A quarter of a million new gamblers are expected as the UK gambling laws relax to allow more casinos and the first supercasinos. It has led to fears that the UK’s relatively low prevalence of problem gambling will more than double, bringing it in line with the United States. JuniorDr’s Michelle Connolly takes a look at pathological gambling, a psychiatric diagnosis, and speaks to Europe’s only professor of gambling studies, Mark Grifiths.
Gambling – ‘the act of risking the loss of something of value on an uncertain outcome in the hope of winning some- thing of greater value’ – isn’t new. Records show the ancient Chinese were placing bets back in 3000BC and even the Egyptians enjoyed a flutter in the shadows of the pyramids.
In fact, whole countries have been decided on the roll of the dice. When the kings of Sweden and Norway couldn’t agree on the ownership of land in 1000AD a roll of the dice turned entire towns over to the Vikings.
Today the acceptance of gambling varies around the world. Some Islamic nations prohibit gambling and the vast majority impose some form of regulation. In the UK, regulation first started when Henry VII banned his soldiers from gambling when he found they were spending more time placing bets than training.
Over the last few years the government has taken the unprecedented step of relaxing legislation.
WHEN IS GAMBLING CONSIDERED PATHOLOGICAL?
Pathological gambling (PG) was first listed as a psychiatric diagnosis in 1980. It is an addiction to the altered psychological state experienced whilst gambling – similar to the high gained from narcotic substances.
Just as a drug addict needs more of a psychoactive substance to get high, the problem gambler must place higher and higher wagers in an attempt to win back lost money – a term known as ‘chasing losses’.
CONSEQUENCES
Afflicting just under one per cent of the UK population, pathological gambling is a chronic, progressive disorder more commonly found in patients being treated for alcohol or drug dependency. The personal and social consequences are obvious (and enormous) – suicide, divorce, bankruptcy and criminal behaviour.
Understanding the thought process of problem gamblers is often difficult to grasp, even for doctors. Those affected will commonly gamble their money used for basic needs, such as food, as in their minds this has become the only way to provide more food.
It’s common for pathological gamblers to have a long history when they present, up to 20 years in many cases. Men typically start gambling 10 years before women, and seek help three years later.
Patrick, a recovering gambler, spoke candidly to JuniorDr about his addiction:
“I lived in Curragh, Ireland, an area famed for its horse racing. Gambling is second nature to most people there,” he explained.
He started betting on horses, then as lottery fever gripped Ireland in 1987, he increased the amounts he was gambling.
“It was turf accounts [horse betting] initially. I’d place up to £5 twenty years ago. Then the Irish lottery began and I would increase my bets to £500,” he says. But it was the advent of online gambling which made Patrick’s gambling addiction worse. “I’d bet up to £5000 online at a time, and larger sums on the horses; I’d bet on anything that moved.”
THE RUSH
Many gamblers are addicted to something specific which influences the type and form of gambling. For Patrick it was the excitement of the event and chance of a big win.
“I had such an adrenaline rush when the events I had bet upon were coming to their conclusion,” he says. “I nearly passed out one day when a horse was involved in a photo finish for £5000 which I lost.”
Many gamblers gradually develop a deepset belief that they will win:
“I began to make plans for a house by the coast and giving up work.
When I went to GA I heard many similar stories of people convinced they’d inhabit their fantasy world once they’d won big.”
“ My work suffered as I was always thinking about my gambling. I used to nip home to place bets until I found out that I could bet on my mobile and even then I was constantly checking results. Colleagues thought I was cheating on my wife,” he adds. “I had got to the stage where I neglected everything. I was at my computer as soon as I came in the door, my wife didn’t mention anything in the beginning, but I started making excuses for not going out; in the end I didn’t even care if she left me. She asked if I was gambling again and I owned up, I had already made the decision to stop though, as I was getting suicidal thoughts and hated my life.”
Despite his own experience Patrick is not opposed to the Government’s plans to build a Las Vegas style ‘super-casinos’ in the UK: “Everyone has the right to be entertained by whatever form they wish. It would be foolish to ban any activity to protect the few who don’t know when to stop.”
Patrick feels the best way to get a problem gambler into recovery is to try all possible treatments, and to find one that works for them.
“After the person has accepted they have a problem, all avenues should be explored: GA, counselling and treatment centres. I don’t think there is one best method,” he says. “I suffered a physical, mental and spiritual decline and am now on the road to recovery one day at a time.”
“Incidentally,” he points out, “I meet a lot of gamblers in Alcoholics Anonymous; I believe it is very common to replace one addiction with another.”
BETTING NATION
It’s not just new casinos, the new act of parliament will see gambling play a more dominant role in Britain’s future landscape impacting everything from restaurants to flying. Ryanair’s maverick chief executive, Michael O’Leary, has already announced that passengers will be able to gamble midflight as a means to offset airfares.
The British Medical Association has warned that the relaxed regulations will herald a rise in addictions which must be countered by better addiction services, which currently even fail to screen for gambling.
Dissatisfied with the act’s aim of raising £3 million annually for the Responsibility in Gambling Trust, the main treatment funding body, the BMA called for a £10 million annual contribution.
