Negative changes in the personality of gambling. Gambling addiction: symptoms, stages, cure. Symptoms of gambling addiction

Gambling is a disease that has already destroyed many destinies. However, there is still an opinion that gambling addiction is just a hobby that unreasonably attracts such close attention from psychologists and psychiatrists. It is followed by those who do not know that in the ICD-10 disease coding system, gambling (aka gambling addiction) has the F63.0 code, which implies a pathological attraction to gambling. Thus, official medicine recognizes that gambling is a disease.

In this article, we will understand the causes of the development of this pathology, its treatment, as well as the prospects for recovery, because, as you know, mental disorders are often subject to only supportive therapy and do not imply 100% recovery.

Causes of the disease

The disease "gambling addiction" develops as a result of various motivational programs that arise in the mind of a person, depending on his personal set of characteristics. Therefore, now we will look at the common causes that most often turn into gambling addiction.

1. Loneliness. A person who feels lonely is looking for ways to socially realize himself. The game is most often a communicative process, so in it you can compensate for the lack of communication by interacting with other players.
2. Greed. If we talk exclusively about gambling, which implies a monetary reward in case of winning, then the thirst for relatively easy money will motivate a person to play constantly, even if there is no winning.
3. Laziness. Again, this disease can be the result of unwillingness to work hard. Such a person refuses to go to real work, because it implies responsibility and the contribution of physical or intellectual forces. It is easier for an individual to put the probability of his income “for good luck” than to receive a stable salary, and at the same time regularly engage in labor activity.
4. Infantilism. An infantile person is not ready for responsible tasks, has an illusory idea of ​​reality, and therefore chooses the same "unsteady" methods of earning when it comes to games with monetary rewards. The extreme degree of naivety in this case brings great financial losses, because systematic losses do not tell the infant about anything, and he believes that one day he will win.
5. Feeling of dissatisfaction. It forces a person to show himself in the game if he cannot do it in real life. This is especially evident depending on online games, where a person makes friends, finds a circle of people with whom he can discuss something or demonstrate his gaming abilities.
6. Addiction propensity. In most cases, this is an innate trait, which is more likely than others to manifest itself in drug addictions: smoking, alcoholism. This is not a decisive factor in the formation of gambling addiction, but one of those that implies a probable tendency to gamble.
7. Mental pathologies. A disharmonious psyche manifests itself in a different person, his falling into dependence on people, things, phenomena.

Signs of the disease

Gambling is a disease that has a number of symptoms:

1. On initial stage a person develops a strong desire to play. There is no pronounced dependence yet, but the frequency and duration of entertainment increases.
2. At the second stage, it is difficult for a person to resist the desire to spend time at the computer, but he still consciously relates to it, because. may ask the question: "to play or not to play?".
3. At the last stage, the person does not have a struggle of motives, the person plays, if possible. He asocializes, and if he participates in gambling demanding cash deposits, then most often, he sharply becomes poorer. No threats from relatives and life problems (for example, deprivation of housing due to debts) can stop him.

Therapy and prospects for recovery

Gambling addiction is a disease, the treatment of which is hampered by the fact that there are no medicines for it. The decision to stop the game (and, accordingly, the possibility of getting rid of addiction) depends only on the patient and his attending psychotherapist, whose task is to help the person realize the destructive impact of the game.

However, each personality has its own characteristics, and, for example, the miserable position of a gambler with a penchant for psychological masochism, with convictions about the destructive influence of this activity, will further spur him to it as a method of self-destruction.

Replacing the area of ​​receiving the necessary sensations received during the game process can also contribute to the disappearance of gambling. Despite this, such people rarely manage to get rid of their addiction, and medical consultations can only reduce the severity of the manifestation of the disease for a certain period, which implies only periodic relief without a 100% cure.

So, in this article, we realized that gambling is a disease that cannot be cured without the patient's conscious and realized desire to get rid of this type of addiction.

Instruction

Further - you must clearly realize that no fortune-tellers, healers, sorcerers and sorcerers will help you. Gambling is not spoilage or evil eye. Charlatans will only gut yours completely. You need to understand that the treatment of gambling addiction should take place in a complex where at least three people are involved - the patient, the doctor and a loved one.

Of course, without the help of an experienced specialist can not do. How do you know that the doctor you have consulted - good specialist? First of all, he will not promise mountains of gold, but will warn that there is a lot of work to be done. Also, he will definitely look for the causes of gambling addiction. After all, it does not occur on empty place and everyone in a row. Any addiction is an escape from reality. This is what the doctor will help you find out.

The specialist will prescribe therapy, which you will have to follow steadily. It can be group therapy or individual therapy. You may be prescribed some medication. At this moment, the support of loved ones is required.

After therapy, you must remember - there are no former gamers. In no case do not provoke yourself to relapse, and do not even play cards! Also remember that a person prone to addiction may find a new object of desire. So that a gamer does not turn into, for example, an alcoholic, think about what can bring you joy in real life.

Sources:

• how to cure gambling

After the entry into force of the ban on gambling activities in Russia, it became easier to deal with gambling. But this is only at first glance... In fact, it was not possible to solve the problem, because there were so-called "interest clubs" that skillfully disguised their activities, as well as online casinos. How to help overcome gambling addiction?

Instruction

Find problems. This will be the first step towards getting rid of gambling addiction. If a person regularly spends his free time behind vending machines, this is not yet a sign of illness. It's like a hobby, like fishing or collecting. But it is not customary to get rid of such hobbies. But if immersion in the gameplay develops into something more than just a pastime, then you should think about weaning yourself from this bad habit. You need to talk about addiction when the game session time exceeds 4 hours, subject to daily visits to thematic sites or clubs. Of course, if the game becomes one of the priorities of life, a source of constant family conflicts, or a means to lower everything, then the disease is obvious. And he has to fight.

Identify the manifestation of addiction. This will determine the course of the "treatment". There are paid and free slot machines, as a rule, immersion in the virtual world of excitement almost always occurs through an innocent passion for playing for fun. But if a person does not stop, then in almost 100% of cases it becomes a real source of ruin. And the second stage is much worse than the first.

Find other hobbies. Free slot machines can be “cured” by a reassessment of priorities, the choice of another, alternative hobby. If with such an addiction there is a penchant for creative self-expression, then it can become that very magic pill. For example, a “patient” dreams of painting, but that time was never enough or simply “there was no reason”. In this case, you can discuss this option with him, enroll in specialized courses. In a word, redirect energy in a different direction.

Use logic and common sense, avoid excessive displays of emotion. If gambling activity leads to a serious gap in the family budget, you need to make it clear that the game is not worth the candle. To do this, you need to sit down with an addicted person at the same table and calculate the amount invested

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In the first published scientific study on the topic of pathological gambling, an opinion was expressed about the multifactorial nature of the development of gambling. Its author is Gerolamo Cardano (1501-1576). Cardano first raised the question that perhaps the passion for the game is an incurable disease. He also assumed that gambling has an active psychological role, "because psychologically the game helps with grief, melancholy, anxiety, tension."

Cardano's works directly indicate that he knew firsthand that during the game a person experiences very specific states of mind, such as loss of control over oneself, the desire to increase the stakes, chasing (chase), fixation on the issues of the game. In addition, he noted that gambling leads to social and legal problems, and all together constitutes the diagnosis of gambling addiction.

ICD-10 code

• F63 Disorders of habits and drives.
• F63.0 Pathological gambling.

Brief historical essay on gambling

Gambling has been known since ancient times. The word "gamble" comes from the Arabic word "alzar" - "dice". The first documentary sources about gambling were found among the ruins of ancient Babylon (3000 BC). In the classical literature of many cultures, the attraction to the game is mentioned (Old and New Testaments, epic poem "Mahabharata" in Sanskrit, etc.). The game of dice was the most widespread game in the Middle Ages. Card games appeared in Europe since crusades in the thirteenth century

The history of the development of legal relations in society and the emergence of negative consequences of gambling indicates that since ancient times, the direct duty of the state as an institution of political power, management and protection of the interests of all segments of society was as follows: gambling should not take place in public, attract a wide range of people affect the material well-being of the broad masses of the population.

It should be noted that the official prohibition of gambling and various eras of the development of society did not destroy them, but only temporarily reduced the number of gambling establishments and their locations. The prohibition of gambling has never guaranteed their real disappearance.

