Bipolar Disorder Gambling Problem

Excessive gambling can drain finances, ruin personal and professional relationships, and harm the gambler's mental health. Gambling disorder affects about 1% of Americans who can't stop, despite the consequences. Gambling covers more than a trip to the casino or an illicit poker game – it includes lotteries, online poker, and sports betting, and there's a debate over whether it also includes daily fantasy sports leagues.

1. What Is Gambling Disorder
2. Bipolar Disorder And Gambling Addiction
3. Symptoms Of Gambling Disorder
4. Bipolar And Gambling Addiction

Yale Medicine is a leader in gambling disorder treatment research, with one of two Centers of Excellence in gambling research in the nation financed by the National Center for Responsible Gaming located at Yale. We take a multidisciplinary approach, including brain imaging, pharmacology, and genetics, to investigate the neurobiology and treatment of gambling disorder.

Risk factors for gambling disorder may include:

• Sex. Men are more likely to have gambling problems than women, but the disparity seems to have narrowed in recent years. Men appear more drawn to such strategic forms of gambling as card games or sports betting, while women tend to prefer such non-strategic forms as bingo or slot machines.
• Age. Two to 7% of youths develop a gambling disorder, compared with about 1% of adults, and many gambling disorders begin in adolescence. College students also gamble at higher rates than the general population.
• Family. People who have a parent with a gambling problem are more likely to have problems too. Yale research is working to understand the connection between genetics and gambling disorders. It's estimated that a gambling disorder's development is 50 percent due to genetic factors and 50 percent due to environmental factors.
• Other behavior or mood disorders. People with gambling disorder often abuse alcohol, tobacco, or other drugs, have mood or personality disorders such as schizophrenia or antisocial personality disorder, or have attention deficit hyperactivity disorder (ADHD). A 2008 study showed that people with psychiatric disorders are 17 times more likely to develop gambling problems.
• Personality traits. People who tend to be restless, easily bored, extremely hard-working, or very competitive may be at greater risk of developing gambling disorder.

Bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. Sometimes children with bipolar disorder feel very happy or 'up' and are much more energetic and active than usual. When viewing the signs of gambling, it is important also to consider the influence of bipolar disorder and mania. If your gambling only occurs during a period of mania, bipolar disorder is your concern, not gambling disorder. Accurately Assessing Your Gambling Habits. People with addictions commonly minimize their symptoms. Co-occurring mental illness or substance use disorders: Mayo Clinic notes that compulsive gambling is more common among people who have a co-occurring mental health diagnosis — such as depression, bipolar disorder, or anxiety — or a substance use disorder.

What's the difference between enjoying gambling and gambling disorder?

Most adults who gamble do not have a gambling disorder, but those who do can face very serious problems. An afflicted gambler may deplete savings, borrow money, or liquidate retirement accounts to finance their gambling, damage personal relationships (especially with a spouse and family), and have troubles at work. People with a gambling disorder often feel guilt or shame and may experience such withdrawal symptoms as restlessness and irritability when attempting to stop gambling.

Many people may take gambling lightly, not realizing that it may be addictive in many of the same ways as drugs are. Gambling problems can be very harmful to affected individuals and their families.

People who, over a 12-month period meet four of these nine criteria devised by the American Psychiatric Association, are considered to have a gambling disorder:

• Need to gamble with increasing amounts of money in order to achieve the desired excitement
• Are restless or irritable when attempting to cut down or stop gambling
• Have made repeated unsuccessful efforts to control, cut back, or stop gambling
• Are 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 gamble when feeling distressed (e.g. helpless, guilty, anxious, depressed)
• After losing money gambling, often return another day to get even ('chasing' one's losses)
• Lie to conceal the extent of involvement with gambling
• Have jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
• Rely on others to provide money to relieve desperate financial situations caused by gambling

What are the treatment options for gambling disorder?

There are three main forms of interventions:

• Psychotherapy. Individual and group approaches such as cognitive behavioral therapy, which helps to identify and modify damaging thinking and behavior, can help people overcome the problem. Another method is motivational interviewing, which helps to turn ambivalence about quitting into motivation to quit and can help patients combat urges to gamble.
• Medications. There are multiple potential pharmaceutical approaches to treatment, although no medication has an FDA indication for gambling disorder. Such opioid antagonists as naltrexone and nalmefene, which may reduce cravings for alcohol, have been found in randomized clinical trials to be superior to placebo in the treatment of gambling disorders. The antidepressant and antianxiety medication escitalopram may help decrease anxiety and problem-gambling severity in people with co-occurring anxiety and gambling disorders. The mood stabilizer lithium has been shown to reduce mania and problem-gambling severity in individuals with co-occurring bipolar-spectrum and gambling disorders. However, most medication trials have been relatively short-term and have involved small sample sizes.
• Support groups. Some people with gambling disorder find help with such groups as Gamblers Anonymous, a 12-step program dedicated to abstinence. Participants meet and share experiences, supporting each other in their efforts to abstain from gambling.

