometric characteristics of these screening devices.
The two most commonly examined psychometric attributes are reliability and validity.
Reliability refers to the capacity of an instrument to measure a relatively enduring trait with some level of consistency over time, across social settings, and between raters.
If a given instrument consistently measures a phenomenon, it is said to be reliable.
Validity pertains to actually measuring that which is sought to be measured, as opposed to something else.
As Goldstein and Simpson 1995 suggest, "Validity refers to the questions 'for what purpose is the indicator being used?
If an instrument distinguishes between pathological or problem gambling and another cooccurring condition—alcoholism, for example—it is said to be valid in that regard.
Validity also relates to sensitivity and specificity: if a net is thrown out, it must have mesh small enough to catch the cases of interest, but large enough to let escape those cases that do not have the attribute being sought.
Sensitivity represents how small the openings are to catch cases and specificity represents how large the openings are to let noncases escape.
Reliability and validity, although related concepts, are sometimes confused; reliability is often mistaken for a measure of validity.
Screening Instrument Validation The problems associated with determining an instrument's validity begin with its very definition.
Validity is neither static nor an inherent characteristic of a screening instrument.
As indicated in the previous section, determining the validity of an instrument or a construct is an unending and dynamic investigative process.
For example, we cannot simply conclude that an instrument has been shown to be valid for all purposes and all settings.
Directed by theoretical and ultimately practical purposes, validity is the dynamic consequence of applying an instrument to a specific measurement task.
However, in the field of gambling studies, there is a paucity of theory-driven research in general and prevalence research in particular Shaffer, 1997a.
When conventional wisdom and theory shift or change, the validity of a measurement instrument can be terminated abruptly.
The history of the SOGS provides an instance of the relative nature of validity.
Although for some time researchers considered that the SOGS lifetime measure had been found valid and reliable Volberg, 1994:238the same investigators now suggest that the SOGS lifetime measures "over-state the actual prevalence of pathological gambling" Volberg, 1997:41 because it combines those with a history of a gambling problem and those who currently have a problem.
Conclusions Gambling behavior inherently involves risk-taking, may involve limited skill, and may best be conceptualized on a continuum ranging from no gambling, to social and recreational gambling, to problem gambling, and to pathological gambling.
Pathological gambling often cooccurs with other disorders, and its social and economic effects theoretically increase once the threshold of problem gambling is crossed, although this dynamic relationship has not yet been demonstrated empirically.
In addition, little is known about the dynamics of gamblers as they move from one level of gambling behavior to another.
Clinical evidence check this out that pathological gamblers engage in destructive behaviors: they commit crime, they run up large debts, they damage relationships with family and friends, and some kill themselves.
Since 1980, pathological gambling has been categorized as a "Disorder of Impulse Control Not Elsewhere Classified" in three versions of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
The effort by the American Psychiatric Association to operationalize pathological gambling has been evolving and today DSM-IV provides a useful definition and diagnostic criteria that is relied on heavily by both clinicians and researchers.
As a diagnostic guide, DSM-IV suggests that persons meeting 5 or more of the 10 criteria should be classified and treated as pathological gamblers.
Even though the DSM-IV definition of pathological gambling is now widely accepted, there remains debate over the precise classification and construct validity of pathological gambling, and also over the conceptualization and definition of less severe problem gambling, which is not addressed in the DSM-IV.
The debate includes the issue of whether source not click at this page gambling should be viewed as a dependent state or an addiction rather than as a disorder of impulse control.
The history of pathological and problem gambling research reflects the developmental process of shifting scientific attempts to measure a singular phenomenon.
The field is still relatively immature compared with many others and, as a result, does not demonstrate a coherent program of scientific inquiry.
The committee recognizes that, although the term pathological gambling and its accepted definition adequately represent severe cases of excessive gamblers, there is a need for more research to validly define other levels of gambling severity.
Not all gamblers experience an excessive relationship with the games they play; not all excessive gamblers experience compulsive or pathological behaviors; not all pathological gamblers experience impairment in every aspect of their activities.
A multilevel system with agreed-on terminology, such as that proposed by Shaffer and Hall 1996 should be considered by experts in the field.
Such consideration could lead to integration of diverse research findings and to a more accurate reflection of the clinical picture.
Scholars of pathological and problem gambling are still struggling with how to demonstrate the validity of pathological gambling as a primary disorder independent of other mental illness, even as scholars in psychiatry in general continue to encounter many of these same validity problems across the full range of mental disorders e.
A high priority for future research is to further advance the validity of pathological gambling constructs.
In order to establish coherent theories and models of pathological gambling, a rigorous scientific work plan is required.
here effort will put the concept of pathological gambling to the test by generating the empirical evidence necessary to fully evaluate its construct validity.
Simply entering the psychiatric nomenclature is not a proxy for validity.
Many psychiatric diagnoses have come and gone over the years.
Although various instruments are available to assess the prevalence of pathological and problem gambling, each instrument is best understood by viewing it through an evaluative lens that can focus on its origin, driving gambling discussion questions, relationship to funding, and inherent strengths and weaknesses.
Notwithstanding improved diagnostic criteria provided by DSM-IV, until the field develops standardized tools with demonstrated psychometric properties, the ability of an instrument to successfully determine whether an individual is a pathological gambler remains dependent on the method of validation, interviewing technique, sampling https://bannerven.com/gambling/effects-of-problem-gambling-in-singapore.html, and other methodological factors.
Consequently, in the absence of a well-formulated model or theory and read article subsequent construct validity that results from a program of empirical research, scientifically based knowledge and understanding cannot be advanced.
Contemporary scientists stand on the shoulders of those who came before.
The efforts of pioneers who undertook the early research on pathological gambling, usually without institutional support, provide the platform on which current investigators stand.
The current conceptualization, definition, and diagnostic criteria for pathological gambling must be carefully studied.
The French biologist Jean Rostand reminds us "nothing leads the scientist so astray as a premature truth" Rostand, 1939.
The field of gambling studies is in its early days.
It is therefore timely to encourage those who study gambling and its effects, as well as those in positions to support such research, to pursue empirical studies for further validation and understanding of this public health problem.
Future research that measures the incidence of related psychiatric disorders along with pathological gambling, interactive processes, and genetic predispositions will provide important insight into these questions.
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This pattern has been observed, however, among people with alcohol, heroin, cocaine, and other addictions e.
Nevertheless, the percentage of those who seek treatment and do return successfully to social or recreational gambling is likely to be so small that clinicians generally and accurately believe that it is not likely.
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The fall and rise of a gambling addict


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