Motivation and emotion/Book/2018/Gambling addiction motivation

Overview
 Case Study: 

Justyn Rees Larcome had his dream life, a successful businessman in the city of London on a six-figure salary, a wife and children, driving nice cars and going on fancy holidays. One day, after a stressful family event, Justyn was watching football and noticed an advertisement for a free $5 bet. He put a bet on, and he won. It started as small bets at first, but as it excelled he withdrew as a husband and a father. He put a large bet of $1000 on a game of tennis to try and win back all of his losses, but he lost. So he called his bank and got an overdraft on his bank account to put on another $1000 bet, but he lost again. Then he lost his job because he got caught using his corporate credit card to gamble, trying to cover the gaps in his finances because no one knew about the gambling. One day his infant son wanted to go to the park, so he put him in the car and ran up to get his coat. At that moment he remembered a bet he’d put on the night before, so he quickly checked it. He had lost. To try and win back what he lost, he went onto an online casino. 3 hours later, he’d emptied his bank account, and his son was still in the car out the front. He lost his job, his wife and kids, and sold his belongings for money to gamble. He thought about two paths to take, to commit a crime, or suicide. He went from living his dream life, to $73,000 of debt and his few belongings in a garbage bag, all because of gambling. (TED, 2017).

Gambling is a risk taking activity, and involves placing something of value on something with an uncertain outcome, in hopes of winning something of greater value (Pallesen, Mitsem, Kvale, Johnsen & Molde, 2005). For example in Justyn’s case above, he put money on sporting events in hopes to win a greater amount of money. Gambling is popular worldwide for many reasons, socially it is a great way to go out and be surrounded by other people, whether it be in a pub, or all glamorous at a horse racing event such as Melbourne Cup. Some of the many forms of gambling are:


 * poker machines (also known as slot machines)
 * TAB and Keno
 * Betting on sporting events
 * lottery and scratchcards
 * card games such as poker

For more information on these methods of gambling, plus more, see gambling types.

While gambling can be a fun and social event in moderation, there is a risk of it becoming harmful to the individual. Gambling has the potential to become addictive, causing people to become preoccupied with gambling over other life events such as going to work, losing control with the money and time they're spending, suffering negative consequences such as guilt and depression, and gambling to fulfill a need (Sussman & Sussman, 2011). The term used for this addiction to gambling in the Diagnostic Statistic Manual 5th edition (DSM-5) is gambling disorder. Gambling disorder after years of research has now been listed in the DSM-5 (American Psychiatric Association, 2013) within the substance-related disorders chapter. It is the first non-substance-related disorder to be added in this chapter, and has been placed there due to the reward centres activated when using substances such as drugs, are the same as ones rewarded by gambling behaviours (APA,2013). Substance-related disorders are categorised by a mix of cognitive, behavioural and psychological symptoms showing that a person continues to use the substance despite the ramifications (APA, 2013).

To put gambling in perspective, in 2014 Australian’s were the highest spenders on gambling, spending $916 per adult, followed by Singapore at $891.16, and America on $505.44 (Caisno.org, 2018). Even though Australian's spend the most on gambling, the highest amount of money lost in 2014 was America losing US$142.6 billion, followed by China at US$95.4 billion, and Japan at US$29.8 billion (Casino.org, 2018). Based on survey data, between 80% - 94% of British adults, 24% - 68% of American adults, and 81% - 92% of Australian adults have gambled at some time in their life (Griffithsro & Delfabbro, 2001).

When there are potential devastating repercussions of gambling, and poor financial consequences, why do so many people continue to do it? This chapter is dedicated to divulging the motivations behind people choosing to gamble and what can be done to help.

Motives to gamble
"Motivation involves both internal and external forces that trigger, direct, intensify and lead to persistence of a behavior."

- Clarke, 2004

The motivation behind gambling is relevant throughout research, especially as the gambling figures continue to increase. Recreation gambling may be motivated by enjoyment, socialising and excitement toward possible wins, whereas problem gambling may be motivated by chasing losses, escaping life stressors and boredom (Griffithsro & Delfabbro, 2001). If a person's gambling worsens, the reason behind their gambling often changes. They may have started gambling for social reasons and the enjoyment of it, however as it goes on it is almost always driven by chasing losses and winning money (Griffiths & Delfabbro, 2001). In an attempt to uncover why people gamble, the motivation theory of self-determination theory (SDT), biological effects, behavioural and social motivations are discussed.