What makes Yale Medicine's gambling disorder research unique?

Yale's Center of Excellence in Gambling Research, one of two such centers in the nation, is supported by the National Center for Responsible Gaming and conducts groundbreaking research into gambling disorder.

The Center, directed by Yale Medicine psychiatrist Marc Potenza, MD, PhD, has conducted the first brain imaging studies on people with gambling problems. The functional imaging investigations, along with volumetric and neurochemical studies, have found that the brain acts similarly during monetary reward processing in individuals with gambling disorder as it does in people with binge-eating, alcohol-use and tobacco-use disorders. Yale Medicine research has made advances in understanding the effects of such opioid antagonist medications as naltrexone and nalmefene on gambling problems (including planning and participating in the largest multi-center, randomized clinical trial thus far to investigate pharmacotherapy for treating gambling disorder). The Yale Center has also investigated gender-related differences in gambling behaviors and disorders. Next for the Center is tracking the brain's activity during effective behavioral and pharmacological treatments.

Dr. Potenza is also director of the Problem Gambling Clinic, a collaboration between the Yale Department of Psychiatry and the Connecticut Mental Health Center, which treats patients and conducts research into gambling disorder. He is also a consulting psychiatrist for and medical director of the New Haven component of the Bettor Choice program operated through The Connection.

Gambling, for some people, is a leisure activity that offers a night out on the town enjoying time with friends and family, with a distant possibility of winning money. For other people, the stakes are higher. After all, gambling is a $40 billion dollar industry in the United States. In Las Vegas alone—the unofficial gambling capital of the world—the casinos bring in over 10 billion dollars from people placing bets. Though many of those people only gamble once in awhile, there are people who make gambling the center of their universe. In other words, they are addicted to gambling.

The temptations to gamble are everywhere and you don't need to be in a casino to try your luck. Every state in America, with the exception of Utah and Hawaii, offer some type of legalized gambling—from old-school slot machines to sports-betting apps and everything in between. The accessibility to gambling has only amplified with the Internet. Based on various surveys in recent years, it is estimated that two million people in the US are addicted to gambling. But that figure has the potential to increase at anytime, because those same surveys revealed as many as 20 million people noting that their gambling habit had begun to interfere with their work and social life. That type of behavior falls into the category of 'compulsive gambling,' which is the stage before gambling addiction.

What is Compulsive Gambling?

'The shortest version is that compulsive gambling is, as its name implies, a compulsion,' says Lance Dodes, MD, author of THE HEART OF ADDICTION: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors. 'Compulsive gambling leads to an addiction, which is a psychological symptom that is well-understood and treatable with psychotherapy oriented toward that understanding. It is not a biological, genetic or moral issue, and it is not fundamentally different from other compulsive behaviors or addictions.'

Worried you or a loved one may be suffering from a gambling addiction?

Take our 2-minute gambling addiction quiz to see if you may benefit from further diagnosis and treatment.

What Is Gambling Disorder

Usually, people start out gambling for fun, and then they lose money they didn't mean to, and they end up chasing that loss until all their money is gone. And in many cases, people are gambling because they have faced emotional and financial losses and they are trying to console themselves.

There is a misconception among many people that problem gambling, another term for gambling addiction, is not a big deal. 'Most people don't realize that problem gambling is a real disorder, just like alcohol or drug addiction,' says Shelia Moran, director of communications and marketing at First Choice Services, a nonprofit agency in West Virginia dedicated to mental health issues and problems. 'They think it's just a bad habit that can be easily ended. The good news is that we find most people who get treatment are able to successfully stop gambling.'

Gambling and Co-Existing Mental Health Conditions

Sadly, it is estimated that over 80% of people who suffer from some type of gambling addiction never seek treatment, no matter how bad their problem is. Other statistics reveal that while there are people who do seek treatment for their gambling addiction, over 70% end up returning to the world of betting. People with this type of disorder are more likely to suffer from other types of mental health and substance abuse issues. Many gamblers also have an alcohol disorder or addiction, and over half were nicotine dependent.

The emotional toll it takes on people is devastating, and in many cases a gambling addiction can also bring bouts of depression, and in extreme situations may lead to suicidal thoughts or tendencies. People with a gambling addiction are also prone to anxiety, high stress and extreme sadness. When a gambler loses everything, their life will suddenly become hopeless and they fear what the future might bring.

