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July 28, 2014

Social supports vital to tackle addiction

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‘Whilst gambling is very common, it is a debilitating problem for many people’

An upcoming conference will hear how easy access to so many forms of gambling makes it harder for people addicted to the habit to overcome their problems, and that support from family and friends is crucial.

The issue of pathological gambling, and its treatment, will be looked at from a clinical perspective at Toranfield House’s NEAR Conference, which is taking place from Thursday 10 to Saturday 12 November, 2011, at the Ritz Carlton Hotel, Powerscourt.

Dr Colin O’Gara, a consultant psychiatrist and senior lecturer at UCD, will speak about pathological gambling and why its classification is about to change to an ‘addiction’ in the next publication of the DSM-V.

There is both ‘hard’ and ‘soft’ evidence that gambling is on the increase in Ireland and it is ubiquitous. There is some sort of gambling behaviour going on everywhere we look — from the lotto, scratch cards or bingo to the local bookies, online gambling and fancy casinos.

Clinically, Dr O’Gara confirmed that he was seeing an “increasing number of pathological gambling patients”. This is interesting, considering that only a small minority of people who may have problems with gambling turn up for assessment or treatment. There are two main reasons for this — the first one being a general lack of awareness of the dangers of compulsive or pathological gambling and a general feeling that gambling is not an illness, just another form of entertainment.

The second reason is the huge stigma still around mental health in Ireland and, as a result, many people are unwilling to admit they have a problem — but they are still out there, suffering in silence.

Dr O’Gara shone some light on the wide range of individuals who present with symptoms of pathological gambling. “We see a diverse range of individuals who suffer from pathological gambling: students preoccupied with gambling and becoming suicidal; people who have lost vast amounts of money; those who steal from their employer or friends to feed their gambling habit; and people who suffer with Parkinson’s disease and develop pathological gambling secondary to their medication,” he said.

So how do these people go about getting help or treatment? According to Dr O’Gara, the realisation (and the acceptance) that gambling is not just a lifestyle choice is an important first step in deciding to seek help. He explained that in DSM-V, due out in 2013, pathological gambling will be classified as an addiction. Heretofore, it was classified as an ‘impulse control disorder NOS (not otherwise specified)’. However, “converging lines of evidence from both neurobiology and neuropsychology make it quite clear that pathological gambling is a brain disorder, like drug or alcohol addiction, to a large extent”.

Behavioural addiction
Talking about that often contentious issue, Dr O’Gara explained: “On the ground, there’s very little difference between pathological gambling and other behavioural addictions. We see the typical traits in pathological gamblers: tolerance — where they need to gamble in increasing amounts; primacy — gambling is performed at the expense of all other activities and all other hobbies go by the wayside; and loss of control — gambling starts to take over people’s daily lives and interfere with their work, school, home, relationships and hobbies.”

Dr O’Gara added: “Very often, you hear people say they used to be really interested in golf or going to the movies, but not anymore. Instead, we observe that there’s no interest in the patient’s life other than gambling.” There are also physical problems associated with pathological gambling, along with all the social and occupational problems that go with an all-pervasive addiction.

In relation to treatment, Dr O’Gara explained that the current treatments for pathological gambling were quite similar to those for substance misuse and other behavioural addictions. Treatment involves an initial phase of detoxification (i.e. no gambling, no mobile phones and no laptops). But clearly – given that gambling is so prevalent and accessible – if people want to engage in gambling, they will. So, the patient’s motivation and participation is critical for success.

Dr Colin O’Gara: ‘Lines of evidence’

If the patient is unwell both physically and mentally as a result of their gambling addiction, treatment in the inpatient setting is appropriate. However, Dr O’Gara pointed out that “the stigma of going into the inpatient setting for the treatment of gambling addiction, or indeed any other addiction, may well be the biggest single issue preventing people accessing services”. There is no doubt that, despite a number of proactive campaigns around the mental health arena, the stigma of having a mental health problem is still enormous in Ireland today.

Other types of treatment available for gambling addiction are psychotherapies such as cognitive behavioural therapy, 12-step programmes, motivational enhancement therapy and talking therapies. “Clearly, in terms of the person getting better, there needs to be strong social support and family involvement — particularly because of the ubiquitous nature of gambling.”

Therefore, families need to assist in understanding the problem of pathological gambling and the treatments available. Occasionally, family members are involved in managing the bank accounts of the patient. The person in recovery can also attend Gamblers Anonymous for mutual support, along with garnering a broad base of support from close friends and the wider community.

Prevalence
The key question for some families is how they can determine if a loved one has a gambling problem, given that gambling is such a popular and acceptable form of entertainment. According to Dr O’Gara, some 70 per cent of people in the country will gamble in some form during any given year. However, he was very clear: “It becomes a problem for roughly 3-5 per cent of the population, while 1 per cent of the population will suffer from pathological gambling.” So, whilst gambling is very common, it is a very real and debilitating problem for many Irish people.

Dr O’Gara concluded: “Pathological gambling is a severe compulsive state, where the person loses total control. Very often, it’s associated with physical symptoms and suicidal thoughts. Clearly, problem gambling is a less severe condition from a sociological perspective. But for the individual, it’s substantially distressing.” He admitted that the differentiation between pathological and problem gambling “can be quite a grey area — like the difference between alcohol dependence versus alcohol misuse”.

The clinical parallel between alcohol addiction, drug addiction and gambling does not end there. The big question often asked is whether gambling is motivated by the money. Dr O’Gara talked about “the chase”, where a person enjoys one big win somewhere (a massive reinforcer) and all their reward systems are activated by that, so they end up wanting to gamble again and again. The reality is they will have had maybe one big win, followed by substantial losses — but they forget the losses. They are in a state of “euphoric recall”.

  • To hear Dr O’Gara speak or learn more about pathological gambling and effective treatments, log on to www.toranfieldhouse.com, email jackie.l@toran fieldhouse.com or call 00353 (1) 276 2300.