Chapter 10 Addictive Disorders PDF

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This document contains notes about addictive disorders, including learning objectives and details on substance use disorders, and gambling disorder.

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10/4/2024 Copyright Notice Do not remove this notice. 1 BEHL 3004 Chapter 10 (Addictive Disorders) 2 1 ...

10/4/2024 Copyright Notice Do not remove this notice. 1 BEHL 3004 Chapter 10 (Addictive Disorders) 2 1 10/4/2024 CHAPTER 10 ADDICTIVE DISORDERS Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-3 3 LEARNING OBJECTIVES 10.1 Describe the diagnostic criteria, epidemiology, aetiology and treatment of substance use disorders 10.2 Describe the diagnostic criteria, epidemiology, aetiology and treatment of gambling disorder Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-4 4 2 10/4/2024 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorders Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-5 5 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-6 6 3 10/4/2024 A Few Useful Resources http://www.drinkwise.org.au http://www.alcohol.org.nz/ http://www.druginfo.adf.org.au/ https://www.apa.org/topics/addiction/ https://www.psychology.org.au/for-the- public/Psychology-topics/Drugs-and-alcohol https://www.psychiatry.org/File%20Library/Psychiatri sts/Practice/DSM/APA_DSM-5-Substance-Use- Disorder.pdf Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-7 7 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-8 8 4 10/4/2024 Key Terms and Definitions A Substance – refers to a psychoactive substance, so any natural or synthesized product that has psychoactive effects—it changes perceptions, thoughts, emotions, and behaviors. Substance Intoxication – Temporary behavioral or psychological changes due to substance accumulation. Tolerance – After repeated use of a substance, state in which the individual would have to increase amount used to achieve the same effects. Substance Withdrawal – Set of physical and psychological disturbances experienced when substance is discontinued. Dual diagnosis - co-occurring mental/psychological disorder and a substance use problem. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-9 9 Key Terms and Definitions Addiction- many possible definitions, e.g. “a condition in which the body must have a drug to avoid physical and psychological withdrawal symptoms”. From http://www.apa.org/topics/addiction/index.aspx From Latin – addicere, meaning enslave “behaviour over which an individual has impaired control with harmful consequences” (West, 2001) Not recognised as a technical term for substance use problems in DSM-5: “uncertain definition” and “potentially negative connotation” Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-10 10 5 10/4/2024 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-11 11 DSM-5 Substance-related & Addictive Disorders Non-substance-related Substance-related disorders disorders Substance-use Substance-induced Gambling disorder disorders disorders (previously abuse & dependence) Substance/medication- Intoxication Withdrawal induced mental disorders e.g., alcohol-induced anxiety disorder e.g., alcohol intoxication e.g., alcohol withdrawal with onset during withdrawal Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-12 12 6 10/4/2024 Substance-Related Disorders Alcohol-Related Caffeine-Related Cannabis-Related Hallucinogen-Related (many) Inhalant-Related Opioid-Related Sedative, Hypnotic, or Anxiolytic-Related Stimulant-Related Tobacco-Related Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-13 13 DSM-5 – Substance-Induced Disorders Substance intoxication: reversible substance-specific maladaptive behavioral and psychological symptoms due to recent ingestion of substance. Substance withdrawal: problematic physiological and psychological changes due to stopping or reducing heavy, prolonged use of a substance Substance/medication-induced mental disorder (e.g., substance induced psychotic disorder, mood disorder, etc.) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-14 14 7 10/4/2024 e.g., Cannabis Intoxication Problematic behavioural or psychological changes: Impaired motor coordination Euphoria Anxiety Sensation of slowed time Impaired judgement Social withdrawal > 2 signs within 2 hours of cannabis use: Conjunctival injection (“red eyes”) Increased appetite Dry mouth Tachycardia Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-15 15 e.g., Alcohol Withdrawal > 2 within several hours – a few days after cessation: Autonomic hyperactivity (sweating, pulse rate > 100 bpm) Hand tremor Insomnia Nausea or vomiting Transient visual, tactile, auditory hallucinations or illusions Psychomotor agitation Anxiety Generalized tonic-clonic seizures Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-16 16 8 10/4/2024 e.g., Methamphetamine-Induced Psychotic Disorder Developing soon after ingesting large amounts of methamphetamine (evidenced by self-report or toxicology screen): Persecutory delusions Tactile hallucinations (e.g., sensation of bugs crawling under skin) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-17 17 DSM-5 Substance-related & Addictive Disorders Non-substance-related Substance-related disorders disorders Substance-use Substance-induced Gambling disorder disorders disorders (previously abuse & dependence) Substance/medication- Intoxication Withdrawal induced mental disorders e.g., alcohol-induced anxiety disorder e.g., alcohol intoxication e.g., alcohol withdrawal with onset during withdrawal Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-18 18 9 10/4/2024 Substance Use Disorder(s) - DSM-5 > 2 of the following within same 12-month period: 1. Taking or doing in larger amounts or over a longer period of time than intended. 