Pathological gambling

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F63.0 Pathological / compulsive gambling
ICD-10 online (WHO version 2019)
A bunch of chips
Roulette : Roulette wheel in a casino
Slot machines in the Magdeburg casino (2016)

Pathological gambling or compulsive gambling , also known colloquially as (gambling) gambling addiction , is an impulse control disorder . It is characterized by the inability of a person concerned to withstand the impulse to gamble or bet , even if this threatens to have serious consequences in the personal, family or professional environment or has already had them. Men are more often affected than women. In Germany there are between 100,000 and 290,000 people affected.

Symptoms

Frequent or episodic repeated games are associated with a pronounced mental preoccupation with "promising" game techniques or opportunities to raise money - the required "initial capital". Attempts to resist the urge to play fail repeatedly, the game itself is hidden from others (family members and therapists), which often leads to serious financial consequences, but ultimately often to the breakdown of relationships, also because the person concerned repeatedly relies on others (family members, friends, old acquaintances) would procure the necessary funds for him “one last time” or pay off the debts.

Playing itself serves to reduce problems or negative moods ( fears , depression , feelings of guilt ). Increasingly greater amounts are used to maintain tension and excitement.

diagnosis

Pathological gambling is classified in the ICD-10 classification (together with trichotillomania , kleptomania and pyromania but without betting) under the abnormal habits and disorders of impulse control . Excessive gambling during manic episodes is not included. In the English language area or DSM-IV, the terms “pathological” or “compulsive gambling” or often “problem gambling” were used. 2013, in the DSM-5 a reclassification of the interference image using the wertneutraleren term "Gambling Disorder" ( gambling disorder made) in the category "Substance-Related Disorders and Addictive". This step represents a paradigm shift, since substance-related and non-substance-related addictions are now nosologically on an equal footing. Various indications, such as similarities in symptoms, high comorbidity rates in epidemiological and clinical studies, shared genetic vulnerabilities , similar biological markers and cognitive impairments, as well as largely overlapping therapeutic settings suggest that the pathological gambling behavior can be assigned to the addictive diseases.

Pathological gambling (gambling disorder) must not be confused with computer game addiction (gaming disorder). However, the transitions between the two disturbance patterns are fluid as soon as computer games contain elements of gambling (e.g. so-called loot boxes ).

Diagnostic criteria according to ICD-10

  • Repeated (2 or more) episodes of gambling for at least a year.
  • These episodes do not bring those affected any profit, but are continued despite the subjective pressure of suffering and disorders of social and professional functionality.
  • Those affected describe an intense urge to play that is difficult to control. Those affected describe that they are unable to interrupt the game by exerting their will.
  • Those affected are constantly preoccupied with thoughts and ideas about gambling or the gambling environment.

Course of disease

A so-called player career is ideally divided into three phases, which are referred to as the win, lose and desperation phase.

Winning phase

  • Occasional gambling
  • Positive sensations before and during the game
  • Unrealistic optimism
  • Developing wishful thoughts
  • Bet bigger and bigger amounts
  • Loss of reality

Loss phase

  • Minimizing the losses
  • Boasting Profits
  • Development of the illusion that losses are covered by profits
  • More frequent play alone
  • Thinking about the game more often
  • First major losses
  • Hiding losses and lying about losses
  • Neglect of family and friends
  • Playing the game during working hours
  • Taking on debt and credit
  • Inability to withstand the game
  • Loss of family and friends

Desperate phase

  • Statutory and unlawful fundraising
  • Debt repayment delay
  • Changes in personality structure: irritability, irritation, restlessness, sleep disorders
  • Complete social retreat
  • Complete alienation from family and friends
  • Loss of social position and reputation
  • Exclusive use of time and money for the game
  • Repeatedly playing for days
  • Remorse and panic reactions
  • Hatred of other (especially winning) players
  • Hopelessness, thoughts or attempt at suicide

However, more recent research findings based on longitudinal data show that there are also episodic, curvilinear and seizure-like developmental courses of player careers.

treatment

A therapy can be divided into 3 phases. Phases 1 and 3 are usually outpatient, phase 2 outpatient or inpatient.

1. the contact and motivation phase

Measures as well as assistance with debt settlement . It is recommended to participate in a self-help group , e.g. B. on the Anonymous Players .

2. the actual weaning phase

The aim of the subsequent weaning phase is to abstain from gaming. Outpatient or inpatient psychotherapy with systemic-strategic behavior therapy or a multimodal treatment concept are used. The effectiveness of behavior therapy is well documented.

Insufficient data are available on drug treatment. Selective serotonin reuptake inhibitors, lithium, clomipramine and naltrexone are used. None of the drugs mentioned are approved for this indication.

