Gambling disorder

Meet the patient

A 34-year-old primary school teacher is brought to the emergency department by his wife at 1am. She found a bank statement. Over fourteen months an in-play sports betting app has taken everything, including the money set aside for their daughter's school fees.^[1][12]

He has not slept in three days. He told nobody, including her, until tonight. He says twice, quietly, that his family would be better off without him.^[1][7]

He has never used an illicit drug and he drinks two beers a week. There is no withdrawal syndrome to treat, no positive screen to point at, and nothing on any blood test. The examiner's question is the whole topic: what makes this an addiction, and what do you do about the fact that the lethal part is the debt?^[1][13]

References16ShowHide

1. [1]Potenza MN, Balodis IM, Derevensky J, Grant JE, Petry NM, Verdejo-Garcia A, et al. Gambling disorder Nat Rev Dis Primers, 2019.PMID 31346179
2. [2]Kim SW, Grant JE, Adson DE, Shin YC Double-blind naltrexone and placebo comparison study in the treatment of pathological gambling Biol Psychiatry, 2001.PMID 11377409
3. [3]Grant JE, Kim SW, Hartman BK A double-blind, placebo-controlled study of the opiate antagonist naltrexone in the treatment of pathological gambling urges J Clin Psychiatry, 2008.PMID 18384246
4. [4]Cowlishaw S, Merkouris S, Dowling N, Anderson C, Jackson A, Thomas S Psychological therapies for pathological and problem gambling Cochrane Database Syst Rev, 2012.PMID 23152266
5. [5]Petry NM, Ammerman Y, Bohl J, Doersch A, Gay H, Kadden R, et al. Cognitive-behavioral therapy for pathological gamblers J Consult Clin Psychol, 2006.PMID 16822112
6. [6]Petry NM, Stinson FS, Grant BF Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions J Clin Psychiatry, 2005.PMID 15889941
7. [7]Kessler RC, Hwang I, LaBrie R, Petukhova M, Sampson NA, Winters KC, et al. DSM-IV pathological gambling in the National Comorbidity Survey Replication Psychol Med, 2008.PMID 18257941
8. [8]Lorains FK, Cowlishaw S, Thomas SA Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys Addiction, 2011.PMID 21210880
9. [9]Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V, et al. Impulse control disorders in Parkinson disease: a cross-sectional study of 3090 patients Arch Neurol, 2010.PMID 20457959
10. [10]Grant JE, Odlaug BL, Potenza MN, Hollander E, Kim SW Nalmefene in the treatment of pathological gambling: multicentre, double-blind, placebo-controlled study Br J Psychiatry, 2010.PMID 20884959
11. [11]Kim SW, Grant JE, Potenza MN, Blanco C, Hollander E The Gambling Symptom Assessment Scale (G-SAS): a reliability and validity study Psychiatry Res, 2009.PMID 19200607
12. [12]Calado F, Griffiths MD Problem gambling worldwide: An update and systematic review of empirical research (2000-2015) J Behav Addict, 2016.PMID 27784180
13. [13]Grant JE, Kim SW Demographic and clinical features of 131 adult pathological gamblers J Clin Psychiatry, 2001.PMID 11780876
14. [14]Weintraub D, Siderowf AD, Potenza MN, Goveas J, Morales KH, Duda JE, et al. Association of dopamine agonist use with impulse control disorders in Parkinson disease Arch Neurol, 2006.PMID 16831966
15. [15]Grant JE, Odlaug BL, Chamberlain SR Gambling disorder, DSM-5 criteria and symptom severity Compr Psychiatry, 2017.PMID 28260605
16. [16]Kim SW, Grant JE, Yoon G, Williams KA, Remmel RP Safety of high-dose naltrexone treatment: hepatic transaminase profiles among outpatients Clin Neuropharmacol, 2006.PMID 16614539