2. Persistent desire or unsuccessful efforts to cut down. 3. Spending a great deal of time trying to get, using, or recovering from effects. 4. Craving or a strong desire. 5. Recurrent use resulting in a failure to fulfil major role obligations. 6. Recurrent use despite having persistent social or interpersonal problems. 7. Important social, occupational or recreational activities given up because of use. 8. Recurrent use in situations that might be hazardous. 9. Continued use despite knowledge of having a physical or psychological problem 10. Tolerance (need more to get same effect or less effect with same amount) 11. Withdrawal (physiological reaction when you stop). Copyright © 2013 American Psychiatric Association Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-19 19 Substance Use Disorder(s) - DSM-5 Severity and Specifiers – mild ~= 2-3 symptoms – moderate ~= 4-5 symptoms – severe ~> 6 symptoms (APA) Course specifiers and descriptive features specifiers: – in early remission – in sustained remission – on maintenance therapy – in a controlled environment – Definitions of each are provided within respective criteria sets. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-20 20 10 10/4/2024 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-21 21 The Epidemiology of Substance Use Disorders Alcohol is the most commonly used drug in Australia Opioid, cannabis and stimulant disorders are less prevalent Opioid and stimulant dependence have a high risk of harm, such as paranoid psychotic states and opioid- related deaths Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-22 22 11 10/4/2024 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-23 23 Scope/ Epidemiology of Substance Use Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-24 24 12 10/4/2024 The Epidemiology of Substance Use Disorders Substance use and its disorders occur predominantly in younger people Younger generations have been exposed to the easier availability of alcohol and drugs compared to older generations Earlier first use of a drug increases the chance of developing a substance use disorder in later life Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-25 25 Average age of first use Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-26 26 13 10/4/2024 The Epidemiology of Substance Use Disorders Comorbidity of substance use disorders and other mental disorders is a major challenge of treatment In Australia approximately 35 per cent of those with a substance use disorder also have other mental disorders Those with a comorbid condition have worse outcomes on a range of measures Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-27 27 The Epidemiology of Substance Use Disorders Substance use disorders are associated with increased physical problems and heightened mortality Older people face particular risks: – they are more susceptible to the effects of alcohol which can lead to increased mortality from falls, motor vehicle accidents and suicide Substance misuse extends beyond the individual. One 2010 study reports almost 75 per cent of Australian adults had been affected by the drinking of others The prevalence of harmful alcohol use among Indigenous Australians is estimated to be twice that of non-Indigenous Australians Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-28 28 14 10/4/2024 iStock A 2010 research report documents 367 people died and approximately 14 000 people were hospitalised during the year of the study as a result of the drinking of others (e.g., as victims of alcohol-related interpersonal violence or drinking and driving). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-29 29 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-30 30 15 10/4/2024 The Aetiology of Substance Use Disorders: Impaired Control Vs. Choice Theories The disease model of addiction describes addiction as a medical disorder in which a loss of control is central Other theories, e.g., choice theory, posit that addictive behaviours reflect a rational choice Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-31 31 The Aetiology of Substance Use Disorders: Biological Factors Adoption and twin studies suggest a strong genetic component in the development of substance use disorder The genetic basis of substance use disorder is thought to be non-specific Substances that can lead to dependence act on the brain’s reward system The major reward systems are the dopaminergic system and the endogenous opioid system The inhibition dysregulation theory argues that addictions are the result of a failure of an inhibitory system Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-32 32 16 10/4/2024 The Aetiology Of Substance Use Disorders: Psychological Factors – Behavioural Theories Traditional behaviour theories focus on learning and conditioning as the basis for acquiring substance use disorders Both classical conditioning and operant conditioning have been used to explain addictive behaviours Incentive-sensitisation theory proposes that drugs of addiction change the areas of the brain responsible for the incentive to use the drugs Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-33 33 The Aetiology of Substance Use Disorders: Psychological Factors – Personality Theories The tri-dimensional personality theory suggests that an interaction between three dimensions of personality influences vulnerability to substance use These traits include: 1. Novelty seeking 2. Harm avoidance 3. Reward dependence Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-34 34 17 10/4/2024 The Aetiology of Substance Use Disorders: Psychological Factors – Cognitive Theories Outcome expectancy theory is a cognitive theory of addiction which states that an individual’s