6b.BPSF+Addictive+Disorder

=Unit 4.=

Dot Point 6b.
 • //application of a biopsychosocial framework to understanding ONE of the following types of mental disorder and its management://  ** Option 2 - Addictive Disorder: Gambling ** ** Main Characteristics of Addictive Disorder: Gambling ** Gambling Addiction, also known as compulsive or pathological gambling is classified by the DSM-IV-TR as a type of impulse control disorder. ** Symptoms / Diagnosis ** ** – Biological contributing factors: ** ** Behavioural Disinhibition: ** Where an individual is unable to restrain themselves from acting on their impulses. Imbalances of the brain chemicals Serotonin, Noradrenaline and Dopamine have been found in pathological gamblers: ** Serotonin: ** a monoamine neurotransmitter in the Central Nervous System. It has been implicated in a wide variety of biological functions including sleep, appetite, sex, aggression and mood. ** Noradrenaline: ** The neurotransmitter that mediates physiological symptoms of anxiety and fear. Pathological gamblers have been found to have reduced levels of noradrenaline. ** Dopamine: ** The brain chemical commonly associated with the reward seeking system of the brain, providing feeling of pleasure and reinforcement to motivate a person to perform certain activities. ** Role of the Dopamine Reward System and as a Target for Treatment ** ** As a target for Treatment: **  Naltrexone has been used as an antagonist inhibiting the neurotransmitter dopamine at the synapse.  It does not cause physical dependence and can be stopped without withdrawal symptoms at any time. It is also used to treat alcohol dependency and addiction to heroin.  A study conducted by Kim and Grant (2001) showed naltrexone to be very effective in treating participants gambling addiction.  Limitation is side effects that naltrexone causes, which is predominately nausea but also can have toxic effects on the liver.
 * Chronic and progressive failure to resist impulses to gamble – it becomes uncontrollable the gambler starts to ‘chase losses’ and becomes irritable when forcibly stopped.
 * Gambling behaviour that compromises or disrupts the gambler’s life: it disrupts family, work or social functioning.
 * Tolerance to gambling emerges, ie increasing amounts of time and money are required to be gambled to experience pleasure
 * Gambling dominates their thoughts and drives their behaviour – even when they know their gambling has serious consequences for themselves and their loved ones.
 * Deficiencies of serotonin have been linked to compulsive behaviour – including gambling.
 * It is released when one is under stress, arousal, or thrill associated with risk-taking, pathological gamblers gamble to make up for under-dosage of the hormone.
 * When dopamine is released in the brain it creates a feeling of enjoyment or satisfaction.
 * These feelings are desired and the person will repeat behaviours that cause the release of dopamine to satisfy that desire.
 * This ‘desire’ can lead to addiction.

