Problem and Pathological Gambling

2 Theories and Models (p. 21-22)

The first chapter provided an overview of problem and pathological gambling including definition, epidemiology, comorbidity, and measurement. With this information in mind, we now turn to a more conceptual focus on explanatory models of gambling problems. Clear and comprehensive theories are necessary to guide successful clinical interventions for addictive behaviors. A good theory is a useful one. Theories or models of psychopathology are judged according to their ability to produce appreciable results.

While the field of substance use disorders has several empirically based models that inform clinical interventions, the existing gambling treatment literature is not as well-established. Several models offer explanations of the etiology of problem gambling, but we believe only those with sufficient empirical support should guide case conceptualization and treatment. In this chapter we provide a review of the primary theories of problem gambling and then offer an integrated model that serves as the foundation for our Guided Self-Change treatment. The chapter concludes with an overview and rationale for this treatment model.

2.1 Gambling as an Addictive Behavior

There is growing support for conceptualizing problem gambling as an addiction (e.g., Dickerson, 2003, Herscovitch, 1999, Klingemann et al., 2001, National Research Council, 1999). The essential element of addiction is that people become completely absorbed in an activity and then pursue it without regard for the negative life outcomes. Problem gambling shares characteristics and consequences with other additive behaviors, including problem drinking, tobacco use, and drug abuse (e.g., National Research Council, 1999, Wickwire et al., 2007). As noted previously, diagnostic criteria for pathological gambling reflect symptoms common to other substance use disorders. Like other addictions, problem gambling includes loss of control, preoccupation, tolerance, withdrawal, escape, cravings, and other concomitant biopsychosocial problems. There is also growing neuroscience evidence from brain imaging studies that compulsive nondrug behaviors share neurobiological commonalities with substance use disorders (Holden, 2001, Koepp et al., 1998).

These parallels between problem gambling and other addictive behaviors indicate that gambling researchers can be informed by addiction treatment literature. Being informed, in this case, does not imply the simple acceptance of alcohol or drug treatments for problem gambling. It suggests that the be havior change principles underlying treatments for these addictive behaviors are worthy of consideration in problem gambling (e.g., Herscovitch, 1999). A promising treatment program for problem gambling should embody the general principles of behavior change while also addressing elements specific to gambling. For example, it is generally accepted that irrational thinking, such as the belief in luck and the illusion of control (e.g., Ladouceur &, Walker, 1996), financial issues, and the highly improbable, but still possible, pot of gold at the end of gambling’s rainbow are either unique to or more prominent in gambling. These phenomena need to be addressed when using general addiction treatment principles with problem gamblers.