Problem gambling

Evidence indicates that pathological gambling is an addiction similar to chemical addiction.^[17] It has been observed that some pathological gamblers have lower levels of norepinephrine than normal gamblers.^[18] New studies regarding this link show that norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their under-dosage.^[19] Studies have compared pathological gamblers to substance addicts, concluding that addicted gamblers display more physical symptoms during withdrawal.^[20] Deficiencies in serotonin might also contribute to compulsive behavior, including a gambling addiction.

The findings in one review indicated that behavioral disorders such as problem gambling and substance use disorder are closely linked; sensitization theory indicates that these disorders are marked by a compulsive drive towards unhealthy behaviors and an inability to control against them.^[21]Dopamine dysregulation syndrome has been observed in the aforementioned theory in people with regard to such activities as gambling.^[22] A limited study was presented at a conference in Berlin, suggesting opioid release differs in problem gamblers from the general population, but in a very different way from people with a substance use disorder.^[23]

Some medical authors suggest that the biomedical model of problem gambling may be unhelpful because it focuses only on individuals. These authors point out that social factors may be a far more important determinant of gambling behavior than brain chemicals, and they suggest that a social model may be more useful in understanding the issue.^[24] For example, an apparent increase in problem gambling in the UK may be better understood as a consequence of changes in legislation which came into force in 2007 and enabled casinos, bookmakers, and online betting sites to advertise on TV and radio for the first time and which eased restrictions on the opening of betting shops and online gambling sites.^[25]

There have also been studies that showcase how factors like gender and age can affect how a person is affected by gambling; examples include the probability of addiction being 11% stronger in men than in women, and the fact that the age range of 19–29 has the highest risk of developing problem gambling or pathological gambling habits.^[26]

問題ギャンブルの発症と維持には、いくつかの心理的メカニズムが関与していると考えられています。^{[ 27 ]}第一に、問題ギャンブラーでは報酬処理が十分に発達していないようです。第二に、一部の人は、生活上の問題から逃れるために問題ギャンブルを利用しています（負の強化の例）。第三に、自己愛、リスク志向、感覚志向、衝動性などの性格要因が関係しています。第四に、問題ギャンブラーは、コントロールの錯覚^{[ 28 ]} 、非現実的な楽観主義、過信、ギャンブラーの誤謬（一連のランダムな出来事は自己修正する傾向があり、さまざまな結果の絶対頻度が互いにバランスを取るという誤った信念）など、いくつかの認知バイアスを持っています。第五に、問題ギャンブラーは、犯罪スピン理論で説明されているように、ギャンブルスピンという行動スピンプロセスの慢性的な状態を表しています。^{[ 29 ]}

ギャンブルをする人の中には、学習性無力感（自分の状況をコントロールできないと信じる心理状態）を発症する人が少なくありません。 ^{[ 30 ]}この信念は、ギャンブルに内在する予測不可能で繰り返される金銭的損失によってさらに強化されます。このメカニズムは、依存症のサイクルを強化する役割を果たすため重要です。^{[ 31 ] [ 32 ]}この現象は、ギャンブルをする人のコントロールの所在を外部へとシフトさせる可能性があります。^{[ 33 ]}すると、ギャンブルをする人は、結果が自分の意志による行動ではなく、制御不能な外部システムによって決定されると認識し始めます。^{[ 34 ]}学習性無力感の理論は、1960年代に心理学者のマーティン・セリグマンとスティーブン・マイヤーによって初めて研究されました。 ^{[ 35 ]}

スペインのギャンブル監視機関は、2019～2020年の責任あるゲーミングプログラムを更新し、問題ギャンブルを精神障害として分類した。^{[ 36 ]}

ギャンブラーズ・アノニマスのような12ステップに基づくプログラムは、ギャンブル依存症に特化したものであり、依存症の克服、経済的健全性の構築、精神的健康の向上といった点で汎用性があります。一方、臨床介入を目的とした商業的な代替プログラムは、最先端の医療科学と応用教育の実践を取り入れ、2007年以降、患者中心の介入ツールとして活用されてきました。これらのプログラムには、効果測定や回復状況の指標が含まれています。

動機づけ面接は、強迫性ギャンブルの治療法の1つです。動機づけ面接者の基本的な目標は、思考と複雑な感情の解決を通して変化への準備を促すことです。攻撃的な対立、議論、レッテル貼り、非難、直接的な説得を避け、面接者は強迫性ギャンブル患者に共感とアドバイスを提供し、患者自身が目標を設定します。焦点は、選択の自由を促進し、変化する能力に対する自信を促すことです。^{[ 54 ]}

