Pathologisches Glücksspielen: Prävention und Behandlung

Abstract

We present the clinical picture of pathological gambling and relevant etiological explanatory models. The model of addiction discriminates between factors relevant for starting and continuing pathological gambling behavior. Multifactorial causes are to be assumed responsible during the "starting phase" of the behavior. During the actual "addiction phase", the excessive addiction behavior is upheld by a strong psychological addiction and the loss of control (inability to remain abstinent). There is an irresistible urge to continue gambling, not least caused by (permanent) structural changes in deeper brain areas such as the reward system. In the beginning, therapy focuses on the addictive behavior. The symptoms that appeared last are to be incorporated into therapy first and the therapy goals are to be formulated in a certain order: motivation, removal of the "drug" (a.k.a. the gambling behavior), insight into the disease and acceptance of it, consolidation of the wish to become abstinent, therapy of causes for gambling, finding alternatives, and learning how to prevent relapses. In the long-term, behavior beneficial for abstinence will only stabilize if it is an advantage compared to the other behavior (gambling). The drug-like effect of gambling essentially comes from risking one's financial existence. Besides individual therapy, group therapy is a vital component in the therapy of gambling. From a cognitive-behavioral point of view, a well-structured and manual-centered group therapy should be the method of choice. The grave individual and social consequences of pathological gambling, which cause high economic costs, underline the importance of suitable preventive concepts.