Compulsive gambling

Compulsive gambling is an urge or addiction to gamble despite harmful negative consequences or a desire to stop. A preferred term among many professionals is problem gambling, as few people described by the term experience true compulsions in the clinical sense of the word. Problem gambling often is defined by whether harm is experienced by the gambler or others rather than by the gambler's behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria.

Pathological gambling
Extreme cases of problem gambling may cross over into the realm of mental disorders. Pathological gambling was recognized as a psychiatric disorder in the DSM-III, but the criteria were significantly reworked based on large-scale studies and statistical methods for the DSM-IV. Pathological gambling is now defined as persistent and recurrent maladaptive gambling behavior meeting at least five of the following criteria, as long as these behaviors are not better explained by a manic episode:


 * 1) Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.
 * 2) Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same "rush."
 * 3) Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.
 * 4) Escape. Subject gambles to improve mood or escape problems.
 * 5) Chasing. Subject attempts to win back gambling losses with more gambling.
 * 6) Lying. Subject attempts to hide the extent of his or her gambling by lying to family, friends, or therapists.
 * 7) Loss of control. Subject has unsuccessfully attempted to reduce gambling.
 * 8) Illegal acts. Subject has broken the law in order to obtain gambling money or recover gambling losses.
 * 9) Risked significant relationship. The subject gambles despite risking or losing a relationship, job, or other significant opportunity.
 * 10) Bailout. Subject turns to family, friends, or another third party for financial assistance as a result of gambling.

As with many disorders, the DSM-IV definition of pathological gambling is widely accepted and used as a basis for research and clinical practice internationally.

Incidence
According to the National Council on Problem Gambling, incidence of problem gambling is 2-3% and pathological gambling is 1% in the United States, though this may vary by country. By contrast, 86% of Americans have gambled in their lives and 60% gamble in a given year.

Available research seems to indicate that problem gambling is an internal tendency, and that problem gamblers will tend to risk money on whatever game is available&mdash;as opposed to the availability of a particular game inducing problem gambling in otherwise "normal" individuals. However research also indicates that problem gamblers tend to risk money on fast-paced games. Thus a problem gambler is much more likely to lose a lot of money on poker or slot machines, where rounds end quickly and there is a constant temptation to play again or increase bets, as opposed to a state lottery where the gambler must wait until the next drawing to see results.

Dopamine agonists, in particular pramipexole (Mirapex), have been shown to cause compulsive gambling (PMID 16009751).