Problem Gambling Symptoms and Diagnosis

When casinos themselves caution you to gamble in a responsible manner, you know that the issue cannot be brushed under the carpet.

The opposite of responsible gambling is problem gambling, which has been defined as an addictive urge to continue gambling despite being aware of the harmful consequences accruing to the gambler or their family. In gambling and medical literature problem gambling is also referred to by other terms like gambling disorder, compulsive gambling and gambling addiction.

If you engage in gambling, even casually, then you must fortify yourself with awareness about problem gambling.

Whether you are a regular online gambler who likes to take a advantage of exclusive casino bonuses and free spins at win real money casinos, there are some precautions to take.

This article is a single window for everything that you need to know.

The topics covered include:

  • Definition of problem gambling
  • Phases of problem gambling
  • Symptoms of problem gambling
  • Diagnosis of problem gambling

Definition of Problem Gambling

Problem gambling is not necessarily about the size of your bets or how much you lose. If you can afford to lose $1000 a month on gambling then it is not a problem. It is like spending the money on fishing or books or any other interest. The problem is in spending more money on gambling than you can afford to, because sooner rather than later this will adversely impact your life and the lives of the people around you. One integral component of problem gambling is that even when you realise that the activity is hurting you, you are unable to stop. This is why it is called compulsive gambling or gambling addiction.

Problem Gambling Is a Disorder

Earlier, problem gambling was considered a product of social upbringing, but researches over the last few decades have resulted in a more sympathetic evaluation. It is now established that problem gambling is a mental disorder, much like substance addiction. The American Psychiatric Association is one of the organisations carrying out research in this area. In his Gambling Addiction: The Problem, the Pain, and the Path to Recovery John Eades points out that the American Psychiatric Association in its fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 reclassified problem gambling as an addictive disorder, thereby removing the associated stigma and making it easier for afflicted gamblers to seek treatment. National Centre for Responsible Gambling estimates that approximately 1% of the adult population in the United States has a gambling problem. The percentages in other countries would not be very different.

Phases of Problem Gambling

The onset of problem gambling does not take place overnight, but it develops in degrees over a period of time. If you are alert you can be aware of a possible affliction in the early stage, where treatment is easier.

Dr Robert L. Custer was a pioneer in helping compulsive gamblers, who established his clinic for this purpose in in 1974. His concept of the three phases of problem gambling is still relevant.

1. The Winning Phase

It may seem ironic, but the first phase is the winning phase. If you lose early on you are likely to be discouraged to take up gambling seriously. Wins bring with them an exhilarating experience along with the fantasies of winning more. During the winning stage it is difficult to tell whether the individual has latent gambling addiction disorder within them.

2. The Losing Phase

The first lesson in gambling states that you cannot go on winning for ever. Sooner or later, you will have to face losses. Players without gambling disorder take this in their stride. They would either cut down on gambling for a while, or maintain the same level if they can afford the losses.

Problem gamblers react differently in the losing phase. The exhilaration of winning was like a drug trip and the craving for that gets intense. They now gamble more often and with bigger amounts in the hope of getting back to winning ways. Problem gamblers usually borrow money and pile up debts. Not only are they losing more money than they can afford, but are spending more time on gambling. The first casualty is time spent with family and friends and next they begin to absent themselves from work.

3. The Desperation Phase

When losses persist then desperation sets in. Now borrowing is no longer possible because all such avenues are exhausted. The next step is stealing money or using funds meant for essentials like medicine or even children’s education. Irritability is common and relations with spouse, family and friends turn sour. Problem gamblers realise that they have done wrong but are unable to take corrective steps. The next big win is the only solution they can see.

Loss of reputation and loss of job follows. Problem gamblers blame everyone else for the predicament. If family or friends do not force the issue and take the problem gambler for professional help, attempted suicides cannot be ruled out.

Symptoms of Problem Gambling

The good news for problem gamblers is that the symptoms are now well known and classified into easily recognisable groups.