In Russia during the period of Soviet power and existence Soviet Union there were no casinos and gambling establishments for playing cards or slot machines. The collapse of the Soviet Union and the change in the political system of Russia very quickly led to the creation of a gaming business and gaming associations. Moscow and St. Petersburg quickly turned into a kind of parody of Las Vegas.

In connection with the negative social consequences associated with the gaming business, in the spring of 2007, a Decree of the Government of Russia was adopted to move gambling establishments outside the city limits.

According to A.K. Egorov (2007) and many other researchers, the relevance of the problem of gambling addiction is due to the following three reasons:

• serious social and financial problems;
• the prevalence of criminal acts among them (up to 60% of patients with gambling addiction commit offenses);
• high suicidal risk (13-40% attempt suicide, 42-70% of patients report suicidal thoughts).

To this list should be added the specific gravity among patients with gambling comorbid disorders (alcoholism, drug addiction, endogenous pathology) and pronounced moral and ethical degradation with all the social consequences characteristic of this contingent of people.

There are currently four main categories of gambling.

1. Permanent legal games - lotteries, video lotteries, race bets, sports bets, bingo, casinos, slot machines.
2. Games in illegal gambling establishments and betting at illegal bookmakers.
3. Various money bets and bets between acquaintances, friends and work colleagues. It can be absolutely any bets and bets that occupy a significant place in the cultural life of the population.
4. Playing on the stock exchange, which does not belong to a professional obligation, but takes on the character of a game of chance.

One of the first systematic study of gambling addiction was taken up at the beginning of the 20th century. American psychologists. They believed that not only anatomical, but also behavioral or "mental" personality characteristics are inherited. Based on these beliefs, it was concluded that the repeated (intentional) approach to life-threatening situations that provoke an involuntary reaction of survival (self-preservation) entails a biological need for such experiences. This hypothetical necessity, which is also considered necessary for the process of survival, is supported by the presence of behavioral strategies leading to the search for risky situations and is transmitted to subsequent generations.

E. Moran (1975), based on the classification of alcoholism into five types proposed by Jellinek, identified five groups of pathological gambling: subcultural, neurotic, impulsive, psychopathic and symptomatic. He viewed pathological gambling as a complex system of interrelationships of the individual constitution, family and social aspects and pressures, the availability of gambling territories, monetary losses and the financial difficulties that they entail, social isolation and family difficulties. In each type, and also in each case of each type, various factors may have a greater influence than others.

Caster (Caster R., 1985) believed that patients go through the entire path of gambling addiction formation in 10-15 years. He identified five main stages in the development of gambling addiction. Caster noted that the "virus" of gambling does not affect everyone who comes into contact with it. His observations made it possible to identify some traits that make a potential player more susceptible to the cure virus. These traits include low self-esteem, intolerance of rejection and disapproval, impulsiveness, high levels of anxiety or deep depression, low tolerance for disappointment and a need for immediate gratification, a sense of omnipotence and a penchant for magical thinking, activity, a thirst for activity, excitement, stimulation and risk .

In recent studies, considerable attention has been paid to the game cycle, which includes a gradual change in certain states (“phases”) that are characteristic of a pathological gambler. Understanding the dynamics of the cycle is important for the formation and solution of psychotherapeutic and pharmacotherapeutic tasks when working with problem players. V.V. Zaitsev and A.F. Shaydulina (200") offered their vision of the development of the phases and behavior of patients, which constitutes the so-called game cycle: the phase of abstinence, the phase of "automatic fantasies", the phase of increasing emotional stress, the phase of making a decision to play, the phase of repressing the decision made, the phase of implementing the decision.

Other researchers (Malygin V.L., Tsygankov B.D., Khvostikov G.S., 2007) established a certain regularity in the formation of the gambling cycle:

• a period of distress immediately following the game;
• a period of moderately pronounced anxiety-depressive disorders;
• a period of subdepressive disorders with a predominance of asthenia or apathy;
• a period of anxiety and dysphoric disorders in combination with subdepression;
• a period of narrowed consciousness (trance of the game), preceding immediately after the breakdown.

The characterological properties of pathological gamblers are determined by the predominance of hyperthymic, excitable and demonstrative character traits, reaching the level of accentuations only in 14.3%. Analysis of the mechanisms of psychological defense reflects the predominance of defense mechanisms of the type of denial, repression, projection and regression.

When studying the psychological characteristics of problem gamblers, most researchers point to the loss of control over their own behavior by a gambler, and this applies to all types of gambling (from betting to slot machines). Australian researchers identify three subgroups of problem gamblers:

• with behavioral disorders
• emotionally unstable;
• antisocial, prone to impulsive actions.

ICD-10 code

F63 Disorders of habits and inclinations

F63.0 Pathological gambling

Epidemiology of gambling

Gambling is spread all over the world, many countries are involved in the gambling business, which brings super profits. The prevalence of pathological gambling in the world population is from 1.4 to 5%

About 5% of regular casino visitors suffer from pathological gambling. On average, 60% of the population in developed countries gamble and 1-1.5% of them may be addicted to gambling.

The classification of crimes registered at gambling enterprises, according to one of the members of the security committee of the Russian Association for the Development of Gaming Business (RARIB), is as follows: crimes related to the attempted sale of counterfeit banknotes in denominations of 100, 500 and theft of funds; hooliganism. From various media sources, it is also known that visitors to gaming establishments commit more serious crimes (arson, destruction of slot machines, shootouts with security guards and murders).

In countries with a developed gambling business, a comprehensive solution to the problems of pathological gambling has been brought to the level of state regulation:

• the state adopts laws governing the activities of the gaming business and controls their implementation;
• the state assumes obligations to study epidemiology, carry out comprehensive measures for the prevention of gambling, treatment and rehabilitation of patients with gambling;
• the state finances preventive, curative and rehabilitation anti-gambling programs and optimizes the activities of commercial structures of the gaming business and public organizations in this direction;
• gambling addiction must be assessed as a serious problem that threatens the mental health of citizens, leading to personal and social maladjustment;

In turn, the gaming business undertakes to finance social protection programs for the population from the negative consequences of its activities, including the prevention, treatment and rehabilitation of patients with gambling.

Social portrait of people with gambling addiction

Most authors note that these are predominantly males, average age is 21-40 years old, education - secondary, incomplete higher, higher (approximately equal distribution with some predominance of secondary education), the majority at the time of the survey worked (42-68%), were married (37.3-73, 0%). relationships in the family are predominantly conflict (average 69.7%), comorbidity with alcoholism 42.4%. It should also be noted that most researchers note that patients with gambling addiction have a high proportion of alcoholic heredity, which averages 41-52%. In addition, suicidal tendencies among patients are 52%. illegal actions - >50%. The social portrait of gamers is supplemented by the results of a psychological examination, which testify to their emotional instability, reduced ability to self-control and reflection, asocial attitudes, a tendency to overvalued ideas and increased activity, which was combined with the predominance of narcissistic and borderline personality traits.

A largely identical social characteristic of a typical player (with the exception of age) is given by many foreign authors (Caster et al., 1985).

Causes of gambling

Despite a significant diversity of opinions on the prerequisites that contribute to the development of gambling addiction, in most cases, preference is given to biological, mental, environmental and social factors.

Of all the components that contribute to the formation of gambling addiction, the influence of the environment is relatively dominant - 36%. The influence of social factors is also high - 22%. It is clear that other predisposing factors, potentiating each other, play an equally important role in the formation of pathological gambling addiction.

In the context of the foregoing, it should be noted that patients often seek the cause and justification of their "life in the game" and its severe consequences, but external "global", mainly in social and environmental factors, and not in themselves. In fact, in the vast majority of cases, they wanted to be successful and economically secure people.

Clinical symptoms of gambling

The addiction syndrome in gambling addiction is represented by a pathological (often irresistible) attraction to gambling, combined with varying degrees of cognitive, behavioral, emotional and somatic manifestations. It may include some of the features observed in addictive disorders resulting from substance abuse (pathological attraction, loss of gambling control, AS, increased gambling tolerance, prolonged participation in gambling despite clear signs of harmful consequences, etc.).

