mental health

Drs. Lieberman, Kupfer and Regier announce the launch of the DSM-5

As the release of the American Psychiatric Association’s (APA) fifth edition of the Diagnostic and Statistical Manual (DSM-5) looms, more than 13,000 psychiatrists descended upon San Francisco, Calif. For the APA, the first order of business was to launch the DSM-5 and answer the many questions about the revisions – and controversy – of this much-anticipated publication.

Changes in health care policies and mental health diagnostic codes are driving a larger conversation about what recovery and prevention should include for those with addictive disorders. From the Affordable Care Act to the American Psychiatric Association’s DSM-5, these changes impact how researchers study gambling disorders, how the industry builds responsible gaming programs to educate their patrons, and how clinicians relate to their clients.

The National Center for Responsible Gaming (NCRG) announced today that Mark S. Gold, M.D., and David Takeuchi, Ph.D., have joined the NCRG Scientific Advisory Board (SAB). These two distinguished researchers and professors will help to enhance the Scientific Advisory Board’s ability to ensure that the NCRG follows rigorous standards in awarding grants, monitor the work of the NCRG Centers of Excellence in Gambling Research and advise the NCRG on funding initiatives and educational activities.  The NCRG is the only national organization devoted to funding peer-reviewed research on gambling disorders and creating public education initiatives to help increase the understanding of pathological and youth gambling and find effective treatment methods of gambling disorders and youth gambling.

Last week, the American Psychological Association (APA) sponsored a “Mental Health Blog Party” where they encouraged everyone to blog about what mental health means to them, either as individuals or mental health professionals. More than 130 blogs were posted and more than 500 people participated on Twitter (hashtag #mhblogday), with topics ranging from depression and bipolar disorder to advising parents on how to talk to their children about drug and alcohol abuse. One concept that resonated throughout the wide variety of topics was the public’s misperception and stigma associated with mental health issues. The same is true for the field of gambling disorders. Even though pathological gambling was not addressed by any blogger for the APA’s blog party, we believe it is important for it to be a part of the conversation.

To understand pathological gambling (PG) one must understand the disorders that co-occur with PG. A 2005 study of more than 43,000 representative Americans found that people with PG often have other mental health disorders at the same time (called comorbid disorders). Examples of these include alcohol use disorders (73 percent), drug use disorders (38 percent), mood disorders (49 percent), anxiety disorders (41 percent) and personality disorders (60 percent) (N. M. Petry, Stinson, & Grant, 2005). While it is reasonable to hypothesize that genetic and environmental factors are both responsible for these co-occurrences, more research is necessary to learn how the two variables work together. One study that addresses these questions was recently published in the Journal of Affective Disorders (Giddens, Xian, Scherrer, Eisen, & Potenza, 2011). The study used data from 7,869 male twins to examine the relationship between PG and two anxiety disorders, generalized anxiety disorder (GAD) and panic disorder (PD).     

Why do so many people relapse when they are trying to stop gambling? It has been estimated that 50 to 75 percent of gamblers resume gambling after attempting to quit (N. M. Petry et al., 2006), but what are the thoughts, feelings and situations that precede these events? Researchers who study alcohol and drug abuse – disorders with similarly high rates of relapse –  have developed a questionnaire designed to answer these questions for their audiences. A recent study published in the journal Experimental and Clinical Psychopharmacology attempts to validate this same type of questionnaire for people with gambling disorders (Nancy M Petry, Rash, & Blanco, 2010). The new study attempts to extend and validate Petry’s previous work adapting the Inventory of Drinking Situations for gambling situations (called the Inventory of Gambling Situations, IGS).

How much college students gamble, and to what extent they suffer from gambling disorders, is an area of great concern in the United States. It is well established that college students suffer from high rates of alcohol and other substance use disorders, and do so in larger numbers than demographically similar non-college students. It is also commonly known that alcohol misuse and gambling disorders are similar in many ways; both cause craving and withdrawal symptoms, have similar neurological characteristics and follow similar clinical courses. This fact raises questions about whether gambling disorders may be found in larger numbers in college populations than in non-college populations with similar demographics. To answer this question, researchers at the Research Institute on Addictions at the University at Buffalo, N.Y., analyzed data from 1,000 representative respondents ages 18-21. Their findings were published in the Journal of American College Health (Barnes, Welte, Hoffman, & Tidwell, 2010).

Despite scientific advances in understanding mental health problems, the stigma surrounding disorders such as depression, substance-use problems and disordered gambling behavior remains a powerful force in today’s society. Mental Health America is observing Mental Health Month in May to increase public awareness of mental health issues and reduce the stigma and prejudice toward these problems.

Clinicians and patients report that embarrassment and shame can be especially acute for individuals with gambling problems because of the lack of public awareness about how an activity like gambling can be as powerful as a drug for a vulnerable person.

To help us reflect on this important issue, we have reproduced, with permission from the American Psychological Association (APA), the following interview about mental health awareness and stigma with Katherine C. Nordal, Ph.D., executive director for professional practice at the APA.