Pathological Gambling Substance Dependence And Other Comorbid Disorders

While pathological gambling is classified as an impulse disorder, it is increasingly viewed as part of the family of addictions. In fact, the criteria for pathological gambling in DSM III-R were modeled after the criteria for psychoactive substance dependence in DSM III-R. The DSM IV criteria for problem gambling blend DSM III and DSM III-R criteria. There is increasing clinical research evidence for sequential and simultaneous dual addictions involving gambling and substances e.g., alcohol, cocaine, tobacco (Lesieur & Blume, 1996). Brain chemistry research and preliminary genetic research have both pointed to biochemical and etio-logical commonalities for pathological gambling and substance dependence. While not as extensively researched, relationships have also been found between pathological gambling and food, sex, and work addictions. Co-morbidity has also been found between pathological gambling and other psychiatric disorders, including clinical depression and other mood disorders, anxiety, attention deficit hyperactivity disorder (ADHD), and personality disorders (Blaszczynski & Steel, 1998; Carlton, et al., 1987; McCormick, et al., 1984).

A theory is developing which places pathological gambling in a compulsive-impulsive spectrum with problem gambling as one of the impulse (ego syntonic) disorders at one end of the spectrum and obsessive-compulsive disorders (ego dystonic) at the other end (Cartwright, et al., 1998). Different degrees of impulsivity and compulsivity are experienced by pathological gamblers, depending upon the stage of the development of the disorder with impulsivity primarily at the early stage and growing compulsion at the later stage.

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