The syndrome of pathological attraction to the game (gaming drive, motivational concept)

Manifested by an uncompromising desire to participate in the game, regardless of any obstacles, be it family, work, social obligations, economic problems, political, professional or criminal activities, somatic diseases that require attention and treatment, in the structure of a pathological attraction to the game outside the withdrawal syndrome pathological players are dominated by ideational disorders, including obsessive ideas (fantasy) about the features of the game, options for a "mandatory" win, combinations of digital, card or symbolic rows that bring "unconditional" victory and personal triumph. There is a feeling of confidence in winning and faith in one's special qualities, a state of anticipation of pleasure from the upcoming game, an illusion of control over the game situation. Fantasizing about the game is often accompanied by infantile ideas about the obligatory material success, the respect gained in the event of a win from the surrounding people and, especially, other significant persons, when “everyone, and, above all, relatives, will understand” that “I didn’t play in vain and believed in success ". Sometimes, against the background of such fantasizing, patients hear sounds characteristic of gambling establishments - the noise of slot machines, roulette, music, etc. There is an unconscious immersion in this state, which allows you to forget, distract from real everyday worries and many negative problems created as an addiction to the game ( predominantly), as well as life itself. In addition to the primary pathological attraction to the game, which occurs against the background of abstinence from the game and is considered a “trigger* of breakdowns and relapses of addiction, the secondary attraction to the game is of fundamental importance. It occurs in the course of participation in the game and indicates a significant decrease in the ability of the patient to stop the game, get out of the game trance and, therefore, control his behavior, despite clear signs of the harmful effects of participation in the game.

The presence of an abstinence syndrome or a withdrawal syndrome as part of gambling is controversial due to the lack of discontinuation of PAS use. Although even with this type of addiction, there is a taking away / deprivation of the game. At the same time, the withdrawal syndrome includes a group of signs of varying severity and combinations: emotional, behavioral, dyssomnic, unsharply pronounced vegetative, somatic disorders and an increasing pathological attraction to the game. Internal emptiness, regret about losing, self-condemnation, sometimes suicidal thoughts, elements of suicidal behavior and aggression dominating in the withdrawal syndrome in patients who lost a game the day before (the vast majority). The structure of affective disorders is dominated by anxiety, subdepression and depression, dysphoria, increased irritability, emotional incontinence. As a rule, there are sleep disorders in the form of insomnia, unpleasant dreams, scenes of game guidance, the game itself, etc. Among vegetative disorders, excessive sweating, tachypnea, reddening of the skin of the face, as well as tachycardia, hypertension, cardialgia, angina pectoris are usually noted. Asthenia, loss of appetite, cardiac and headaches, decreased efficiency and interest in work, alienation from members of the seven are not uncommon. Against this background, as affective, somatic, and vegetative disorders subside, a growing obsessive desire to "revenge", "recoup", "prove" periodically arises, which is gradually replaced by an irresistible craving for the game. In the acute period of the withdrawal syndrome, the pathological craving for the game is mainly manifested by the behavioral component (thinking about the system for overcoming obstacles that stand in the way of satisfying one’s desire, avoiding people who oppose the game, getting money using a wide range of methods of deception, theft, extortion, etc.). The duration of this syndrome is from 12 hours to 2 days. In cases of winning, the condition of patients is completely different. They have good dream, pleasant dreams. The mood is upbeat, they experience a feeling of victory, superiority, complacency, they are prone to spending money, make gifts, make unrealistic plans, and in particular, about partial repayment of debts. They are attracted to the game, they hope to repeat the success, they fantasize profusely about the upcoming game and what they will do with very big money, which they will definitely win, set themselves up for a moderate and cautious game, believe in repeated game luck. The illusory idea of ​​the ability to control the game situation and the ability to turn luck in one's favor is aggravated.

game trance syndrome

Absorption in the game, excitement, the inability to stop the game, despite a win or a significant loss. Most often, the game lasts from 4 to 14 hours, in fact, as long as there are funds (money) to participate in the game. The main goal of the player is to win, win. It is also preserved during a long game trance, but at the same time it loses its original brightness and contrast. In the course of the game, the motivational focus shifts from winning to the game itself, gambling passion and overstrain gradually begin to predominate, which leads to pronounced asthenic and vascular disorders. Hypertension, tachycardia, cardialgia appear, concentration of attention, memory weakens, gaming performance and professionalism decrease. Players completely forget rational and behavioral attitudes. Consciousness narrows and an adequate response to the situation is lost, the ability to control the course of the game and fully use game skills disappears. The ability to stop the game in time, get up and leave the gaming establishment is lost. The patient is immersed in a kind of state of "hanging" in the game, in which it is impossible to stop the game on their own, and friends or relatives are not able to forcibly pull the player out of the gaming establishment due to his violent resistance. Given this feature, many players are afraid of a long game cycle and give it great importance. At a short distance (2-3 hours), as they believe, the ability to control the course of the game and their actions is preserved and, therefore, there is always a high probability of winning. At a long distance (over 3 to 14 hours), in their opinion, many game or “fighting” qualities are lost, which leads to a mandatory loss. Often, at a long game distance, a certain critical state occurs, in which the main motive of the game - winning - practically disappears, the desire that the game ends with any result, even a loss, dominates, and then "you can calmly leave" and rest (game exhaustion syndrome). It should be noted that, being in a state of gaming trance, patients forget about all the personal and social problems created by painful addiction. They claim to "rest", relax and recover from hard work, that they supposedly "have the right to do so." In fact, this is one of the myths of gamers, which, by the way, is the most important target of psychotherapists.

win syndrome

Elevated, sometimes euphoric, mood, energy stuck, a sense of superiority, the joy of achieving a goal. This state is a great pleasure (“it is worth living and playing for the sake of it,” as patients believe). Winning creates confidence in oneself, in one's abilities, allows one to fantasize about the most attractive directions in life, including further success in the game and the acquired wealth. It, being fixed and memory, contributes to breakdowns and relapses of the disease.

At the first stage of the dependence syndrome formation, the win syndrome lasts from several hours to several days. At the same time, patients are in euphoria, show extravagance and good nature. At the stage of severe gambling pathology, the duration of the win syndrome, as a rule, does not exceed 4-10 hours and, which is very characteristic, has a much less pronounced positive affective component.

Loss Syndrome

Occurs during the game, immediately after its completion, or can be set aside for one, less often, for two days. Losing during the game and realizing that there is less and less chance to win back, patients experience increasing anxiety, increased irritability, a feeling of anger, and sometimes regret that they started playing. Often they want to leave the game, but they are stopped by the excitement, the constant hope of winning, the memories of winnings and significant successes fixed in their memory. Aggression appears, a periodic desire to take revenge, find and punish the perpetrators. Being in such a state, in some cases, patients ask divine or devilish powers to help them, to have pity, in others they swear and curse everything. Often they cross themselves, read prayers, cast spells, stroke the slot machine, or, conversely, damage and destroy it.

After the end of the game, when the patient leaves the gaming establishment, the loss syndrome is manifested by depressed mood, incontinence, increased irritability, rudeness, sometimes aggression and destructive actions, frustration, suicidal thoughts. Sleep is disturbed, disturbing dreams are disturbed, there is no appetite, the head and heart often hurt. The painful state is accompanied by self-condemnation, suicidal thoughts and tendencies, temporary self-criticism, promises "never to play again" (similar to promises in the state of withdrawal syndrome in alcoholism - "never drink again"). It can last from 12 hours to 2 days, gradually fades, and it is replaced by an ever-increasing attraction to the game.

Tolerance to the game and its dynamics

In the process of involvement in gambling addiction, patients significantly increase their tolerance for prolonged participation in the game. So, if at the initial stage of addiction, patients spend 1.5-3.5 hours in a gambling establishment, then later, when signs of decompensation appear, they are able to play for 10-24 hours. In fact, as long as there is money and work gaming establishment. At the same time, in the category of patients over 50 years of age, gaming tolerance decreases, and patients are physically unable to participate in the game for more than 4-5 hours due to rapid exhaustion.

