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NRGP

National Gambling Board

South African Responsible Gambling Foundation

Problem Gambling - Overview

  • Introduction
  • Defining problem gambling as a mental illness

1.1   Introduction

We are going to look in some detail at what happens when gambling stops being a harmless recreational activity and changes into something more sinister – an obsessive activity that can ruin the life of a gambler and harm his or her family and friends.

 We are aware that in South Africa, especially since the introduction of the national Lottery, many people gamble – that is bet money , with the hope of winning more money, on an unpredictable outcome. Some estimates are that up to 90% of the adult of population of South Africa gambles, with almost half of these people playing on the Lottery only.

 We are all also aware of the term addiction, most commonly as applied to abuse of drugs. By addiction we generally mean that the person is unable to stop participating in the addictive activity without some form of assistance, and will experience psychological and/or physiological withdrawal if he or she suddenly stops the activity in question.

 Increasingly, even professionals, such as social workers and psychologists and counsellors, now refer to people who spend extreme amounts of time (and often money) on an activity as being addicts. So in this light we might speak about people being addicted to the Internet, to Computer Games, to pornography, to sex, to overeating, or to gambling. Strictly speaking however we have to look at some definitions before we decide whether we can speak of being addicted to gambling in the same way as we might refer to someone as being addicted to alcohol.

If you are interested in the development of gambling you may wish to view an excellent, detailed set of videos outlining the History of Gambling specifically in the USA

>>  Point to Ponder 1

Scenario 1: Lebogang Peloeng started drinking at age sixteen when he was still at school. By the time he was twenty he was drinking fairly heavily every day and often missing his classes at University because he was too hung-over to get out of bed. By age twenty five Lebogang has lost his job as a salesperson because of frequent absenteeism, he has been fined for driving under the influence of alcohol. He has tried repeatedly to stop drinking but is unable to. Eventually he becomes a homeless beggar who spends the little money he makes everyday on cheap wine.

Scenario 2: Annie Parker is in her mid thirties. She first played the slot machines at a Casino for fun. Over the years she has spent more and more time gambling. Eventually she ends up badly in debt and unable to care for her children, She has tried to stop gambling as she know she is destroying herself and her family but is unable to. Eventually she steals money from work to gamble gets caught and is sent to jail.

Are there similarities between these two? Are they ill or weak-willed? What do you think?

 

Throughout the world, the Diagnostic and Statistical Manual of Mental Disorders (DSM), developed and revised form time to time by the American Psychiatric Association, (we are now on DSM IV )  is widely used to diagnose mental illness. Interestingly the manual does not refer to addiction as such, but describes what might generally be seen as addiction as “substance abuse”. The definition is:-

Substance Dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders..."

DSM IV TR as quoted in: http://en.wikipedia.org/wiki/Addiction

The DSM IV defines “Pathological Gambling” as one of a few Impulse Control Disorders.

Video The following video shows how problem gamblingis increasing amongst women.  

 

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>>  Glossary 1

Intermittent: Not happening all the time; happening at irregular intervals
Explosive: Behaviour that is out of control (in this context)
Disorder: A set of symptoms that constitute an illness
Impulse: Sudden strong urge to do something
Compulsion: An uncontrollable sense of being forced (compelled) to do something
Recurrent: Occurring frequently
Kleptomania: Uncontrollable urge or compulsion to steal
Pathological: To an extent that indicates illness or abnormality
Pyromania: Compulsive and uncontrollable fire-setting
Trichotillomania: Compulsive hair pulling
Persistent: Continuing; frequent without stopping
Recurrent: Occurring over and over again
Maladaptive: Unhealthy and destructive
Criteria: List of items on which a judgement is made (in this case a diagnosis)
Manic episode:  Type of mental disorder during which patient behaves in an excitable and reckless manner to a pathological extent
Wagers: Bets

 

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1.2 Defining Problem Gambling as a Mental Illness:-

