Pathological Gambling

Pathological Gambling

Pathological gambling is being unable to resist impulses to gamble, which can lead to severe personal or social consequences.
Causes

Pathological gambling usually begins in early adolescence in men, and between ages 20 and 40 in women.

Pathological gambling often involves repetitive behaviors. People with this problem have a hard time resisting or controlling the impulse to gamble. Although it shares features of obsessive compulsive disorder, pathological gambling is likely a different condition.

In people who develop pathological gambling, occasional gambling leads to a gambling habit. Stressful situations can worsen gambling problems.
Symptoms

People with pathological gambling often feel ashamed and try to avoid letting others know of their problem. The American Psychiatric Association defines pathological gambling as having five or more of the following symptoms:

Committing crimes to get money to gamble
Feeling restless or irritable when trying to cut back or quit gambling
Gambling to escape problems or feelings of sadness or anxiety
Gambling larger amounts of money to try to make back previous losses
Having had many unsuccessful attempts to cut back or quit gambling
Losing a job, relationship, or educational or career opportunity due to gambling
Lying about the amount of time or money spent gambling
Needing to borrow money due to gambling losses
Needing to gamble larger amounts of money in order to feel excitement
Spending a lot of time thinking about gambling, such as remembering past experiences or ways to get more money with which to gamble

A psychiatric evaluation and history can be used to diagnose pathological gambling. Screening tools such as the Gamblers Anonymous 20 Questions can help with the diagnosis.

Treatment

Treatment for people with pathological gambling begins with recognizing the problem. Pathological gambling is often associated with denial. People with the illness often refuse to accept that they have a problem or need treatment.

Most people with pathological gambling enter treatment under pressure from others, rather than voluntarily accepting the need for treatment.

Treatment options include:

    Cognitive behavioral therapy CBT has been found to be effective.
Self-help support groups, such as Gamblers Anonymous. Gamblers Anonymous is a 12-step program similar to Alcoholics Anonymous. Principles related to stopping the habit abstinence for other types of addiction, such as substance abuse and alcohol dependence, can also be helpful in the treatment of pathological gambling.
A few studies have been done on medications for the treatment of pathological gambling. Early results suggest that antidepressants and opioid antagonists naltrexone may help treat the symptoms of pathological gambling. However, it is not yet clear which people will respond to medications.

Like alcohol or drug addiction, pathological gambling is a chronic disorder that tends to get worse without treatment. Even with treatment, it's common to start gambling again relapse. However, people with pathological gambling can do very well with the right treatment.

 

Effective Treatment Principles

Addiction is a complex but treatable condition that affects brain function and behavior. The abuse of drugs alters the structure and function of the brain, resulting in changes that persist long after drug use. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. No single treatment is appropriate for every user in recovery. Matching treatment settings, interventions and services to the particular problems and needs of a patient is critical to achieving success in returning to productive functioning in the family, workplace and society. Treatment needs to be readily available. Because individuals addicted to drugs may be uncertain about entering treatment, it is critical to take advantage of available services the moment people are ready for treatment. Patients can be lost if treatment is not immediately available or readily accessible. As with other chronic conditions, the earlier the user seeks treatment, the greater the likelihood of positive outcomes. Effective treatment addresses the multiple needs of the individual, not just drug abuse. To be effective, treatment must address the drug abuse and any associated medical, psychological, social, vocational and legal problems. It is also important that treatment be appropriate to the age, gender, ethnicity and culture of the user. It is critical that the user remain in treatment for an adequate recovery period. The appropriate duration for an individual depends on the type and degree of problems and needs. Research indicates that most addicted individuals need at least three months in treatment to significantly reduce or stop drug use. Studies also suggest that the best recovery outcomes occur with longer durations of treatment. Recovery from drug addiction is a long process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and signifies that treatment should be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. The most commonly used forms of drug abuse treatment are counseling in individual and or groups and other behavioral therapies. Behavioral therapies vary in focus and may involve addressing a the motivation of a user to change, providing incentives for abstinence, building skills to resist drug use, replacing activities involving drugs with constructive and rewarding activities, improving problem solving skills and facilitating better interpersonal relationships. Participation in group therapy and other peer support programs during and following treatment can help maintain abstinence from drugs. Medications can be an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize and reduce illicit drug use. Naltrexone is also an effective medication for some individuals addicted to opioids and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram and topiramate. For persons addicted to nicotine, a nicotine replacement product such as patches, gum or lozenges or an oral medication such as bupropion or varenicline can be an effective component of treatment when part of a comprehensive behavioral rehab program. Doctors must modify and monitor the treatments and services for each patient to ensure that the rehabilitation meets the changing needs of the addict in recovery. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation and or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to changing needs. Many individuals addicted to drugs also have other mental disorders. Because drug abuse and addiction, which are both mental disorders, often occur together with additional mental illnesses, doctors should carefully assess patients that present with one condition for the other. When these problems occur together, treatment should address both by the use of medication. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change the effects of drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and, for some, can pave the way for effective addiction treatment in the end, detoxification alone is rarely sufficient to help addicted individuals achieve a new lifestyle of abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement. Specialists must continually monitor drug use during treatment, as patients can lapse during treatment. Another powerful motivator to get clean is if patients know that doctors monitor the drug intake of each patient. Monitoring also provides an early indication of a return to drug use, signaling the possible need to adjust the treatment plan of an individual to better meet changing needs. Drug abuse treatment can facilitate adherence to other medical treatments. Patients may be reluctant to accept screening for HIV and other infectious conditions. Specialists should encourage and support HIV screening and inform patients that highly active antiretroviral therapy can be effective in combating HIV. Treatments vary, depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services.