Syndrome of personality changes

Very quickly (6-12 months) during the formation of gambling addiction, signs of negative personal, behavioral, emotional and intellectual-mnestic disorders appear against the background of varying degrees of severity of the gambling addiction syndrome. These are deceit, irresponsibility, conflict, violations of industrial discipline, temporary or persistent indifference to work (frequent job changes) in the family, decreased efficiency, criminality (theft, fraud, forgery, etc.), loneliness. In addition to emotional coarsening, they note a significant decrease in exactingness to their appearance, personal hygiene, untidiness, etc. Affective disorders are manifested by constant anxiety, subdepressions, depressions, dysphoria. Suicidal thoughts and tendencies are characteristic. The range of interests narrows, long-term ties with friends are lost. Gradually worsening memory, working capacity, as well as the ability to creative activity.

People suffering from gambling become touchy, quick-tempered, rude, "dim", sexually weak, selfish, make unreasonable demands, do not want to buy things necessary for the family, products, save on everything for the sake of saving money for the game.

Personal degradation and social maladjustment not only prevented patients from participating in gambling, but also contributed to the progression and stabilization of the disease.

Gambling and comorbidities

Patients with gambling addiction are 3 times more likely to have symptoms of depression, schizophrenia and alcoholism. They are 6 times more likely than non-gamers to have symptoms of antisocial personality disorder. In ICD-10, antisocial personality disorder is positioned as antisocial personality disorder. In the presence of both diagnoses, antisocial personality disorder occurs earlier, on average by 11.4 years. Alcoholism in most cases outstrips the emergence of gambling by an average of 2 years, drug addiction - by 1-1.5 years. A study of 4,499 pairs of twins also showed a direct link between various disorders in childhood, the subsequent onset of antisocial personality disorder, and the onset of gambling. It has been established that the genetic predisposition, at least partially, determines the described comorbidity. Hereditary burden of alcoholism was found in 41.4% of patients with gambling addiction, drug addiction - in 2.7%, mental illness - in 37.4%. According to research data, 36% of the surveyed patients with gambling addiction had problems with alcohol, they were treated for alcoholism, in more than half of the patients (53.6%) heredity was aggravated by alcoholism.

In patients with schizophrenia, the clinical manifestations of the syndrome of pathological attraction are significantly modified. According to O.Zh. Busika (2007). in patients with schizophrenia, combined with pathological gambling, the syndrome of pathological attraction to gambling is manifested by less intensity than in patients with only gambling and in patients with gambling, combined with dependence on alcohol or drugs. The ideational, affective and behavioral components of the syndrome of pathological attraction also "differed in less brightness and severity."

Pathological players may suffer from overeating and are prone to the use of various substances and drugs in large doses, 30% observe compulsive sexual disorders, 25% - addiction to shopping. At least 50% of gamblers have obsessive-copultive disorders, 43% have depression, 7% have bipolar affective disorders, and 5% have schizophrenia. These statistics indicate that obsessive-compulsive and emotional disorders (depression, affective pathology) play the main role in the formation of pathological gambling.

Stages of gambling

The development of clinical manifestations of gambling goes through three interrelated stages: compensation, subcompensation, decompensation. They differ from each other in the severity of qualitative manifestations of syndromic disorders, as well as in the severity of their manifestation. Naturally, severe disorders are clearly visible in the second and third stages of the disease, when “game” degradation occurs, including personal and social components.

Stage of compensation

At the compensation stage, a syndrome of pathological attraction to the game is formed, in the structure of which the ideational component predominates at first, “crazy and passionate thoughts”, “premonitions” of an indispensable win crystallize. There is, as F. Dostoevsky wrote, “self-poisoning by one’s own fantasy”, which, repeated many times, is reliably fixed in the mind, turning into a worldview concept, sometimes into a “sweet” one. creative activity, and, consequently, produces an ever-increasing "thirst for risk." Playing and losing is just a kind of payment for immersion in the world of creative fantasies and imaginary gains, for the illusion of a holistic "I", a protected feeling of loneliness, guilt, shame, fear, temporary or sometimes total insolvency, for leaving the period of the game and the game trance from states of deprivation and despondency. For all this, dependent patients are ready to pay “big” and pay with money, expensive property, cars, summer cottages, apartments, social stability and family well-being, with their own lives.

At this stage of gambling, there is an increase in gaming tolerance, a joyful feeling of the game itself is fixed, game paraphernalia is fetishized, game myth-making is formed, the first signs of personal deviations of the moral and ethical spectrum appear. In the compensation stage, patients keep their jobs, their families, they believe that “everything will somehow work out”, despite the debts and troubles that have appeared. The ability to spontaneous remissions is preserved. Social losses are beginning to create serious problems and cause anxiety. The rapid entry into the stage of the formation of the disease is due to the biological and mental predisposition to gambling addiction. Its average duration is from 6 months to 2 years.

Subcompensation stage

At the stage of subcompensation (stabilization of the disease), such syndromes as withdrawal syndrome, game trance, gain, loss, personal degradation and social maladaptation are formed. The components of the withdrawal syndrome - mental, vegetative, somatic disorders - are manifested by characteristic and easily recognizable symptoms. Game tolerance is high and stable. Patients can play for 5-20 hours a day. Strongly expressed secondary attraction to the game. Spontaneous remissions, during which patients lead an orderly life and work, are rare. These "light gaps" easily replace long episodes of the game. Winning brings a feeling of confidence, strength and omnipotence. Patients overestimate cognitive abilities and intuitive qualities, the ability to "foresee" the result. The attitude to constant failures is frivolous and uncritical. They make desperate attempts to return the lost money, often making large bets. Systematic failures in the game lead to a significant change in behavior, which is accompanied by ever more frequent cases of cheating relatives, friends, employers. In a game trance, patients find salvation from disappointments and bad moods. Sleep is disturbed, most dreams become disturbing and unpleasant. Family relationships are on the verge of collapse or have already been broken. Patients are looking for a way out in big wins and big luck. Finally, the day comes when all possible legal financial resources are exhausted and the "system failure" occurs. It is at this stage that thoughts of suicide and the desire to hide from everyone (from family, friends, creditors) first appear. For some players, the phase of refusal to fight for a big win begins, gaming tolerance decreases, and disappointment sets in. It is in this state, under pressure from close relatives, that the players agree to treatment. The duration of this stage is 3-6 years.

Stage of decompensation

This stage corresponds to the second and third stages of the gambling addiction syndrome. The ideational component of the attraction syndrome and the feeling of "confidence" in one's winnings weaken. Significantly reduced criticism of the clear signs of the dangerous consequences of gambling. There is a small register of really strong motives for abstinence in patients' reasoning, which, as a rule, does not stop them from gambling. In patients, a significant moral and ethical decline and emotional coarsening are noted. Suicidal tendencies are often realized. Expressed affective disorders with a predominance of depression. Decreased sexual interest and libido. Families are destroyed, problems arise with work (often jobs are lost) and law enforcement agencies. The somatic condition is characterized by exacerbation cardiovascular diseases(arterial hypertension, angina pectoris, etc.). diseases of the digestive system, etc.

The duration of the formation of this stage is from 7 to 15 years.

Diagnosis of pathological gambling addiction

Pathological gambling is considered in the chapter "Disorders of personality and behavior in adulthood" in the heading F6O-F69 "Disorders of habits and drives" of ICD-10. Pathological attraction to gambling (F63.0) consists in frequent repeated episodes of participation in gambling, which dominates the life of the subject and leads to a decrease in social, professional, material and family values. Patients may risk their jobs, borrow large sums, and break the law in order to raise money or avoid paying debts. They describe a strong urge to gamble that is difficult to control, as well as mastery thoughts and ideas about the act of gambling and the circumstances that accompany this act. These mastery perceptions and drives are usually intensified at times when there is stress in their lives. This disorder is also called compulsive gambling, but this term seems to be controversial, since the specified behavior is not compulsive in nature, nor in the presence of a connection of these disorders with obsessive-compulsive neurosis.

Diagnostic instructions

The main symptom is recurring gambling that continues and often deepens despite social consequences such as impoverishment, disruption of family relationships and the ruin of personal life.

Differential Diagnosis

Pathological gambling should be distinguished from:

• propensity to gamble and bet (Z72.6):
• frequent gambling for pleasure or money; such people usually restrain their attraction when faced with large losses or other adverse consequences of gambling;
• excessive gambling of manic patients (F30); gambling of sociopathic personalities (F60.2*); these individuals exhibit a broader persistent impairment social behavior manifested by aggressive actions, through which they show their indifference to the well-being and feelings of others.

