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Abnormal Psychology
Leading Researcher Perspectives
Edited by Elizabeth Rieger
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Chapter 7
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A 2010 research report documents 367 people died and approximately 14
000 people were hospitalised during the year of the study as a result of the
drinking of others (e.g., as victims of alcohol-related interpersonal violence
or drinking and driving).
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Figure 1 The dopaminergic reward pathway in the brain, through
which messages from the dopamine-rich ventral tegmental area (VTA)
are sent to the nucleus accumbens and on to the prefrontal cortex
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© Newspix/News LTD
Public education campaigns on the harms associated
with smoking tobacco have been effective at reducing
the prevalence of smoking.
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Figure 2 According to the Stages of Change Model, people move through a
series of stages in changing an addictive behaviour
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Courtesy A. Blaszczynski
Standard multi-reel poker machines
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Figure 3 The complex interaction of biological, psychological and
sociocultural factors in the aetiology of pathological gambling
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Figure 4 The Integrated Pathways Model of pathological gambling in which individuals are
theorised to follow one of three different pathways in the development of pathological gambling
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Manchan/Getty Images
Gamblers Anonymous emphasises shared common experiences provided by
mutually supportive peers in a group setting. It espouses that compulsive
gambling is an illness that cannot be cured and that abstinence is the only
valid treatment goal.
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Proposed changes for addictive
behaviours in DSM-V
• Disorders of substance dependence and substance abuse are to be
combined into a single disorder and be referred to as substance-use
disorder.
• Substance-use disorder should have a grading severity (moderate or
severe) depending on how many symptoms the individual experiences.
• Pathological gambling is to be redefined, away from the concept of an
impulse control to an addictive disorder, and be re-classified as a
‘behavioural addiction’ within the tentatively renamed ‘Addictions
and Related Disorders’ category (previously ‘Substance Related
Disorders’).
• For pathological gambling, the criterion related to the commission of
criminal offences is to be deleted, since this item is the least endorsed
and fails to improve diagnostic accuracy.
• The requisite number of criteria items to satisfy a diagnosis will be
reduced from the current five out of 10, to four out of nine.
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Chapter 7 Summary
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Both substance-use disorders and pathological gambling entail
persistent engagement in the behaviour despite the multiple and
severe problems the individual encounters as a result.
Numerous substance-use disorders are recognised in the DSM-IV-TR,
including alcohol, amphetamine, cocaine, cannabis, hallucinogen,
inhalant, nicotine, opioid and sedative abuse and dependence.
The comorbid medical and psychological disorders, as well as elevated
mortality among those with a substance-use disorder, highlight the
importance of research on these conditions.
Substance-use disorders predominantly affect young men and occur
due to a wide variety of factors, including genes, neurobiological
processes, learned behaviours, personality factors, cognitive
processes, family/peer influences and cultural norms.
There is a range of effective treatments that draw on psychological
approaches (such as motivational enhancement therapy, brief
interventions and skills training) and pharmacological options.
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Chapter 7 Summary (continued)
• Approximately 1% of the adult population meets DSM-IV-TR criteria for
pathological gambling, with a higher rate of 5% exhibited by adolescents.
• In addition to financial problems, this group suffers high rates of
depression, substance-use disorders, employment difficulties, and
criminal offences motivated by a drive to maintain their gambling.
• Multiple factors are involved in the aetiology of pathological gambling.
Most aetiological models of gambling focus on one component but
recognise that complex interactions exist between biological, personality,
cognitive, behavioural and environmental variables.
• The Integrated Pathways Model is a conceptual model that integrates
the multitude of aetiological factors into a coherent framework that
recognises different subtypes among those with pathological gambling,
and guides treatment interventions.
• To date, cognitive behaviour therapy has received the strongest support
in the management of pathological gambling, with success rates in the
vicinity of 75%.
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