expectation of positive consequences from substance use increases propensity to use Relapse prevention theory is a cognitive-behavioural theory of substance use that argues individuals in high-risk situations will use substances if: – They do not have appropriate coping strategies – They have positive expectations relating to the effects of the substance – They have a low degree of self-efficacy Single relapse  full relapse = abstinence violation effect Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-35 35 The Aetiology of Substance Use Disorders: Psychological Factors – Motivation PRIME theory – Plans, Responses, Impulses, Motives and Evaluations are five different levels of motivation – Actions depend on momentary processes and events – Exposure to substances alters motivational neural circuits – Identity and self-awareness influence self-control – Motivation is inherently unstable Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-36 36 18 10/4/2024 The Aetiology of Substance Use Disorders: Social And Cultural Factors Family functioning, parental modelling, low levels of parental monitoring, and permissive or harsh disciplinary approaches are linked to substance use Peer influences are important Substance use disorders in Indigenous communities need to be placed within a historical framework. Effects of social and economic marginalisation must be considered Cultural influences—availability, cost and the social acceptability of substances influence use Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-37 37 Smoking prevalence in response to public health interventions Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-38 38 19 10/4/2024 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-39 39 The Treatment of Substance Use Disorders Set up goals—e.g., abstinence or controlled use Detoxification—as a useful first step Use of medications—but compliance may be an issue Motivational interviewing Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-40 40 20 10/4/2024 The Treatment of Substance Use Disorders Brief interventions are generally considered to be most useful for those whose substance use is not yet severe Cognitive behaviour training in a range of skills, including relapse prevention, has been associated with a good outcome There is some evidence for the utility of internet-based interventions Recovery models recognise that people start at different points, have different goals, and these goals may differ from family or society more broadly Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-41 41 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-42 42 21 10/4/2024 More about Alcohol Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-43 43 Physiological Effects of Alcohol Interacts with several neural systems – Stimulates GABA receptors  Reduces tension – Increases dopamine and serotonin – Increases opioid neurotransmission  Produces pleasurable effects – Inhibits glutamate receptors  Produces cognitive difficulties (e.g., slowed thinking, memory loss) Effect of ingesting large amounts – Significant motor impairment – Poor decision making – Poor awareness of errors made Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-44 44 22 10/4/2024 Long-term Effects of Alcohol Malnutrition Damage to endocrine glands and – Calories from alcohol lack pancreas nutrients Heart failure – Alcohol interferes with digestion Erectile dysfunction and absorption of vitamins from food Hypertension – Deficiency of B-complex Stroke vitamins causes Amnestic Capillary hemorrhages syndrome – Facial swelling and redness,  Severe loss of memory for especially in nose both long-and-short-term information Destruction of brain cells Cirrhosis of the liver – Especially areas important to – Liver cells engorged with fat and memory protein, impeding functioning – Cells die, triggering scar tissue which obstructs blood flow – Liver disease and cirrhosis rank 12th in U.S. causes of death. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-45 45 THEORIES OF ALCOHOL Theories DEPENDENCE of Alcohol Dependence Biological – Runs in families – Genetic markers and genetic mapping Psychological (over 100 published theories) – Learning (both operant and classical) – Expectancy model – Abstinence violation effect Sociocultural – Family, community, & cultural stressors – Children of alcoholics at greater risk – Young drinking not a positive thing Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-46 46 23 10/4/2024 Treatment of Alcohol Use Disorders Inpatient hospital treatment – Detoxification  Withdrawal from alcohol under medical supervision  The therapeutic results of hospital treatment are not superior to those of outpatient treatment  May be necessary for those without social support or with other serious psychological problems Alcoholics Anonymous (AA) – Largest self-help group for problem drinkers – Regular meetings provide support, understanding, and acceptance – Promotes complete abstinence – Although some studies have shown AA participation predicts better outcome, recent studies suggest AA no more effective than other forms of therapy Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-47 47 The 12 Steps of AA Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-48 48 24 10/4/2024 Treatment of Alcohol Use Disorders Cognitive and Behavioural Treatments – Contingency-Management Therapy  Patient and family reinforce behaviours inconsistent with drinking e.g., avoiding places associated with drinking  Teach problem drinker how to deal with uncomfortable situations e.g., refusing the offer of a drink – Relapse prevention  Strategies to prevent relapse Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-49 49 Treatment of Alcohol Use Disorders Relapse