Monday, 11 April 2016
Media release – Akeso Clinics
Addiction can have serious mental health consequences
In recent years casinos have become part and parcel of South Africa’s entertainment scene, luring a growing number of people to have fun and enjoy the thrill of winning money. Sadly however, before they may know it, some gamblers become addicted to gambling and more often than not end up in a spiral of debt, causing themselves and their families endless heartache and misery.
The statistics are staggering: while all forms of gambling except sports betting were illegal until 1996, 20 years later South Africa has over 40 licensed, regulated and taxed casinos. Moreover, about 57% of South Africa’s 55-million population gamble with the most popular forms being the national lotto, casino slots and limited pay-out machines (LPM).
According to Dr Mike West, clinical psychiatrist at Milnerton Akeso Clinic in Cape Town, today 4-7% of South Africa’s gambling population are problem gamblers and 1% approximately pathological gamblers.
Problem gambling, gambling addiction
Problem gambling refers to a sub-clinical group who may have problems as a result of their gambling but do not fulfil the full criteria of ‘gambling disorder’. They may also be referred to as ‘at-risk’ gamblers, Dr West explains.
On the other hand, gambling disorder or pathological gambling refers to a persistent and recurrent maladaptive gambling behaviour, characterised by urges to gamble continuously despite negative social, occupational or interpersonal consequences, oftentimes with several failed attempts to cut down or quit the behaviour, he adds.
“Not everyone who gambles a lot becomes a problem gambler, but there are certain warning signs that suggest a problem may be developing. These include a preoccupation with gambling (for example, planning the next venture, thinking of ways to get money with which to gamble), gambling with increased amounts of money, gambling to escape from problems or to address feelings of guilt, anxiety and depression, ‘chasing the losses’ (gambling to get even with a previous day’s losses), lying to family members and jeopardizing or losing relationships, jobs or other opportunities because of gambling,” Dr West points out.
It is acknowledged that certain types of gambling are more risky than others. For example, lotteries are often considered to be the least harmful, whereas electronic gaming machines (such as poker machines, slot machines) are commonly associated with problem gambling. Other studies suggest that the more times a game is played, it is more closely related to its particular risk, as opposed to the nature of the game itself. In that case, games in which multiple bets can be made in quick succession may be especially risky,” he adds.
Nonsubstance-related addictive disorder
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders. fifth edition) characterises and describes gambling disorder as a nonsubstance-related addictive disorder. “There are striking similarities between substance abuse and pathological gambling, including symptoms of tolerance, withdrawal, craving, a chronic and relapsing course, failed attempts to cut down or quit, excessive time spent on the behaviour and so on; it is becoming increasingly apparent that certain behaviours (such as gambling, eating, or sex) are able to influence the brains natural reward systems in significant ways, similarly so with drugs of abuse.
The growing phenomenon of online-gambling has the potential to exacerbate the problem, Dr West stresses. “Online gambling has exploded on the internet and generated a global revenue of $41.36 billion in 2015. It appears to be most popular amongst the youth, and young adults who are often attracted to online gambling because of a strong desire for money. The internet provides 24/7-365 access to thousands of websites dedicated to gambling where a user can gamble privately without anyone being aware, at home, at work or on their smart phones.
“One’s bank account is often one click away, amplifying the temptation to ‘chase’ losses or bet impulsively. Furthermore, there is little in the way of identity and background checks with regards to children and adolescent accessing and using these services. “Online gambling in South Africa is legal when using a licensed and registered South African bookmaker, however gambling with international companies from within South Africa remains illegal.”
Gamblers prone to other addictions
According to Dr West, problem gamblers are three times more likely to report current or past alcohol or other substance abuse. “This may be due to shared environmental and neurobiological influences. Also, patterns of gambling may be different in those with a comorbid substance use disorder – these individuals tend to have a younger age of onset of gambling, and are more likely to engage in heavier gambling with greater risk.”
Problem gamblers may experience:
- financial difficulties,
- accumulating debt,
- breakdown in relationships,
- loss of employment,
- psychiatric comorbidity; and
- increased risk of suicide.
“Persistence in gambling in spite of these negative consequences is how pathological gambling is defined, also referred to as “gambling disorder”, and represents the most severe form of problem gambling,” Dr West points out.
High risk of depression, suicide
According to Dr West, psychiatric comorbidity is common among individuals with problem gambling.
“The most common co-occurring conditions are major depressive disorder, anxiety disorders and substance use disorders. Conservatively, 50% of problem gamblers will experience a depressive episode at some point in their lives. In certain populations and contexts that figure would be significantly higher, such as being of female gender, unemployed, single, and living in a setting of low socio-economic circumstances.”
Children, adolescents particularly at risk
Studies in the US have found that the lifetime prevalence of pathological and problem gambling in children and adolescents is, in certain instances, higher than that of adults, Dr West adds.
“In South Africa, a total of 13.5% of students could be considered to have a mild-predisposition to gambling, while 5.1% have a strong-predisposition, the latter group being the most at risk of becoming problem gamblers. Children from homes in which they were subjected to physical abuse or in which alcohol and gambling were common and tolerated, are most at risk, and tend to demonstrate other risk-taking behaviour, such as substance abuse and promiscuity.”
Following a thorough examination of, and investigation into, a person’s history, a mental health professional is best equipped to assess whether a person suffers from gambling addiction, Dr West advises.
When it comes to screening for problem gambling, the internationally recognised “lie/bet” screening test is useful. This entails the following questions:
- Have you ever lied to anyone important to you about how much you gamble?
- Have you ever felt the need to bet more and more money?
“A yes answer to one or both questions means that further assessment is needed,” says Dr West.
Private sector psychiatric clinics such as Akeso Clinics offer inpatient and outpatient treatment for gambling disorder itself, as well as related substance use and other psychiatric comorbidities (such as depression and bipolar disorder) that occur commonly during the course of a primary gambling disorder. All medical schemes provide cover for these conditions, as part of the Prescribed Minimum Benefits (PMBs).
Additionally, the National Responsible Gambling Programme (NRGP) is a country-wide public-private sector initiative offering a toll-free counselling line and SMS service, outpatient and inpatient treatment, family counselling, aftercare and debt management. (www.responsiblegambling.co.za).
References available on request.
Gambling addiction - treatment tips
- Speak to your psychiatrist or family doctor – there are medications that are effective for many of the comorbid conditions occurring with gambling disorder and may themselves be associated with improved gambling outcomes.
- Treat any comorbid conditions and intervene to address and reduce suicide risk.
- Psychological therapies have been shown to have positive short- and long-term effects.
- The National Responsible Gambling Programme provides support, counselling and treatment for problem gamblers (www.reponsiblegambling.co.za)
- Enlist family members to assist in encouraging the gambler to follow through on treatment recommendations.
- Provide the gambler and family members with support resources, such as Gambler’s Anonymous, Gam-Anon and the NRGP.
About Akeso Clinics
Akeso Clinics is a group of private in-patient psychiatric clinics that prides itself on providing individual, integrated and family-oriented treatment for a range of psychiatric, psychological and addictive conditions. Akeso Clinics offer specialised in-patient treatment facilities.
Please visit www.akeso.co.za or contact us on 011 447 0268 for further information.
In the event of a psychological crisis, please call 0861 4357 87 for assistance.