The treatment of pathological gambling

All potentially addictive behaviors begin to be controlled by positive reinforcement (the pleasant aspect of the behavior itself), but end up being controlled by negative reinforcers (alleviating discomfort). Appears in the subject a strong psychological dependence to such conduct, acts impulsively forward, loses interest in any other previous rewarding activity, despite the negative consequences experienced, can not be controlled.

A habit so bad for the person as a gambling addiction is perpetuated, among other reasons, depending on the various cognitive distortions that keep the affected: the denial or minimization of the problem, the illusion of control (perception that the game depends on ability), the selective memories of the profits in the game and forgetting the bitter moments suffered, and the underestimation of losses. Also, just as with substance drugs have a remarkable ability to increase dopamine neurotransmitter levels so does the coupling to a slot machine. The subject, once addicted to a substance or behavior, become accustomed to high concentrations of dopamine.

Why a pathological gambler is playing? On the one hand the person you expect to make money and, therefore, we will respect and appreciate more. On the other hand, tries to compensate for the discomfort endured throughout the day as a result of work, relationship with people, etc.. Also, time begins to associate colors and sounds to the pleasurable sensations that gives the game and whenever he sees or hears some of these stimuli, comes the desire to play. In addition, any acquired habit has an inherent power to continue over time. It also appears the idea that the problem has no solution. Finally, failures in attempts to leave the game originate keep playing.

Given the motivation, activation of memory, experiences, patterns of action and structure of an addictive gambler, the solution of the problem is not easy. In turn, since exposure to the game is continuous and is now quite feasible (due to the Internet) is advisable intervention at the earliest signs of pathological gambling. Finally, problem gamblers often deny they have a problem and, therefore, treatment begins with the recognition of this problem by the affected.

The treatment of pathological gambling is determined by certain drugs, support groups and cognitive behavioral therapy. The drugs used in gambling are paroxetine, lithium and malmefeno. Among the highlights support groups Gamblers Anonymous 12-step program similar to Alcoholics Anonymous and its emphasis on self-help approach. Within the context of cognitive behavioral therapy and Spain, one of the effective treatments of pathological gambling is conducted by the Hospital de Bellvitge. Three out of four gamblers overcome their addiction. The main actions of its protocol of intervention are getting the patient to admit your problem, try the final withdrawal, a change of lifestyle and family aware that the patient is not responsible for their disorder, but the confluence of factors genetic predisposition of personality and social.

Also in cognitive behavioral therapy, courses of action in pathological gambling Echeburúa Henry postulates are: a) control of stimuli associated with addiction, b) prolonged exposure to the elements arising from greed or craving for the addictive behavior, c) resolution of specific problems, d) creation of a new lifestyle, and e) relapse prevention.

The stimulus control refers to the avoidance of stimuli associated with the uncontrolled behavior. The gambling is exercising control over the money (eg, pooling the savings account), bypass circuits of risk (the tendency of individuals to play in the same places), avoid relationships with friends players and, where necessary, resort to self-banning the entry into bingo and casinos, as well as planning to return to their debts. The total recovery (objective and subjective), ie the disappearance of the hunger for inappropriate behavior only occurs when the subject is exposed to the risk signs of a gradual and regular, and is able to resist them without taking behaviors of escape. For example, a former player can walk into a bar with a friend, order a coffee, being in the presence of a slot machine and hold internal unrest without playing and without leaving the bar until the discomfort has decreased considerably.

Another objective is to teach the therapeutic subject to up to deal with the difficulties of daily life without resorting to addictive behavior as a solution. To control the urge to re-engage in addictive behavior are appropriate cognitive distraction techniques, among which attentional orientation nonthreatening external events, occupation of the mind in an absorbing activity and physical exercise. Moreover, to control anxiety (tension, restlessness and nervousness) are useful control of breathing and relaxation. Finally, because a sad mood can lead to relapse in addiction is necessary to control depression. So, sometimes negative events of daily life can lead a person to a depressed mood. But the important thing is that there are negative events themselves that cause sadness, but what we think about them (automatic thoughts). And what comes in these circumstances is to change these automatic thoughts and replace them with rational thoughts. Also, as an additional problem in the addict is often the existence of a poor repertoire of behaviors, feelings of boredom and / or loneliness, the solution is distracted, playing some enjoyable activity and chat with other people.

Finally, the risk of a hard living is higher in people who are addicted and in this sense, consistency is necessary to instil confidence in those who may have a negative bias on the patient.

Furthermore, as is common when the patient has left the addictive behavior not know how to fill free time and you might have thoughts or feelings of guilt naysayers for life, pay attention to the overall lifestyle of the subject. In this sense, we must restore balance to the patient through the dedication of a certain time every day to the practice of rewarding activities and create some new habits of the previous substitute. Only a stable life change ensures the maintenance of long-term abstinence. A lifestyle is a satisfactory balance between obligations and desires.

Relapses are common in all addictions and all the patterns they follow a similar temporal process: about two thirds of all of them occur in the first three months after termination of treatment. If a person stays away from addiction for an extended period (1 or 2 years), the probability of relapse decreases significantly. As more temporary control of behavior and which is able to cope successfully with the various situations presented in everyday life, the subject experiences a sense of control, which increases the expectation of success in the future. As with other addictions, episodes of relapse in pathological gambling are often associated with negative emotional states, interpersonal conflict and social pressure. We must distinguish fall and relapse. Fall is an uncontrolled isolated episode, a mistake, a slip, while relapse is a return to uncontrolled behavior before treatment. It usually passes quickly fall in relapse due to the implementation of a cognitive process known effect of abstinence violation. Intervention strategies for relapse are the identification of high risk situations, coping responses to problematic situations, changing expectations about the consequences of involvement in addictive behavior and reviewing the patient's lifestyle.

Since most of the pathological gamblers are slot machines, we mention them. If the gamblers, among other things, they realize the true meaning of slot machines (ie machines that swallow bitches with no possibility of recovering a), if internalized absolutely have no control over them because the awards are set randomly and if instead of remembering their lights and sounds you remember what that is loaded with coins administrator after raising them can leave the game on them. But if this is not enough and decide to carry out a treatment with a professional psychologist, then the problem is solved.



Dr.? Angel Retuerto

Psychologist www.psicologoadistancia.com