Gambling has been prevalent on the internet for many years now attracting its share of players from around the world, both the young and the not so young. Online poker has become a popular form of gambling with thousands of sites in existence providing thousands and even hundreds of thousands of dollars in cash prizes. From 1994, the online gaming industry’s revenues jumped from $30 million to approximately $100 billion by 2004.

Unfortunately for many players including those who fancy poker, online gambling has become more than just a form of entertainment and has turned into an addiction. This fact is what led two people, Caroline Jawad and Stephen Griffiths, to conduct a study in a bid to provide solutions to what they call problem gambling as differentiated from responsible gambling. Seeing a lack of research on responsible gambling and protection options for players, Jawad expects their recommendations to help organizations in designing prevention and education services meant for problem gamblers.

So far, previous surveys only provided basic yet very little information on player protection efforts. These include age limits, limits to setting time, money and loss as well as provision of on-site counselor.

Meanwhile, a 2008 survey by eCogra failed to delve much on players’ attitudes. It only showed that women are actually the ones spending more time playing in online casinos than men. The difference is that they spend only little money compared to men who are big spenders despite the little playing time they spend on the internet. Online gamblers have also been found to go after the big bonuses, the variety when it concerns games and the depositing options.

Pathological Gambling Runs in Families
10% of family members of a problem-gambler also have gambling problems themselves. These relatives also had an increased rate of:

• alcoholism and drug use
• depression
• anxiety
• antisocial personality

So some of the problems in these families come from the mental illness and addiction that they suffer from.

Problem Gamblers Had Poor Childhoods
One study showed that 40% of gamblers reported childhoods of neglect. Only 17-30% had really good childhoods. Their families also had:

• lower commitment to the family
• less support
• fewer intellectual activities
• higher expressed anger

So How Does the Problem-Gambler Affect His Family?

The Spouse or Partner
Gamblers have a higher divorce rate: problem gamblers at 40% and pathological gamblers at 54%. Not surprisingly, financial problems (huge debts, second mortgages, and illegal loans) and psychological stress (anger, resentment, depression, isolation, and loss of trust) contribute to the higher divorce rate. Spouses had more physical problems, like severe headaches and stomach-aches. Sex was markedly decreased. 86% of spouses thought about leaving. 48% considered having an affair, while 23% did so.

Physical abuse often occurs. Some horrendous statistics: a woman whose partner has problem-gambling is 10 times more likely to be abused. If the partner has a gambling problem and drinks, abuse is 50 times more likely. The National Gambling Impact Study reports that when a casino opens in a community, domestic violence often goes up. When casinos opened in Mississippi, domestic violence shelters had a 100% – 300% increase in business.

The Kids
Kids of problem gamblers were more likely to:

• smoke
• have alcohol and drug use
• have educational difficulties
• be depressed and show suicidal behavior (68%)
• report they come from a broken home
• be gamblers themselves (4 times higher rate)
• be abused by their gambling parent
• feel angry all the time (44%)

Overall, some pretty horrible effects.

If you gamble, gamble responsibly.
If you have a problem gambling, visit Gamblers Anonymous.
If your family member has a problem gambling, visit Gam-Anon.

The original study appeared in the August 2007 issue of CNS Spectrum. Thanks to uncleboatshoes for the photo from Flickr.

A recent study out of Canada looked at visits by problem gamblers (PG) to an emergency room near Quebec’s largest casino.  Interesting stats…

Who came to the ER?  3 times as many men came in as women for PG.

How many visits for gambling problems compared to other problems?  About 1 out of each 100 visits were for gambling problems, and this percentage is increasing.

Why did gamblers come in?  The 3 most common reasons were:

• depression
• suicidal thoughts
• attempted suicide

Besides their gambling problem, what other diagnoses were these gamblers given?

• depression
• drug or alcohol problems
• problems adjusting to a stress

If you’re getting in over your head, visit Gamblers Anonymous.

The original study appeared in the August 2007 issue of the Canadian Journal of Psychiatry.

3 classes of medication have been found to help PG.

1. Opioid Antagonists
   These medications, like Naltrexone, work the same way that they do with heroin addiction.  The medication blocks dopamine, which gives gamblers the “high” from gambling excitement, as well as cravings.  No high = less reason to gamble.
2. Antidepressants
   SSRI-type antidepressants, like Prozac, have shown some effect, but the overall benefit remains unclear.  Particularly interesting is that antidepressants work even if the gambler isn’t depressed.
3. Mood Stabilizers
   Medications like Lithium, used for bipolar disorder, help with gambling when it’s associated with bipolar disorder.  What could be interesting about these type of medications is that they’re useful for many other conditions were behavior control is a problem, so they might be promising.

We’re only at the beginning stages of finding the best treatment approaches for PG.  Stay tuned…

Treatment is divided into psychological treatment and medication treatment.  One of the most important interventions before treating the actual gambling problem is figuring out if there are also “co-existing” disorders.

We know that other mental health problems often occur at the same time in people with gambling problems.  These other psychological problems include:

• - 70% of gamblers have mood problems, for example, depression or bipolar disorder
• - 60% of gamblers have drug and alcohol problems
• - 40% of gamblers have anxiety disorders

If you treat the gambling problem, you also have to treat any other mental illness or the gambler won’t get better.

So let’s look at psychological treatment.  Studies show that these treatments work:

1. 1. Cognitive Therapy
   Cognitive Therapy helps a patient look at his thoughts about gambling to weed out the unrealistic ones.  For example, “I know a big win is coming up.”  Is this realistic or not?  In cognitive therapy, thoughts related to gambling are also looked at, for example, “The only way I’ll be respected is if I have a lot of money.”  How accurate is this?
2. 2. Behavioral Therapy
   Behavioral Therapy looks at what behaviors fuel the addiction.  Similar to AA, what “people, places and things” are cues to gamble?  After identifying these, you figure out how to avoid them.  If your only socialization is with people who gamble, you may need to find new friends to hang out with.  You may need to come up with new hobbies to do in your free time instead of gambling.  You may need to put away your computer in the evening, so you’re not tempted to go to those online poker sites.
3. 3. Motivational Interviewing
   This treatment meets people where they in terms of their gambling addiction.  Not sure if you want to stop gambling?  Then a therapist would help you weigh and pros and cons.  Sometimes spelling out the costs of gambling (not just $$, but emotional, relationship, and work costs) help gamblers move to doing something about their problem.

An important part of therapy is helping gamblers identify the good they get from gambling, and then figuring out how to get those goodies without gambling.  Does gambling relax you?  Then work to find other non-gambling ways to do that.  Is gambling what you do when you hang out with your buddies?  Then what other ways can you socialize?

Research hasn’t identified 1 best way to treat all patients with PG , but we do have many options.

Upcoming post #3 in this series:  What are the Drug Treatments for PG?