Is gambling a pleasure or a disease?

This is the 2950th article of Da Yi Xiao Hu

With ICD-11 including gambling disorder as a behavioral addiction in mental illness, "gambling" has once again become a hot topic. Is gambling a disease? If gambling is a disease, can it be cured? How to treat gambling disorder?

Throughout history, many people have been addicted to gambling, including monarchs, scholars, and even politicians and soldiers. The Encyclopedia Britannica defines gambling as "a competition in which something valuable is staked with the awareness of risk and the hope of profit. The outcome is entirely determined by chance." In ancient China, gambling was called "Boxi" and was considered a game in which the outcome of the game determined the ownership of the money and property jointly reserved by the participants.

Gambling has been strongly opposed since ancient times. Confucius once said that "a gentleman should not gamble". The rulers of successive dynasties in China also listed gambling as one of the social vices, believing that gambling robs people of their wealth and destroys their morals. The rulers of the Qing Dynasty also listed gambling on the same level as rioters and thieves, believing that there is no worse folk vice than gambling.

Is gambling a disease?

In the past, people judged "gambling" more from a moral perspective, believing that gambling behavior violated social morality, so the management method was mainly punishment. However, more and more research results have confirmed that gambling addiction has similarities with the pathogenesis of substance addiction in terms of pathological mechanisms and pathological loops, and has similar clinical manifestations as substance addiction. For example, in the early stages, the positive reward effect (winning money) caused by engaging in the behavior prompted the patient to repeat the behavior, which eventually led to the formation of addictive behavior (that is, if the gambler has never won money from beginning to end, he will not repeat the gambling behavior). Therefore, in our country, gambling is an illegal act on the one hand, and once addicted, it is a chronic recurrent brain disease. Whether gambling is "pleasure" or a disease depends on whether the individual can control the gambling behavior? Does gambling bring a series of adverse consequences to himself or his family relationships? Once it is out of control and brings a series of adverse effects to himself and his family, gambling has developed into a disease.

If it is a disease, it must be treated. Can gambling be cured?

Gambling traffic controllers have been included in the disease classification (ICD-10: pathological gambling; ICD-11: gambling disorder), and have a clear definition. Gambling disorder refers to excessive gambling behavior that leads to impaired social function (therefore, if it is not excessive or does not lead to impaired social function, it cannot be called gambling disorder). The treatment of gambling disorder is currently mainly drug therapy and psychotherapy. Drug therapy mainly gives anti-anxiety and antidepressant drugs to patients with anxiety or negative emotions after they stop gambling, so as to avoid patients from repeating gambling behaviors under the influence of negative emotions. Psychological therapy only uses psychological intervention techniques to help patients enhance their motivation for behavioral changes (motivational reinforcement techniques), discover high-risk factors for repeated gambling behaviors (negative emotions, misperceptions, stress, etc.) and develop corresponding prevention techniques. Physical therapy (repetitive transcranial magnetic stimulation, direct current stimulation) can also be used as an auxiliary means of treatment to help patients improve symptoms.

Gambling disorder, like all addictive diseases, is a chronic relapsing brain disease. Therefore, the treatment process should also follow the principle of chronic disease treatment, "chronic disease, slow treatment". The joint efforts of the patient, family support system, and professionals can help patients better resolve gambling disorder.