Self-determination theory
SDT focuses on the motivations of human behaviour, and assumes that we have three needs to be met for optimal functioning: competence (need to be effective dealing with the environment), relatedness (need to have good relationships) and autonomy (need to control their own life) (Ryan & Deci, 2000). Ryan & Deci (2000) founded that personality differed in individuals who had varying degrees of these needs met. Self-determination is measured by causality orientations, which refers to how people adapt to their environment (Ryan & Deci, 2000). Table.1, causality orientations explained (Neighbors & Larimer, 2004; Rodriguez, Neighbors, Rink & Stud, 2015; Ryan & Deci, 2000).

Studies about gambling addiction have found that people with higher scores on controlled orientation spend more time and money gambling, are more likely to meet the criteria for gambling disorder, and have more negative consequences (Neighbors & Larimer, 2004). Because controlled individuals are more defensive and negative, they experience wins as an ego boost and losses as a threat, and therefore gamble in excess to win back any losses (Neighbors & Larimer, 2004). Rodriguez et al. (2015) concluded the same, controlled orientation positively correlated with problem gambling due to higher levels of chasing losses, and autonomous orientation negatively correlated and even protected against problem gambling, because they were less likely to chase losses, and weren't using gambling as a way to escape.

People with positive self-determination gambled for interest and enjoyment, and often gambled in ways that require some knowledge such as horse racing or poker (Rodriguez et al., 2015). While on the contrary, people with low self-determination gambled for monetary gains, and gambled on things that were dependent on chance such as lottery and poker machines (Rodriguez et al., 2015).

Biological


There is evidence to indicate that gambling disorder is an addiction, with similar chemical activity to a drug addiction (Jazaeri & Habil, 2012). Norepinephrine is a naturally occurring hormone in the body, which is secreted under arousal, thrill and stress, so problem gamblers gamble to make up the dosage (Jazaeri & Habil, 2012). Furthermore, an experiment conducted whereby functional magnetic imagaing (fMRI) device was used to measure participants reactions to a gambling game where they could win, lose or break even. According to the results, winning money in gambling produces very similar brain activation to that observed in a cocaine addict receiving a hit of cocaine (experiment by Harvard Medical School Division on Addiction, as cited in Jazaeri & Habil, 2012).

In the brain, pleasure is from the release of dopamine in the nucleus accumbens, also known as the brain's "pleasure centre" (Volkow, Wang, Telang, Fowler, Logan, Childress & Wong, 2006). Whether someone will get addicted to something is linked to the speed of the dopamine release, the intensity and the reliability of the release (Volkow et al., 2006). The hippocampus keeps the memory of the feeling of satisfaction, and the amygdala creates a conditioned response to that stimuli. Repeated exposure to the addiction causes nerve cells in the nucleus accumbens and the prefrontal cortex to communicate in way that means liking something means you want it, and to go after it (Volkow et al., 2006). This is the process that motivates a person to seek out the pleasure source.

Behavioural
In regards to the behaviourist perspective, both classical and operant conditioning have both been used to explain why people gamble (Griffiths & Delfabbro, 2001). Explaining using operant conditioning, frequent gambling is seen as a conditioned behaviour due to the randomness of reinforcement, usually a variable-ratio schedule (Griffiths & Delfabbro, 2001). An example of this is the famous experiment by BF Skinner, who trained a rat to press a lever for food pellets (called Skinners Box). If it was received every time, it would only press the lever when it was hungry. However, if it was random and never knew when the pellet was coming, the rat would continuously press the lever. This experiment worked on rats, pigeons, and now humans too in the form of poker machines. The key element is surprise.



As for classical conditioning, it is argued that people gamble because of the excitement associated, so that when they stop playing they feel restless and bored (Griffiths & Delfabbro, 2001). Positive reinforcement is used in the way of lights and sounds when someone wins. In the documentary Ka-Ching: Pokie Nation (Lawrence, Goldman & Manning, 2015), a great deal of emphasis is put on the sound effects that poker machines make. If you win any amount of money, the machine will make a happy sound, to alert the player of a win (Lawrence et al., 2015). They also explain how machines keep you there even if you are losing money, with the "losses disguised as wins". You could bet $1 and win 20 cents, but because the music still plays and reinforces a win, you feel good about it and continue to gamble. The same goes for negative reinforcement, because when problem gamblers gamble, they often to do to relieve tension, stress and boredom (Clarke, 2004). Therefore, relieving those feelings reinforces the gambling behaviour.