Pathological gambling should also include:

• obsessive attraction to gambling;
• compulsive gambling. Stages of gambling addiction and rehabilitation potential in pathological gambling

Gambling addiction (pathological gambling, ludomania) is based on a pathological craving for gambling, which belongs to the field of mental pathology. Therefore, like other mental illnesses, gambling addiction is characterized by a sequence of occurrence of clinical syndromes of the disease, their dynamics, staging, which together reflect the evolutionary development of the pathology. The severity of gambling addiction is determined by the strength and dynamics of the attraction to the game, loss of control, tolerance, severity of the withdrawal syndrome, the degree of personal and social degradation. It is the differences in the severity and stability of gambling addiction syndromes that make up the essence of the individual stages of the disease, which in turn largely determine the level of rehabilitation potential of patients with gambling addiction.

Rehabilitation potential in pathological gambling

IN last years considerable attention is paid to the personal potential of patients with addictive disorders and, in particular, to the rehabilitation potential, which determines the features of the formation of addiction and the way out of it (spiritual) development and social status of patients. The levels of the rehabilitation potential of patients with gambling addiction were established (the concept of T.N. Dudko). Patients with an average and low level of rehabilitation potential seek medical help, the proportion of patients with a high level of rehabilitation potential is not more than 10%. The main components of the levels of rehabilitation potential of patients with gambling, of course, have their own specific relativity. They note a significant fluctuation of diagnostic features inherent in each of the four blocks, characterizing high, medium or low levels of rehabilitation potential.

In monogamy addiction (in the absence of comorbidity), each of the levels of rehabilitation potential most often has the following features:

High level of rehabilitation potential

Predisposition. Low proportion of hereditary burden of mental and narcological diseases (up to 10-15%). Mental and physical development is predominantly within the normal range, the upbringing environment is prosperous.

clinical picture. The stage of compensation and the appearance of the first signs of subcompensation; the initial (first) stage of the gambling addiction syndrome, high tolerance to the game and even its growth; low intensity gaming withdrawal syndrome. Gaps between gaming episodes, especially after another loss, can reach several months. A high level of rehabilitation potential is characterized by the mandatory presence of spontaneous remissions, including long-term remissions after losing and even winning. The fetishization of game paraphernalia, the illusion of controlling the game situation, is being crystallized. Increased secondary attraction to the game. Gradual involvement in the study of "game theory". Predominate abstinence from the abuse of alcohol. Duration of dependence syndrome is 1-3 years.

Personal change. Moral and ethical deviations in the form of "petty" lies, violations of obligations, responsibility, episodes of borrowing money for a game, returning money, but not always within the promised time. The first episodes of thieves in the family. Some reduction in criticism, frivolous attitude to the facts of the consequences of addiction, disturbing thoughts about changed behavior. After work, I do not want to return home because of the "boring atmosphere of family existence." There are signs of affective disorders of the neurotic series in the form of incontinence, conflict, moderate anxiety and depressive disorders.

social consequences. The appearance of the first signs of social maladjustment, including the deterioration of family relations, minor conflicts at the place of work or study due to a decrease in responsibility; some narrowing of the circle of interests; reduction of time for the usual leisure pastime (family, sports, physical education, art, tourism).

In patients with a high level of rehabilitation potential, all the characteristic signs of gambling addiction are noted, including not only the appearance of clinically defined symptoms of attraction disorders, but also mild moral and ethical changes, affective disorders, and a decrease in criticism of the negative manifestations of gambling addiction.

Average level of rehabilitation potential

Predisposition. The average proportion of hereditary burden of mental and drug addiction (20-25%); upbringing in an incomplete family, often with uneven or conflicting relationships between family members. Often deviant behavior and associated uneven school performance, inconstancy of hobbies. Increased suggestibility.

clinical picture. subcompensation stage. Middle (second) stage of gambling addiction syndrome; consistently high tolerance for the game; severity of gaming AS and post-withdrawal disorders. The secondary attraction is expressed after the beginning of the game, the patient is not able to interrupt the started game. The stability of the formed ideology of participation in gambling, the "resistant system" of protecting one's beliefs. Illusion of game control. A frivolous attitude to the abuse of alcohol and other surfactants. The duration of the dependence syndrome is at least three years.

Personal changes. Constant conflict relations with parents and family; decrease in moral and ethical qualities: theft of money not only in the family, but also at the place of work, fraud, hooliganism, increasing debts. Decreased sexual desire and potency, avoiding meetings with the spouse.

A sharp decrease in criticism of the facts of personal and social collapse. Periodically aggravated desire to work intensively and hard, especially with the threat of dismissal. Severe affective disorders in the form of psychogenic depression, sleep disorders, suicidal tendencies (mostly thoughts and demonstrative threats to commit suicide).

social consequences. Family and social maladaptation. Negative dynamics of family relations; leaving the family, the threat of divorce or divorce. Conflict at the place of work or study. Prosecution. Frequent layoffs. Narrowing the circle of interests.

Low level of rehabilitation potential

Predisposition. High proportion of hereditary burden of mental and narcological diseases (more than 30%). Growing up in an incomplete family, destructive relationships between family members, alcohol abuse by one or two family members, neurotic development, personality deviations, uneven school performance, inconstancy of hobbies, passion for gambling.

Symptoms. stage of decompensation. The second or third stage of the gambling addiction syndrome; stable or somewhat reduced tolerance to the game; the severity of gaming withdrawal syndrome and post-abstinence disorders. Spontaneous remissions are practically not observed, they are often caused by external motivators - illness, lack of money, imprisonment. Participation or non-participation in the game depends on the presence or absence of money. There is some disappointment in the fetishization of game paraphernalia and control of the game situation. The intensity of the euphoric component of the gaming trance and the win syndrome decreases, the loss syndrome largely loses its inherent bright negatively colored emotionality and painful regret. Losing is perceived as something ordinary, there is only a slight hope - "maybe lucky next time." The ideology of participation in gambling and the "strong system" of protecting one's beliefs remain, but in their presentation one can trace uncertainty and pessimism. Very often patients abuse alcohol and other surfactants. Duration of addiction syndrome for at least 5 years, Personality changes. Conflict relations with parents and family. A pronounced decrease in moral and ethical qualities: theft, fraud, hooliganism, the growth of debts and the absence of any desire to return them. Decreased libido and sexual potency. A gross reduction in criticism of the disease, the alienation of the facts of personal and social collapse. Family indifference. Persistent affective disorders in the form of dysphoria, depression, sleep disorders, suicidal tendencies. Expressing suicidal thoughts and committing suicide attempts.

social consequences. Pronounced family and social maladaptation. Continued deterioration in family relationships, leaving the family, the threat of divorce or divorce. Conflict at the place of work or study. Prosecution. Systematic unemployment or work with a lower skill level. The patient is indifferent to work, mainly aims to "make some money". Narrow circle of social interests.

Differentiation of patients according to the level of rehabilitation potential allows predicting the prospect of treatment, creating and implementing the most optimal programs for the treatment and rehabilitation process for patients and psycho-correction programs for their relatives.

Treatment of gambling addiction and rehabilitation of patients with addiction to gambling

Observations made it possible to establish that the consent and, consequently, the external and internal motivation of patients with gambling addiction for treatment and rehabilitation are determined by the following main factors:

• a significant deterioration in family (family conflicts, the threat of divorce or divorce) and social status (trouble at work, the threat of dismissal or dismissal, debts), accompanied by feelings of guilt, feelings of personal and social collapse;
• psychological pressure of family members, the closest environment or society due to the insolubility of long-term psycho-traumatic problems and the growing consequences of maladaptation;
• the appearance of subjectively palpable painful signs of mental health deterioration - neurotic and depressive disorders, as well as suicidal tendencies due to addiction to gambling.

Treatment and rehabilitation of pathological gamblers begins at the first contact of the patient with the doctor, when the foundation is laid for the subsequent creation and consolidation of relationships in the form of an agreement and a joint plan for overcoming addiction and recovery.