治療方法として普及しつつあるのがピアサポートです。オンラインギャンブルの普及に伴い、問題を抱える多くのギャンブラーが回復を支援するために様々なオンラインピアサポートグループを利用しています。これにより匿名性が守られ、多くの場合、愛する人に問題を明かすことなく、自力で回復を試みることができます。^{[ 55 ]}

ギャンブル依存症患者に対するセルフヘルプに関する研究では、効果が示されています。^{[ 56 ]}ミズーリ大学のウェンディ・スルツケによる研究では、病的ギャンブル依存症患者の3分の1が自然回復によって克服したと結論付けられています。^{[ 57 ]}

ギャンブル依存症の治療には、抗うつ薬、非定型抗精神病薬、気分安定薬、オピオイド拮抗薬など、数多くの薬物療法が提案されているが、最適な治療法、投与量や投与時期を含む治療計画は明確ではない。^{[ 58 ]}ナルトレキソンやナルメフェンなどのオピオイド拮抗薬、オランザピンなどの非定型抗精神病薬は、短期的にはギャンブル症状の重症度を軽減するのに役立つ可能性があるという証拠はあるが、これらの薬がこの障害に関連する他の心理症状の改善や、問題ギャンブルからの長期的な症状緩和に効果的かどうかは明らかではない。 ^{[ 58 ]}気分安定薬の有効性を示唆する証拠は明確ではない。^{[ 58 ]}

問題のあるギャンブルの治療における抗うつ剤の有効性を判断するために、一連の抗うつ剤研究が実施されました。これらの研究から、3 つの重要な発見が得られました。^{[ 40 ]}

1. _{抗うつ薬は、セロトニン再取り込み阻害薬や5- HT1} /5-HT2_受容体拮抗薬に作用する場合、病的ギャンブルを軽減することができる。
2. 強迫性障害の一症状である病的ギャンブルは、うつ病性障害の場合と同様に、より高用量の抗うつ薬を必要とする。
3. In cases where participants do not have or have minimal symptoms of anxiety or depression, antidepressants may still have an effect.

Gambling self-exclusion (voluntary exclusion) programs are available in the US, the UK, Canada, Australia, South Africa, France, and other countries. They seem to help some (but not all) problem gamblers to gamble less often.^[59]

Some experts maintain that casinos in general arrange for self-exclusion programs as a public relations measure without actually helping many of those with problem gambling issues. A campaign of this type merely "deflects attention away from problematic products and industries", according to Natasha Dow Schull, a cultural anthropologist at New York University and author of the book Addiction by Design.^[60]

There is also a question as to the effectiveness of such programs, which can be difficult to enforce.^[61] In the province of Ontario, Canada, for example, the Self-Exclusion program operated by the government's Ontario Lottery and Gaming Corporation (OLG) is not effective, according to investigation conducted by the television series, revealed in late 2017: "Gambling addicts ... said that while on the ... self-exclusion list, they entered OLG properties on a regular basis" in spite of the facial recognition technology in place at the casinos, according to the Canadian Broadcasting Corporation. As well, a CBC journalist who tested the system found that he was able to enter Ontario casinos and gamble on four distinct occasions, in spite of having been registered and photographed for the self-exclusion program. An OLG spokesman provided this response when questioned by the CBC: "We provide supports to self-excluders by training our staff, by providing disincentives, by providing facial recognition, by providing our security officers to look for players. No one element is going to be foolproof because it is not designed to be foolproof".^[60]

According to the Productivity Commission's 2010 final report into gambling, the social cost of problem gambling is close to 4.7 billion dollars a year. Some of the harms resulting from problem gambling include depression, suicide, lower work productivity, job loss, relationship breakdown, crime and bankruptcy.^[62] A survey conducted in 2008 found that the most common motivation for fraud was problem gambling, with each incident averaging a loss of $1.1 million.^[62] According to Darren R. Christensen. Nicki A. Dowling, Alun C. Jackson and Shane A. Thomas, a survey done from 1994 to 2008 in Tasmania gave results that gambling participation rates have risen rather than fallen over this period.^[63]

In Europe, the rate of problem gambling is typically 0.5 to 3 percent.^[64] The "British Gambling Prevalence Survey 2007", conducted by the British Gambling Commission, found approximately 0.6 percent of the adult population had problem gambling issues—the same percentage as in 1999.^[65] The highest prevalence of problem gambling was found among those who participated in spread betting (14.7%), fixed odds betting terminals (11.2%), and betting exchanges (9.8%).^[65] In Norway, a December 2007 study showed the amount of current problem gamblers was 0.7 percent.^[66]

With gambling addiction on the rise worldwide and across Europe in particular, those calling gambling a disease have been gaining grounds. The British Gambling Commission announced a significant shift in their approach to gambling through their reclassification of gambling as a disease, and therefore that it should be addressed adequately by the NHS.

