Keywords

Gambling disorders; Incidence; Prevention; Psychological intervention

Introduction

Even though the term ”pathological gambling” was introduced in 1980 in the Diagnostic and Statistical Manual of Mental Disorders [1] as an “Impulse Control Disorder” based on the experience of Dr. Robert Cluster and other mental care professionals. The next pathological gambling classification was made in 2000 in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [2] as part of “Impulse-Control Disorders Not Elsewhere Classified”, where was emphasized the common elements with substance addiction. In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders [3] the pathological gambling was included in the chapter “Non-Substance-Related Disorder” and classified as “Gambling Disorder.” Another new element was provided by the time period on which an individual displays the symptoms specific to the gambling disorder, i.e. 12 months, as defined in the Diagnostic Criteria [3] for gambling disorders: “Persistent and recurrent problematic gambling behaviors leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period”. Furthermore, the severity level is established depending on the number of criteria endorsed:

• Mild: 4-5 criteria met.

• Moderate: 6-7 criteria met.

• Severe: 8-9 criteria met.

Moreover, the gambling disorder is associated to “some specific medical diagnoses” and “high rates of co-morbidity with other mental disorders” [3].

Survey on the Incidence of Gambling In Romania

The survey named “Betts and Gambling in Romania” was conducted for the “ROMSLOT- Slot Organizers’ Association” and for “Romanian Bookmakers”. The data were collected by means of an interview taken from 988 individuals (N=988) during July 25-August 16, 2016, on a national representative sample +18, with a sampling error of ± 3%.

Romania is at the lower limit of the European average, that is to say 0.5%-2% problem gamblers of the total population over 18 years, according to the most recent survey carried out by GfK Romania [4]. This means that 0.6% of the total population over 18 years have gambled beyond the limit of entertainment in comparison with the European average ranging between 0.5%- 2%.

The study conducted by GfK Romania showed the following conclusions [4]:

• 15% of the total population over 18 years gambled at least once in the last 12 months such as online gambling, offline sports betting, slot machines, lottery, scratch cards or cards;

• Romanians who play on weekly basis are generally young men, aged between 18 and 24 years old, single, coming from urban areas;

• Most of them gamble for pleasure, but also to earn money or valuables;

• Individuals who play to earn money or valuables may be tempted to spend more money than initially proposed and driven further by the desire to recover the amounts lost.

According to the aforementioned survey, Romanian gamblers may be divided into two categories, as follows [4]:

1. Occasional gamblers: 25% of Romanian adult men gambled at least once in the last 12 months, while in the same period women were 7%; the occasional gamblers are mainly living in small towns, having up to 30,000 inhabitants, where the entertainment possibilities are limited.

2. Regular gamblers, who gamble at least once a week and are mainly young men, with an average income of 2,500 lei per month, aged between 18 and 24 years old, single, with an upper secondary education level, coming from urban areas.

Predominantly, the gamblers with a weekly frequency gamble or bet for amusement and to earn money or other valuables. When were asked what are the reasons for gambling, 87% answered that they feel good when gamble, while 74% responded that they gamble or beat in order to earn money.

In compliance with the results of the above mentioned survey, the incidence of problem gamblers in Romania with over 18 years of age is 0.6%, namely 98,000 individuals [4].

Method of Psychotherapeutic Intervention

The first step that a person should take in order to change the problematic gambling behavior is to accept that he/she needs help. A person suffering from a gambling disorder shall need more than a psychotherapist, but also the support of this/ her entire surrounding family and friends.

In this respect, we have developed a cognitive-behavioral approach having the following key tasks: assessment and formulation; psycho-education; cognitive restructuring; problemsolving training; assertiveness skills training; relapse prevention [5]. In a study conducted in a number of 119 subjects who joined the Responsible Gambling Project in Romania, we have concluded that after the application of the proposed psychotherapy program, 74.6% of the participants who completed the program no longer fulfilled the diagnostic criteria for pathological gambling and were reclassified as problem gamblers; also, the results were consistent at the 3 month follow-up [6].

The psychotherapeutic intervention aims to enhance the adaptive and coping behavior of the gamblers by keeping the gambling in the area of healthy recreational activities involving low or affordable financial and personal risks.

Furthermore, a range of prevention programs should support the psychotherapeutic intervention as such prevention programs have lowered the rates of individuals requiring treatment for mental health problems (American Psychological Association Public Policy Office 2004).

