During the COVID-19 pandemic, many people have shifted from offline gambling to online gambling [1]. Although most people regard gambling as a mere pastime and will not be seriously negatively affected, the epidemic has led to an increase in the number of gambling addicts. In the UK, for example, the number of women struggling with gambling problems seeking help has seen the largest ever increase [2]. Gambling addiction can lead to mental health, cognitive and interpersonal problems, and more seriously, bankruptcy and crime.
Unlike alcohol and drug addiction, the physical symptoms and physiological manifestations of gambling addiction are not obvious. Our new article, published in The Lancet Psychiatry, reviews relevant research on gambling addiction [3] and makes recommendations on how best to prevent and treat gambling addiction.
Gambling problems have a huge impact. According to the latest estimates from the World Health Organization, global players have lost a total of $400 billion (£295 billion) a year since 2016. In 2021, the UK Gambling Commission estimates that the prevalence of "gambling disorders" accounts for 0.4% of the total population [5].
Another survey found that Problem Gambling had the highest rates in Asia,[6] followed by Oceania and North America, with lower rates of problem gambling in Europe.
- Marco Goran Romano -
Researchers developed simulation games (which they call "tests") to measure problem gambling,[7] such as the Iowa Gambling Task and the CANTAB Cambridge Gambling Task. The Cambridge Gambling Test is used to assess risk decision-making behavior and gambling behavior. In the test, participants were asked to guess whether a yellow token was hidden in a blue or red box, and the ratio of blue and red boxes changed over time. After that, they can decide how many points to bet.
If they win, those points are added to the total, but if they lose, they lose those points. Participants were told to avoid "bankruptcy" – losing all their points. This test may help identify gamblers who are at risk[9] but have not yet developed a gambling disorder, particularly those who show signs of impulsivity [10].
The findings found that gambling behavior is most common in healthy people ages 17 to 27 and declines with age [11]. Another study showed that gamblers with addiction problems tend to increase their stakes over time and eventually lead to bankruptcy. Alcohol and nicotine dependence are also closely linked to gambling problems .[13]
- Guga Abramishvili -
The brain of a gambler
Several important areas of the brain are closely associated with risk decision-making[14] as can be seen from neuroimaging studies—including the medial prefrontal cortex (involved in decision-making, memory, and mood regulation); the orbitofrontal cortex (which helps the body respond to emotions); and the insular lobe (which helps regulate the autonomic nervous system). Therefore, the activity of these brain regions in people who are addicted to gambling may be increased.
As gamblers watched the results of their bets, the activity of their brain reward system, including the caudate nucleus, also increased [15-16]. This is especially evident in people who are addicted to gambling.
Dopamine is a neurotransmitter that helps nerve cells communicate and is an important chemical in the brain's reward system. One study found that problem gamblers had significantly higher levels of excitement when the brain released dopamine compared to healthy people. The release of dopamine appears to reinforce problem gambling behaviors by raising excitability levels, reducing inhibitions of risky decisions, or a combination of the two.
In addition, the accumbens play an important role in the processing of rewards, and it has been shown to be associated with high-risk behaviors in adolescents and adults [18]. There is a high concentration of dopamine in this area, indicating a further role of dopamine in high-risk behaviors.
-Andrew Murray -
Dealing with gambling addiction
Currently, gambling disorders are diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Society. Guidelines for the treatment and management of gambling disorders from the National Institute for Health and Care Excellence are also being developed and are expected to be published in 2024.
Current treatment options for gambling disorders include certain forms of cognitive behavioral therapy [19] (which can help people change their mindset) and self-help groups. Some medications, such as selective serotonin reuptake inhibitors (SSRIs), may be effective in reducing some of the symptoms of gambling disorders,[20] such as depressive symptoms.
We also know that opioid receptors in the brain help it process rewards, so it has long been suspected to be a driver of addiction [21]. Some evidence suggests that a drug called naltrexone [22] blocks opioid receptors and may help people with gambling disorders [23]. But more research is needed before this becomes the standard of care.
People can also do things on their own to control their gambling behavior. The NHS Live Well website[21] provides information on services to problem gamblers. The site also offers advice on how to pay bills before gambling, spend time with friends and family who don't gamble, and how to deal with debt issues. Gamblers should also avoid seeing gambling as a way to make money, not hiding concerns about gambling habits, and avoid using credit cards to pay for the costs of gambling.
As with all mental health issues, the key to addressing gambling disorders is to get early support and treatment. This is especially important because it keeps normal rewards — such as spending time with your family, or enjoying walks and exercise — enjoyable and prevents the human brain's reward system from being controlled by gambling.
bibliography
1.https://www.intergameonline.com/casino/news/lockdown-shift-to-online-gambling-says-british-gambling-commission
2.https://www.independent.co.uk/news/uk/home-news/gambling-harm-women-pandemic-b2003051.html
3.Bowden-Jones, Henrietta, et al. "Gambling disorder in the UK: key research priorities and the urgent need for independent research funding." The Lancet Psychiatry (2022).
4.https://www.who.int/docs/default-source/substance-use/the-epidemiology-and-impact-of-gambling-disorder-and-other-gambling-relate-harm.pdf?sfvrsn=5901c849_2
5.https://www.gamblingcommission.gov.uk/statistics-and-research/publication/statistics-on-participation-and-problem-gambling-for-the-year-to-june-2021#:%7E:text=The%20overall%20problem%20gambling%20rate,in%20year%20to%20June%202020.
6.https://www.who.int/docs/default-source/substance-use/the-epidemiology-and-impact-of-gambling-disorder-and-other-gambling-relate-harm.pdf?sfvrsn=5901c849_2
7.http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.407.9471&rep=rep1&type=pdf
8.https://www.cambridgecognition.com/cantab/cognitive-tests/executive-function/cambridge-gambling-task-cgt/
9.https://www.sciencedirect.com/science/article/abs/pii/S0165178111004318?via%3Dihub
10.https://www.nature.com/articles/s41386-019-0393-9
11.https://pubmed.ncbi.nlm.nih.gov/15327737/
12.https://onlinelibrary.wiley.com/doi/full/10.1111/j.1360-0443.2009.02533.x
13.https://onlinelibrary.wiley.com/doi/pdf/10.1002/brb3.231
14.https://pubmed.ncbi.nlm.nih.gov/18390562/
15.https://pubmed.ncbi.nlm.nih.gov/30142396/
16.https://neuroscientificallychallenged.com/posts/know-your-brain-caudate-nucleus
17.https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03126.x
18.https://www.nature.com/articles/s41386-022-01273-w
19.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008937.pub2/pdf/full
20.https://www.mayoclinic.org/diseases-conditions/compulsive-gambling/diagnosis-treatment/drc-20355184
21.https://www.nature.com/articles/s41583-018-0028-x
22.https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naltrexone
23.https://www.psychiatrist.com/jcp/ocd/pathological-gambling/double-blind-placebo-controlled-study-opiate-antagonist/
24.https://www.nhs.uk/live-well/addiction-support/gambling-addiction/
作者：Barbara Jacquelyn Sahakian、Christelle Langley、Henrietta Bowden-Jones、Sam Chamberlain
Translator: Andie
Proofreader: Wang Boxiao
Cover: Fran ois Cauderlier
Edit: Pheasant
Typography: Yo yo yo yo
Original: https://theconversation.com/gambling-what-happens-in-the-brain-when-we-get-hooked-and-how-to-regain-control-176901