Gambling in the Context of All Addictions

There are several reasons to include other addictions when thinking about gambling addiction:

  • While the nature of addiction varies between types (as well as between unique individuals) much of the research in substance and other behavioural addictions can throw a good light on the nature of addiction generally.
  • It seems, in particular, that neuroscience points to common factors across addictions, involving specific neurotransmitters and learned neural pathways.
  • Many with gambling addiction suffer one or more other addictions.
  • Addictions of all types are strongly related to specific diagnoses of mental disorders which precede or follow addiction, or which accompany addiction, or all three.
  • Research into gambling, medical and other professional knowledge and expertise, and public awareness of gambling addiction are relatively sparse compared with more well known addictions. What has been learned and known about the latter can inform ways of seeing gambling addiction.
  • Debates about alcohol, substance and some behavioural addictions have been ongoing in most cases much longer than current gambling debates. Much disagreement exists beteen professionals, lawmakers, industry, people affected by addiction and the general public. Overviewing these controversies helps place gambling in context as many of the issues are identical. Of particular interest is the extent to which focus has been upon individual ‘pathology’ with lesser attention piad to wider factors which contribute to addiction. In some ways, these debates reflect those in the field of general mental health where an individual is seen as the centre of attention to the detriment of studying social, economic and other wider contributors to mental distress.
  • The presence of stigma against addiction is best looked at with a broad view of all addictions.
  • The relative underfunding and research around gambling, and a lack of support services is best understood by examining addictions generally. This will suggest that gambling addiction is particularly under-resourced.
  • Evidence about what works and what does not work in addiction education – in formal education and public health campaigns – is available for substance addiction, and this can inform developments in gambling education. Although alcohol and drugs education has been around for a long time, there has been no uniform approach to implementing it. Some emerging evidence suggests what doesn’t work – for instance, one’off ‘lecturing’, ‘thou shalt not’ approaches – there is relatively litle evaluation and pointers to good practice. We’ll be discussing this more on our site.
  • The questions around industry funded research and education have been highlighted with alcohol. For instance, it is claimed that industry funded initiatives may avoid discussion of subjects which cause discomfort to the funders.
  • Local councils have responsibility for commissioning addiction services (including NHS and Third Sector*) and may be likely to treat addiction generically rather than by type of addiction.
  • While it is true that addiction can afflict anybody, whatever their socioeconomic background and status, there are strong correlations between different sub-populations. For instance, adults who had adverse childhood experiences are more prone to mental health disorders including addiction. Poverty and other disdvantages also correlate with the likelihood of addiction. Studies across the field of addiction can examine such correlations more fruitfully than framing addiction as simply an individual pathology.
  • There are no neat divisions between harmful habits, compulsive behaviour, things called addictions metaphorically (e.g. shopping addiction), psychological dependence on behaviours or substances (without addiction), repeated deep modes of distraction (such as immersion in television or other screen activities). Clinically diagnosed addiction develops over time (gambling addiction has only relatively recently been admitted to clinical definitions; some psychologists include ‘internet addiction’). Many ‘normal’ behaviours such as immersion in social media offer distractions from the world. Psychological relief and life patterns provide both escape and security, so perhaps extreme addiction can be formulated as part of ordinary everyday behaviour.
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A Life Pervaded by Addiction: an interview with Joe

The common phrase ‘problem gambler’ is thrown about very casually as if the compulsive gambling behaviour that so many experience (about 5% of the UK polulation including the 0.7% of life threatening cases). Too often a person is defined as an ‘addict’ or a ‘problem’. People do have problems and addictions but to identify them buy labellig them only in these terms is dehumanising and wrong.

The way we all too often label people needs challenging. Hence we have anti-stigma campaigns. There are many such campaigns around mental health. People should not be labelled for many reasons: one is that it lessens or belittles them; another is that it isolates people by their being seen as ‘different’; a third is that negative labelling deters people from seeking help and support.

This interview with Joe reveals a life of suffering from compulsive gambling. Rather than facts and statistics, academic studies, medical discourses, we think it is essential and in many ways more powerful and relevant to listen to the unique, individual voices of people who face the danger of being boxed into a dehumanising label and stereotype.