Gambling Addiction Symptoms and Signs

As with other addictions, there are warning signs to look out for. These include:

• Keeping gambling habits a secret
• Having trouble controlling their gambling habit
• Continuing to be involved with a gambling habit when they cannot financially afford to do so.
• Resorting to illegal activities to pay for their gambling habit

Physical symptoms of excessive gambling include problems sleeping, weight gain or loss, dark circles under the eyes and extreme headaches.

How can you tell if someone has a gambling disorder? The American Psychiatric Association has developed guidelines and says that a person requires at least four of the following issues to take place during the past year:

Bipolar Disorder And Gambling Addiction

1. A person feels the need to gamble with an increasing amount of money in order to achieve the desired excitement.
2. A person becomes angry, restless or irritable when someone tells them to cut back on their gambling, or to stop it altogether.
3. A person will have unsuccessfully tried to cut back or stop gambling on their own.
4. A person has frequent thoughts about gambling, including reliving past gambling adventures, planning their next gambling outing, and thinking of ways to get money to gamble with.
5. A person will often gamble when they are feeling distressed.
6. After a person loses money, they return to try and 'get even' (referred to as 'chasing' one's losses)
7. A person will not hesitate to lie to hide their gambling activity.
8. A person will jeopardize or lose a significant relationship, job or educational/career opportunity because of gambling.
9. A person will begin relying on others to help with money problems caused by their gambling habits.

Treatment Options for Gambling Addicts

If you suspect that someone in your life is addicted to gambling or a compulsive gambler, you should know that there is help. Here are treatment options to consider:

• 'Behavior therapy and cognitive behavior therapy are recommended for compulsive gamblers,' says Katie Hurley, LCSW. 'Behavioral therapy uses systematic exposure to the behavior to teach skills to reduce the urges, while cognitive behavioral therapy focuses on identifying unhealthy and irrational thoughts and replacing them with positive/adaptive ones. Family therapy is another option,' Hurley explains.
• Apps can help instill healthy habits and encourage consideration of events and emotions that lead to compulsive behaviors. Addiction AVERT app can help curb cravings. BreakFree can help people who use their smartphones to gamble spend less time on their phone.
• Adaptive coping strategies like exercise, deep breathing, progressive muscle relaxation, mindfulness, and meditation are all positive options. There are even meditation apps that can help anyone who doesn't know where to start.

Yale's Center of Excellence in Gambling Research, one of two such centers in the nation, is supported by the National Center for Responsible Gaming and conducts groundbreaking research into gambling disorder.

The Center, directed by Yale Medicine psychiatrist Marc Potenza, MD, PhD, has conducted the first brain imaging studies on people with gambling problems. The functional imaging investigations, along with volumetric and neurochemical studies, have found that the brain acts similarly during monetary reward processing in individuals with gambling disorder as it does in people with binge-eating, alcohol-use and tobacco-use disorders. Yale Medicine research has made advances in understanding the effects of such opioid antagonist medications as naltrexone and nalmefene on gambling problems (including planning and participating in the largest multi-center, randomized clinical trial thus far to investigate pharmacotherapy for treating gambling disorder). The Yale Center has also investigated gender-related differences in gambling behaviors and disorders. Next for the Center is tracking the brain's activity during effective behavioral and pharmacological treatments.

Dr. Potenza is also director of the Problem Gambling Clinic, a collaboration between the Yale Department of Psychiatry and the Connecticut Mental Health Center, which treats patients and conducts research into gambling disorder. He is also a consulting psychiatrist for and medical director of the New Haven component of the Bettor Choice program operated through The Connection.

Gambling, for some people, is a leisure activity that offers a night out on the town enjoying time with friends and family, with a distant possibility of winning money. For other people, the stakes are higher. After all, gambling is a $40 billion dollar industry in the United States. In Las Vegas alone—the unofficial gambling capital of the world—the casinos bring in over 10 billion dollars from people placing bets. Though many of those people only gamble once in awhile, there are people who make gambling the center of their universe. In other words, they are addicted to gambling.

The temptations to gamble are everywhere and you don't need to be in a casino to try your luck. Every state in America, with the exception of Utah and Hawaii, offer some type of legalized gambling—from old-school slot machines to sports-betting apps and everything in between. The accessibility to gambling has only amplified with the Internet. Based on various surveys in recent years, it is estimated that two million people in the US are addicted to gambling. But that figure has the potential to increase at anytime, because those same surveys revealed as many as 20 million people noting that their gambling habit had begun to interfere with their work and social life. That type of behavior falls into the category of 'compulsive gambling,' which is the stage before gambling addiction.

What is Compulsive Gambling?

'The shortest version is that compulsive gambling is, as its name implies, a compulsion,' says Lance Dodes, MD, author of THE HEART OF ADDICTION: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors. 'Compulsive gambling leads to an addiction, which is a psychological symptom that is well-understood and treatable with psychotherapy oriented toward that understanding. It is not a biological, genetic or moral issue, and it is not fundamentally different from other compulsive behaviors or addictions.'