"It's my fault that I was gambling, but I didn't expect to get hypnotised."

- Victim of gambling disorder talking about poker machines, as cited in Lawrence et al., 2015

Social
Humans have a natural desire for risk, competition and fun, which is why sociologists say that gambling is an inherent part of society (Griffithsro & Delfabbro, 2001). Gambling venues provide a place that people can go out to socialise with others and meet new people. Recreational gambling is a fun and exciting activity and something to do with friends. When it comes to the elderly, their motivations behind gambling are much more social due to them being alone at home, out of the workforce, and thus having a greater need to go out to fulfil social needs (Southwell, Boreham & Laffan, 2008). Methods of gambling for this age group include poker machines, horse racing, and the ever popular game of bingo. As fun and rewarding it can be at the start, it does have the potential to become harmful if they start gambling beyond their means as a way of socialising, especially for the single, pension income individuals (Southwell et al., 2008). The study found that for the people who were experiencing reduced control, relieving negative emotional states was a motivating factor to gamble. Stress, depression and loneliness were the dominating factors for those who were losing control (Southwell et al, 2008).

As well as the older generation gambling for social reasons, adolescents find enjoyment in gambling as a way to socialise. Betting on sports such as the Super Bowl or horse racing in a tavern or pub, it is an exciting way to be competitive and get thrills from risk taking behaviour.

Addiction
People who become problem gamblers do so because they become addicted to the behaviour of gambling. After performing a literature review on 52 studies, Sussman & Sussman (2011) defined addiction as: performing the behaviour to fulfil a need, becoming preoccupied by the behaviour, losing control and suffering negative consequences as a result of the behaviour. To put it in perspective, someone who has become addicted to gambling would gamble because they need to, not for socialising or enjoying it. They would think about gambling often, such as when they could next gamble, and this could effect their family and/or work life. They would lose control of how much time they spend gambling, and how much money they've spent, and they would consequently suffer from poor general and mental health.

The occurrence of tolerance and withdrawal is another reason gambling disorder is classed as an addiction. Over time, there is a drive to increase the amount of gambling and/or money spent, while abstaining from the behaviour causes similar cravings as a drug addiction (el-Guebaly et al., 2012).

Diagnostic criterion of gambling disorder
Gambling disorder is in the DSM-5 as a substance-related disorder. The criterion for gambling disorder is:

"Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: Table 2, diagnostic criterion for gambling disorder in the DSM 5 (American Psychiatric Association, 2013). Rizeanu (2018) identified multiple signs of gambling harm including:


 * Debt and other financial difficulties
 * Relationship problems - family breakdown, social isolation
 * Problems at work
 * Mental health issues
 * Feeling ashamed and guilty about how much you're spending
 * Lying about what you're spending, or lying to get money to gamble
 * Trying to win back losses.

If someone is experiencing any of these signs and four or more of the criteria from the DSM-5, their gambling may be becoming problematic.

What can be done about gambling disorder?
As explained above, gambling disorder has extremely negative effects on not only the person doing the gambling, but there friends and family. The monetary losses, stress, withdrawal from normal daily activities and decline in social relationships all has the potential to cause grave harm. Therefore, it is important to find ways to combat the disorder. The treatment of gambling disorder is similar to other substance addictions, which involves the implementation of measures to manage the cravings (Rizeanu, 2018). The two most common treatments are cognitive behavioural therapy (CBT), and group counselling (such as gamblers anonymous).

Cognitive Behavioural Therapy
CBT is commonly suggested when treating gambling disorder. CBT is a form psychotherapy that focuses on challenging and changing distorted or irrational thoughts (Gooding & Tarrier, 2009). Because problem gamblers often have irrational beliefs about being able to predict a win or keep gambling to win all their money back, CBT challenges these beliefs and in turn changes the gambling behaviour (Rizeanu, 2018). CBT redirects problem gamblers beliefs from external to internal locus of control, it helps them overcome negative thoughts, and combats the side effects of depression (Clarke, 2004). It is important to build up a person's self-worth and their ability to influence events to reduce their gambling behaviours (Clarke, 2004).