Prevention Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-50 50 25 10/4/2024 Treatment of Alcohol Use Disorders Motivational interviewing – Designed to curb heavy drinking in college/university Goals – Finding out which stage the client is at, and addressing the concerns specific to their stage – Have the client articulate their “pros” and “cons” so they can better process and ultimately resolve the conflict between them. – Empathising and empowering the client to take steps towards change by affirming their strengths as well as the centrality of their initiative in lasting change Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-51 51 Treatment of Alcohol Use Disorders Controlled drinking – Belief that problem drinkers can consume alcohol in moderation – Avoid total abstinence and inebriation – Guided self-change Medications – Antabuse (disulfiram)  Produces nausea and vomiting if alcohol is consumed – Other medications include naltrexone, naloxone, and acamprosate  Most effective when combined with CBT Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-52 52 26 10/4/2024 In Australia and NZ …. A focus on harm minimisation – Example … alternating drinks of alcohol and water. – Reducing drinking rather than stopping. – It’s not the drinking; it’s how we’re drinking. – and – Telling Friends to ease up. – and – Stopping friends from driving. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-53 53 Lecture Outline A few useful resources Key Terms and Definitions Substance-Related Disorders in General Scope/Epidemiology of substance use The Aetiology of substance use disorder Treatment of substance use disorders More on Alcohol (including aetiology and treatment) Gambling (time permitting) Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-54 54 27 10/4/2024 Gambling Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-55 55 Gambling Disorder: Historical Approaches Gaming and gambling have existed in almost every culture since antiquity Their social acceptability differs across cultures Gambling is an integral part of the Australian cultural ethos There are numerous anecdotal case histories of problem gambling Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-56 56 28 10/4/2024 Gambling expenditure in Australia Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-57 57 Gambling Disorder- DSM-5 A. Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress, as indicated by the individual exhibiting four or more of the following in a 12-month period: Needs to gamble with increasing amounts of money in order to achieve the desired excitement. Is restless or irritable when attempting to cut down or stop gambling. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. Is often preoccupied with gambling. Often gambles wen feeling distressed. After losing money gambling, often returns another day to get even. Lies to conceal the extent of involvement with gambling. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. Relies on others to provide money to relieve desperate financial situations caused by gambling. B. The gambling behaviour is not better explained by a manic episode. Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-58 58 29 10/4/2024 The Epidemiology of Gambling Disorder Approx. 5 per cent of adolescents meet the criteria for pathological gambling—2–5 times the rate for adults Adolescent and adult males gamble more frequently and intensely than adolescent and adult females The ratio of male to female problem gamblers seeking treatment is 3:2 Females are motivated by dealing with negative emotional states Males are motivated by winning, excitement and chasing losses 90 per cent of problem gamblers begin before 20 years Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-59 59 Epidemiology of Problem Gambling Gainsbury et al (2014). Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-60 60 30 10/4/2024 Epidemiology of problem gambling Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-61 61 The Aetiology of Gambling Disorder Serotonin, dopamine and noradrenaline are implicated in inhibitory control, reward mechanisms and arousal in impulsive and addictive disorders Certain personality factors such as impulsivity are associated with problem gambling Both classical and operant conditioning are important in the aetiology and maintenance of problem gambling Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-62 62 31 10/4/2024 The Aetiology of Gambling Disorder Cognitive models emphasise cognitive errors that are hypothesised to result in problem gambling Parental modelling and early negative childhood experiences can contribute to the development of problem gambling Cultural attitudes towards gambling and the availability of opportunities to gamble are influential Integrated pathways model – Includes behaviourally conditioned, emotionally vulnerable, and biologically based problem gamblers Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-63 63 Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-64 64 32 10/4/2024 The Integrated Pathways Model of Pathological Gambling Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-65 65 THE TREATMENT OF GAMBLING DISORDER Psychoanalytic and psychodynamic approaches – Primal addiction Gamblers Anonymous – Emphasis on shared common experiences Behavioural and cognitive interventions – Gambling as a learned maladaptive behaviour – Challenge dysfunctional beliefs that lead to the behaviour Pharmacological interventions – SSRIs, opioid antagonists, mood stabilisers Public health model – External societal determinants of gambling – Consumer protection approach Copyright © 2017 McGraw-Hill Education (Australia) Pty Ltd Rieger, Abnormal Psychology, 4e 10-66 66 33

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