Most experts believe that when providing treatment and rehabilitation care to patients with gambling addiction, a systematic approach should be used, based on the principles of complexity, multidisciplinarity, continuity of periods and stages, and long-term. The principle of complexity implies the unity of medical, psychological, psychotherapeutic and social methods of recovery of patients, including examination, diagnostics, pharmacotherapy, psychotherapy and sociotherapy. The principle of multidisciplinarity is based on the use of a brigade (team) approach to work, which combines the efforts and experience of a psychiatrist-narcologist, a clinical psychologist. psychotherapist, social worker and other specialists in the field of diagnostics and rehabilitation. The principle of succession is based on sin periods: pre-rehabilitation, proper rehabilitation and preventive. The first includes the use diagnostic technologies, treatment of acute and subacute conditions caused by gaming addiction (treatment of gaming AS, post-abstinence disorders, suppression of pathological attraction to the game, motivation to participate in rehabilitation programs). Its duration is usually 2-4 weeks. Actually, the rehabilitation period includes the whole complex of therapeutic, psychotherapeutic and social measures aimed at restoring mental health, suppressing the craving for the game, normalizing family relations, social status. Usually it takes 9 to 12 months to solve his problems. The prophylactic period is aimed at preventing recurrence of the disease, includes medication and psychotherapeutic support and optimization of the patient's social attitudes. Its duration is at least one year.

Conditions for the implementation of medical and rehabilitation care: an outpatient clinic, a semi-hospital (day hospital) and a hospital. The choice of specific conditions is determined by the level of rehabilitation potential, the severity of pathological gambling, its comorbidity with other mental illnesses, and the social status of patients. More often, treatment and rehabilitation is carried out on an outpatient basis, in some cases in hospitals.

The main indications for the treatment of patients with gambling addiction in hospitals include:

• severe manifestations of gaming abstinence syndrome, including unbridled, uncorrectable attraction to the game and objectively confirmed daily or very frequent visits to gambling establishments, accompanied by alcohol abuse;
• severe affective pathology, including depression and dysphoria;
• combination with dependence on PAS and psychopathy in the stage of decompensation;
• combination with endogenous mental illness in the acute stage;
• pronounced suicidal risk, including suicidal statements by them tending to implement them;
• complex family relationships, manifested by an increase in hostility and threatening the breakup of the family.

The total duration of treatment and rehabilitation care, taking into account the progradient nature of the disease, is determined by the stabilization of therapeutic remissions and the social adaptation of patients, but should be at least 2 years.

It should be noted that there is currently no specific psychopharmacological and psychotherapeutic treatment for gambling and related disorders. There are no standards for medical treatment. Drug treatment should be combined with various kinds of psychotherapy. Medications are selected based on the commonality or similarity of some mental disorders in pathological gambling and well-known psychopathological conditions

Psychotherapy

IN practical guide But the Massachusetts Department of Health (2004) identified four options for psychotherapeutic and therapeutic effects in the treatment of gambling addiction:

• minimizing the harmful consequences of the game for the player and his micro-society (family, friends, colleagues);
• reducing risk in situations directly related to money;
• the ability to cope with anxiety, depression, loneliness, tension through mastering new forms of behavior;
• satisfaction of the need for entertainment and communication through a less destructive and more balanced type of leisure.

Researchers at the University of Laval in Quebec (Hnjod et al.. 1994; Sylvain et ni. 1997) have created a treatment model, also based on CBT, that includes four components:

• correcting logical distortions related to gambling (cognitive restructuring);
• choice of a solution (precise definition of the problem, collection of necessary information, offers different options with a study of the consequences, a list of the advantages and disadvantages of each option, the implementation and evaluation of the decision made);
• social skills training (communication, quantitative thinking), as well as emotion management and learning to refuse; relaxation along with physical activity and meditation; elements of symbolism);
• training in relapse prevention skills - behavioral therapy, including desensitization techniques, aversion.

For persons with a mild degree of gambling addiction, psychodynamic psychotherapy is used as a variant of "quick" treatment. It is believed that the game is a replacement for an unsatisfied need that should be identified and implemented.

Of the other psychotherapeutic techniques, it should be noted the desensitization of eye movements (Henry, 1996), acupuncture, hypnosis, meditation, biological feedback, the use of physical exercise during leisure time and the Gamblers Anonymous 12-Step Program.

12 step program

According to a number of researchers (Stuart, Brown, 1988; Zaitsev V.V., Shaidulina A.F., 2003), one of the ways of self-improvement, changing attitudes towards gambling and developing personal responsibility for actively confronting pathological addiction is the ideology of a group of anonymous players with well structured and carefully crafted "12 step" program. The proven belief that people with similar problems can help and exemplify each other is a fundamental conceptual principle of the Gamblers Anonymous program. The only condition for membership is the desire to stop playing and attend groups of anonymous players. Gamblers Anonymous societies were first remembered in the United States in 1957. Currently, they operate in many countries, including Russia (Moscow, St. Petersburg, etc.).

There is an opinion that approximately 70-90% of the visitors to the groups of anonymous players drop out at the first stages of participation in the treatment, and only 10% become active members. Of these, only 10% are in remission for a year or more (Brown, 1985).

Family psychotherapy. Family psychotherapy is one of the mandatory components of an integrated approach to the treatment and rehabilitation of patients with gambling addiction. A.F. Shaidulina (2007) describes four stereotypes of family response (“denial”, “active actions”, “isolation”, “adequate response”) that one has to face in the process of working with patients and their families. By changing the behavior of family members, it was possible to gradually change the behavior of the player. Patients acquired new behavioral skills, increased motives for participating in the treatment and rehabilitation process and changing their own lives.

The National Research Center for Narcology (Institute of Rehabilitation) has developed a concept of rehabilitation potential, on the basis of which the strategy and tactics of treatment and rehabilitation work are determined (Dudko T.N.). Depending on the level of rehabilitation potential, they use various options complex approaches, and also consider the issue of the duration of the treatment and rehabilitation process. In all cases, the strategy and tactics of treatment and rehabilitation care is based on a systematic approach, including the use of principles and technologies for the recovery of patients with addictive disorders.

Medical treatment for gambling

Antipsychotics, tranquilizers, anticonvulsants, antidepressants, neurometabolic drugs, opiate receptor blockers are used.

In the pre-rehabilitation period (mainly therapeutic) with withdrawal disorders in pathological players, psychopharmacotherapy is mainly used. A combination of one of the stimulant antidepressants is recommended (Prozac at a dose of up to 60 mg per day, paroxetine (Paxil) at a dose of up to 40 mg per day, wellbutrin at a dose of 225-450 mg per day, amineptine (survector) at a dose of 100-500 mg per day ) with sedatives (amitriptyline in medium doses), as well as with antipsychotics (stelazin, clozapine, chlorprothixene). A combination of clomipramine with sufficiently high doses of antipsychotics is successfully used: perphenazine (etaperazine) at a dose of up to 60 mg, stelazin up to 30 mg, clozapine (leponex) at a dose of up to 75 mg. The choice of drugs is determined by the nature of the depressive affect. So, with the predominance of melancholy, the combination of clomipramine (anafranil) is most preferable. With anxiety, it is advisable to combine amitriptyline with clozapine (leponex) and phenazepam. Of the serotonergic antidepressants, a positive effect is achieved with the appointment of fluvoxamine (fevarin). In addition, with a tendency to anxiety-phobic reactions, benzodiazepine tranquilizers were used. Considering the data on the negative effect of tranquilizers on cognitive function, drugs with minimal muscle relaxant and sedative effects are more preferable: tranxen up to 30 mg, alprazolam (Xanax) at a dose of up to 1.5 mg, lexomil at a dose of up to 12 mg per day.

A significant place in the treatment of gambling is given to naltrexone. V.V. Khaiykov (2007) believes that the leading place in the self-report of gambling patients who took naltrexone was occupied by:

• a decrease in the brightness of the experiences of a game trance, up to an almost complete leveling of the emotional component of the game;
• a significant weakening of fixation on the game with the ability to observe the environment, assess the situation, respond to calls, etc.;
• the emergence of the possibility of stopping the game before a catastrophic loss;
• the appearance of "fatigue from the game", "loss of interest", previously either not typical at all, or coming much later (2 or more times).