Money Related Symptoms

All of us are aware of the luxurious life-styles of the uber rich and many of us dream to be a part of that elite set. Some of us face more urgent needs of large sums of money for medical treatment or higher education of our children. Movies and novels often portray gambling as a quick source of big money. Nothing is further from the truth. All gambling games have a house edge in the odds, that favour the casinos. Gamblers know that they cannot continuously win in the long run.

Players with gambling disorder are unable to grip this reality, particularly if they start with a few good wins. They feel that the solution to all their money problems will come from the next spin of the roulette wheel. So, they keep fuelling this misconception first with their disposable incomes, then savings, then borrowed money and finally stolen money.

Some specific symptoms are:

  • Spending more money on gambling every month
  • Looking at gambling to solve all your money problems
  • Ending the session only when everything has been lost
  • Playing to recoup losses
  • Increasing bet sizes in order to achieve the same thrill from gambling
  • Diverting money for essential spending to gambling
  • Borrowing money for gambling
  • Stealing money for gambling

Time Related Symptoms

Most gamblers would fix a time period for a session, say one hour. At the end of that session, they would leave the table, cash their balance chips and walk out. Problem gamblers behave differently. They find excuses to extend their scheduled time and leave the table only when their chips are over. Their planned sessions also become longer with passing time. This has become easier with online casinos where you can play from home.

Spending more time on gambling eventually eats into other daily activities. You begin by giving up your other interests and then foregoing time spent with friends. The ultimate point is reached when you begin to neglect your spouse and immediate family.

Some specific symptoms are:

  • Staying away from work because of gambling
  • Not being able to concentrate at work
  • Loss of ambitions and goals

Social Symptoms

Problem gambling ultimately begins to affect the social life of the players as they move away from family, friends, partners and co-workers. This is probably the last chance for the problem gambler to seek treatment. The problem is that gambling addicts are convinced that there is no issue and with one big win all their strained relationships will be rectified. They routinely lie about their gambling habits, so it is up to their friends and family to take matters in hand and nudge the gambling addict towards treatment.

Financial setbacks, loss of job and social estrangement can lead to loss of esteem, from which recovery will be very difficult.

Some specific symptoms are:

  • Deteriorating social relationships
  • Lying about gambling habits
  • Loss of esteem

Psychological Symptoms

At some point, the problem gamblers will realise that they have all but ruined their lives. They also know that if they get more funds in their hands, they will be compelled to throw it away in the casinos. This realisation brings with it a sense of fear. When they are at the tables, they forget the fear and experience exhilaration, but when the money runs out the fear returns.

The fear makes gambling addicts restless and tense and they are unable to focus on anything, and even lose sleep. In the normal course, the company of family and friends helps, but problem gamblers get irritated by any attempts to put them at ease. The worst part is that they cannot even talk about their gambling addiction and thwart all attempts to make them go for professional treatment. If this continues for some time then depression sets in and this often leads to suicidal tendencies. The only solace comes through gambling, which becomes an escape mechanism.

Some specific symptoms are:

  • Fear of the future
  • Irritability in interacting with family and friends
  • Inability to sleep
  • Suicidal thoughts
  • The use of gambling as an escape

The symptoms of problem gambling are all internal. There is no limp in your walk or rashes on your skin to tell you and your close ones that something is wrong. Fortunately, the experts in the treatment of problem gambling have created structured easy to use mechanisms, some of which we will discuss later in this section. But first we must address one critical pitfall. If a gambler realises that there could be a problem, the first reaction is to push the outcome under the carpet and refrain from continuing with the diagnostic mechanism. Hence, it falls on family and friends to do the diagnosis. If your spouse or child or friend is a regular gambler then the onus is on you to be aware of the symptoms and check them against the diagnostic mechanisms at set intervals.

The diagnostic process involves checking actual gambling behaviour against a self-assessment questionnaire and then taking prescribed action. Different expert agencies have devised different questionnaire structures and because the issue is of paramount importance, we will look at a few of them.