Worried you or a loved one may be suffering from a gambling addiction?

Take our 2-minute gambling addiction quiz to see if you may benefit from further diagnosis and treatment.

What Is Gambling Disorder

Usually, people start out gambling for fun, and then they lose money they didn't mean to, and they end up chasing that loss until all their money is gone. And in many cases, people are gambling because they have faced emotional and financial losses and they are trying to console themselves.

There is a misconception among many people that problem gambling, another term for gambling addiction, is not a big deal. 'Most people don't realize that problem gambling is a real disorder, just like alcohol or drug addiction,' says Shelia Moran, director of communications and marketing at First Choice Services, a nonprofit agency in West Virginia dedicated to mental health issues and problems. 'They think it's just a bad habit that can be easily ended. The good news is that we find most people who get treatment are able to successfully stop gambling.'

Gambling and Co-Existing Mental Health Conditions

Sadly, it is estimated that over 80% of people who suffer from some type of gambling addiction never seek treatment, no matter how bad their problem is. Other statistics reveal that while there are people who do seek treatment for their gambling addiction, over 70% end up returning to the world of betting. People with this type of disorder are more likely to suffer from other types of mental health and substance abuse issues. Many gamblers also have an alcohol disorder or addiction, and over half were nicotine dependent.

The emotional toll it takes on people is devastating, and in many cases a gambling addiction can also bring bouts of depression, and in extreme situations may lead to suicidal thoughts or tendencies. People with a gambling addiction are also prone to anxiety, high stress and extreme sadness. When a gambler loses everything, their life will suddenly become hopeless and they fear what the future might bring.

Gambling Addiction Symptoms and Signs

As with other addictions, there are warning signs to look out for. These include:

• Keeping gambling habits a secret
• Having trouble controlling their gambling habit
• Continuing to be involved with a gambling habit when they cannot financially afford to do so.
• Resorting to illegal activities to pay for their gambling habit

Physical symptoms of excessive gambling include problems sleeping, weight gain or loss, dark circles under the eyes and extreme headaches.

How can you tell if someone has a gambling disorder? The American Psychiatric Association has developed guidelines and says that a person requires at least four of the following issues to take place during the past year:

Bipolar Disorder And Gambling Addiction

1. A person feels the need to gamble with an increasing amount of money in order to achieve the desired excitement.
2. A person becomes angry, restless or irritable when someone tells them to cut back on their gambling, or to stop it altogether.
3. A person will have unsuccessfully tried to cut back or stop gambling on their own.
4. A person has frequent thoughts about gambling, including reliving past gambling adventures, planning their next gambling outing, and thinking of ways to get money to gamble with.
5. A person will often gamble when they are feeling distressed.
6. After a person loses money, they return to try and 'get even' (referred to as 'chasing' one's losses)
7. A person will not hesitate to lie to hide their gambling activity.
8. A person will jeopardize or lose a significant relationship, job or educational/career opportunity because of gambling.
9. A person will begin relying on others to help with money problems caused by their gambling habits.

Treatment Options for Gambling Addicts

If you suspect that someone in your life is addicted to gambling or a compulsive gambler, you should know that there is help. Here are treatment options to consider:

• 'Behavior therapy and cognitive behavior therapy are recommended for compulsive gamblers,' says Katie Hurley, LCSW. 'Behavioral therapy uses systematic exposure to the behavior to teach skills to reduce the urges, while cognitive behavioral therapy focuses on identifying unhealthy and irrational thoughts and replacing them with positive/adaptive ones. Family therapy is another option,' Hurley explains.
• Apps can help instill healthy habits and encourage consideration of events and emotions that lead to compulsive behaviors. Addiction AVERT app can help curb cravings. BreakFree can help people who use their smartphones to gamble spend less time on their phone.
• Adaptive coping strategies like exercise, deep breathing, progressive muscle relaxation, mindfulness, and meditation are all positive options. There are even meditation apps that can help anyone who doesn't know where to start.

According to the American Psychiatric Association, as of 2016, there are no FDA-approved medications for the treatment of gambling disorder. There is, however, emerging scientific research that has shown that medications can be effective in reducing the intensity of urges and cravings for gambling.

Symptoms Of Gambling Disorder

Finally, Gamblers Anonymous has been beneficial in the lives of people who have an addiction; however, they must first admit they have a problem, which is often times the most difficult thing to do. If someone is unable to find an accessible chapter of Gamblers Anonymous, Alcoholics Anonymous addresses many of the same behaviors.

Just as anyone can become addicted to gambling, anyone can stop.

Bipolar And Gambling Addiction

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