Treatment with naltrexone can be carried out starting from the withdrawal and post-abstinence periods, the dosage is 50-100 mg per day, the duration of treatment is 2-16 weeks. In patients using naltrexone, the attraction to the game and anxiety quickly decrease, and mood improves. With an unauthorized dose reduction or discontinuation of naltrexone, the craving increased.

Treatment and rehabilitation of patients with a high level of rehabilitation potential is usually carried out in an outpatient setting. Of the psychotherapeutic methods, preference is given to rational psychotherapy, auto-training, neurolinguistic programming, body-oriented therapy, keeping diaries, and doing homework. An important place is occupied by the transactional analysis technique, which is carried out not only with the patient, but also with family members. Patients with a high level of rehabilitation potential often refuse group sessions, including visiting groups of anonymous players, but willingly agree to individual work and medication. Drug treatment is symptomatic, non-intensive and short-term. The course of treatment with naltrexone is at least three months.

Patients with an average level of rehabilitation potential need additional and longer treatment. For the most part, these are individuals with comorbid forms of addiction. But even if these are patients with monodependence, then, first of all, the method of rational psychotherapy should be used. including, in addition to motivating for treatment, a thorough study of hymitomas and syndromes of the disease, medical and social consequences of gambling. Drug treatment is prescribed for a long time. Hypnosis sessions can be added to the above methods of psychotherapy (after determining the degree of hypnotizability and setting the patient to this type of psychotherapy). Patients are encouraged to attend groups of anonymous players. Carrying out family therapy is in all cases a prerequisite. Naltrexone is prescribed in courses of two to three months with breaks of up to two weeks, during which it is necessary to study the dynamics of the mental state and attitude to the game. With stable remission, treatment with naltrexone is continued for 6-9 months. In the preventive period of rehabilitation, in cases of exacerbation of craving, small doses of anticonvulsants are recommended (carbamazepine at a dose of 50-150 mg per day), with the appearance of affective disorders, antidepressants [citalopram at a dose of 35 mg per day, fluvoxamine at a dose of 200-300 mg per day, cipramil (at a dose of 20 mg in the morning), mirtazapine (Remeron) at a dose of 15-30 mg at night], small doses of tranquilizers (phenazelam, afobazole, diazepam, phenibut).

The effectiveness of the treatment of gambling

Gambling is a progressive disease. Persistent spontaneous or therapeutic remissions are mainly observed in patients with a high level of rehabilitation potential. Scientific publications on the effectiveness of the treatment and rehabilitation of patients with gambling contain a number of conflicting points of view, which is largely due to the complexity of organizing the treatment and rehabilitation process and the difficulty of observing its basic principles. Often, the effectiveness of only individual methods or technologies is evaluated: behavioral therapy, psychodynamic approaches, the work of groups of anonymous players, drug treatment, etc. According to Bujold (1985), when using the psychotherapeutic method of communities of anonymous players, remissions are achieved in 10% of patients. Only as a result of the use of combined therapy, including individual, collective therapy and the mandatory participation in the work of groups of anonymous players, can higher efficiency (55%) be achieved.

A follow-up examination of patients with gambling addiction with an average level of rehabilitation potential revealed six-month remissions in 43.7% of patients and remissions lasting more than one year in 25%. The duration of remissions is directly proportional to the duration of treatment, i.e. the period of systematic medical and psychotherapeutic work with patients and their relatives.

Treatment and rehabilitation in a hospital for at least 28 days made it possible to achieve stable remission within one year in 54% of patients. R.L. Caster, using individual and group psychotherapy, as well as the participation of patients with gambling in groups of anonymous players, achieved a stable improvement in 50% of cases. V.V. Zaitsev, A.F. Shaidulina (2003) note that the cycle of psychotherapy developed by them from 15-20 sessions made it possible to obtain therapeutic effect in 55-65% of patients. In all cases, in order to achieve high and stable effectiveness, treatment should be comprehensive, consistent and long-term.

What is the prognosis for gambling?

The prognosis of gambling addiction is determined by many factors.

Signs of a good prognosis when patients are involved in a treatment and rehabilitation program:

• high level of rehabilitation potential, including successful heredity, constructive family, positive dynamics of physical and personal development, good premorbid, social and professional history;
• late formation of pathological dependence, the presence of spontaneous remissions, mild or moderate degree of the disease (stage of compensation or subcompensation);
• strong marital relations, the desire to save the family, attachment to the family;
• availability of work and a system of social and psychological support from the family and significant others;
• lack of debts or a real ability and desire to pay off debts (mental discomfort in the presence of monetary debts);
• stable motivation for treatment, the ability to stay in a formed motivational field and use the experience of latent positive motives for refusing to participate in gambling;
• long-term participation in treatment and rehabilitation programs, visiting groups of anonymous players.

gambling addiction one of the most common addiction diseases at the present time. People suffer from it different ages in different parts of the world, from childhood to adulthood.

gambling addiction- this is a painful attraction to the game as such, and not just to gambling, as it begins to develop from the usual seemingly harmless hobby for computer games. Unlike related diseases of drug addiction and alcoholism, this one is closer to mental illness, emotions, and does not affect physical health. But the principle of attraction itself is similar to her. After all, attraction and continuing to be drawn into your addiction is the main problem of addiction. This is sometimes misleading. After all, if in drug addiction and alcoholism the physical symptoms indicate a painful condition, then in the case of gambling this is naturally not observed.

For gambling addicts, there is even a support society "Gamblers Anonymous", which is something similar to the "Alcoholics Anonymous" groups.

You shouldn't think that gambling addiction disease of our time. In fact, this disease existed before, it was just that psychiatry and medicine were not well developed then, and there was no psychology at all. After all, gambling is a mental illness. Basically, like all dependencies. Help is provided in psychiatric hospitals.

And drug addicts and alcoholics, due to addiction to chemicals they also poison the body, then it is treated by doctors. After the treatment of physical dependence, the necessary psychotherapeutic or psychological stage of treatment begins.

The worst thing that makes gambling addiction such is the impossibility of recognizing it at the beginning of the development of the disease.

gambling statistics.

According to statistics, it is revealed that teenagers are most prone to gambling addiction. Although the age period covers all generations. Men are predominantly affected.

Some psychologists even note the usefulness of the game in that it helps to relieve stress and distract. But not everyone becomes gamer. Usually, those who prefer intellectual games, quests, do not develop gambling addiction. This is most likely due to the well-known excitement. Excitement does not stand still for a long time, and as a result leads to tragedy. Hidden prerequisites for excitement are also visible in dangerous sports and activities. It is excitement that pushes to the subsequent retraction into the disease, dependence.

We can say that in the nature of drug addiction, this very passion also lies to some extent.

History of gambling.

Gambling has always existed, although it received its name recently, and acquired the status of addiction.

Also in Ancient Egypt people of different age categories played dice. The dice were gambling, and were the most ordinary dice.

In China, they played cards that are not too different from modern ones.

gambling addiction was in almost all countries of the past. In Europe, this type of game was punished. Only cheaters were punished.

Playing cards came to Russia illegally from Europe.

All gamers in 1649 began to be called criminals and indulged in all kinds of torture. But it lasted until the reign of Peter the Great.

Then, under Peter the Great, cards were banned altogether, and gamblers were fined.

Empress Elizabeth, in turn, divided all the cards into non-forbidden and prohibited.

Already under Catherine II, the first gambling establishment appeared.

As for the attitude of the Soviet authorities to gaming activities, it was negative, so any gambling was prohibited in the USSR. Only racing was supported, but even then high stakes were unacceptable.

The first casino in Russia was opened in the late 80s by special order of the USSR government. This casino was intended only for the rich.

But in 1993, a machine appeared not for the rich. Anyone could play.

Gambling thus survived to this day.

As for the attitude of the church towards gambling in the past and present, it becomes clear in advance that it is negative, as, in other respects, the attitude of any other religion.

Symptoms of gambling.

Unfortunately, gambling addiction at first, it is not so easy to recognize. Sometimes people around know about it already by obvious unhealthy signs.

The first signs of a developing illness include a great involvement in the game, a strong experience of it.

A person constantly plays the situation of the past game, and already feels the impulse to a new one. At the same time, the gambler is excited and experiences constant anxiety. When he comes to the club and sits down at the machine, he is even more excited, which pushes him to raise the stakes.