DSM-IV: Impulse-Control Disorders

“Individuals with these mental disorders suffer from recurrent failure to resist impulsive behaviours that may be harmful to themselves or others.
These include: Intermittent Explosive Disorder | Kleptomania | Pathological Gambling | Pyromania | Trichotillomania” (DSM IV)

 Problem gambling (ludomania) is an urge to gamble despite harmful negative consequences or a desire to stop. The term is preferred to compulsive gambling among many professionals, as few people described by the term experience true compulsions in the clinical sense of the word. Problem gambling often is defined by whether harm is experienced by the gambler or others, rather than by the gambler's behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria. Although the term gambling addiction is common in the recovery movement pathological gambling is considered to be an impulse control disorder and is therefore not considered by the American Psychological Association to be an addiction.

Pathological gambling is now defined as persistent and recurrent maladaptive gambling behavior meeting at least five of the following criteria as long as these behaviors are not better explained by a manic episode

Preoccupation. The subject has frequent thoughts about gambling experiences, whether past, future, or fantasy.

Tolerance. As with drug tolerance, the subject requires larger or more frequent wagers to experience the same "rush".

Withdrawal. Restlessness or irritability associated with attempts to cease or reduce gambling.

Escape. The subject gambles to improve mood or escape problems.

Chasing. The subject tries to win back gambling losses with more gambling.

Lying. The subject tries to hide the extent of his or her gambling by lying to family, friends, or therapists.

Loss of control. The person has unsuccessfully attempted to reduce gambling.

Illegal acts. The person has broken the law in order to obtain gambling money or recover gambling losses. This may include acts of theft, embezzlement, fraud, forgery, or bad checks.

Risked significant relationship. The person gambles despite risking or losing a relationship, job, or other significant opportunity.

Bailout. The person turns to family, friends, or another third party for financial assistance as a result of gambling.

(Adapted from DSM IV and http://en.wikipedia.org/wiki/Problem_gambling)

An interesting site that has a number of links to discussions about problem gambling and addiction.
http://www.amazines.com/Gambling_Addiction_related.html

 We can see from the above, that pathological or severe problem gambling is defined as an illness – this is sometimes referred to as the Medical Model. This is the case with substance abuse (addiction to drugs, including alcohol and nicotine) as well, where addicts are seen as suffering from a disease. This medical model is sometimes criticised as giving the addict an out – if he or she is diseased, then he or she is not responsible for his or her condition, anymore than a diabetic is. People who criticise this model feel that those who ruin their own and others lives by repeatedly indulging in a destructive pastime are simply weak-willed and could “pull themselves together“ if they sincerely wished to.

For a brief overview on The Medical Model read:-
http://substanceabuse.lifetips.com/newsletter/2006/11/24/medical-model/index.html

For a critique on the Medical Model read:- (note that you have to register first to access this article)
https://online.sagepub.com/cgi/register

 Others believe that social circumstances such as the ready availability of potentially harmful substances or pastimes are to blame and would advocate a zero tolerance approach to such substances and activities,

(For an interesting case study on a failed example of zero tolerance, read this about Prohibition in the USA:-
http://cocktails.about.com/od/history/a/prohibition.htm

Generally, however, it is widely accepted by most professionals in the field that for certain people, potentially harmful substances or pastimes take control of their lives in a manner which they are unable to prevent even though they may recognise the destructive nature of their activities. Much research has been done on this issue and makes for fascinating reading and interesting discussion.

If you are interested in this then in addition to the links already mentioned you may want to read an academic article about research into whether or not problem gambling can be viewed as an addiction in the same way that other similar impulse control disorders may be.
http://ajp.psychiatryonline.org/cgi/reprint/163/2/297.pdf

In addition the next site gives a good overview of recent research into this issue:-
http://www.nlm.nih.gov/medlineplus/ency/article/001520.htm

VID:-  This is an interesting clip on problem gambling by a self confessed problem gambler. If you access this on YouTube you will also see links to other clips on problem gambling.
http://www.youtube.com/watch?v=7jCwRzunfY8

>>  Point to Ponder 2

There are some radical thinkers who do not believe in addiction at all and claim that all behaviour is a choice. Thomas Szasz is one such author who believes that those individuals whom society describes as addicts have chosen their lifestyle and it is a high risk one which is in conflict with the more socially approved low-risk one. What do you think? If you want to read more about Thomas Szasz go to: www.szasz.com/SymposiumProgram.html

 

We now have a clearer idea of how gambling can become a pathological disorder that is destructive to the gambler and to his or her family.