3. the aftercare phase

The connection of the weaned person to a counseling center or an outpatient therapeutic facility serves to avoid or provide support after relapses into the pathological behavior pattern.

There are specialized outpatient clinics and contact points that refer those affected to suitable therapy centers.

distribution

In Germany

The total number of pathological players in Germany was determined in a total of twelve surveys, seven of which were initiated by the Federal Center for Health Education (BZgA) : 100,000 (BZgA 2007), 103,000, 242,000 (BZgA 2009), 290,000, 159,000 and 193,000, what Prevalence rates of 0.19% to 0.56% in the age groups examined (14, 16 and 18 to 64 and 65 years respectively). Starting in 2011, prevalence rates of 0.23% ( TNS-Emnid ), 0.49% (BZgA 2011), 0.82% (BZgA 2013), 0.37% (corresponding to 215,000 pathological players, BZgA 2015) were found in four studies ), 0.31% (corresponding to 180,000 pathological players, BZgA 2017) and 0.34% (corresponding to 200,000 pathological players, BZgA 2019).

  • The increase in prevalence determined by the BZgA in 2013 is based on a sample selection procedure that has changed compared to the previous studies, which now also takes into account participants without a landline connection. For the sample selection previously practiced, the prevalence would have been 0.38%. In 2015, despite the retention of the sampling method used in 2013, the value was at the level of previous years.
  • A distribution across the various forms of gambling is given in the study on which the second figure is based. According to this, the 103,000 pathological gamblers “split equally between sports betting , casino games and gaming machines in amusement arcades (around 25-30,000 each) and, by far, lottery games (around 12,000)”. Compared to their market shares measured by gross income, pathological gamblers are overrepresented 5.5 times in online games (online sports betting, card games) and 2.2 times in casino offers, while they are overrepresented by the factor for lottery and gaming machines 0.3 and 0.8 are underrepresented. According to the 2015 BZgA study, 43% of the at least problematic players played " 6 out of 49 ", 41% other lotteries (especially scratch cards ), 38% private games of chance, 28% sports betting, 24% commercial slot machines and 18% casino offers . According to the results of the BZgA study from 2017, 45% of the at least problematic players played “6 out of 49”, 36% other lotteries (especially scratch cards), 33% commercial slot machines, 31% private games of chance and 23% sports betting.
  • The TNS-Emnid study divides the expenses of pathological gamblers: 20.7% for poker (according to the study, poker is played “above average” on the Internet, i.e. by non-German online casinos ), 16.2% for casinos - Offers (without poker), 15.4% for gaming machines in amusement arcades and restaurants, 13.5% for lottery and lotteries. A pathological gambler takes part in an average of five different forms of play, whereas an average gambler only takes part in two.
  • The study on which the fourth figure (290,000) is based provides information about the stakes of pathological gamblers. According to this, a pathological gambler bets an average of € 121.40 per month for games of chance, while a player with no or few gambling problems only bets € 31.40.

In Germany, pathological gaming has been the focus of scientific research and public interest since the early 1980s. With the entry into force of the State Treaty on Gambling , the conditions for the research and therapy of pathological gambling have been significantly improved since 2008.

In Austria

Two studies that were carried out in Austria from 2009 to 2011 showed prevalence rates of 0.66% and 0.71% for pathological gamers.

In Switzerland

According to a study carried out by the Swiss Federal Gaming Board in April 2009, the proportion of pathological gamblers in Switzerland is 0.5%. The report explains that "despite changes in the offers (opening of 19 casinos, development in the Internet sector, disappearance of slot machines in bars and restaurants, etc.)", the regular use of games of chance changed only insignificantly in the period from 2002 to 2007.

In Finnland

In Finland, where the state monopoly on gambling, all, including z. B. includes slot machines installed in restaurants, the proportion of pathological gamblers in the age group from 15 to 74 years was 1.3% in 2015.

Laws to protect players in Germany

For games of chance in the legal sense

The protection of gamblers is regulated by a state treaty on gaming in Germany (State Gambling Treaty - GlüStV), which the federal states concluded and which came into force on January 1, 2008. The State Treaty follows the requirements of the Federal Constitutional Court. Accordingly, the state monopoly on gambling can only be justified through consistent and credible compliance with state addiction prevention.

For the commercial game area

For the area of ​​commercially installed slot machines , player protection is regulated by the provisions of the Trade Regulations , the Gaming Ordinance and the various arcade and implementation laws for the State Treaty on Gambling Amendments (GlüÄndStV).