During the game, a person finds it very difficult to break away from it. It's like he's being held by an unknown force. Anxiety builds as gamer stops playing and heads home to compose new version family scam.

Over time, irritability appears during the exit from the game.

Such a person constantly has an idea: how to get money for the next game, what can be sold, what can be mortgaged, and even stolen.

The most unpleasant thing in this situation is that the gamer is trying to hide his true motive by being busy with the game to the last. He will invent anything, but he does not confess his desire, even if he already feels that he is falling ill.

As a result, the case of the gambler becomes even worse. He loses his family (if the wife is not completely co-dependent), children, relationships with friends and comrades, loses his job. And his state of mind leaves much to be desired.

In this state, he again borrows debts from some acquaintances, but already in order to return them to others, from whom he once took for a game. All this can last indefinitely, if time is not intervened.

Usually gamer goes through several stages of the disease.

First stage starts with random games, during which he sometimes wins. then he has the idea of ​​raising the rate. At this stage, usually gamers gather in a group and visit clubs together.

Second phase characterized by full involvement in the game. Here already a person begins to borrow, to get into debt. The time of his stay in the playing hall increases and, accordingly, becomes more frequent. Now the gamer spends his games alone.

It happens that the gamer's friends who went with him several times to the gaming room no longer try to play, and do not realize that their friend still visits such establishments.

Third stage heavier. It's time to sort things out with loved ones, problems with work, unsuccessful games, despair.

Final stage ( fourth) is the stage of continuous problems. There may be a break with the family, dismissal from work, loss of friends. Anxiety reaches a state of panic. At this point, the mental state of the gamer is so unstable that thoughts of suicide may arise.

Gamers break into alcohol, rowdy, which is usually the reason for going to the doctor.

But gambling addiction is curable! Now there are programs specifically for the treatment of gamers. Regular psychotherapy also helps. It all depends on how much a person is interested in his treatment.

How not to become a gamer.

The game itself is not dangerous. But in order not to become a gamer, it is important to be a little prepared if you are going to play.

In order not to get involved in the game, you should have many other interests, or at least a few. Basically, playing is a hobby. But for gamers, this is not a hobby.

To begin with, every person must have an idea that gambling tends to be addictive, and that it is a disease, the same as all other addictions.

You always need to be able to use money, and plan the game in advance for an affordable budget. That is, do not rush headlong to the club and lose all the money spontaneously.

In no case should you make big bets, even if in money a person does not know deprivation.

Why doesn't everyone become a gamer? Some factors influence the development of the disease. For example, alcohol. Usually it is alcohol that contributes to the successful development of the disease. According to its influence, it is most difficult for a person to stop. These two dependencies often go hand in hand. But then again, all this dependencies, and all of them, including gambling from one element, luring, of a certain type of character, personalities.

You should also know that the state of mind of those who come to play in the casino is also of great importance. If a person has troubles at home, in general, he is unlucky at this stage of his life, it is better to completely abandon this idea - visiting such establishments. Melancholy, depression, boredom contribute to the escape from reality. In general, there are many reasons for the development of gambling addiction. Therefore, a person must have at least a little self-observation in order to understand what is going on in his soul. This can really help and save you from future problems.

It is also worth having some greed for your budget. It is always necessary to remember that the casino owners take the money, and the player is left with nothing. And every time he spends more and more on the game.

It is necessary to appreciate close and dear people, who in the end can be lost, to appreciate the work. In general, you need to love and appreciate yourself. Not one game is not worth such mental, material costs.

You can not forget the game and take it seriously. This is another mistake of the future gamer.

Ultimately: gambling. So where is the hobby? He has long since disappeared.

The principle of operation of slot machines.

The slot machine has its own system of work. This system implies that in the future the machine does not give any winnings. Yes, it was in the beginning, that's all. It is not uncommon to see how a completely new player who has come to the club wins immediately, just behind this machine. The more people who play, the more likely it is that another person will win. After that, it's not a sin to drop your hands. But they play anyway.

Slot machines, as you know, were released a long time ago. This was done in order to gain as many customers as possible (or rather their money) in their institution. Currently, there are a huge number of slot machines, and all descended from one ancestor, invented, as already described above, in the 90s. Invented by Charles Fey. He developed a special design, on the principle of which slot machines work. They consist of sets of wheels and symbols.

Then the wheels had the symbols of the usual playing cards, and some others such as bells, stars, horseshoes. Now there are more diverse icons.

The reward was given in the case when three symbols fell out in a row, especially three bells. The invention of such machines, therefore, was also called the "Liberty Bell". And then all slot machines began to be called that.

Further complicated the process of winning, in the future, Herbert Stefan Mills. He increased the size of the wheels - the result is 20 characters on each. In this case, the winning combination often becomes simply impossible. This has a strong effect on the psyche of gamers.

concept Jackpot also owes its origin to Gilbert Mills. Before the introduction of the jackpot, slot machines did not attract much interest, but the opportunity to get an incredible amount of winnings for a small payout is the strongest temptation for a gambler. Thus, the more a person plays - for a low amount - the more money the owners and administration of the clubs earn.

A very important circumstance that spurred the excitement of the players even more was the change introduced by Stefan Mills. He increased the size of the automaton window. If earlier only three symbols were visible in the window - the pay line, now players see the pay lines and subsequent ones. This little detail can be said to somehow play its part. The excitement intensifies.

In modern machines, the lines may go slightly off the screen.

The fact of winning in itself is pure coincidence. All this is the nonsense of a man who believed too seriously in his game.

Currently, slot machines are a computer. The case of winning depends on how the program decides. Therefore, the hope of winning can be more successfully discarded as an unnecessary thing.

And so, it turns out that gambling is fertile ground for stuffing wallets.

Now slot machines are banned in Russia, but they still exist. They exist illegally. The number of gamers is not decreasing.

Overdependence on gameplay. Today, this disorder has become more common due to modern technologies making computer games accessible to everyone. But it was known before, and not only in the 21st century, but then gambling was practically untreatable, since little was known about psychology.

Gambling affects people of different age categories. At first it is only harmless gambling or computer games. Gradually, they capture the patient's subconscious and he wants to play more than do everything else in the world. Gambling turns into addiction. But unlike alcoholism or drug addiction, it is displayed only on the mental health of a person, and not physical. Diagnosis of the disease in the early stages is very difficult, since it does not manifest itself at the somatic level.

Causes of gambling

A disorder of this nature can arise due to social and psychological reasons. Even today, many people deny gambling as a disease, because they consider it a normal pastime that is completely safe, does not require effort and energy, and is suitable for distracting from life's problems.

The problem of computer gambling is that caring parents make their child addicted with their own hands. Indeed, it is much easier to put him at the computer so that they play on their own than to tell him fairy tales or play together after a hard day. Moreover, it is now impossible to get rid of gambling addiction even outside the home, as there are tablets, smartphones and game consoles.

It is possible to get rid of gambling addiction in the same way as from other addictions. It is strictly forbidden to turn a blind eye to this addiction. It is necessary to sincerely talk with a person, without trying to shout or crush him. This can lead to even more self-isolation. It is very important to talk with a professional psychologist who will find the cause of the disorder and show the right way to get rid of addiction.

Treatment of gambling addiction

It is necessary to understand that getting rid of an already rooted addiction is quite difficult and time consuming. This requires the desire of relatives and the patient himself. Only patience and complex treatment will get rid of the disorder. The procedure for treating gambling addiction is closely related to bringing the human psyche to a normal state, reassessing the meaning of his life and changing his lifestyle.

At home, a person needs to be distracted from the game in every possible way so that he does not have free time. For example, a teenager can be asked to do something around the house for a small fee. For the husband, you can arrange role-playing games. It will be useful to spend the evening with the whole family at the table, watch an interesting movie, go somewhere. You can talk with the patient about what each person should have good job, and computer games only interfere with this. This will give him the opportunity to form a negative image of the game.

Sick again. To do this, you need to visit crowded places, gather relatives or friends at the same table. In severe stages, medications are indispensable. Of course, today there are no remedies for gambling; for this, a separate therapy is prescribed in each case, often with the use of antidepressants.

Psychologists play an important role in addiction treatment. It is he who should point out all the pros and cons of real life and the cons of virtual life. Methods of suggestion are used that make a person indifferent to games.