|Year : 2019 | Volume
| Issue : 1 | Page : 50-54
Role of exercise in the treatment of gambling disorder
Chidiebere Emmanuel Okechukwu
Department of Physical Activity and Health Promotion, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
|Date of Web Publication||13-Sep-2019|
Chidiebere Emmanuel Okechukwu
Department of Physical Activity and Health Promotion, Faculty of Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Roma
Source of Support: None, Conflict of Interest: None
Gambling disorder(GD)is a behavioral addiction recognized by the Diagnostic and Statistical Manual for Mental Disorders 5th version and the International Statistical Classification of Diseases 10th version (ICD-10). GD according to the ICD-10 is characterized by maladaptive and recurrent pattern of gambling behavior that persists despite the negative consequences for the individual and his family. GD is a rising global health issue, and its consequences are family problems, substance abuse, suicide ideation, suicide attempts, suicide, and criminal behaviors such as theft and drug trafficking to raise money for gambling activities. Mood disorders such as major depressive disorder, anxiety, obsessions, and personality disorders are comorbid with GD. Papers were searched using key terms indicating addiction, exercise, physical activity, and GD on PubMed, Science Direct, Psych INFO, Medline, and Google Scholar database. Exercise is effective in the prevention and treatment of depression in addition to psychotherapy and antidepressant drug therapies. Pathological gamblers who are not physically active are expected to have poor cardiovascular and mental health, lack of physical fitness, and low quality of life compared to healthy controls who exercise regularly. There is a need to include a standard exercise program in support of psychotherapeutic and pharmacological treatment of GD because of the benefits of regular exercise in the improvement of cardiovascular and mental health, lifestyle modification, and in the primary and secondary prevention of chronic diseases. Exercise was found to be effective as an adjunctive therapy in the treatment of GD and co-occurring psychiatric disorders.
Keywords: Addiction, exercise, gambling disorder, pathological gamblers, psychiatric disorders
|How to cite this article:|
Okechukwu CE. Role of exercise in the treatment of gambling disorder. Niger J Exp Clin Biosci 2019;7:50-4
| Introduction|| |
Gambling disorder (GD) is a behavioral addiction recognized by the Diagnostic and Statistical Manual for Mental Disorders 5th version (DSM-5) and the International Statistical Classification of Diseases 10th version (ICD-10). In the DSM-5 classification, pathological gambling (PG) was renamed GD; it was moved from impulse control disorders to the section of behavioral addiction; but, the term PG is still used to describe frequent and uncontrolled gambling behavior. According to the ICD-10, GD is a behavioral addiction, characterized by maladaptive and recurrent pattern of gambling behavior that persists despite the negative consequences for the individual and his family. Frequent gambling is linked to high stress responsiveness such as elevated heart rates and cortisol levels, and there are prevalence of psychiatric disorders among pathological gamblers (PGs). GD is a rising global health issue, and its consequences are family problems, substance abuse, suicide ideation, suicide attempts, suicide, and criminal behaviors such as theft and drug trafficking to raise money for gambling activities. PGs often experience financial hardship and poverty as a result of constant betting. Mood disorders such as major depressive disorder, anxiety, and personality disorders are comorbid with GD. Exercise is very effective in the prevention and treatment of depression in addition to psychotherapy and antidepressant drug therapies. PGs who are not physically active as a result of time spent in gambling are expected to have poor cardiovascular and mental health, lack of physical fitness, and low quality of life compared to healthy individuals who exercise regularly.
| Literature Search|| |
Papers were searched using key terms indicating addiction, substance use disorder, exercise, physical activity, GD, gambling addiction, PG, psychiatric disorder, depression, and mental health. PubMed, Science Direct, Psych INFO, Medline, Web of Science, Cochrane Library, and Google Scholar database were searched using the specified key terms.