  1. Gamblers Anonymous questionnaire
  2. DSM-5 diagnosis
  3. Other diagnostic tools

Gamblers Anonymous Questionnaire

Gamblers Anonymous, constructed on line lines of Alcoholics Anonymous, is one of the biggest global organizations that deals with problem gambling. It has published a questionnaire with 20 ‘yes’ or ‘no’ answers that will help gamblers diagnose whether they are veering towards problem gambling. We reproduce that questionnaire in its totality.

  • Did you ever lose time from work or school due to gambling?
  • Has gambling ever made your home life unhappy?
  • Did gambling affect your reputation?
  • Have you ever felt remorse after gambling?
  • Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
  • Did gambling cause a decrease in your ambition or efficiency?
  • After losing did you feel you must return as soon as possible and win back your losses?
  • After a win did you have a strong urge to return and win more?
  • Did you often gamble until all your money was gone?
  • Did you ever borrow to finance your gambling?
  • Have you ever sold anything to finance gambling?
  • Were you reluctant to use “gambling money” for normal expenditures?
  • Did gambling make you careless of the welfare of yourself or your family?
  • Did you ever gamble longer than you had planned?
  • Have you ever gambled to escape worry, trouble, boredom, loneliness, grief or loss?
  • Have you ever committed, or considered committing, an illegal act to finance gambling?
  • Did gambling cause you to have difficulty in sleeping?
  • Do arguments, disappointments or frustrations create within you an urge to gamble?
  • Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
  • Have you ever considered self-destruction or suicide as a result of your gambling?

The diagnosis works in the following manner.

If you answer ‘yes’ to 7 or more of these questions then you have a tendency for problem gambling and should immediately seek professional help.

DSM-5 Diagnosis

DSM-5 is the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, which has an important section on the diagnosis of gambling disorders. The process is a bit more involved than the Gambling Anonymous steps described above. This diagnostic test is meant to be given by professionals and you should consult one if you feel that your gambling behaviour is changing for the worse.

DSM-5 defines two different types of gambling disorders – episodic and persistent.

  • Episodic: Meets a level of diagnostic criteria at more than one point in time, involving symptoms that subside between periods of gambling disorder for at least several months.
  • Persistent: Experiences continuous symptoms, and meets diagnostic criteria for multiple years.

The individual is diagnosed with persistent and recurrent problematic gambling behaviour if they exhibit four (or more) of the following in a 12-month period. A caveat is added that the behaviour is not better explained by a manic episode.

  • Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
  • Is restless or irritable when attempting to cut down or stop gambling.
  • Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
  • Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
  • Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
  • After losing money gambling, often returns another day to get even (“chasing” one’s losses).
  • Lies to conceal the extent of involvement with gambling.
  • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
  • Relies on others to provide money to relieve desperate financial situations caused by gambling.

The DSM-5 specifies three levels of severity.

Mild: four to five criteria met

Moderate: six to seven criteria met

Severe: eight to nine criteria met

DSM-5 also recommends that individuals treated for gambling disorders continue with diagnostic tests in order to confirm remission.

  • Early remission: After the treatment has been completed, none of the criteria for gambling disorders have been met for at least three months.
  • Sustained remission: After the treatment has been completed, none of the criteria for gambling disorders have been met during a period of 12 months or longer.

Other Diagnostic Tools

There are a number of agencies offering assistance and therapy for individuals afflicted with problem gambling. The core is the same and consists of questions about multiple symptoms of problem gambling. Each tool has its own assessment method as to the degree of problem gambling the individual might be in. We provide links to three of the more commonly used ones.

CONCLUSION

Here we would like to point out that every gambler starts off thinking that they are immune to problem gambling. Unfortunately, this is not so and there is no medical test that can predetermine if the potential for gambling disorder exists. The indicators would come into play only after the individual has started gambling.

Hence, it is crucial that all gamblers continuously take the self-assessment diagnostic tests regularly and seek professional assistance without delay. The treatment of problem gambling is a complex and multi-layered process and merits independent treatment. As in normal physical disorders like hypertension or diabetes, delaying the treatment only leads to the disease taking a stronger hold.