Gambling Disorder in Asians Xu Zhang Chen, M.D. If you dont gamble, - - PDF document

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Gambling Disorder in Asians

Xu Zhang Chen, M.D.

“If you don’t gamble, you don’t know how lucky you are”

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Why is gambling so popular among Asians?

• Gambling disorders 2-3 times more

common in Asians (one study showed 60 times greater)

• Trauma and social isolation increase risk
• f gambling disorder
• Immigrants are selected “risk takers”

– Immigration is a “gamble”

Gambling in Asian Culture

• Gambling as a routine social activity
• Superstition, numerology, and “luck”

– Concept of destiny reduces perception of risk

• Casino Community

– No language barrier when gambling – Marketing targeted at Asians

• Stigma – a moral problem

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Types of gambling in Chinese Community

• Casino
• Lottery
• Mahjong
• Card clubs
• OTB (Off track betting)
• Sports
• Stock market

Gambling is Like a Drug

• Euphoria of winning
• Repeated euphoria establishes pattern
• Anxious, bored, restless, depressed when

not gambling

• Continued gambling to relieve anxiety
• Tolerance through increased amount

gambled or frequency

• Dependence = Gambling disorder

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Classification of Gambler

• 1. Social activity
• 2. Sometimes, Occasionally
• 3. Limited money

Social Gambler

Classification of Gambler

• 1. Gambling is seen as a regular

entertainment or leisure active

• 2. Gamble with spare money only and with

limited time and betting

Regular Gambler

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Classification of Gambler

• 1. Those who has a sudden change in life

e.g. lost love, divorce, death of relative, lost job, business, etc.

Transitional Gambler

Classification of Gambler

• 1. Gambling as a professional,
• 2. Studying the ways gambling and

Probability with high self-discipline

Professional Gambler

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DSM-5: Gambling Disorder

• Needs to gamble more money to maintain

excitement

• Restless/irritable when trying to reduce
• Repeated attempts to reduce
• Preoccupied with gambling
• Gambles when depressed
• After losing, “chases” losses by gambling

again

DSM 5: Gambling Disorder

• Lies to conceal gambling/losses
• Gambling affected family/work
• Relies on others for money for gambing
• Not due to manic episode
• > 3 of the above in 12 months.

– Mild (4-5), Moderate (6-7), Severe (>7)

• Episodic vs. Persistent

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Process

– Initially social or entertainment – Euphoria of “Winning big money” – Escalation of betting amount (tolerance) – Reinforcement effect, which makes gamblers keep gambling even losing money.

Winning Phase

Process

– Loan, Lying – Neglecting work and family – “chasing” desire of gamble – Pattern affecting personality

Losing Phase

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Process

– Family isolation/conflict – Serious debt, may commit crimes – Depression – No self-reflection, projects blame to others

Desperation Phase

Process

– Strong guilt and helplessness – Crimes for money – Defaulting on loans – Suicide or homicide attempts

Giving up phase

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Positive experience Negative experience Never gamble Social gambler Transitional gambler Gambling disorder Severe gambling disorder Regular gambler Development Winning phase Losing phase Desperation phase Giving Up phase

Depressed Family/work impairment

Betting more to pay for loans Beneficial attachment Irrational thinking Key Phase Win Big Money

Chinese Community Problem Gambling Project (SF, Ca)

• Early intervention

– Gambling problems emerge early (10 y/o) – Change culture of acceptance

• Community support

– ESL, job training, public benefits, financial counseling

• Family support

– Involve family, support family – treat family members (MH, domestic violence, etc.)

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Chinese Community Problem Gambling Project (SF, Ca)

• Mental Health

– Identify comorbid conditions (e.g. mood, compulsive disorders; PTSD; antisocial personality disorder; substance abuse) – Culturally sensitive MH treatment

• “chatting over tea” rather than therapy/counseling
• Focus on impact on family rather than gambling

behavior

• Advocacy

– Public education, research, personal repsonsibility

Treatment of Gambling Disorder

• Fluvoxamine (mean 195 mg/d)
• Naltrexone (mean 150 - 200 mg/d)
• Lithium
• Valproate
• Behavioral therapies

– Desensitization – Spousal contingency contracting

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Treatment of Gambling Disorder

• Cognitive restructuring

– Correct cognitive errors (e.g. that outcome can be controlled/predicted)

• Cognitive behavioral therapy

– assertiveness, social-skills, problem solving, relaxation – Individual or group

• Gamblers Anonymous

– 12-step program, no therapist, religion based