by: Donald W. Black, Adam S. Goodie, Harold Wynne and Anneke Goudriaan | Jun 3, 2010
The recently proposed changes to the definition of pathological gambling for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) prompted us to think about the dizzying pace of change within the field over the past 30 years.
In this month’s Issues & Insights, four researchers reflect on the progress of the field by answering the question, “What has been the most significant change in how scientists look at disordered gambling over the past 30 years?” Their conclusions range from the inclusion of pathological gambling in the DSM-III in 1980 to advances in understanding the neurobiology of disordered gambling behavior. All agree that there have been tremendous advances in the field in the past three decades. You can read their full comments in June’s Issues & Insights.
What do you think has been the most significant change in gambling research during the past 30 years? Share your thoughts with us in the comments section below.
Donald W. Black, M.D., Professor of Psychiatry, University of Iowa College of Medicine
The most significant change was the inclusion of pathological gambling (PG) in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition in 1980. While disordered gambling has been around since antiquity, it had not been considered a formal disorder that psychiatrists and other mental health professionals could identify and treat. This set off a paradigm shift away from disordered gambling being considered strictly a social and behavioral phenomenon, to that of it being a neuropsychiatric disorder. Clinicians and researchers now had operational criteria that allowed them to identify homogeneous groups of subjects. This has led to an explosion in the amount of research in PG, bringing with it new ways to conceptualize its pathophysiology, genetics and treatment. Once considered a problem that could only be addressed through a 12-step program, cognitive behavioral therapy was soon applied, followed by medication treatment studies. All these advances have transformed the way PG is thought of by the general public, mental health professionals and researchers.
Adam S. Goodie, Ph.D., Associate Professor and Undergraduate Coordinator, Department of Psychology, University of Georgia
There has been an upsurge in the breadth, depth and maturity of the ways that scientists confront disordered gambling. Thirty years ago, the field was marked by a preponderance of prevalence studies and relatively raw, subjective clinical observations, which revealed a priority simply on establishing that disordered gambling was serious and widespread. (Prevalence studies are an essential piece of the puzzle, but sometimes it seemed the field did little more than count up numbers of people with gambling problems.) Today, research covers all the issues that characterize a serious disorder, and is conducted by individuals as adept with modern research methods as they are with clinical practice. Clinical research is enriched and informed by basic research in fields of social and cognitive psychology, neuroscience, behavioral genetics and others. More than any single research finding, the maturing of the research culture has accelerated our progress in understanding and treating!
Harold Wynne, Ph.D., President, Wynne Resources
The “psycho-bio-social” perspective is frequently cited as the best way to understand behaviour associated with disordered gambling. The order of this term is illustrative of the evolution of research in the field; that is, 30 years ago psychologists started to examine this disorder by looking inside the individual gambler. In the past five to 10 years, neurobiologists and geneticists focused on physiological evidence for answers. More recently, attention has been given to the social milieu wherein the disordered gambler lives day-to-day: the family, peer group, work place, cultural group and community. As gambling is a social activity, this latter focus on behaviour-influencing factors external to the individual is a welcome and significant contribution to understanding disordered gambling.
Anneke Goudriaan, Ph.D., Senior Researcher, Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam
As I have been in gambling research for almost 10 years now, my perspective relates to this period. I think that the field of gambling research has advanced in several ways: both in the depth and quality of studies, and in broadening research directions. There is now much more attention to pathological gambling and comparing it with other disorders. For example, the efficacy of successful treatment strategies for substance dependence is now being investigated in pathological gambling. Behavioral treatments that have been effective for substance dependence, such as contingency management (i.e., using rewards to encourage positive change), are being studied, and we now know that pharmacological treatments such as nalmefene (a drug used to blunt cravings for alcohol) can be effective for treating pathological gambling. Compared to 10 years ago, there is greater insight into the neurobiology of pathological gambling. We now know that near wins elicit similar reward areas in the brain as actual wins, and that diminished neurocognitive functions influence relapse negatively. I hope that we will be able to implement this new knowledge in developing new interventions and improving treatment strategies.