| Role of Exercise in the Treatment of Addiction and Its Comorbid Psychiatric Disorders|| |
Exercise is effective as an adjunct therapy in addition to pharmacological and psychotherapeutic treatment of addiction because exercise boost self-esteem, stimulate endorphin release, and repair the abnormal changes in the brain's reward pathway triggered by addiction. Aerobic and anaerobic exercise are able to improve mood, as long as they are not too vigorous. Exercise can be effective as a long-term intervention for anxiety and major depressive disorder associated with GD. Endurance training stimulates the release of brain-derived neurotrophic factor secretion which is linked to neuroprotection and plasticity. Findings from animal studies showed that aerobic exercise improves the dopaminergic pathway in the brain  which may likely change the reward pathway primed for PG and substance abuse. Dopamine is associated with substance use disorders, which is prevalent among PGs. Exercise improves cognitive functioning both in humans and animal models.
GD is a risk factor for the development of alcohol, nicotine, cannabis dependence, and cocaine abuse. Research findings indicate that regular endurance exercise training prevents the development of drug addiction, and it is an effective adjunct therapy for drug and substance use disorder. Regular aerobic exercise depending on the type, duration, and intensity may prevent the development of drug addiction by altering ΔFosB – a master protein that plays a role in the development and continuity of behavioral and drug addiction and c-Fos activity linked to relapse to substance use and other behavioral changes associated with substance abuse such as GD in the striatum and other parts of the reward system.
Aerobic exercise decreases the physiological response to acute mental stress, thus making aerobic exercise an effective antidepressant in the treatment of addiction. From research findings, substance use disorder leads to a decrease in striatal dopamine receptor (DRD2) density, and aerobic exercise was found to reduce substance use cravings and relapse by effecting changes on the DRD2 signaling by increasing DRD2 density. If PGs participate in regular aerobic exercise program, it might lead to general improvements in their mood, self-esteem, cognitive performance, and overall mental health. All healthy American adults are expected to accumulate at least 150 min per week of moderate-intensity aerobic exercise or 75 min per week of vigorous aerobic exercise or a combination of both.,
| Research Evidence on the Role of Exercise in Addition to Psychotherapeutic and Pharmacological Treatment of Gambling Disorder and Co-Occurring Psychiatric Disorders|| |
Exercise can be a cost-effective and accessible adjunctive therapy in support of the psychotherapeutic and pharmacological treatment of comorbid psychiatric disorders associated with GD. Anna CP et al., conducted a randomized controlled trial on the impact of an exercise training program as a treatment for GD. A total of 59 subjects diagnosed with GD participated in the trial. 32 subjects (treatment group) took part in 50- min exercise sessions (10 min stretching and 40 min running at 70-85% HRmax twice a week), while 27 subjects (control group) took part in 50-min group stretching sessions twice a week. the results of the study shows a decrease in gambling severity and psychiatric co-morbidities in both the treatment and control groups, and there was a significant decrease in depression, anxiety, and gambling craving when compared with the control group.
A meta-analysis study demonstrated that moderate- and high-intensity aerobic exercise, designed according to the guidelines of American College of Sports Medicine, and the mind-body exercises can be an effective adjunctive therapy for those with substance use disorders; there was a significant decrease in depressive symptoms among alcohol and illicit drug abusers. Dance movement therapy and dance were effective for decreasing depression, anxiety, positive mood, affect, and body image in individuals who participated in aerobic dance exercise. The improvements associated with an exercise program designed for the treatment of GD which are significant decrease in depression, anxiety, and gambling cravings are similar to those observed after psychotherapy or pharmacological therapy; a combination of psychotherapeutic, pharmacological, and exercise training program may be more effective in the treatment of GD. The type of exercise, specific workloads, frequency, duration, intensity, and safety precautions are factors to consider when planning an exercise program. PGs were found to gamble less after participating in a well-planned exercise program; yoga therapy was found to improve cardiorespiratory function, promote recovery from addiction, prevent relapse, and improve the treatment of addiction; these studies are evidence that exercise is effective in decreasing gambling craving and prevention of relapse. PGs are exposed to many cardiovascular diseases most especially high blood pressure, angina, and tachycardia,,, while long-term participation in exercise promotes a net reduction in blood pressure at rest. There is a need to design more comprehensive and effective strategies for the prevention and treatment of GD as well as an increased mental health promotion strategies on the harmful effects of excessive gambling activities. The prevalence rates of GD among females were found to be less than half when compared to the males. A standard individualized-tailored exercise program in support of psychotherapeutic and pharmacological treatment of GD will enable clinicians to improve the fitness and mental wellness in PGs and to develop more effective intervention strategies for the prevention, treatment, and management of GD and its potential effects on public health.
