Abnormal Psychology 3018 Addiction: Non-Substance

When the repetitive (and persistent) behaviours result in significant harm or distress (to oneself or to others) that causes functional impairment.

1990 with the publication of a prominent text. Afterwards there was a rapid escalation in behaviours being labelled as ‘behavioural addictions.’

Gambling. It was identified as a serious problem as far back as 4000 BC, and since then has gone through phases of being reported on.
From 1970 - 1980 there arose the concept of ‘pathological gambling’ as a psychiatric disorder, and it was included in the DSM-3 as an Impulse Control Disorder: Not Elsewhere Classified.

‘Repeated behaviour that led to significant impairment and distress in the individual.’

The DSM-5 created a new category called Substance-Related and Addictive Disorders, with Gambling Disorder included as the only diagnosable Behavioural Addictive Disorder.

Gambling Disorder was included as an Addictive Disorder for two reasons:

1. Scientifically it is viewed as an addiction.

2. Politically it was important for Gambling Disorder to be seen as an Addictive Disorder so it can be covered by medicare.

It was classified previously as pathological gambling, and now it is known as Gambling Disorder.

Internet Gaming Disorder - (conditions for further study).
It was included because:
1. IGD has similarities to substance abuse disorders.
2. Has significant public health implications.
3. Internet gaming was recognised by the Chinese Government as a disorder and pushed heavily for it to be included in the ICD-10 (which it has been).

Criterion A (four or more):

1. Preoccupation (psychological dependance).

2. Increased amount gambled (tolerance).

3. Irritability/restlessness on cessation (withdrawal).

4. Escape from stress (negative reinforcement & motivation).

5. Chasing losses (erroneous & distorted cognitions).

6. Lying.

7. Repeated failure to cease (impaired control).

8. Risking significant relationships.

9. Bailout.

Symptoms and consequences of symptoms.

‘Gaming’. Can refer to gambling activities (sometimes on the internet) or video and arcade games.

No, the internet is a virtual communication network, you cannot be addicted to it any more than you can to a telephone. What people become addicted to is the object of desire that the internet allows access to (pornography, eSports, videos, web surfing).

1. Gambling Disorder (DSM-5).

2. Sex addiction.

3. Compulsive shopping.

4. Internet addiction.

5. Internet gaming disorder.

6. Kleptomania.

1. Exercise addiction.

2. Eating addiction.

3. Love addiction.

4. Work addiction.

5. Social networking addiction.

6. Smart phone addiction.

7. Tanning addiction.

1. Anecdotal observations that consider the behaviour as addictive.

2. Screening instrument is used.

3. Identifying risk factors that play a role in the development and maintenance of the addiction (biological, psychological, social).

It does not extrapolate to all behaviours or problems (like taking the criteria from one cancer and trying to apply it to another).
The model ignores:
1. functional impairment of the behaviour.
2. the stability of the behaviour (is it a passing fad? a behaviour that is transient and context specific?).

Gambling involves risking an item of value based on the outcome of events that are determined by chance, all for personal gain.

Problem Gambling: sub-threshold but people nevertheless experience personal or social harm.
Pathological Gambling/Gambling Disorder: Meet the criteria in the DSM.

The excitement of uncertainty mingled with hope & the fun .

• Hope to recoup losses (chasing).

• Emotional escape (trauma sufferers).

• Satisfy emotional needs (narcissism, ego).

• Manage dysfunctional affective states (depression, anxiety, trying to dissociate).

Gambling: 60-85% of general population, this means we know that the majority of adults gamble responsibly.
Pathological gambling: around 1%.

Today it is very acceptable and there is widespread access to gambling programs, particularly on the internet and smartphone applications.

15-25% are pathological gamblers.

They will create a free game where the odds are stacked in the favour of the participant. This gives them enough confidence to start playing with money, however, in the paid versions the odds are moved back to the operator. You are guaranteed to lose if you play.

The majority will cease to gamble after experiencing a harm, but a portion will continue to gamble into adulthood.

The normalisation of gambling.

Gaming industries say that the game is popular and the child being immersed in it is not necessarily a bad thing, it is the parents who have a problem. If the child spent as much time being isolated due to reading would the parent criticise that behaviour?
However, IGD is associated with significant problems like: RSI, eye strain, back problems, not eating for long periods of time. Also, impairment in cognition, psycho-social relationships, & daily life.

Between 0.8-26.7% | In Asian countries, it is above 10%.

Gambling-like features in a game can be a gateway to more problematic gambling.

• 13% played regularly. | - 32% played at least once.

• 23%. | - 22%.

Many games (such as candy crush) do a 'break in play' right at the height of the game to create a craving. Often there is an option to wait, or to pay money to immediately continue.

• they are very accessible on multiple platforms.

• attract people with psychological issues and potentially exacerbate them: depression, social anxiety, ADD, impulsivity.

• Anonymity and the capacity to play unsupervised.

• Any age can play.

• Multiple pay options (around 260 ways to pay).

1. Psychodynamic (addiction or gambling is a form of psychic self-punishment for unresolved complexes).

2. Behavioural (around 1973 report about a problem gambler who stole money, he was lobotomised. Other types of therapies have been used - relaxation, aversive, stimulus control).

3. Cognitive-Behavioural (arose from the recognition of erroneous beliefs).

4. Addictions model.

5. Biological model (looking at biology and neurochemistry as the underlying core of addiction).

1. Cognitive component: erroneous beliefs about gambling are maintained and reinforced through biased interpretations of gambling outcomes.

2. Behavioural component:
   the learning of maladaptive behaviour caused by early experiences and reinforcement schedules.

1. Illusions of control (believe they have personal skills and overestimate their ability to win).

2. Gambler's fallacy (a misunderstanding of probability, believing that if you have a run of bad luck on a machine, you will eventually get a big win. This is false, as each game has the same 50/50 odds).

3. Biased evaluation (if I win it is because of my skill, if I loose it is because of external factors).

4. Mutual independence (again, not understanding that games are independent of one another).

5. Probabilities (not understanding the probability you will loose over time).

6. Illusory correlations (superstitions, wearing a certain thing to try and guarantee a win).

Because conditioning occurs when you have a big win and you want to win more. If in your initial exposures to gambling you have big win, that is exciting and reinforces the idea that gambling is an easy way to make money.
It activates neuro-cognitive and psychophysiological processes.

Dopamine increases after a big win, this reduces executive functioning so people are more likely to make poor decisions.

That pathological gamblers are not a homogenous population, they may have common phenomenological elements but they have different aetiological factors.

Because even though each person may have different aetiological factors, when they present clinically all gamblers can appear somewhat the same.

1. Common phenomenology.

2. Different aetiological factors.

3. Differ in treatment requirements.

• Pathway 1: symptoms are caused by GAMBLING (first big win conditions the problem).

• Pathway 2: the previous presence of psychological disturbances, poor coping skills contribute to gambling.

• Pathway 3: deficits in reward and impulse pathways.

Initial arousal/excitement and the development of cognitive schemas surrounding the gambling behaviour.

It is driven by the motivation to keep winning and the absence of psychopathology.

Person is psychologically vulnerable, might have a background of psychopathology/trauma/poor coping strategies.
Uses gambling as an emotional escape, not about winning.

There are deficits in certain neurotransmitters that push the person to being more impulsive. This person is likely to have other problem behaviours (criminality, substance abuse, impaired relationships).