Bipolar Disorder Gambling Problem

1. Bipolar Disorder Gambling Problem Solving
2. What Is Gambling Disorder
3. Bipolar And Gambling Addiction

Dr Tom Richardson, Principal Clinical Psychologist, Solent NHS Trust and Visiting Academic, University of Southampton

• Oftentimes, a person with a gambling addiction also suffers from bipolar disorder, depression, ADHD or obsessive-compulsive disorder, so medication or therapy to treat those conditions can alleviate gambling addiction. Gamblers Anonymous and other self-help groups help many people as well. Deciding Between Gambling Addiction Solutions.
• Bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. Sometimes children with bipolar disorder feel very happy or “up” and are much more energetic and active than usual.

When viewing the signs of gambling, it is important also to consider the influence of bipolar disorder and mania. If your gambling only occurs during a period of mania, bipolar disorder is your concern, not gambling disorder. Accurately Assessing Your Gambling Habits. People with addictions commonly minimize their symptoms.

In the world of mental health I wear many hats. I’m a clinical psychologist. I’m an academic. And I’m a service-user, I have a diagnosis of bipolar disorder myself.

So my latest research, on the links between bipolar disorder and spending, is something very close to my heart.

The background

Bipolar disorder is a mental health problem characterised by episodes of depression and hypomania or mania. When people are hypomanic or manic, they may have symptoms such as grandiosity, elevated mood, decreased need for sleep and an increase in ‘goal directed activity’ – that is, activities focused on very specific projects or ambitions.

It has been shown that people with bipolar can be impulsive, especially when manic. Indeed a potential symptom, according to the diagnostic criteria for the condition, is ‘excessive involvement in pleasurable activities with high potential for painful consequence’ (for example, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). Those with bipolar disorder are also at higher risk of gambling and compulsive spending, and caregivers often report that this causes them stress.

However, despite excessive spending being included in the diagnostic criteria and many screening questionnaires for the condition, there is very little research on it in bipolar disorder. Research has shown that those with depression are more than twice as likely to be in debt, and research with students suggests a vicious cycle between financial difficulties and mental health problems. However there is little research on the impact of debt on mental health in bipolar disorder specifically.

Themes in the current study

A study I conducted in Portsmouth, which is in press in the journal Clinical Psychology Forum, asked 44 people with bipolar disorder how they saw their finances as related to their mental health and found a number of themes:

1. Overspending, and within this impulse shopping and excessive generosity: for example giving all money to charity when high
2. Anxiety and depression, and within this suicidality: for example feeling depressed when people realise how much debt they are in
3. Regret/Guilt: for example regretting overspending when manic
4. Poor planning/avoidant coping: for example ignoring bills
5. Vicious cycle: For example realising in that they are debt and feeling depressed, and then comfort spending to cope
6. Poor employment: For example having to take pay cuts due to mental health problems
7. Comfort spending: For example buying things to feel better when down

The relationship over time

A simultaneous study I conducted in Portsmouth (both papers of which are being written up, so results are preliminary) gave 54 clients with bipolar disorder questionnaires about finances, compulsive shopping, mood and psychological variables such as mindfulness. 40 clients also completed these again at a second time point four months later.

This found that, across one time point (baseline results not controlled for):

• Greater impulsivity led to greater financial difficulties over time
• Poorer perceived financial wellness lowered self-esteem over time
• Being in greater financial difficulty at the beginning of the study increased the likelihood of later hypomanic thoughts around a need to achieve and being goal focused

After baseline scores were controlled for:

• Poorer perceived financial wellness increased anxiety and stress over time
• How clients saw their finances subjectively was more important than objective measures such as the number of loans.
• Compulsive shopping got worse over time with higher symptoms of depression anxiety and stress, as well as lower mindfulness, higher dependency on others and a greater focus on achieving specific goals. Dependency and anxiety were also increased by compulsive spending suggesting a vicious cycle.

A preliminary psychological model

From these findings, a preliminary psychological model is being developed to try and map the complex relationships between finances and mental health in bipolar disorder.

Essentially, we find a potential cycle between financial difficulties, worry about finances, anxiety, depression and suicidality, and compulsive spending. Financial difficulties lead to anxiety and low self-esteem as people worry about their finances. This low-self esteem can also lead to depression. Anxiety and depression can then cause people to comfort spend. These mental health problems can also worsen financial difficulties, as people avoid financial management, struggle with financial planning and struggle to find and maintain stable employment. Low mood and anxiety can also lead to higher spending, creating another pathway to financial difficulties. When people are depressed they can be less mindful or aware, which makes them more vulnerable to compulsive shopping, buying things in an attempt to feel better. When people have low self-esteem they can also feel more dependent on others, and need to feel approved by those close to them, in some cases offering gifts to try and win this approval. In both cases,this spending can create a vicious cycle when fuelling guilt and regret, which exacerbates anxiety. Financial difficulties can also trigger hypomanic symptoms and thoughts around a need to achieve – the ideas about how to achieve can sometimes include ideas about how to get themselves out of their financial hole. In some cases, this might mean a plan to try and spend money to make money, which fuels compulsive shopping and ultimately ends up increasing financial difficulties.

Not everyone with bipolar disorder will experience financial difficulties or changes in spending behaviour, and where these are experienced they will not always follow these routes. For some the goal focus might be key, for others avoiding their finances when anxious might be important. But understanding how these issues are connected will make it easier to ensure people receive the right support.

Conclusions

This study suggested that:

• Finances affect mental health and vice versa in people with bipolar disorder: there is a vicious cycle.
• Compulsive spending is a key factor: This is not always random, there are potential themes and it is goal-focused, that is, directed towards specific ideas and projects that a person may fixate on
• Many psychological mechanisms are important and psychological therapies such as CBT and mindfulness might help break the link
• Future research is needed to help test the model and develop interventions to help.