Let’s consider the question of whether the increase in the opportunity to gamble (for example, more Casinos, National Lottery, many slot machines more readily available) leads to an increase in problem and/or pathological gambling  We may automatically think that the answer is definitely a big and resounding “yes!” Well, let us read what some very experienced researchers have to say on this matter:-

In short, the answer to the question: "Does Increased Availability of Gambling Opportunities Lead to an Increase in the Prevalence of Problem Gambling?" is "It depends on how a society regulates the increase and what else it does when it authorises the increase?"
In South Africa the introduction of new forms of legal gambling has been carried out in such a way as to minimise the temptation to gamble on impulse, especially at casinos. More importantly, the South African National Responsible Gambling Programme, supervised by National and Regional Governments and paid for by the Gambling Industry, has carried out extensive campaigns to make people aware of the dangers of gambling and how to avoid them. It is, therefore, not in fact as surprising as might initially appear that we have witnessed over the past six years in South Africa a decline in problem gambling numbers despite the authorisation of a considerable increase in legalised gambling.

Barr; G.; Collins, P. (2007) “The National Prevalence Study 2006: Gambling and Problem Gambling in South Africa.

So it would seem that our automatic answer is not necessarily the correct one. In fact, then, if programmes to educate people about gambling and treatment for problem gambling are made available, as in South Africa, the rate may go down.
So what are the actual numbers involved here?  Research done by the two academics quoted earlier, Professors Barr and Collins, in their 2006 Study undertaken for the NRPG show that about 90% of the adult population of South Africa, gambles in some form or another. Of this number about 4.5 % will experience some aspect of problem gambling, with about 1% being classified as severely pathological gamblers.
Obviously we now need to look at how we diagnose problem and pathological gambling. If we have a disease we will exhibit certain symptoms. This is true whether we are talking about mental or physical illness and disorders. In the next section we will look at some diagnostic instruments in some detail.

For a small group Activity based on the knowledge gained on the topic so far, let us look at what sort of questions you would ask a person whom you think may have a real problem with gambling:

>>  Small Group Activity

Activity 1: Creating a Questionnaire (1)

Small Groups

Imagine you have been asked, as you are studying the subject, to design a questionnaire that would establish whether or not some one has a real gambling problem. Working in your small groups, brainstorm the topic and draw up a list of at least 6 questions you would ask such a person in order to determine whether or not he or she was a problem gambler. Your questions need to be phrased in such a way that the person will answer yes or no. You would then make your diagnosis on the basis of the number of positive responses you got.

For example, if you were trying to determine whether or not someone was a drug addict you might ask:

  • Have you ever stolen in order to get money to buy drugs?
  • Have you ever been in trouble with the law because of your drug use?
  • Has your drug use caused problems for any member of your family? (And so on.)

When you have finished drawing up your questions, transfer them onto a large piece of cardboard. Now look at all the groups’ posters. Discuss the questions and note differences and similarities. Then draw up a final set of between 6 and 10 questions that you all agree would make the most appropriate questionnaire.

 

Some points to consider:-

There is much on-going discussion amongst academics and researchers in the field of addiction studies regarding the precise definitions and use of terms such as compulsive behaviour, impulse control disorder, addiction, physiological dependence; psychological dependence; pathological gambling and problem gambling. You need to be aware that this is a very complex field and is dynamic and therefore does not remain fixed over time.

Generally though, we hope you are clear that there is a set of behaviours which is personally and socially destructive over which individuals appear to have very little control. We will now move on to look at the four most commonly used questionnaires to define problem and/or pathological gambling.