Hong Kong J Psychiatry 2007;17:70


Adolescent Pathological Gambling: Prevention and Treatment (Chinese edition)
Dr Grace TY Leung

The Chinese University Press, 2006
US$14.00; pp192; ISBN: 978-962-996-303-3

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This book, written in Chinese by an associate professor of Applied Social Studies, discusses pathological gambling in adolescents. Since it targets at social workers, teachers, and youth counsellors, it is principally written from a broad, sociological perspective.

The author tries to awaken us to the magnitude of the problem of pathological gambling (especially in adolescents) using local and global statistics. In Hong Kong, 2.6 to 4.9% of adolescents are found to be pathological gamblers, and adolescent pathological gamblers outnumber their adult counterparts by the ratio of 5 to 1. Moreover, pathological gamblers are getting younger. Unfortunately, less than 8% of pathological gamblers have sought help from professionals. In addition, a study conducted on professionals including doctors, nurses, and social workers suggests that professionals may have insufficient awareness of the problem.

Being a Doctor of Psychology, the author enriches the book with an extensive coverage of psychological material, especially the psychological aspects of aetiology and treatment. Moreover, where appropriate, fundamental research and statistical concepts are incorporated in order to enhance the readers’ understanding of aetiological studies and evidence-based practice.

Because it focused on such a specific topic, I did not find this book particularly appealing initially. Nonetheless as I read on, I realised that it could be a helpful guide for managing clients with these problems.

The book consists of 9 chapters. Chapters 1 to 3 and 5 encompass definitions, classification, epidemiology, aetiology, risk and protective factors, early warning signs, symptoms, course, and the adverse consequences of pathological gambling. Chapter 4 is primarily concerned with internet addiction and internet gambling. All of these are covered in detail from different angles.

There is controversy over the definition and classification of pathological gambling given in Chapter 2. The author considers pathological gambling an impulse control disorder, an addiction, an affective spectrum disorder, and an obsessive-compulsive spectrum disorder, all at the same time. Putting these conflicting concepts together without adequate explanation may appear confusing.

Among the wide-ranging problems mentioned, the association with an increased risk of mental and physical co-morbidities and suicidal behaviour is more interesting to psychiatrists. Apart from that, the co-morbidities of substance and alcohol misuse seen in adolescent pathological gamblers are also worth noting.

Chapters 6 to 8 are about assessment and diagnostic tools, treatment, and prevention of pathological gambling. The diagnostic criteria of DSM-IV are elucidated, and tools like Gamblers Anonymous’ Twenty Questions (GA-20) are introduced. Treatment modalities ranging from self- help methods to residential services are discussed, and the author highlights a lack of well-established, evidence-based interventions and a high treatment dropout rate. Different levels of prevention used in individuals, parents, schools, government, and gambling organisations are mentioned. The last chapter is the conclusion and includes future directions for combating pathological gambling.

The appendices must not be overlooked. There are user-friendly checklists and questionnaires aiding with charting gambling behaviour, setting aims and monitoring the progress of treatment. Information on local community resources is provided as well.

As pathological gambling has only received scant attention in the psychiatric literature, this book can serve as a comprehensive reference for practising psychiatrists and provide, in particular, good information on the current situation in Hong Kong.

Dr Grace TY Leung
Department of Psychiatry
Tai Po Hospital
Hong Kong

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