Poker Crazy Pineapple Hi-Low Split

Crazy Pineapple Hi-Low Split

Crazy Pineapple Hi-Low Split

Crazy Pineapple Hi-Low Split is played with a standard 52-card deck. In order for a hand to qualify for the low hand, the hand must contain an 8-low or better (lower). Blinds are posted by players who sit in consecutive clockwise order from the button. Action is initiated on the first betting round by the poker player to the left of the person who posted blind clockwise from the button. The blinds act last on the first betting.

All players receive three cards dealt face down (hole cards) as their initial hand. The first round of betting occurs. Check and raises are permitted. Three cards are turned face up in the middle of the board simultaneously (flop). These board cards are community cards and available to all players. The second round of betting occurs. At this time players choose to keep two of their three cards hole cards from their initial hand and discard the third. The next two board cards are turned up one at a time with a round of betting after each card. After the final round of betting has been completed, a player may use any combination of five cards (one hole card and four from the board, etc.) to determine their best high and qualifying low hand. A poker player may use all of the board cards (playing the board). The qualifying low hand must have an 8-low or better. The winning poker hand must show both hole cards face up on the table. The best five-card high and five-card qualifying low poker hand splits the pot. If there is no qualifying low hand, the high hand wins the entire pot. In the event of a tie, that portion of the pot is split equally.

Dead Mans Hand

The dead man's hand is a two-pair poker hand, namely aces and eights. This card combination gets its name from a legend that it was the five-card-draw hand held by Wild Bill Hickok, when he was murdered on August 2, 1876, in Saloon No. 10 at Deadwood, South Dakota.

According to the popular version, Hickok's final hand included the aces and eights of both black suits. As Hickok's biographer, Joseph Rosa puts it: the accepted version is that the cards were the ace of spades, the ace of clubs, two black eights clubs and spades, and the queen of clubs as the kicker. However, Rosa says no contemporary source for this exact hand can be found. The earliest detailed reference to the dead man's hand is 1886, where it was described as a full house consisting of three jacks and a pair of tens.

In accounts that mention two aces and eights, there are various claims regarding the identity of Hickok's fifth card, suggestions that he had discarded one card and/or that the draw was curtailed by the shooting and Hickok therefore never received his fifth card.

In the HBO television historical drama series Deadwood, a nine of diamonds is depicted, although the show posits that another player concocted the hand, to further his own newsworthiness. An episode of Ripley's Believe it or Not shows Hickok holding a queen of clubs. An episode of Quantum Leap also shows Sam's love interest holding a Dead Man's Hand.

Historical displays in the town of Deadwood, including one in a reconstruction of the original Saloon No. 10, also show the nine of diamonds as the fifth card. The Lucky Nugget Gambling Hall, which holds the historic site of Saloon No. 10, instead displays a jack of diamonds. The Adams Museum in Deadwood has a display that claims to be the actual squeezer cards held by Hickok. The hand is: ace of diamonds, ace of clubs, eight of hearts, eight of spades, and the queen of hearts. The Stardust on the Las Vegas Strip has used a five of diamonds in related displays and the Las Vegas Metropolitan Police Department Homicide Division uses the dead man's hand in its insignia, as does the Armed Forces Medical Examiner System.