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New Understanding, New Definition

Redefining gambling disorders sparks debate, speculation among experts

In February, the American Psychiatric Society made headlines when it announced proposed changes to its encyclopedia of mental illness, the Diagnostic and Statistical Manual of Mental Disorders, or DSM.

The DSM-arguably one of a clinician’s most important tools-dictates the diagnosis and treatment of thousands of mental illnesses, from adjustment disorders to sleep disorders. Changes to the manual influence not only the field of psychiatry, but also have profound implications for the academic, pharmaceutical and legal communities.

But how do changes to the DSM affect our industry? Essentially, the proposed revisions include adjustments to the way pathological gambling is labeled, classified and diagnosed.

Most lay people consider pathological gambling to be an addiction-one that is characterized by compulsive or out-of-control behavior. However, the clinical definition of pathological gambling is far more nuanced.

Among the most important proposed adjustments to the definition is a change in nomenclature. In the DSM-V, the term “pathological gambling” would be replaced with “disordered gambling,” a less pejorative label that is more consistent with how other mental illnesses are listed in the manual.

Also, once considered an impulse-control disorder, the condition would be moved to a new classification, Addiction and Related Disorders, along with drug and alcohol addiction, among others. The new classification would include a separate category called “Behavioral Addictions.” Because it is a substance-less addiction, disordered gambling would be the sole condition within that category.

Disordered gambling was first recognized in the DSM-III, which was published in 1980. Unfortunately, the initial diagnostic code for the condition primarily was based on the observations and experiences of a few psychiatrists, rather than on empirical research. The definition included in the subsequent edition, DSM-IV, was an improvement upon the original version, though many researchers and clinicians still consider it to be flawed.

Specifically, many have long questioned the DSM-IV classification of disordered gambling as an impulse-control disorder, a label that does not seem to fit. For example, individuals with traditional impulse-control disorders-such as kleptomania or pyromania-do not gain pleasure from the activity in question. Rather, they are overwhelmed by an impulse to act and feel a sense of relief after doing so. This is not the case with disordered gamblers, who enjoy gambling and typically experience distress only afterwards.

And contrary to the DSM-IV definition, disordered gambling is not typically a “persistent and recurrent” condition. Rather, treatment providers have found that individuals with the condition tend to fluctuate between varying states of health and addiction.

Since the DSM-IV was published, the field of gambling research has grown exponentially, and the scientific community’s comprehension of disordered gambling has increased by leaps and bounds. In recent years, we have learned a great deal more about both the nature and prevalence of disordered gambling.

For example, research clearly demonstrates that, despite the exponential growth of the gaming industry during the past 30 years, the prevalence rate of pathological gambling has held steady. Approximately 1 percent of the population suffers from pathological gambling, and an additional 2 percent have problems gambling.

A growing body of evidence also indicates that people with gambling disorders most closely resemble alcoholics-as opposed to kleptomaniacs or pyromaniacs-in both internal and external manifestations of the condition.

In fact, research suggests that all addictive behaviors are part of a larger addiction syndrome. As such, individuals with addiction tend to share certain neurobiological and genetic factors that may predispose them to the illness. We also have learned that people who struggle with gambling problems tend to have other psychological problems, or other addictions, as well.

Similarly, research has found that things-such as food, the internet or even slot machines-are not inherently addictive. Instead, addiction is widely understood to be a relationship between a vulnerable person and the object of his or her addiction. Vulnerabilities might include psychological problems, social problems or an inherited neurobiological disorder.

Many of these research breakthroughs have been made possible by contributions from the gaming industry.

Our support of the National Center for Responsible Gaming-which has infused millions of dollars into this crucial field of study-has revolutionized the way the condition is identified, prevented and treated. And, in turn, research has informed our industry’s approach to responsible gaming.

To those familiar with the gambling research field, the proposed revisions to the DSM are hardly surprising; in fact, they are expected. Quite simply, they are evidence of the great strides researchers have made during recent years-progress encouraged by the gaming industry.

And yet, some gaming opponents-always eager for an opportunity to attack-have suggested that the proposed changes somehow reflect poorly on our industry. In fact, in a recent interview with the Washington Times, a gaming critic falsely claimed that the DSM revisions impeach our industry’s contention that disordered gambling is a personal weakness, rather than a legitimate psychiatric condition.

Such an assertion has absolutely no basis in fact. Instead, it reflects a deep misunderstanding about both the gaming industry’s stance on this issue and its substantial contributions to the field of gambling research. Our industry has never claimed that disordered gambling is an illegitimate condition. In fact, as anyone with even a superficial grasp of this issue would agree, the changes to the DSM definition of disordered gambling are, in many ways, a direct result of research funded by our industry.

Disordered gambling is an issue the gaming industry takes very seriously-one in which we have invested considerable resources and attention. Therefore, we will continue to closely monitor the development of the DSM-V. In the meantime, however, we must be prepared to vigilantly deflect whatever unfounded criticism comes our way.

The proposed changes to the DSM do not diminish our dedication to this issue; on the contrary, they only strengthen it.

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