| Discussion|| |
GD is a serious public health issue in developed and developing countries. According to a public opinion poll conducted by Ngozi Okonjo-Iweala Polls in Nigeria, 77% of a significant sample of Nigerian population confirmed the high prevalence of betting and gambling activities within their locality, most especially in the South-West and South-South geopolitical zones in Nigeria. The poll also confirmed that Bet9ja, Nairabet, Pool, and Lotto were the most popular gambling outlets in Nigeria. In terms of active participation, 53% of the participants agreed that they engage in daily gambling activities which is a risk factor of GD. Participants identified the reasons why Nigerians engage in sports gambling which they describe as: quest for quick money, high rate of unemployment in Nigeria, and greed. According to the polls, Nigerians aged between 18 and 35 years were mostly engaged in gambling activities. Sports' gambling is becoming very popular in Nigeria, most especially among the country's youth population and football fans because football is the most popular sports in Nigeria. Uncontrolled sports gambling behavior is on the rise in Nigeria. The prevalence of GD is caused by the popularity and marketing of gambling activities. The rate of gambling activities in Nigeria should be controlled and monitored, in order to avoid adverse consequences in the future, because of high level of sports betting marketing and poor mental health awareness in the country; this may be associated with undiagnosed GD among the country's sports bettors unlike in developed countries that have an advanced mental health system and facilities for the epidemiological study and treatment of GD. In Europe, the prevalence rate for GD is between 1% and 3.4%; in Italy, it is between 1.3% and 2.2%. Poverty and unemployment are associated with an increase in impulse to risk one's money to gain more. Unemployed youths and people living in poverty are usually desperate to change their financial condition through a gambling win or jackpot. Obsession with money is the major psychology and economic factor of gambling, and it plays a role in the development of GD. Well-designed regular exercise program for PGs will promote a global epidemiological examination of GD and its associated psychiatric disorders to understand the factors that influence a transition from normal gambling state to GD. Having an in-depth knowledge of sports gambling and its potential effects on public health will broaden the understanding of GD, identify the risk factors of GD amongst different population, and enable the development of interventions to tackle GD. Consequences of GD are constant domestic violence, substance abuse, depression, bipolar disorder, anxiety, attention deficit disorder, suicidal ideation, suicide attempts, suicide, bankruptcy, poor service delivery by an individual in his/her place of work, loss of employment, and poverty as a result of constant wagering and betting and criminal behaviors such as theft and drug trafficking to raise money for gambling activities.
The findings from research studies conducted on GD in the 90s when top sports betting companies present today were coming up, by Black and Moyer, 1998, Bland et al., 1993, Blaszczynski and Farrell, 1998, Blaszczynski and Steel, 1998, Blaszczynski and McConaghy, 1994, Brownson et al., 1997, and Briggs et al., 1996, show that excessive gambling activities negatively affects the mental well-being of PGs and can lead to substance abuse which pose as a serious threat to public health. Excessive gambling lure many PGs into criminal activities such as robbery, internet fraud, and kidnapping because a lot of PGs are in constant need of money to gamble to recover their losses and in the process of trying to recover their losses they lose more money. Brown, 1987, emphasized on the link between GD, associated patterns of crime, alcohol and drug abuse. According to the findings of Martinsen et al., 1990, exercise reduces depressive symptoms and the progression of depression. GD is associated with increased prevalence rates of depression, suicidal thoughts, and behavior. 96% of individuals with GD are suffering from one or more psychiatric disorder(s). PGs often suffer from insomnia, cardiorespiratory diseases, intestinal distress, headaches, and cardiovascular diseases.