Excessive gambling can drain finances, ruin personal and professional relationships, and harm the gambler’s mental health. Gambling disorder affects about 1% of Americans who can’t stop, despite the consequences. Gambling covers more than a trip to the casino or an illicit poker game – it includes lotteries, online poker, and sports betting, and there's a debate over whether it also includes daily fantasy sports leagues.

Yale Medicine is a leader in gambling disorder treatment research, with one of two Centers of Excellence in gambling research in the nation financed by the National Center for Responsible Gaming located at Yale. We take a multidisciplinary approach, including brain imaging, pharmacology, and genetics, to investigate the neurobiology and treatment of gambling disorder.

Risk factors for gambling disorder may include:

• Sex. Men are more likely to have gambling problems than women, but the disparity seems to have narrowed in recent years. Men appear more drawn to such strategic forms of gambling as card games or sports betting, while women tend to prefer such non-strategic forms as bingo or slot machines.
• Age. Two to 7% of youths develop a gambling disorder, compared with about 1% of adults, and many gambling disorders begin in adolescence. College students also gamble at higher rates than the general population.
• Family. People who have a parent with a gambling problem are more likely to have problems too. Yale research is working to understand the connection between genetics and gambling disorders. It’s estimated that a gambling disorder’s development is 50 percent due to genetic factors and 50 percent due to environmental factors.
• Other behavior or mood disorders. People with gambling disorder often abuse alcohol, tobacco, or other drugs, have mood or personality disorders such as schizophrenia or antisocial personality disorder, or have attention deficit hyperactivity disorder (ADHD). A 2008 study showed that people with psychiatric disorders are 17 times more likely to develop gambling problems.
• Personality traits. People who tend to be restless, easily bored, extremely hard-working, or very competitive may be at greater risk of developing gambling disorder.

What’s the difference between enjoying gambling and gambling disorder?

Most adults who gamble do not have a gambling disorder, but those who do can face very serious problems. An afflicted gambler may deplete savings, borrow money, or liquidate retirement accounts to finance their gambling, damage personal relationships (especially with a spouse and family), and have troubles at work. People with a gambling disorder often feel guilt or shame and may experience such withdrawal symptoms as restlessness and irritability when attempting to stop gambling.

Many people may take gambling lightly, not realizing that it may be addictive in many of the same ways as drugs are. Gambling problems can be very harmful to affected individuals and their families.

People who, over a 12-month period meet four of these nine criteria devised by the American Psychiatric Association, are considered to have a gambling disorder:

• Need to gamble with increasing amounts of money in order to achieve the desired excitement
• Are restless or irritable when attempting to cut down or stop gambling
• Have made repeated unsuccessful efforts to control, cut back, or stop gambling
• Are often preoccupied with gambling (e.g. having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)
• Often gamble when feeling distressed (e.g. helpless, guilty, anxious, depressed)
• After losing money gambling, often return another day to get even (“chasing” one’s losses)
• Lie to conceal the extent of involvement with gambling
• Have jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
• Rely on others to provide money to relieve desperate financial situations caused by gambling

Bipolar Disorder Gambling Problem Solving

What are the treatment options for gambling disorder?

There are three main forms of interventions:

• Psychotherapy. Individual and group approaches such as cognitive behavioral therapy, which helps to identify and modify damaging thinking and behavior, can help people overcome the problem. Another method is motivational interviewing, which helps to turn ambivalence about quitting into motivation to quit and can help patients combat urges to gamble.
• Medications. There are multiple potential pharmaceutical approaches to treatment, although no medication has an FDA indication for gambling disorder. Such opioid antagonists as naltrexone and nalmefene, which may reduce cravings for alcohol, have been found in randomized clinical trials to be superior to placebo in the treatment of gambling disorders. The antidepressant and antianxiety medication escitalopram may help decrease anxiety and problem-gambling severity in people with co-occurring anxiety and gambling disorders. The mood stabilizer lithium has been shown to reduce mania and problem-gambling severity in individuals with co-occurring bipolar-spectrum and gambling disorders. However, most medication trials have been relatively short-term and have involved small sample sizes.
• Support groups. Some people with gambling disorder find help with such groups as Gamblers Anonymous, a 12-step program dedicated to abstinence. Participants meet and share experiences, supporting each other in their efforts to abstain from gambling.

What makes Yale Medicine’s gambling disorder research unique?

What Is Gambling Disorder

Yale’s Center of Excellence in Gambling Research, one of two such centers in the nation, is supported by the National Center for Responsible Gaming and conducts groundbreaking research into gambling disorder.

The Center, directed by Yale Medicine psychiatrist Marc Potenza, MD, PhD, has conducted the first brain imaging studies on people with gambling problems. The functional imaging investigations, along with volumetric and neurochemical studies, have found that the brain acts similarly during monetary reward processing in individuals with gambling disorder as it does in people with binge-eating, alcohol-use and tobacco-use disorders. Yale Medicine research has made advances in understanding the effects of such opioid antagonist medications as naltrexone and nalmefene on gambling problems (including planning and participating in the largest multi-center, randomized clinical trial thus far to investigate pharmacotherapy for treating gambling disorder). The Yale Center has also investigated gender-related differences in gambling behaviors and disorders. Next for the Center is tracking the brain’s activity during effective behavioral and pharmacological treatments.

Dr. Potenza is also director of the Problem Gambling Clinic, a collaboration between the Yale Department of Psychiatry and the Connecticut Mental Health Center, which treats patients and conducts research into gambling disorder. He is also a consulting psychiatrist for and medical director of the New Haven component of the Bettor Choice program operated through The Connection.

Bipolar And Gambling Addiction