Raising Awareness of Problem Gambling

[J.Adderton, BSN, MSN]

Approximately 2 million U.S. adults are estimated to meet the medical criteria for gambling disorder. However, another 4 to 6 million meet one or more diagnostic criteria and may be experiencing the consequences of problem gambling. March is National Problem Gambling Awareness Month and an opportunity to better understand the addictive behavior of gambling. Signs of gambling are often easier to hide than the physical signs of substance or alcohol abuse. But, the change in personality, manipulative behavior, financial difficulties and broken relationships associated with gambling disorders are just as destructive as other addictions.

Research indicates that most adults who choose to gamble are able to do so responsibly. Gambling becomes a problem when an individual experiences negative consequences from gambling behaviors. The preoccupation with gambling, need to bet more and loss of control continue despite relationship, financial, job or legal problems.

Escalating Signs of a Problem

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes gambling disorder in the category of behavioral addictions. The diagnostic criteria for gambling disorder outlines signs and symptoms that escalate as the addiction progresses.

• Desire to gamble with increasing amounts of money to experience the same level of excitement.
• Becomes restless or irritable when trying to cut back or quit gambling
• Has made previous unsuccessful attempts to control, cut back or stop gambling.
• Preoccupation with gambling- where, situation and how to get more money
• Gambles when feeling distressed (depressed, anxious, hopeless).
• Gambles after losing money to “chase” to get even
• Lies to hide the extent of gambling (downplays loses and exaggerates winnings)
• At risk or has lost relationships, jobs or opportunities as a result of gambling
• Need to rely on others for help due to financial crisis

The physical, social and emotional issues caused by compulsive gambling are significant. Problem gamblers often have problems with substance abuse, alcohol, depression and anxiety. The National Council on Problem Gambling reports 1 in 5 pathological gamblers attempt suicide.

Risk Factors

Most people who play cards, wager or visit a casino never have a problem with gambling. However, there are certain risk factors that are more often associated with compulsive gambling:

Mental health disorders - problem gamblers often have substance abuse problems, personality disorders, anxiety or depression. Other associated mental health disorders include obsessive-compulsive disorder, attention deficit/hyperactivity disorder and bipolar disease.

Age - Problem gambling occurs at any age, however, it is more common in young and middle aged individuals. Risk is also increased if an individual begins gambling during childhood and teenage years.

Sex - Compulsive gambling is more common in men, but gambling patterns among men and women have become more similar.

Family or friend influence - If you have family or friends with gambling problems, your risk is higher for developing a gambling problem.

Certain medication - Research has shown dopamine agonists have a rare side effect that may result in compulsive behaviors, such as gambling, in some people. Dopamine agonist medications are used to treat Parkinson’s disease and restless leg syndrome.

Certain personality traits - The risk for problem gambling may increase for individuals who are highly competitive, impulsive, restless or easily bored.

Treatment

The good news is...compulsive gambling is treatable. Recognizing there is a problem is the first step towards treatment. The treatment for problem gambling is multi-faceted and similar to treatment for other addictions. The effects of compulsive gambling can be devastating in all areas of a person’s life and a comprehensive program of recovery is essential. Treatment may include inpatient and outpatient treatment programs, support groups and psychotherapy. In some cases, medication may be needed to address underlying mental health conditions, such as bipolar disorder or depression. Opioid antagonists or narcotic antagonists have also been shown to be beneficial in treating compulsive gambling.

The Role of Healthcare Providers

It is helpful for individuals at risk for gambling problems to limit exposure. However, with easy access to casinos, lotteries and electronic and internet gambling, prevention is a challenge. Healthcare providers do have an opportunity to increase screening for high risk groups. It is known individuals with gambling disorders have higher rates of drug use, higher impulsivity and more mental health symptoms. According to Kessler et al., 2008 (National Comorbidity Survey Replication), nearly half of those with lifetime pathological gambling received treatment for mental health or substance abuse problems, however, none reported treatment for gambling problems. One approach for better screening is to address gambling problems in substance use programs for the following reasons:

• Gambling may become a sequential addiction for individuals recovering from substance use disorder
• Gambling could be a factor that leads to substance use relapse
• Gambling and problem gambling may increase psychiatric symptoms
• Individuals entering treatment for substance use may have the following attitudes towards gambling:
  • Never thought of it as a problem or believe it could be a solution to their problems
  • Realize it may be a problem but don’t want to give it up
  • Feel overwhelmed by dealing with just one problem
  • May not acknowledge problem because of shame

Healthcare providers should integrate gambling throughout the assessment in addition to use of specific screening tools. Screening tools are also appropriate for primary care when a patient presents with a substance abuse or mental health issue. Finally, healthcare providers should be aware of resources available, including those offered by their state, to assist with patient advocacy, education, prevention and diagnosis.

Resources:

The prevalence and correlates of DSM-IV Pathological Gambling in the National Comorbidity Survey Replication article

2019 Problem Gambling Awareness Month Toolkit .The National Council of Problem Gambling

[Workitinurfava, BSN, RN]

I have gambled before and when I went I saw a nurse in her scrubs at the place, which means the person was going to work or just getting off work. Do you think that could signify a problem or addiction? Have you ever been in your scrubs at the casino?