Consequences and complications

The gambling addict is often concerned with gambling and "improved" gaming techniques. Attempts are made to raise money for gambling, which can lead to theft , over-indebtedness and fraud . In extreme cases, work and family are neglected because gambling determines everyday life.

Legal consequences

Germany

In criminal proceedings the existence of such can behavioral addiction - in terms of criminal responsibility - be be considered if committed offenses the continuation of playing serve. Recently, the Federal Court of Justice has formulated the requirements restrictively, but at the same time clarified the possibilities of integrating the disease into the system of Section 20 of the German Criminal Code ( incapacity ):

"A considerable reduction in the ability to control is only given in exceptional cases when the addiction has led to the most severe personality changes or the perpetrator has suffered from withdrawal symptoms during procurement acts". When assessing this question, it depends on "to what extent the entire appearance of the perpetrator shows psychological changes in personality which are pathologically caused or - as other psychological abnormalities - are equivalent in severity to pathological psychological disorders."

In these cases , the judging court must consult an expert to clarify this question .

In civil law , a so-called game contract is concluded between the player and the game provider . However, if a game ban has been ordered or agreed (the latter e.g. at the request of the player himself (also referred to as self- ban) not to allow him to play due to risk of addiction), the gaming operator (e.g. the casino ) has to lift this ban before to check with sufficient certainty and to provide evidence that the lifting of the ban does not conflict with the protection of the player from himself, therefore there is no longer any risk of gambling addiction and that the player is able to play a controlled game.

United States

For the United States , a 2005 literature review by Williams showed that a third of all offenders met the criteria for pathological gambling and every second offense in detainees with a background of pathological gambling can be traced back to their persistence.

Pathological play in literature and film

Pathological play is a common motif in literature and film. A literary processing can be found e.g. B. in Dostoevsky's novel The Player (1866) and in Peter Carey's novel Oscar and Lucinda (1988; filmed as Oscar and Lucinda ). In his novel Ein Sommer in Baden-Baden, Leonid Zypkin describes Dostoyevsky's gambling addiction at the roulette table in Baden-Baden during his trip to Germany with his second wife Anna in 1867. The writer Heinz Strunk describes his addictive behavior to slot machines in various novels, including meat my vegetables (2004) and Heinz Strunk in Africa (2011).

Examples of films include Die Schicksalswürfel (1929), Die blonde Sünderin (1962) and The Only Game in Town (1970), "The Player" (2009) with Gerard Butler.

