Addiction. Mental Health. Which?

We were enjoying cappuccino and chatting about the somewhat ambiguous relationship between ‘mental health’ and ‘addiction’. Not being experts, the questions we raised only represent the view from the bottom – or, more precisely, they only represent our own coffee time discussion.

• Why do campaign groups big support organisations, medical and government sources seem very reluctant to include addiction as a mental health issue? Certainly they all mention addiction but it seems to us that it is put in a box of its own and not given anything like the prominence of, for instance, depression and anxiety.
• This seems odd especially because it is well known that depression and anxiety alone are very closely related with substance and behavioural addictions. They may lead to addictions via ‘self medication’ or the impulse to escape intolerable pain; both are likely consequences of addiction. It’s a cycle.
• We are aware of the concept of  ‘dual diagnosis’ or ‘comorbidity’ where addiction is often accompanied by another mental health disorder. We are aware too that this is well known among professionals and has been researched and discussed for decades. There are organisations dedicated to researching and promoting discussion around dual diagnosis, such as Progress and many others but in practice we believe on the ground support and awareness is patchy geographically or non-existent.
• Give that some mental health disorders such as gambling addiction and bipolar have high rates of comorbid substance abuse we find it odd that publicity around the issue is very feeble.
• Anti-stigma campaigns around mental health issues are to be celebrated if they are evidenced as effective. Stigma is a huge barrier to recovery, seeking treatment and engaging socially. Yet we are not aware of any ongoing, well-resourced anti-stigma campaigns relating to addiction.
• In our next post we consider the prevalence of addiction in the UK. We are concerned that a great deal of suffering is not being as adequately addressed as it could and should be.

 

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Addiction Musings (1) Introduction

We’re beginning a series of posts ‘musing’ about addiction. Musing rather than thinking too hard, as the subject is so vast and split into thousands of specialist research specialities. Not to metioned the all too often ignored experiences and ideas of people who have personal acquaintance with addictions.

Words – any words – can be highly misleading. The word ‘addiction’ does not refer to a thing that can be seen or otherwise sensed, weighed, measured. It is helpful to think of it as just a signpost to hundreds of different states which are often barely understood by addicts themselves or expert specialists. No one has, and no one ever will, come up with a unified ‘theory of addiction’ because unlike, for instance, things that can be weighed or measured or seen in a microscope, there are no tight borders around the term. Everything is blurred. In everyday life people talk about being ‘addicted’ to such-and-such a television series or type of biscuit. Such usage of the word belittles the suffering of  severe addiction states.

On the other hand, it is accepted as a fact that not only substance dependence but behaviours can be characterised medically as addictions. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition which is one of the main diagnostic manuals used by psychiatrists identifies ‘gambling disorder’ as a clear-cut case of addiction.

Increasingly mentioned in the media are things like ‘internet addiction’, ‘smartphone addiction’ and ‘social media addiction’. Serious research has yet to suggest whether these are ‘true’ addictions – but they certainly have many of the characteristics of addictions.

An interesting case of possible addiction relates to climbers for whom climbing is one of the most, if not the most, important part of their lives. They have reported ‘withdrawl symptoms’ of depression and anxiety if injury prevents their activity. It’s well known too, that many love exercise and the gym so much that they would feel bereft without them. Activities such as exercise and climbing are known to relese chemicals i the brain which produce a ‘feel good’ factor and in some cases, especially when combined with risk, a definite high or ‘buzz’.

On this site we mean by addiction a condition which involves compulsive activity over which an indidual feels they have little or no control, and which produces extremely negative consequences. Negative consequences involve physical and mental health, financial problems, relationship breakdowns and other serious problems – including, of course, death. In some cases, people suffering with addiction will be ‘in denial’ and not realise or admit the devestating consequences of their behaviour; equally, many are only too aware yet feel they cannot stop the compulsion. Invariably, the lives of those close to somebody suffering from addiction are seriously affected too.

More people than today used to talk of a ‘demon’ within, such as ‘the demon drink’. Interestingly, the word addiction in mediaeval times was used to describle priests’ giving themselves up to God. Addiction was a contract, and in Roman times a slave would be ‘addicted’ to a master. We still talk about being enslaved by addiction.

There is still a great deal of stigma around those suffering with addiction (and other mental health ailments too). It is seen by some uninformed people as a character weakness or a moral flaw. In reality addiction is a mental health condition that requires every bit as much understanding, research and treatment as, for instance, depression or anxiety.

In fact, depression and anxiety are often the primary disorders which lead people to ‘self medicate’ or take part in risky behaviours in an attempt to alleviate suffering: addiction may follow (and when it does it usually makes the original conditions worse).

Addiction can strike anybody irrespective of age, gender or social class. While it is true that some addictions correlate with factors such as deprivation, poverty and social exclusion, many addictions do not. There are plenty of teachers, police officers, doctors, nurses, politicians, judges who succumb to alcohol. Online gambling prevalence is highly correlated with middle class professionals. Away from ‘skid row’ stereotypes, thousands of ‘respectable’ people are becoming addicted to over the counter painkillers and prescription only drugs obtained illegally (mainly online).

Current research shows that 9% of men and 4% of women are physically dependent upon alcohol. That is a staggeringly high figure and it may well increase.

Addiction is not, then, something which happens to a few unfortunates or degenerates. It is almost certain that somebody reading this now is on the road to addiction if not already there. And it is completely certain that everybody knows someone suffering from addiction be it at home, at work, among friends. And for each of these people, many more will be suffering too – from their addiction.

 

Children Learning to Gamble

In the digital environment – where some toddlers learn to use a digital device before they can talk – bright and cheerful interactive apps and games are the norm for children.