The World Health Organization has also classified gambling a disease. In its 72nd World Health Assembly held on Saturday, May 25, 2019, 'gaming disorder' was recognized as an official illness. The 194-member meet added excessive gaming to a classified list of diseases as it revised its International Statistical Classification of Diseases and Related Health Problems (ICD-11).

Lizbeth García Quevedo, director of the Coordination with Federal Entities (CONADIC), spoke of pathological gambling as a strong addiction in Mexico: "It has very similar behaviors, that is why some experts consider it an addiction because it is similar in the behaviors, in the origins, some risk factors that can trigger pathological gambling, it can also trigger drug consumption". In Mexico there could be between one and three million people addicted to gambling. "They should be aware of what their children are doing, and on the other hand, they should motivate pro-active gambling, healthy gambling", commented Lizbeth García Quevedo. The Ministry of Health document highlights that a study on pathological gambling that analyzed 46 studies carried out in Canada, the United States, Australia, Sweden, Norway, England, Switzerland and Spain, revealed that the prevalence of pathological gambling is relatively higher among adolescents, which shows the continuity of the problem considering that many pathological gamblers state that they started their gambling behavior at an early age.^[67]

In the United States, the percentage of pathological gamblers was 0.6 percent, and the percentage of problem gamblers was 2.3 percent in 2008.^[68] Studies commissioned by the National Gambling Impact Study Commission Act has shown the prevalence rate ranges from 0.1 percent to 0.6 percent.^[69] Nevada has the highest percentage of pathological gambling; a 2002 report estimated 2.2 to 3.6 percent of Nevada residents over the age of 18 could be called problem gamblers. Also, 2.7 to 4.3 percent could be called probable pathological gamblers.^[70]

According to a 1997 meta-analysis by Harvard Medical School's division on addictions, 1.1 percent of the adult population of the United States and Canada could be called pathological gamblers.^[71] A 1996 study estimated 1.2 to 1.9 percent of adults in Canada were pathological.^[72] In Ontario, a 2006 report showed 2.6 percent of residents experienced "moderate gambling problems" and 0.8 percent had "severe gambling problems".^[73] In Quebec, an estimated 0.8 percent of the adult population were pathological gamblers in 2002.^[74] Although most who gamble do so without harm, approximately 6 million American adults are addicted to gambling.^[75]

According to a survey of 11th and 12th graders in Wood County, Ohio found that the percentage who reported being unable to control their gambling rose to 8.3 percent in 2022, up from just 4.2 percent in 2018. The reasons for the increase cited, are the time spent online during the COVID-19 pandemic, gambling-like elements put into video games, and the increased legalization of sports betting in a number of U.S. states.^[76]

According to Jennifer Trimpey, as the legality of online sport betting and online casino gambling increase across the United States, almost all governments of states with legal online gambling offer state-run self-exclusion programs, and most major online betting operators provide their own self-exclusion programs as well.^[77] A 2025 study from the University of California, Los Angeles found that the spread of legal sports betting caused consumers to take on more problematic debt and led to an increase in bankruptcies.^[78]

For Isabel Sánchez Sosa, coordinator of the Compulsive Gamblers Association of Argentina, "gambling addiction is growing a lot in the country because the offer is impressive" and in this sense she asserted that the presence of bingos is a common issue in all neighborhoods. In the province of Buenos Aires there are 46 bingos.^[79]

Similar to other parts of the world, Africa's gambling rates are increasing, especially among youths. In East African countries like Kenya and Uganda, more than a majority of youths surveyed reported gambling behaviors in the last 12 months.^[80] Additionally, many youths begin gambling before the age of 18, which correlates with the psychological etiologies of risk-taking and low self-control. Gambling in East Africa is correlated with substance use, risky sexual behaviors such as unprotected sex and frequent sexual encounters, and risks of crime.^[80] Regarding youths who gamble, almost 50% of them report some form of gambling severe enough to be classified as problematic by the DSM.^[80]