See also

literature

Web links

Wiktionary: Passion for gaming  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, DSM-5 . Washington, DC 2013, Fifth Edition, ISBN 978-0-89042-555-8 , pp. 585-589.
  2. ↑ G. Meyer: Accommodation with gambling addiction . In: Journal for Legal Policy Issue 5, 2013, pp. 140–143
  3. ↑ a b Dieter Ebert: Impulse control disorders . In: Psychiatry Psychotherapy Up2date . tape 2 , no. 5 . Georg Thieme Verlag KG, Stuttgart / New York 2008, p. 321-336 , doi : 10.1055 / s-2008-1067449 .
  4. ↑ G. Meyer, M. Bachmann: Gambling addiction: causes, therapy and prevention of gambling-related addictive behavior . Springer, 3rd edition, Berlin 2011, ISBN 978-3-642-20069-4 , doi : 10.1007 / 978-3-642-20070-0
  5. ↑ J. Grant et al.: In: J. Clin. Psych. 69 (2008), pp. 783-789.
  6. ↑ a b Federal Center for Health Education (BZgA): Gambling behavior in Germany 2007 and 2009: Results from two representative population surveys, results report, January 2010 ( online version )
  7. ↑ a b G. Bühringer et al: Statement by the IFT Institute for Therapy Research to the Committee on Health of the German Bundestag on July 1, 2009 ( online version ; PDF; 166 kB)
  8. ↑ Gerhard Bühringer, Ludwig Kraus, Dilek Sonntag, Tim Pfeiffer-Gerschel, Susanne Steiner: Pathological Gambling in Germany: Gambling and Population Risks, Addiction, Volume 53, Issue 5, 2007, pp. 296-308 ( online version ( Memento from August 29, 2013 in the Internet Archive ))
  9. ↑ A tabular comparison of the first four results can be found in Franz W. Peren, Reiner Clement: Pathology Potentials of Gambling Products - A Comparative Assessment of Game Forms offered in Germany. Research Institute for Gambling and Betting , 2011, p. 8, online version (PDF; 267 kB) ( Memento from February 1, 2012 in the Internet Archive ).
  10. ↑ Monika Sassen et al., Gambling among adults in Germany: Prevalence, disorder and risk factors , in: Sucht 57, 2011, pp. 249-257, doi: 10.1024 / 0939-5911.a000115 (quoted from Meyer, Jahrbuch Sucht 2018 )
  11. ↑ Hans-Jürgen Rumpf et al.: Pathological gamblers: condition factors, behavior seeking help, remission. Results of the PAGE study , results (PDF; 1.7 MB), final report ( Memento from April 25, 2013 in the Internet Archive ) (PDF; 0.9 MB)
  12. ↑ a b TNS EMNID: Playing with and for money in Germany. Results of a representative population survey. Special evaluation: pathological gambling behavior , October 2011 ( online (PDF; 266 kB), presentation ; PDF; 533 kB)
  13. ↑ Federal Center for Health Education (BZgA): Gambling behavior and gambling addiction in Germany 2007, 2009 and 2011, results from three representative population surveys , 2012 ( online )
  14. ↑ a b Federal Center for Health Education (BZgA): Gambling behavior and gambling addiction in Germany 2013 , 2014 ( online )
  15. ↑ Gerhard Meyer , Glücksspiel - Numbers and Facts , in: Jahrbuch Sucht 2016, ISBN 978-3-95853-172-7 , pp. 126–144, p. 127.
  16. ↑ a b Federal Center for Health Education (BZgA): Gambling behavior and gambling addiction in Germany. Results of the 2015 survey and trends , 2016 ( online )
  17. ↑ Gerhard Meyer, Glücksspiel - Numbers and Facts , in: Jahrbuch Sucht 2018, ISBN 978-3-95853-380-6 , pp. 113-133, there p. 129, online ( Memento from April 9, 2018 in the Internet Archive )
  18. ^ Federal Center for Health Education (BZgA): Gambling behavior and gambling addiction in Germany. Results of the 2017 survey and trends , 2018 ( online )
  19. ^ Federal Center for Health Education (BZgA): Gambling behavior and gambling addiction in Germany. Results of the 2019 survey and trends , 2020 ( online )
  20. ↑ Franz W. Peren , Reiner Clement: Evaluation of the pathologic potential of gambling products , in: The Journal of Gambling Business and Economics , Volume 5, Issue 3, 2011, pp. 44-54 ( German online version, especially p. 26 ( Memento from February 1, 2012 in the Internet Archive ); PDF; 267 kB). The quotients reported are referred to by the authors as pathology potentials .
  21. ^ Federal Center for Health Education (BZgA): Gambling behavior and gambling addiction in Germany. Results of the 2015 survey and trends , 2016, Table 45 (in conjunction with Table 23)
  22. ^ Federal Center for Health Education (BZgA): Gambling behavior and gambling addiction in Germany. Results of the 2017 survey and trends , 2018, Table 46
  23. ↑ S. Buth, H. Stöver: Participation in gambling and gambling problems in Germany: results of a representative German survey. In: Suchttherapie , Volume 9, 2008, pp. 3–11, Table 6 .
  24. ↑ Slot machines: Golden series . In: Der Spiegel . No. 10 , 1983, p. 92-94 ( Online - Mar. 7, 1983 ).
  25. ↑ Michael Fröhlingsdorf, Nicole Serocka: Jackpot for therapists . In: Der Spiegel . No. 25 , 2008, p. 46 ( online - June 16, 2008 ).
  26. ↑ Jens Kalke u. A .: Austrian trial for the prevention of gambling addiction (2009-2011) , presentation slides ( Memento of 4 March 2016 Internet Archive ) (PDF, 1.3 MB) p.14, 15 Summary .
  27. ↑ Swiss Federal Gaming Board : Casino landscape in Switzerland at the end of 2009 ( memento from June 16, 2013 in the Internet Archive ) (PDF; 0.9 MB), p. 6.
  28. ^ Riitta Matilainen: Production and consumption of recreational gambling in twentieth-century Finland , Dissertation, Helsinki 2017, p. 18, online
  29. ↑ State Treaty on Gambling in Germany (GlüStV) ( Memento from April 21, 2012 in the Internet Archive )
  30. ^ Judgment of the Federal Constitutional Court of March 28, 2006 on the state sports betting monopoly
  31. ↑ cf. Federal Court of Justice , NStZ 1994, 501, Federal Court of Justice, JR 1989, 379 m. (Note Kröber, Higher Regional Court Hamm , NStZ-RR 1998, 241)
  32. ↑ red. Guideline for NStZ 2005, 281
  33. ↑ Federal Court of Justice (BGH), judgment of October 20, 2011, Az. III ZR 251/10, NJW 2012, 48 [1]
  34. ↑ Robert J. Williams, Jennifer Royston, Brad F. Hagen: Gambling and Problem Gambling Within Forensic Populations A Review of the Literature.