CBT is intended to reduce and stop gambling behaviour by teaching the client skills they can continue to use, and also gives homework tasks to practice and reinforce the skills learnt in the session ( Okuda, Balán, Petry, Oquendo & Blanco,2009). Functional analysis is a component of CBT and requires the client to document the chain of thoughts, feeling and actions that lead them to gamble, which can then be used to identify triggers and worked through to reduce the risk of gambling (Okuda et al., 2009). Below is a case study showing CBT in action (as cited in Okuda et al., 2009) on a person with gambling disorder.

Case Study

Jane sought out counselling for her gambling addiction after she tried to stop herself but relapsed. The gambling was causing financial strain, social withdrawal and it was effecting her family. During treatment, the counsellor asked her to identify her triggers. They included her dreams about numbers, her financial difficulties, the sight of gambling advertisement and the convenience store she often bought her lottery tickets at. One identified, Jane and the counsellor explored each trigger and came up with ways to minimise them. For example, she stopped writing down the numbers she saw in her dreams and went to a different store. The counsellor also started keeping a graph of days she did and didn't gamble, so Jane could visualise her progress. The thing that helped Jane the most was functional analysis every time she got the urge to gamble. Jane began to feel less excited about gambling, and by changing the beliefs about her dreams telling her the winning numbers, she removed her biggest trigger. Jane learnt vital skills during her 10 sessions that she still uses to abstain from gambling.

CBT has the most evidence for the effective treatment of gambling disorder (Clarker, 2004; Okuda et al., 2009; Rizeanu, 2018).

Group Counselling
Group counselling offers clients multiple therapeutic benefits and is widely used to help addiction sufferers by providing emotional support and education, as well as the benefits from interacting with others in a similar situation (Coman, Evans & Burrows, 2002). Gamblers Anonymous (GA) is an exmaple of group counselling, and is the most popular method for gambling intervention (Petry, 2005). It started in Los Angeles in 1957, and now has meetings available in countries worldwide including Spain, Germany, UK, Japan and Brazil (Petry, 2005). It is based on a twelve-step program that was first developed by alcoholics anonymous, but is now used to help with many types of addictions (Petry, 2005). One difference that makes GA unique is that it also focuses on the financial difficulties many of the attendees are facing, and counsels people on those financial and legal challenges (Schuler, Ferentzy, Turner, Skinner, McIsaac, Ziegler & Matheson, 2016). Despite counsellors in treatment barely being involved, GA is an accessible option for people needing help as it is free of charge, and they say all you need to bring is "a desire to stop gambling" (Schuler et al., 2016). In a review by Schuler et al. (2016), they founded that people who attended GA meetings were more motivated to receive help, however had worse gambling symptoms. They also found that involvement in the program resulting in increased readiness for change, increases in coping skills and abstinence (Schuler et al., 2016). Overall, GA gives people a place to network and talk to other people in similar situations. It is important for people suffering from gambling disorder to feel like they're not alone, and have people to support them through the journey to recovery (Schuler et al., 2016).

Table 2. A summary of the twelve-step program by the American Psychological Association (as cited in VandenBos, 2007).

Conclusion
The prevalence of gambling continues to grow. While some people gamble as a way to have fun and socialise, the potential of becoming addicted to the behaviour is something of concern.The SDT helps to explain the motivation behind gambling, that if needs aren't met, people gamble for the wrong reasons (such as chasing losses) because a loss has a negative impact on their ego. There are also biological, behavioural and social reasons to explain why people continue to gambling. When someone's gambling becomes problematic, it could be classified as gambling disorder.

Gambling disorder causes the individual to become preoccupied by the behaviour, lose control and suffer negative consequences. While the impacts of gambling disorder can severely effect the individual, as well as their friends and family, there are proven ways to help. CBT has the most evidence towards conquering the disorder, by challenging the irrational beliefs that lead someone to gamble, such as gambling when you need money or thinking you know when something will win and betting on it. There is also evidence for group counselling helping those effected by gambling disorder, in the way of talking and being surrounded by people who are in the same situation. While gambling doesn't mean you will get addicted, it is vital that people gamble responsibly.

Quiz questions
{Which one of these is NOT a sign of problem gambling? - Spending more than you can afford + Getting excited over a win - Lying about how much you spend - Losing focus at work
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{The prevalence of gambling is higher per adult in + Australia - America - Singapore - Canada
 * type=""}