What’s also brought out in this interview is that problem gambling involves far more than individuals who gamble. It includes the environment and culture. It also includes the design of gambling machines in our digital age – specifically, in Joe’s case, fixed odds betting terminals and online gambling.

How prevalent is addiction?

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Following on from the previous post, our coffee discussion turned to the prevalence of addiction in the UK. We were both coming from a belief that it reveals an astonishingly large number of people in trouble. We believe it is a massive social problem that is not getting the attention it requires.

Later reflection considers the following:

  • There is a problem understanding what may be referred to as addiction. There is a very large number of people whose addictions have resulted in actual or potential life ruin involving finance, employment, social status, relationship breakdowns, a range of severe physical and metal health problems, and death.
  • However, there are many more cases where people are nearing these severe states. There are many whose drinking or other substance dependence are working slowly to take years off their lives. Nicotine addiction is an an obvious case. This applies to behavioural addictions such as gambling also, and statistics for these groups are hard to achieve if at all.
  • Unknown numbers of people are addicted to over the counter painkillers or prescribed medicines. Unknown again is the number of people illegally ordering prescription only addictive medication online.
  • There is a range of other addictions which are now taken seriously by researchers and treatment providers such as eating disorders, sex addiction and internet addictions.
  • Many ‘normal’ behaviours share characteristically common features of addictions. Compulsive shopping, perfectionism, workaholism for instance have similar neural substrates to all addictions.
  • A research paper has suggested that 47% of Americans are addicts in some sense.
  • Statistics for all addictions taken together in the UK are hard to come by. Limited statistics are available separately, e.g. for alcohol, opiates, marijuana (usually treated as psychological dependence),  gambling, amphetamines, heroin, cocaine.
  • It is extremely difficult to gather statistics. Since many addictions are to illegal substances and do not get reflected in medical interventions for instance, the true scale of actual addictions to a substance or behaviour can only be estimated.
  • Nevertheless, what figures there are contribute to an understanding of the prevalence of addiction. 9% of men and 4% of women are dependent upon alcohol. In Scotland there are 50% higher rates. The Gambling Commission also reflects geographical variation:

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  • Such figures cannot disclose current trends nor the breakdown of specifics of for instance, types of alcohol behaviour, methods of gambling. As for gambling, since it is increasingly done at home using online technology, only sources such as publicised personal catastrophes, some suicides, treatment statistics are available. The stigma associated with addiction is that even many severe cases will be attributed to financial ruin or depression etc.
  • For every addict at the extreme negative end of the spectrum, many more people will be affected, especially children and families. The problems of addiction therefore affect very large swathes of the population.
  • Besides the immense personal costs and suffering, society as a whole spends many billions of pounds because of addiction. These costs relate to health, crime, lost productivity and the welfare bill.
  • We aren’t remotely expert or knowledgeable but believe the true rate of addiction is extremely high. It needs much more urgent focus by policy makers across government services and within government, especially:
  1. Researching and acknowledging the scale of the issue as a whole rather than by reference to particular addictions.
  2. Identifying social, environmental, business contributions to addiction and curtailing them. For instance, prohibiting products designed to entice vulnerable people or induce people towards addictive behaviour, such as fixed odds betting terminals, advertising, online design; minimum unit pricing for alcohol.
  3. Raising awareness among professionals and ancillaries; ensuring destigmatisation among support providers and workers.
  4. Not allowing loss of government revenues to be used as an excuse to prevent public harm.
  5. Acknowledge once and for all that addictions represent one of the nation’s main mental health disorders. Integrate metal health services, educate staff, resource much greater treatment provision.
  6. Roll out public health promotion and advertising.
  7. Rethink drugs policy. Seek best practices globally for decriminalisation or legalisation. Emphasise treatment over punishment.
  8. Immediately produce policies and strategies to support the many people who suffer dual diagnosis disorders.

Addiction Musings (1) Introduction

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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.

 

What treatment for gambling addiction?

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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.

 

 

 

 

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.

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