Go to an online gambling site for adults and you see the same sort of bright and cheerful apps and ‘games’. Roulette? You can play for free using virtual credits. Just a click of a button and you can play for real money. Children are no different from adults in enjoying risk, winning and losing chances, and are likely to be drawn to these games of chance.

In addition, the format of children’s games and gambling screens is blurred. A child who learns to love screen games is already primed to love online adult ‘games’.

The Australian Gambling Research Centre has published a worrying report:

According to the report, the fact that gambling and gaming have been mixed together means that gambling has been normalised for children. 

Young people are effectively being taught the basics of gambling at a younger age than ever before. 

But from making one click on your Facebook page, to one simple swipe on your smartphone, simulated gambling games are everywhere and they can be difficult to avoid.

Since television and online advertising for gambling is on the increase, and children today grow up in a world where televised football, for example, equals televised gambling, there is cause for concern.

Image Lee Davy

What treatment for gambling addiction?

There are many profit making facilities for recovery from every kind of addiction – substances, alcohol, increasingly ‘digital addiction’. Some offer expensive promises for recovery from gambling addiction. There’s Gamblers Anonymous too, a 12-step programme which may or may not work for some people, but many don’t like the approach. Figures suggest only 5% of problem gamblers seek help and only 1% receive it.

What’s available on the NHS? Gambling addiction is recognised as a psychiatric disorder and described in detail in the DSM, one of the psychiatrists’ ‘bibles’. So if you go say to your GP what’ll happen? A lot will  depend on your GP but she may recommend cognitive behavioural therapy (though you may have to wait a long time before you get it). Truth to tell, CBT has not been proven to be universally effective. A GP may offer meds for concurrent depression or anxiety. Very rarely will you be referred to a NHS psychiatrist.

I was talking to a psychiatrist today and asked what treatment was available. He said possibly CBT but the condition is under-researched. It’s true though that some medication trials and research are promising, but the overall situation is very thin and patchy.

Given that gambling addiction carries with it a much higher suicide risk than the general population, various mental ailments such as anxiety, depression or obsessive compulsive disorder, and in 70% of cases parallel substance abuse disorders, you’d think research and treatment would be much more advanced by now.

There are hundreds of thousands of gambling addicts just in the UK, an dtheir addiction has a ripple effect on families and society as a whole. Gambling addiction is a case of awful individual suffering. And it’s likely to become a greater problem as gambling seeps into the DNA of our culture where even children are becoming problem gamblers.

 

 

 

 

Fixed odds betting online and on the high street

An article in The Guardian argues that the age old distinction between gaming and betting has been eroded by the advent of digital gambling machines in high street bookmakers and online. Many people who enjoy or provide betting are upset that an element of skill and genuine odds based on probabilities of outcome are taken away by fixed odds machines.

 

If Lionel Messi gets injured in the warm-up, for instance, the odds about a Barcelona win will immediately start to drift. And because the odds fluctuate and come down to a matter of judgment, shrewd gamblers – and there are plenty – can make a longterm profit from their betting.

In gaming, the odds are fixed, because the chance of every possible outcome is known, and also fixed. The maths which governs the payouts and probabilities is as immutable and well-understood as the laws of planetary motion. For as long as we live in a universe where an apple falls down and not up, no gambler can win at gaming in the long run.

For 200 years in Britain, from the birth of both bookmaking and roulette in the last decade of the 18th century until the arrival of internet gambling, betting and gaming knew their place. Betting took place on racecourses and, since the early 1960s, in high-street betting shops. Gaming was restricted to casinos. Its availability, in other words, was more tightly regulated.

The internet has changed all that, and it is betting firms, both online and on the high street, that have been doing their utmost to blur the centuries-old dividing line. The “B” in FOBT stands for “betting”, for instance, but these are gaming machines, pure and simple. The FOBTs produce guaranteed profits – an average of more than £50,000 per machine per year – and never ask for a pay rise or phone in sick.

Addiction by Design

Natasha Dow Schüll is an anthropologist who spent 15 years studying machine gambling in Las Vegas. Her resulting book is a close examination of the people, the machines and the several contexts that interact to produce gambling addiction. The idea that a machine’s design interacts with a user (not one or the other but both) is a core theme. The book is something of a page turner, full of deeply human insights into the people she met whose lives have fallen prey to addiction.

There is a growing awareness both in and beyond academia that the design of gambling machines is crucial to understanding addiction. The book is highly recommended. For a good overview, watch her lecture:

Young Men and Gambling Problems

Good article in The Guardian. Click here to see full piece.

 

Men of my age often feel trapped between one group of people telling us to “man up” and another suggesting that our plight is less grave than that of others. Indeed, many will probably shrug when they learn that a new study suggests that a quarter of men between 18 and 24 have a gambling problem. Yet it does not take a genius to see a link between gambling and millennial males’ current place in society. We are a group lacking hope – and gambling is just one symptom.

My demographic is gambling for a number of reasons – some of them innocent – but economics and mental health are crucial. Of course, the cause of minority groups are generally more pressing than that of millennial men – we should not feel uneasy about asking not to be forgotten, while advocating other progressive issues. It is coherent to champion both.

Pioneering books such as The Pinch and Jilted Generation show that, generationally speaking, our prospects are being damaged by a toxic mix of debt, unemployment, demographic factors, globalisation and rising house prices. But as a gender, young males’ mental wellbeing is quietly in crisis. We can over-politicise gambling but, as it becomes increasingly normalised, it can appear an easy, supposedly masculine escape – one that’s advertised wall-to-wall during sport on TV.

Site Launch

Great to be able to offer the world our new site. It’s a very close look at Fixed Odds Betting Terminals. We see this as a case study for learning about politics, industry, psychology and much more. Plus, of course, there’s lots of controversial conflict around the machines that can be found in evry high street, and are often referred to as ‘the crack cocaine’ of gambling.