Although this method is very structured, resulting from the cognitive-behavioural approach, this may not be effective to the individuals with wider and/or more complex emotional and behavioural disorders or mental issues.

Conclusion

There were very few studies conducted in Romania in this respect and generally in the Eastern European countries.

Consequently, this study could be very helpful to all the organizations involved in the programs for responsible gaming in Romania. Such organizations will be able to benefit from the expertise of clinicians, of those who already have been working on this kind of programs in many other countries.

Even if the survey carried out by GfK Romania showed that Romania is at the lower limit of the European average, the gambling disorders still remain an important public health issue, associated to high rates of psychiatric co-morbidity.

Responsible Gambling Project in Romania has launched the following set of ethical principles which should underlie the activity (or should be observed by all) of all the gambling organizers [7]:

1. Promote your business as a means of entertainment, not as a method to earn money.

2. Earmark human resources in order to generate and involve the company in social responsibility and client protection actions. Provide a budget in this respect.

3. Train your employees permanently on the latest practices related to the assurance of a responsible relation of the client with the gambling.

4. Provide to the client limited services and facilities associated to gambling that might encourage the excessive gambling.

5. Inform permanently and openly the clients on the dangers involved by the excessive gambling and on how the gambling problems are treated.

6. Make sure that you identify the problem gamblers on due time and correctly.

7. Take immediate action when you have identified a gambler with problems.

8. If necessary, cooperate with the gambler’s family in order to help the problem gambler more efficiently.

9. Make sure that the access of minors to the gambling rooms is strictly forbidden.

10. Seek permanently the partnership with the relevant authorities and the voluntary participation to the actions aiming the social responsibility.

The National Comorbidity Study Replication indicates that 74% of cases where the individual with gambling disorder meets criteria for another lifetime disorder, at least one other such disorder began at an earlier age than the gambling disorder [8]. In a study conducted in Romania we concluded that Romanian compulsive gamblers showed a depressive disorder in 76.46% of the cases, an average level of anxiety in 64.71% of the cases and a personality disorder in 44.5% of the cases [9,10]. Therefore, the individuals suffering from gambling disorder should initially undergo psychotherapy for other associated disorders and subsequently undergo psychotherapeutic intervention for pathological gambling.

As severe gambling problems have been shown to originate during childhood and adolescence, the specialists consider that young people must be informed about the steps that can lead to form pathological game of chance: fun, excitement, obsession, naivety, wrong choices; highlighting and decay [11]. A study conducted in Romania on a total number of 180 participants concluded that the impulsivity level is higher in the clinical group (diagnosed pathological gamblers) than in the control group and this high level of impulsivity, most of the times, represents a risk factor in maintaining gambling disorder and in the occurrence of relapse [12].

Responsible gambling represents an informed choice on the probability of winning, a form of entertainment and relaxation in low-risk situations; it promotes a gambler’s state of well-being [13].

References

1.  American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders. (3rd Edtn), Washington DC, USA.
2. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, Washington DC, USA.
3. American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Washington DC, USA.
4. Rizeanu S (2012) Proposal for a cognitive model to the treatment of pathological gambling. Procedia Soc Behav Sci 33:742-746.
5. Rizeanu S (2014) Psychological profile of the Romanian pathological gambler. Procedia Soc Behav Sci 127:265-269.
6. Rizeanu S (2014) Efficacy of the cognitive-behavioral intervention in pathological gambling treatment. Procedia Soc Behav Sci 127: 626- 630.
7.  https://www.casinoinside.ro/?p=15992
8. Rizeanu S (2014) Pathological gambling and impulsivity. J Exp Psychol Appl 5: 86-94.
9. Rizeanu S. (2016) Romanian pathological gambler’s psychology. Abnorm Behav Psychol 2: 1.
10. https://jocresponsabil.ro/conform-celui-mai-recent-studiugfk- romania-se-situeaza-in-media-europeana-respectiv-05-2- practicanti-impatimiti-ai-jocurilor-de-noroc-din-totalul-populatieipeste- 18-ani/
11. Kessler RC, Hwang I, LaBrie R, et al. (2008) DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol Med 38: 1351-1360.
12. Gupta R, Derevensky JL, Ellenbogen S (2006) Personality characteristics and risk-taking tendencies among adolescent gamblers. Can J Behav Sci 38: 201-213.
13. Rizeanu S (2015) Responsible gambling in Romania. J Addict Behav Ther Rehabil 4:3.