This week on ‘Addicted’ on 103.2 Dublin City FM, I interview Dr. Colin O Gara consultant psychiatrist at St. John of God’s Hospital, on the topic of gambling addiction and treatment for gambling addiction. Gambling treatment services in Ireland are limited. They tend to form part of the general addiction services. But there is help for gamblers and there is treatment for gambling addiction.
It is estimated that between 5 to 7% of the population are at risk to developing a gambling addiction. At risk means they gamble in a way that is harmful but they maintain the access to finance to continue gambling. Many will continue to gamble until they have a ‘wipe out’, where they can no longer access the resources required to make their next bet.
Harvard University’s estimate that 1% of an adult population are problem gamblers and have what is referred to as a gambling disorder. This equates to 28,000 people in Ireland (based on adult population of 2.8m). The problem is that few present for treatment, so the problem remains hidden to some degree. Those who do present to St. John of God’s, have health insurance and so can access private treatment.
The process of moving from being at risk to becoming a pathological gambler is similar to that of a substance addiction. Gambling is an impulse control disorder. The individual develops significant problems in their close relationships, their finances suffer and their ability to sustain work can lead to the loss of employment.
Last year the American Psychiatric Association (APA) classified for the first time Gambling as a medical disorder, following their review of the scientific literature and clinical findings. This is the first time a process addiction has been classified in this way. Soon we may see Internet Use Disorder or sex addiction also being classified.
According to Dr. O Gara, the majority of people who present to their services for gambling generally present with other symptoms such as depression, anxiety, hypomania or with suicidal ideation. Their clients include students who have incurred gambling debts that their parents have to repay. In other cases it can be employees who have used their employer’s finances to feed their gambling habit and have incurrent losses ranging from thousands to hundreds of thousands.
Treatment takes different forms in St. John of Gods. The first response is to remove the person from the devise used to gamble e.g., computer or smart phone. This can be done in an inpatient setting or outpatient setting. For a lot of people today it’s their smart phone that gives them access to their gambling platforms. Many of them will never have set foot in a bookie’s shop. According to Dr. O Gara in Japan they have created “Fasting Camps” for teenagers, who have become addicted to the use of smart phones and overuse of the Internet.
Psychological therapies are also used in the treatment of Gambling Disorder. In particular Cognitive Behavioral Therapy (CBT). Gambling invariably involves a process of distorted thinking or cognitive distortions e.g., the next bet will be a win or “I have lost three times, so I am going to win this time”. This is known as gamblers fallacy. Motivational interviewing is also used with people in treatment, to support the person take control again. Dr. O Gara also supports Gamblers Anonymous (GA) which is very active in Dublin and when used with other treatments can improve outcomes. You can find meetings in Dublin by clicking on this link. Medication is also used, but only as a conjunct to psychosocial treatments.
According to Gamble Aware in Ireland we spend €5 billion per year on gambling. That’s €14 million per day or €10,000 per minute. It has become socially acceptable to take financial risks. As citizens we are suffering because of the financial risks taken by our own Government. We will continue to feel the pain of our financial losses, until the debts have been repaid. The question is will we learn from this experience? Do we need treatment as a nation? Should we gamble proof our politicians?