Physical inactivity remains a global health issue. Modern technology seems to discourage physical activity by helping man to save energy which he may utilize in carrying out his daily activities. According to the findings of Clarke et al., 2018, exercise significantly decreased anxiety and depression in healthy adults. A randomized controlled trial conducted by Linardatou et al., 2014, revealed a statistically significant reduction in stress, depression, anxiety, and an increase in quality of life among PGs that participated in an 8-week stress management program consisting of diet modification, exercise, stress coping techniques, deep and relaxation breathing, and progressive muscle relaxation. There are limited research work on the impact of exercise intervention in the management and treatment of GD. Aerobic exercise may lead to better treatment outcomes when used as an adjunct therapy in addition to psychotherapeutic and pharmacological treatment of GD and its comorbid psychiatric disorders.
| Conclusion|| |
A well-planned exercise program in support of psychotherapeutic and pharmacological treatment of GD can be more effective and may lead to a better outcome in the treatment and management of GD and co-occurring psychiatric disorders.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th
ed. Washington DC: American Psychiatric Association; 2013.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization; 1992. Available from: http://www.who.int/iris/handle/10665/37958
. [Last accessed on 2019 Apr 16].
Lorains FK, Cowlishaw S, Thomas SA. Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta-analysis of population surveys. Addiction 2011;106:490-8.
Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, et al.
Exercise for depression. Cochrane Database Syst Rev 2013;9:CD004366.
Linke SE, Ussher M. Exercise-based treatments for substance use disorders: Evidence, theory, and practicality. Am J Drug Alcohol Abuse 2015;41:7-15.
Seifert T, Brassard P, Wissenberg M, Rasmussen P, Nordby P, Stallknecht B, et al.
Endurance training enhances BDNF release from the human brain. Am J Physiol Regul Integr Comp Physiol 2010;298:R372-7.
Boecker H, Sprenger T, Spilker ME, Henriksen G, Koppenhoefer M, Wagner KJ, et al.
The runner's high: Opioidergic mechanisms in the human brain. Cereb Cortex 2008;18:2523-31.
Basso JC, Suzuki WA. The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: A review. Brain Plast 2017;2:127-52.
Olsen CM. Natural rewards, neuroplasticity, and non-drug addictions. Neuropharmacology 2011;61:1109-22.
Sim YJ, Kim H, Shin MS, Chang HK, Shin MC, Ko IG, et al.
Effect of post natal exercise on c-Fos expression in the hippocampus of rat pups born from alcohol-intoxicated mothers. Brain Dev 2008;30:118-25.
Zhou Y, Zhao M, Zhou C, Li R. Sex differences in drug addiction and response to exercise intervention: From human to animal studies. Front Neuroendocrinol 2016;40:24-41.
US Department of Health and Human Services. Physical Activity Guidelines for Americans. 2nd
ed. Washington, DC: US Department of Health and Human Services; 2018.
Anna CP, Hyon SK, Antonio MC, Hermano T. The impact of an exercise program as a treatment for gambling disorder: A randomized controlled trial. Ment Health Phys Act 2018;15:53-62.
Wang D, Wang Y, Wang Y, Li R, Zhou C. Impact of physical exercise on substance use disorders: A meta-analysis. PLoS One 2014;9:e110728.
Sabin K, Teresa K, Sissy L, Robyn C. Effects of dance movement therapy and dance on health-related psychological outcomes: A meta-analysis. Arts Psychother 2014;41:46-64.
Angelo DL, Tavares H, Zilberman ML. Evaluation of a physical activity program for pathological gamblers in treatment. J Gambl Stud 2013;29:589-99.