Culture Secretary at the time of the Act’s introduction, Tessa Jowell, tried to re-assure parliament that Britain wasn’t gambling with its mental health saying that:
“Las Vegas is not coming to Great Britain. British casinos will be under the strictest controls in the world. Tricks of the trade will not be allowed. There will be no free alcohol to induce more gambling, and no pumped oxygen to keep players awake.”
The government reassured the public that if the loosened gambling law results in an increase in Britain’s relatively low problem gambling incidence, she will shut them down.
JuniorDr spoke to Professor Mark Griffiths, a gambler himself, based at the International Gaming Research Unit, Nottingham Trent University.
“I do gamble, but only because I am buying a form of entertainment,” he says. “My sole aim is not to win money. If one enters a casino with the sole aim of winning money, then one is much more likely to become addicted than if the evening at the casino is treated as simply a ‘night out’, an alternative to the pub.”
When the National Lottery was launched in 1994, it sparked a similar outcry. Medical journals received many letters from doctors worried that we’d turn into an offshore Las Vegas.
“That was all very knee-jerk. You cannot become addicted to something that takes place only twice a week,” asserts Professor Griffiths. “You can never ever become addicted to the National Lottery but you can become addicted to buying tickets.”
Six years after the Lottery’s introduction the British Gambling Prevalence Survey, in which Professor Griffiths was involved, found that less than one percent of the adult population were problem gamblers but that amongst adolescents, the figure was as high as five percent.
“A study found that some 15 year olds got a buzz from buying lottery tickets, which was heightened as they were doing it illegally and it was this feeling to which they were addicted,” he explains.
Griffiths wants a loophole in the Act to be closed that allows children to gamble on slot machines in arcades and leisure centres. He feel this is imperative given that slot machines are the most damaging form of gambling:
“Slot machines are the crack cocaine of gambling because of the high event frequency – you can gamble twelve times in a minute, and the machine manufacturers build in ‘near misses’ that give the impression that you’re close to winning.”
MEDICALISATION
Pathological gambling is a specific psychiatric diagnosis. It falls into a similar category as schizophrenia and depression. Many argue, however, that the medicalisation of gambling is a step too far.
“I’m not trying to medicalise gambling,” he says. “But this behaviour is pathological. I receive lots of calls from the media about gardening, internet and sex addicts – that’s the medicalisation of society for you!
But with those ‘addictions’, they’re not addicted in the pathological sense, as they don’t exhibit the classical signs of dependency.” “Gambling is particularly debilitating, as there is a big financialloss involved; if one is addicted to the internet, the only loss is time. Furthermore, problem gamblers often engage in criminal activity to recoup losses. The same cannot be said of being addicted to the internet or sex. And very few video games addicts fulfil all the criteria of addiction, i.e. they do not suffer withdrawal, nor do they become tolerant.”
ADDICTIVE PERSONALITIES
Many gamblers excuse their actions stating that they simply have an ‘addictive personality’, but it’s not something Griffiths believes in:
“I don’t believe in the concept of an addictive personality,” he says. “People who are addicted to gambling exhibit traits that are not unique to addiction. There is no evidence that there’s one personality trait that points to an addictive personality. Addicts often use the addictive personality as an excuse for their behaviour.”
“Problem gambling shows all the traits of addiction to alcohol or psychoactive substances. In addition, studies have shown that SSRIs such as fluoxetine are elective PG therapies.”
NHS TREATMENT
Questions remain on how well the NHS is prepared for an increase in problem gamblers. Professor Griffiths recalls how, on registering with a new GP, he was asked whether he smokes, drinks or takes illicit substances, but not whether he gambles.
“Doctors certainly do not receive enough training in tackling addictions. The NHS urgently needs to put gambling on the same footing as other forms of addiction. People understand that you can be addicted to a substance,” he says. “But they find it hard to see how someone can be addicted to the high that the action of gambling causes.”
“I am not anti-gambling,” he emphasises. “I even gamble myself, but I believe that the protective mechanisms need to be enhanced and the intoxicated must be stopped from gambling. People are owed an informed choice: they should be told the chances of winning.”
REFERENCES
Professor Griffiths authored the BMA report Gambling addiction and its treatment within the NHS, which can be downloaded here – www.bma.org.uk/ap.nsf/Content/gamblingaddiction
Beaudoin, C & Cox B (1999) – Characteristics of problem gambling: A preliminary study using DSM-IV based questionnaire. Canadian Journal of Psychiatry, June 1999.
Lesieur HR, Rosenthal RJ: Pathological gambling: a review of the literature (prepared for the American Psychiatric Association Task Force on DMS-IV Committee on Disorders of Impulse Control Not Elsewhere Classified). Journal of Gambling Studies 1991;7:5-39.
RESOURCES
Gamblers Anonymous
gamblersanonymous.org.uk
Offering support since 1964.
Gam Anon
www.gamanon.org.uk
08700 50 88 80
For those affected by another person’s gambling.
GamCare
www.gamcare.org.uk
0845 6000 133
Provides online chat rooms as an outlet for problem gamblers to talk to others, and residential programs.
