This blog is a special one.  I am lucky to have a guest blogger who is a friend of mine for over 20 years and an expert in the treatment of compulsive gamblers.   NJ  recently passed a law legalizing on line gambling.  In addition, one of the major changes in the new DSM V relates to  compulsive gambling. It has gone from an “Impulse disorder” into a diagnosable addiction similar to alcohol or drug addiction.  To explain all of this in more detail, is Lenny Brazer

 Most research suggests that when the public has access to the availability of gambling the number of people who gamble will increase. This is not rocket science. The concern of professionals who treat problem and pathological gamblers is that with the increase in the number of people who gamble the proportion of those who will encounter problems or become pathological gamblers also will increase as well. Once again in New Jersey there is going to be a significant increase the amount of gambling that takes place. Gov. Christie recently signed legislation that will legalize online gambling. What this means is that virtually any person who has a computer or access to the Internet will be able to gamble in the comforts of their home. This will include gambling machines table games and any other type of gambling that goes on in the casino.

There are many caveats as well as benefits that go along with this new legislation. On the positive side the legislation will enact for the first time a significant source of funding for the treatment of problem/pathological in the state of New Jersey. Casinos in order to be licensed will have to pay an annual fee of $150,000 and it is anticipated that  eight casinos will apply for the license. Portions of that money will be divided between treatment and prevention/education via the Council on compulsive gambling of New Jersey Incorporated. One anticipated difficulty in spite of some sophisticated language and controls will be monitoring whether underage (people 18 years of age and younger)will be able to access a site and gamble illegally.

The American Medical Association recently published its Fifth edition of the Diagnostic and Statistical Manual of mental disorders(DSM V). An important departure from previous  diagnostic manuals is that the substance related disorders chapter has been expanded to include Gambling Disorder this change reflects the increasing and consistent evidence that some behaviors such as gambling activate the brain’s reward system with similar effects to those of drugs of abuse and the fact that gambling disorder symptoms resemble substance use disorders to a certain extent.

In order to diagnose gambling disorder one must have a persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress as indicated by the individual exhibiting four or more of the following in a 12 month period.

1) Needs to gamble with increasing amounts of money in order to achieve the desired excitement

2) Is restless or bored when attempting to cut down or stop gambling

3) Has made repeated unsuccessful efforts to control cutback or stop gambling

4) Is often preoccupied with gambling e.g. having persistent thoughts of re-living past gambling experiences, handicapping or planning the next gambling venture, thinking of ways to get money with which to gamble.

5) Often gambles when feeling distressed e.g. helpless guilty anxious depressed.

6) After losing money gambling, often returns another day to get even “chasing” one’s losses.

7) Lies to conceal the extent of one’s involvement with gambling.

8) Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.

9) Relies on others to provide money to relieve desperate financial situations caused by gambling (bailout).

Gambling behavior is not explained by a manic episode.

When making the diagnosis one can differentiate between

Episodic:meeting diagnostic criterion at more than the one time point with symptoms subsiding between episodes of gambling disorder for at least several months.

Or

Persistent: experiencing continuous symptoms to meet diagnostic criteria for multiple years.

It can also be classified as in Early Remission:

after full criterion for gambling disorder were previously met none of the criteria for gambling disorder have been met for at least three months but for less than 12 months.

Sustained Remission would suggest that after full criterion for gambling disorder were previously met none of the criteria for gambling disorder have been met during a period of 12 months or longer.

Severity can also be monitored now, ie mild 4 to 5 criteria met; moderate 6 to 7 criteria met; severe 8 to 9 criteria met.

Discussions during the development of these new criteria suggested that the reclassification of pathological gambling from being an impulse control disorder to a behavioral addiction will help those who have been suffering from this disorder gain access to treatment. It was also suggested that more insurers would recognize gambling disorders as treatable and third party reimbursement for treatment would increase. That is yet to be seen. Given the potential proliferation of gambling that will be happening in New Jersey, this therapist certainly hopes for the aforementioned to become realities.

Leonard Brazer Ed.S. CCGC

300 West Main Street

Rockaway,New Jersey 07866

Hoosierlen@aol.com

Leonard Brazer, Ed.S., M.A., CCGC is a New Jersey Licensed Marriage and Family Therapist. He is also a certified New Jersey School Psychologist and a Certified Compulsive Gambling Counselor. He completed a one year internship in Clinical Psychology at Monmouth Medical Center. His professional degrees are from Seton Hall University. Mr. Brazer worked for two years in a Mental Health Center prior o entering the field of addictions in 1980. He has developed comprehensive Chemical Dependency Rehabilitation Programs for adults and adolescents. Mr. Brazer also founded and supervised the Pathological Gambling and Money Disorder Programs at Saint Clare’s Hospital, and at Hackettstown Hospital.

Mr. Brazer has appeared as a guest on the Sally Jessie Raphael, Joan Rivers, Good Day New York, News Talk New York, Channel 12 News, The O’Reilly Report and Caveat Venditor, and on various radio talk shows as an expert, offering information on gambling and money disorders. He has written articles for several major New Jersey newspapers, and authored a chapter for a text “I Shop, Therefore I Am, Compulsive Buying and the Search for Self”. He has consulted with 48 Hours and the Oprah Winfrey shows on feature stories regarding gambling and spending. As well, he has lectured at most major statewide conferences and East Stroudsburg University, Montclair State University, and New Jersey City University.

 Mr. Brazer has been a private practitioner and consultant since 1983.