Angelo DL, Tavares H, Bottura HM, Zilberman ML. Physical exercise for pathological gamblers. Braz J Psychiatry 2009;31:76.
Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga 2011;4:49-54.
] [Full text]
Mutschler J, Bühler M, Diehl A, Mann K, Kiefer F. Disulfiram, an old drug with new potential in the treatment of pathological gambling? Med Hypotheses 2010;74:209-10.
Larimer ME, Lostutter TW, Neighbors C. Gambling in primary care patients: Why should we care and what can we do about it? Gen Hosp Psychiatry 2006;28:89-91.
Potenza MN, Fiellin DA, Heninger GR, Rounsaville BJ, Mazure CM. Gambling: An addictive behavior with health and primary care implications. J Gen Intern Med 2002;17:721-32.
Fagard RH. Exercise is good for your blood pressure: Effects of endurance training and resistance training. Clin Exp Pharmacol Physiol 2006;33:853-6.
Blanco C, Hasin DS, Petry N, Stinson FS, Grant BF. Sex differences in subclinical and DSM-IV pathological gambling: Results from the national epidemiologic survey on alcohol and related conditions. Psychol Med 2006;36:943-53.
Calado F, Griffiths MD. Problem gambling worldwide: An update and systematic review of empirical research (2000-2015). J Behav Addict 2016;5:592-613.
Scavone C, Stelitone, Rafaniello C, Rossi F, Sportiello L, Capuano A. Drug induced Gambling: An analysis of Italian spontaneous reporting system. J Gambl Stud 2019. doi: 10.1007/s10899-019-09828-1. [ Epub ahead of print].
Bastiani L, Gori M, Colasante E, Siciliano V, Capitanucci D, Jarre P, et al.
Complex factors and behaviors in the gambling population of Italy. J Gambl Stud 2013;29:1-3.
Black DW, Moyer T. Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior. Psychiatr Serv 1998;49:1434-9.
Bland RC, Newman SC, Orn H, Stebelsky G. Epidemiology of pathological gambling in Edmonton. Can J Psychiatry 1993;38:108-12.
Blaszczynski A, Farrell E. A case series of 44 completed gambling-related suicides. J Gambl Stud 1998;14:93-109.
Blaszczynski A, Steel Z. Personality disorders among pathological gamblers. J Gambl Stud 1998;14:51-71.
Blaszczynski AP, McConaghy N. Criminal offenses in gamblers anonymous and hospital treated pathological gamblers. J Gambl Stud 1994;10:99-127.
Brownson RC, Newschaffer CJ, Ali-Abarghoui F. Policy research for disease prevention: Challenges and practical recommendations. Am J Public Health 1997;87:735-9.
Briggs JR, Goodin BJ, Nelson T. Pathological gamblers and alcoholics: Do they share the same addictions? Addict Behav 1996;21:515-9.
Brown RI. Pathological gambling and associated patterns of crime: Comparisons with alcohol and other drug addictions. J Gambl Behav 1987;3:98-114.
Martinsen EW. Benefits of exercise for the treatment of depression. Sports Med 1990;9:380-9.
Moghaddam JF, Yoon G, Dickerson DL, Kim SW, Westermeyer J. Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the national epidemiologic survey on alcohol and related conditions. Am J Addict 2015;24:292-8.
Kessler RC, Hwang I, LaBrie R, Petukhova M, Sampson NA, Winters KC, et al.
DSM-IV pathological gambling in the national comorbidity survey replication. Psychol Med 2008;38:1351-60.
Clarke SC, Cooper NR, Rana M, Mackintosh B. Cognitive interpretation bias: The effect of a single session moderate exercise protocol on anxiety and depression. Front Psychol 2018;9:1363.
Kim SW, Grant JE, Eckert ED, Faris PL, Hartman BK. Pathological gambling and mood disorders: Clinical associations and treatment implications. J Affect Disord. 2006;92:109-116.
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