(For additional details, please see Psychiatric Times October 2001-Ed.) The protocol involved the exposure of healthy controls and cocaine-dependent subjects to three different types of videotaped scenarios (cocaine-related, happy and sad) during brain imaging tests. Wexler and colleagues (2001) recently conducted a functional magnetic resonance imaging-based study of cocaine cravings in individuals with cocaine dependence. A craving or appetitive urge state is also common to both drug dependence and pathological gambling. In order to gain a better understanding of the etiology and pathophysiology of pathological gambling and its relationship to drug dependence, rigorous study needs to be applied to pathological gambling as it has been to drug dependence.Ĭraving represents a highly clinically relevant internal state as it often immediately precedes engagement in a self-destructive addictive behavior and is consequently a target of both behavioral and pharmacological treatments. (For additional details, please see Psychiatric Times October 2001-Ed.) Given these similarities, it has been proposed that pathological gambling may be conceptualized as an addiction without the drug. Pathological gambling and substance dependence share many features, including similarities in diagnostic features, clinical courses and high rates of comorbidity. As such, there exists a need for increased efforts in prevention, treatment and research in order to advance current clinical practice. Together, these data suggest that pathological gambling is as or is more common than several other major psychiatric disorders (e.g., schizophrenia or bipolar disorder) and represents a significant cost to society. For example, when the cost related to the elevated rates of divorce as a result of problem gambling were calculated, only the resulting legal fees were used to represent the costs incurred and the often devastating effects on family members were not taken into consideration (NGISC, 1999). However, this figure is likely an underestimate of the true expense due to costs that are difficult to eliminate and thus often go unaccounted. The annual cost to society attributable to problem and pathological gambling in the United States has been estimated at $5 billion annually (NGISC, 1999). The study data also suggest that the rates of problem gambling and pathological gambling have risen in conjunction with the increased availability of legalized gambling. An additional 2.80% and 3.85% were estimated to have experienced problem gambling over the past-year or lifetime, respectively. Results from a meta-analysis of studies performed over the past several decades in North America yielded past year and lifetime prevalence rate estimates for pathological gambling of 1.14% and 1.60%, respectively (Shaffer et al., 1999). Prevalence RatesAlthough most people have gambled, only a relatively small proportion develops problems with gambling (Potenza et al., 2001). ![]() ![]() With the introduction and expansion of newer types of gambling (e.g., Internet and video gambling) the landscape is likely to change further. As compared with 25 years ago, today more people report having gambled at some point in their lives: 86% of the general adult population in 1998 as compared with 68% in 1975 (NGISC, 1999, as cited in Potenza et al., 2001). State-run lotteries were reintroduced in 1964, and legal changes, such as those encompassed in the Indian Gaming Regulatory Act of 1988, have resulted in gambling becoming a big business, grossing an estimated $50 billion annually. Over the past several decades, there has been a rapid proliferation of legalized gambling across the United States, creating a markedly different environment from only a generation ago (National Gambling Impact Study Commission, 1999). It is a human behavior that has persisted for millennia some of humanity's earliest historical accounts document gambling as a practice of ancient civilizations (France, 1902 Potenza and Charney, 2001). By definition, gambling is the process of placing something of value (usually money) at risk in the hopes of gaining something of greater value (Potenza et al., 2001).
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