Gambling is a common practice amongst Australians. It’s not seen as an unusual practice to gamble on Lotto, scratchies, the Melbourne Cup and poker machines, but pathological gambling is different. It is a persistent and recurrent maladaptive gambling behaviour. Pathological gambling has been included as a disorder of impulse control that affects a gambling addict. Pathological gambling can also be viewed as an addictive disorder, an affective spectrum disorder and an obsessive– compulsive spectrum disorder.
Australian adults lose the highest annual amount of money on gambling worldwide, according to the Economist. Each adult loses US$1,300 yearly to gambling. Australians lose AU$19bn to gambling yearly; 12bn of these go to about 200,000 poker machines.
What is gambling addiction?
It is important to know when gambling ceases to be a common behaviour and starts to become a behaviour that calls for counselling for gambling addiction. Pathological gambling is characterized by a preoccupation with gambling. For example, the gambling addict becomes preoccupied with reliving previous gambling experiences, contemplating ways to obtain gambling money or planning his/her next venture. The patient finds him/herself needing to use increasing amount of money to gamble to reach the required levels of excitement. The patient often has repeated attempts to stop gambling, control it, or to cut back, but these attempts are unsuccessful and lead to restlessness and irritability.
Behaviours that are frequently impulsive in nature such as pathological gambling have severe financial consequences. The person is likely to feel that he can no longer tolerate the internal tension and that giving in to the impulse will provide relief to an uncomfortable internal state. The individual may spend considerable amounts of time fighting off the urge, trying not to carry out the impulse. The inability to resist the impulse is the common core of this disorder.
Some people commit crimes to obtain gambling money like theft, embezzlement, fraud and forgery. These people commonly lose or jeopardise their education, jobs, career opportunities or significant relationships as a consequence of gambling.
Local studies show a 3-5% rate of addiction gambling, and a 1% rate of pathological gambling is present in the Australian population.
Causes of gambling addiction
The parallels between pathological gambling and addictive disorders are manifold. Pathological gambling has been viewed as the “pure” addiction, because it involves several aspects of addictive behaviour without the use of a chemical substance. The parallels between substance dependence, in particular alcohol dependence and pathological gambling have led to the successful adoption of the self-help group model of Alcohol Anonymous for the treatment for problem gambling, called GA, Gamblers Anonymous.
Pathological gambling can be a method for patients to escape dysphoric moods like feelings of depression, helplessness, guilt and anxiety.
Patterns of co-morbidity also suggest a possible link between pathological gambling and addictions, in particular alcoholism. In addition to the co-morbidity of pathological gambling and substance use disorders, family studies have demonstrated a familial clustering of alcoholism and pathological gambling. 50% of patients with pathological gambling have a parent with alcoholism and a family history of substance dependence in patients with pathological gambling. There is also a greater prevalence of pathological gambling in parents of patients with pathological gambling.
Treatment for problem gambling
The goals of treatment for problem gambling are the achievement of abstinence from gambling, rehabilitation of the damaged family, work roles and relationship and treatment of co-morbid disorders and relapse prevention.
This approach echoes the goals of treatment of an individual with substance dependence. Inpatient treatment in specialised programs may be considered if the gambler is unable to stop gambling, lacks significant family or peer support, or is suicidal, acutely depressed, multiply addicted, or contemplating some dangerous activity. This can be important in some cases as pathological gambling has been linked to suicide. An Australian hospital study conducted in 2010 discovered that 17% of the suicidal patients admitted to the emergency department in Alfred Hospital were suffering from problem gambling.
The treatment of pathological gambling may consist of participation in Gamblers Anonymous, individual therapy, family therapy, treatment of co-morbid disorders and medication treatment. As is the case for substance dependence, the gambler needs to be abstinent to be accessible to any or all of these treatment modalities.
For many gamblers, participation in Gamblers Anonymous is sufficient, and it is an essential part of most treatment plans. Gamblers Anonymous is a 12-step group built on the same principles as Alcoholics Anonymous. It utilises empathic confrontation by peers who struggle with the same impulses and a group support approach. Gam-Anon is a peer support group for family members of patients with pathological gambling.
The greatest differences between the treatment of pathological gambling and other addictions are in the area of family therapy, because relapse may be difficult to detect. Frequent family sessions are often essential to offer the gambler an opportunity to make amends, learn communication skills and deal with pre-existing intimacy problems. In addition, the spouse and other family members have often acquired their own psychiatric illnesses during the course of the patient’s pathological gambling and need individualized treatment to recover.
Small trials have reported on the use of SSRIs, mood stabilizers and naltrexone with the recommendation of dosing at the high end of usual treatment ranges. The appropriate medical plan is determined by GP in consultation with other helping professionals.
Are you or someone you know suffering from a gambling addiction or problem gambling? Australia Counselling has a range of problem gambling counsellors and gambling addiction psychologists who are able to help you. Visit our Addictions -Gambling page to find a counsellor or psychologist in your local area.
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