西アフリカでは、ナイジェリアやガーナなどの国々で同様の傾向が見られます。若者の大多数が生涯にわたってギャンブル行為に参加しており、ギャンブルをする人の70%以上が過去1年間に継続的にギャンブルをしたと報告しています。^{[ 80 ]}西アフリカのギャンブルは、法執行機関やその他の当局との問題、薬物使用、無謀な金銭支出と関連付けられています。^{[ 80 ]}アフリカ全域で、スポーツ賭博とカードゲームが最も一般的なギャンブル形態となっており、特に週末には大多数の人がギャンブルをしています。スポーツ賭博は高校生や大学生の間で非常に一般的で、若い男性の間で最もよく見られます。^{[ 80 ]}

アジアにおけるギャンブルは、多くの国で禁止されているため、研究するのが特に困難です。中国や日本などの国では、合法的にギャンブルをする唯一の方法は、政府が運営する宝くじやカジノを利用することです。^{[ 81 ]}合法かどうかに関わらず、ギャンブルは地下ネットワークや、日本のパチンコのような法律の抜け穴を通じて行われています。ギャンブル行動は、特に大阪市のような場所で、ホームレスと密接に関連しています。^{[ 82 ]}貧困の中でホームレスを経験した人々のうち、43.7%が生涯ギャンブルをしたことがあると述べています。^{[ 82 ]}この関連性には多くの危険因子が関係しており、主に、生涯を通じてホームレス状態が長く続くことや、ホームレス状態が繰り返されることが、ギャンブル行動のリスクを高めます。^{[ 81 ]}

ギャンブルはゲーム行動、特にルートボックスの普及と密接に関連しています。^{[ 83 ]}ルートボックスは特定のゲーム内に存在し、プレイヤーが偶然特定のアイテムをアンロックできる宝くじのようなゲーム内商品化で構成されています。ルートボックスには、コモンからレジェンダリーまでレアリティによって等級付けされたアイテムが含まれており、このレアリティとアンロックチャンスの関係は、スロットマシンのジャックポットなど、特定のギャンブルマシンの配当とよく似ています。ジャックポットは非常に高額な報酬ですが、それを獲得できる可能性は非常に低く、これはルートボックスを通じてレジェンダリーアイテムをアンロックする希少性を模倣しています。270の研究全体で、特定のゲーム行動の普及の増加とギャンブル依存症のリスクの増加の間には有意な因果関係があります。^{[ 83 ]}

Casinos and poker machines in pubs and clubs facilitate problem gambling in Australia. The building of new hotels and casinos has been described as "one of the most active construction markets in Australia"; for example, AUD$860 million was allocated to rebuild and expand the Star Complex in Sydney.^[84]

A 2010 study, conducted in the Northern Territory by researchers from the Australian National University (ANU) and Southern Cross University (SCU), found that the proximity of a person's residence to a gambling venue is significant in terms of prevalence. Harmful gambling in the study was prevalent among those living within 100 meters of any gambling venue, and was over 50% higher than among those living ten kilometers from a venue. The study's data stated:

Specifically, people who lived 100 meters from their favorite venue visited an estimated average of 3.4 times per month. This compared to an average of 2.8 times per month for people living one kilometer away, and 2.2 times per month for people living ten kilometers away.^[85]

According to the Productivity Commission's 2016 report into gambling, 0.5% to 1% (80,000 to 160,000)^[86] of the Australian adult population had significant problems resulting from gambling. A further 1.4% to 2.1% (230,000 to 350,000) of the Australian adult population experienced moderate risks making them likely to be vulnerable to problem gambling.^[87] Estimates show that problem gamblers account for an average of 41% of the total gaming machine spending.^[87]

A gambler who does not receive treatment for pathological gambling when in a desperation phase may contemplate suicide.^[89] Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.^[90][91]

ギャンブル依存症の早期発症は、生涯にわたる自殺リスクを高める可能性がある。^{[ 92 ]}併存する物質使用^{[ 93 ] [ 94 ]}と併存する精神障害は、ギャンブル依存症の人の自殺リスクを高める。^{[ 95 ]} 2010年のオーストラリアの病院の研究では、アルフレッド病院の救急外来に入院した自殺患者の17%がギャンブル依存症であったことが判明した。 ^{[ 96 ]}