** – Psychological contributing factors: social learning theory and schedules of reinforcement; ** ** Social Learning Theory: ** Defines gambling as being on a continuum and that gambling is due to interactions between social and environmental and individual internal factors. Brown (1988) proposes the following elements in continuation or escalation of gambling: ** Schedules of Reinforcement ** This is because the gambler thinks that each response brings them closer to a response that will be reinforced however this is false belief when the RR schedule is used ** The use of psychotherapies in treatment including cognitive behavioural and psychodynamic ** ** therapies ** ** Cognitive Behavioural Therapy ** ** Psychodynamic Therapy: ** ** Treatment ** ** Limitation ** of this approach is it is hard to scientifically examine the unconscious and obtain empirical data ** – Socio-cultural contributing factors: social permission of gambling opportunities; management including social network and recovery groups ** ** Social Permission of Gambling Opportunities: ** ** Management of Pathological Gambling – Support Networks and Recovery Groups ** ** Support Networks ** Gamblers are more likely to abstain from gambling when they associate with individuals who support their abstinence ** Recovery Groups ** GA is more likely to be effective when used in combination with psychological therapy.
 * Friends or peers are the most common sources of introducing one to gambling
 * Expectancy and Reinforcement become critical in the development of the pathological behaviour.
 * A large early win has been shown as an indicator of people who become problem gamblers.
 * The reinforcement of gambling behaviour
 * Arousal is regulated
 * There is relief from anxiety/depressive symptoms
 * Internal fantasies and cognitive distortions exist
 * Social approval is present
 * It is commonly known that a variable schedule of reinforcement promotes a steady response rate over a longer period of time and is much more resistant to extinction in comparison to a fixed schedule
 * Gambling and in particular poker machines are often described as using a variable ratio reinforcement (VR) schedule however they actually use a schedul known as random ratio (RR) (Haw, 2008)
 * If you had a variable ratio of 20 (VR20) that would mean that although unpredictable over a large number of correct responses say 100 would equal 20 payouts
 * This is not truly random as there is an upper limit on the maximum number of responses given before reinforcement occurs
 * In contrast in a random ratio schedule there is no predetermined upper limit before reinforcement is given
 * Each spin is completely independent of the next and it may take 100 0r 1 000 000 responses before the RR20 is achieved
 * A RR schedule of reinforcement leads the gambler to respond at high rates for relatively little reinforcement, and to persist in long periods of responding even when no payout is forthcoming
 * CBT treatment aims to assist the individual to examine their thought processes and examine other alternatives when looking at their situation
 * Many gambling addicts have cognitive distortions with two of the most common being illusions of control and gambler’s fallacy
 * ** Illusions of control ** occurs when the gambler thinks they can beat the odds using their knowledge or skills
 * The gambler would attribute wins due to their personal actions and losses to factors outside their control
 * By using this thought process the gambler will be able to maintain their false belief that their gambling strategies are effective
 * ** Gambler’s fallacy ** refers to the belief that future events can be predicted by past events in a series of independent chance events
 * This is evident in coin tosses or ‘hot streaks’
 * Most people with gambling problems are unaware that they have cognitive distortions
 * The first step of the cognitive component when using CBT is to obtain information of the individuals gambling patterns and distortions. This may involve role plays, diaries or simulations
 * The next step involves educating the person to develop an awareness of concepts such as probability, random and chance events
 * An important aspect of the cognitive component of CBT is to encourage the individual to directly challenge and correct their distorted thoughts and provide problem solving strategies to gain control over their impulses
 * The behavioural component of CBT assists the individual to manage the arousal, anxiety or tension that is associated with the urges to gamble
 * A common method of achieving this is using **imaginal desensitisation**. In this technique the gambler is asked to imagine being in a typical gambling situation while in a state of relaxation
 * The goal being to extinguish the arousal and gambling and replace it with relaxation
 * Psychodynamic psychotherapy is based on the theories proposed by Freud and was widely used in treating people with problem gambling prior to the development of CBT
 * It is a type of psychological treatment that aims to help people understand the roots of emotional distress by exploring unconscious conflicts, motives, needs and defences
 * Based on Freud’s theory that all mental disorders are caused by unresolved psychological conflicts that occur in the unconscious with their origins being in early childhood
 * The aim of this treatment is to help people to understand the cause of the emotional distress which for problem gambling revolves around the Oedipal complex (Freud, 1928)
 * When using the psychodynamic approach the therapist will try to achieve abstinence from gambling which can be a lengthy process thus it is important that the client is an active participant
 * When treating problem gambling therapists use a range of techniques such as free association, dream interpretation, identification of defence mechanisms and displays of transference
 * ** Free association ** is when the client is encouraged to say whatever comes to their minds in order to identify the themes involved in their gambling
 * ** Dream interpretation ** involves clients sharing their dreams as the psychodynamic perspective has the belief that dreams symbolically represent information stored in the unconscious mind
 * __ Identification of defence mechanisms __ is essential for treatment to work as it prevents the unconscious conflicts from being explored and resolved. Denial and omnipotence are two common defence mechanisms that gamblers use
 * ** Denial ** is the refusal to believe whatever it is that may be causing ones anxiety or emotional conflict; omnipotence refers to the feeling of being ‘all powerful’ and is a direct defence against feelings of inadequacy and helplessness
 * ** Transference ** provides a valuable source of information by the client unconsciously responding to the therapist as though they are a significant person in their life
 * Gambling is regarded by many Australians as part of their cultural heritage. Around in three in four Australians gamble at some time in the year
 * There is the Melbourne Cup, two-up during Anzac day and constant advertising that provides and reinforces a positive image of gambling in our society
 * Research indicates that when there is a perception that gambling is socially acceptable younger people are more likely to try gambling and less likely to associate negative consequences with it (Australian Psychological Society, 1997)
 * Social psychologists have defined a social network in terms of the social structure that maps out the relationships between individuals
 * These relationships usually have some kind of significance or importance to the individual – immediate family, friends, colleagues
 * Another characteristic of the social network is that people within the network may also have some kind of connection with each other, as well as the individual
 * ** The main benefit of a social network ** is that it gives access to social support – help or assistance from other people during a recovery process, this can take different forms
 * Appraisal support – such as having access to someone with whom to talk and obtain feedback from
 * Tangible assistance – such as help with a bill payment or a meal
 * Information support – such as providing the website of a social network or a recovery group in the community
 * Emotional support – such as help in coping with problems experienced
 * ** A limitation of social networks ** is that the network of someone with a gambling problem usually includes others with a gambling problem.
 * This seems to be especially true for females who have gambling problems with poker machines
 * This continued association with other problem gamblers may cause the cues that promote or initiate gambling to re-emerge
 * A recovery group or support group is a not for profit group run by and for people who interact on the basis of common interests or experiences to support one another
 * One of the best known recovery groups for people experiencing problem gambling is Gamblers Anonymous (GA)
 * GA is based on the principles of peer support and the power of relating to people whose gambling has left them with feelings of emptiness, isolation, guilt and shame
 * GA sessions run for 90 minutes, there are no fees with the only requirement for membership being a desire to stop gambling
 * The initial process in recovery for the problem gambler is admitting they are powerless in controlling their gambling and surrendering to a ‘higher power’
 * Another key feature of GA is having a sponsor who is a former problem gambler who has remained abstinent and can provide support and guidance through the recovery process
 * GA although social in its structure does use some psychological theories such as:
 * Positive reinforcement when the gambler is given rewards from not gambling for a period of time
 * Behavioural techniques that provide different social activities other then gambling
 * Cognitive approaches encourage problem gamblers to take one day at a time thus decisions are more likely to be rational and self-controlling (Grant, 2007)
 * Some of the **limitations** of GA is that:
 * It believes that abstinence is the only solution for problem gambling. There has been empirical research to show a reduced and responsible gambling behaviour for some people can be a realistic goal

** – The Interaction between biological, psychological and socio-cultural factors which contribute to an understanding of the disorder and its management ** A biopsychosocial framework is the best approach to understanding and treating pathological gambling as no one approach is able to fully consider all possible factors. Resources: