Impaired control: a look at the laying brick of pathological gamblingредакционная статья
Аннотация: Impaired control: a look at the laying brick of pathological gambling Prejuízo de controle: um exame dos alicerces do jogo patológicoWhen pathological gambling (PG) was first included in the DSM-III in 1980, its core element was described as a progressive difficulty for one's to limit his/her gambling behavior.This was popularized under the terminology "loss of control".Where does that notion come from?Castellani described how gambling "excess" was first regarded as a vice and progressively evolved towards a disease. 1 With the progressive legalization of gambling in North America, the former conception was challenged.In the 70s, a psychiatrist named Robert Custer opened the first treatment facility for gamblers and became a strong proponent of the inclusion of PG in the DSM.Custer's clientele was essentially formed by Gamblers Anonymous (GA) members.This particular sample seems to have strongly influenced the conceptualization of PG.GA philosophy derives from the Alcoholics Anonymous (AA) one, where alcoholism is viewed as a progressive and permanent disease.For alcoholics, even one drop of alcohol was believed to create a domino reaction that inevitably leads to binge drinking.With this perspective, control is impossible for alcoholics and one of the first steps when becoming active in the AA fraternity is to recognize the impossibility to control alcohol intake.The "loss of control" base of alcoholism was further popularized by Elvin Morton Jellineck, 2 who developed the conceptualization of alcoholism which became the WHO official one.In the mid-70s, this view came under critics.Researchers found that even strongly dependent alcoholics managed to drink in a controlled way (e.g.Maisto & Schefft 3 ).The terminology changed to "impaired control", since control was seen as intermittently impaired rather than lost.Although this clarification was theoretically justified, it was criticized for its lack of testability.Impaired control seems to be something evident, with good face validity.It is commonly reported by gamblers in treatment and actively sought by practitioners.Several researchers have already suggested that impaired control is an etiological factor for PG.Here lies a major hindrance to the evolvement of this concept: impaired control ends up as both an inferred manifestation and a developmental factor of PG, leading to circular reasoning.The idea that gambling is out of control stems from two observable phenomena: 1) On a long term basis, gambling leads to monetary losses for most gamblers, and in some instances, losses will lead to pervasive negative consequences; 2) The excessive behavior persists despite obvious harm.However, logically speaking, impaired control can be verified only after gambling has occurred and is essentially based on a gambler's verbal report.People find much easier to classify as poor control if one goes gambling and loses money.But what if he or she eventually wins?Dickerson and O'Connor state that gambling impaired control must be disentangled from gambling harm, defining it as "an inability to consistently maintain preferred limits to expenditure of time and money on gambling". 4But where and when does one overstep the bounds of social gambling?To further understand
Год издания: 2007
Издательство: Associação Brasileira de Psiquiatria
Источник: Brazilian Journal of Psychiatry
Ключевые слова: Child Therapy and Development, Gambling Behavior and Treatments
Другие ссылки: Brazilian Journal of Psychiatry (PDF)
Brazilian Journal of Psychiatry (HTML)
DOAJ (DOAJ: Directory of Open Access Journals) (HTML)
PubMed (HTML)
Brazilian Journal of Psychiatry (HTML)
DOAJ (DOAJ: Directory of Open Access Journals) (HTML)
PubMed (HTML)
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Том: 29
Выпуск: 3
Страницы: 203–204