Gambling: The Lottery of Addiction

Article by Ishbel Straker, Consultant Prescribing Nurse

As we drove into the car park with the large TK-Maxx, B&Q, Next Home and Mothercare all in clear view, I noticed that positioned very comfortably next to the Harvester was a BETFRED.

“That’s odd,” I remarked to my husband, who incredulously stated that in reality it wasn’t actually that odd and some people’s everyday lives and routines are structured around placing a bet.

Of course, I know the extremes of this from working in the field of addiction for fifteen years and have seen an increased smattering of such addicts, but the statistics show that the UK is a nation of gamblers.

I initially found the idea of the Great British public avidly working out a multitude of complicated odds and combinations before finding the nearest betting shop to risk their pay check, baffling and frankly absurd.

But with the gambling industry generating fourteen billion pounds in 2017 and 76% of the UK population playing the national lottery and using scratch cards on a weekly basis, I soon came to realise that there was a wider issue at large.

It is important to note that it is no more confusing to me that someone would jeopardise the weekly shopping budget on a horse race, than a person’s need to drink or use a mind-altering substance to feel normal, shopping continually to feel fulfilled, exercising obsessively to the point of injury or to spend every waking moment holding a gaming controller and staring at moving pixels on a screen.

I am aware people do all of the above and they are all recognised addictions I see on a regular basis, but gambling seems to have its grip on the nation without most people even being aware.

Data shows that the National Lottery in retail outlets are used by 58% of the population, Scratch-cards are used by 32%, private betting/slot machines 24%, other lotteries 22% and betting on horse/dog races are last at 21%.

Looking from a societal perspective, I feel gambling and alcohol fall into similar categories. Both are legal, both are socially acceptable to most people and both have friendship and social elements to them. They are also incredibly accessible and are promoted by celebrities, making them almost ideals to strive for.

But most importantly, they are both a rapidly escalating issue, creeping up on users until it is too late and they have slipped into a cycle of managing the physical and financial consequences of these addictions. The Gambling Commission in 2017 estimated a shocking 430,000 people were problem gamblers and that men were seven-and-a-half times more likely than women to develop a problem.

Due to the fact that men are statistically greater risk takers and more impulsive, this is of particular relevance when dealing with chasing financial losses. Also, statistically more at risk from addiction are young people from black and minority ethnic (BME) backgrounds, people with mental illness and people who misuse substances.

Gamblers are unable to switch on their computer without a barrage of popups inviting them to have a game of online poker, blackjack or place a bet. With one click the addiction is satiated and the patient has stepped into the cycle once again. While only 4% of people nationally gamble online, almost 35% of at-risk gamblers do it online.

So, why do people gamble?

The answer is how long is piece of string? Like any addiction, gambling makes the patient display isolating behaviours in an attempt to hide the issues. It is tempting to believe it is about money or having a competitive nature. In clinical terms, the phases of gambling look like the following: winning, losing, desperation, hopelessness.

It's an everlasting cycle that can only be broken with an affirmed decision to change, seek help and ultimately stop.

There is now far more support widely available and resources can be sought online in the form of self-help part of the initial treatment is being open and honest in where the pitfalls lie. GamCare has some fantastic resources that allow a person to work through the addiction and discover where they need to be through workbooks and online support.

They provide blocking software that prevents the barrage of temptation for those who are online and have used this as a forum for their gambling practices in the past.

They also provide the following SMART Goal Planner, Access, Time and Money worksheet, My Gambling Diary, Me Today Planner, What Will I Gain worksheet, Building a Support Network worksheet, Mood Diary, Boundaries Map and Stress Checklist.

There are specialist providers that can treat gamblers, either as inpatients or in the community. As a clinician when assessing gambling behaviours in a patient we use the following recognised tools:

• LIE/BET Questionaire

• South Oaks Gambling Screen (SOGS)

• Brief Biosocial Gambling Screen (BBGS)

• DSM-5 Gambling Disorder Criteria

• NORC Diagnostic Screen for Gambling Problems - Self Administered (NODS-SA)

• GHQ-12.

The DSM-5-2013 Gambling disorder – diagnostic criteria must meet 4 out of 9 criteria with 4-5 criteria: mild gambling disorder, 6-7 criteria: moderate gambling disorder, 8-9 criteria: severe gambling disorder.

1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.

2. Is restless or irritable when attempting to cut down or stop gambling.

3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.

4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).

5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).

6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).

7. Lies to conceal the extent of involvement with gambling.

8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.

9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

There are recognised neurological & cognitive difficulties symptomatic with gambling which include; a Decreased Orbitofrontal Cortex, Basal ganglia & thalamus which affects speech, movement and posture. The combination of such symptoms is parkinsonism.

Mesolimbic/dopaminergic abnormalities have a significant role in the control of addiction. Similar pathology is seen in obsessive compulsive & addictive disorders and Corpus Callosum – fractional anisotropy.

There are also measurable symptoms to note with a patient who chase losses: impulsiveness, has difficulties with cognitive flexibility and time management estimation, deficits with working memory and diminished performance on inhibition and decision making.

We have moved on leaps and bounds with the pharmacological treatments for gambling addiction available. The following are now reasonably successful and worth consideration within specialist services.

We have moved on leaps and bounds with the pharmacological treatments for gambling addiction available... naltrexone and opioid antagonists have shown the most promising results...

Naltrexone and opioid antagonists have shown the most promising results for gambling disorder to date as they modulate dopaminergic transmission in the mesolimbic pathway and decrease the urges to gamble as well as the gambling behavior itself.

In conclusion, despite the clear increase of gambling issues, there are positive steps being made to treat those who want help. However, with all addictions, the first step is to seek help and those who are most likely to be faced with the initial problems are GP’s.

With online resources and referral pathways within addiction services and private practice at their fingertips, GP’s have a plethora of outlets to point their patients towards, benefitting from not only therapeutic tools but prescriptive provision.

For further information, Ishbel can be contacted at www.ishbelstraker.co.uk

Ishbel Straker

www.ishbelstraker.co.uk

Ishbel Straker is a Consultant Prescribing Nurse who runs a private clinic on Rodney St, Liverpool. As an expert in the field of Addiction and mental wellbeing, Ishbel is focused on offering a bespoke service to her patients, combining clinically evidenced therapies such as Cognitive Behavioural Therapy, Motivational Interviewing, Solution Focused Therapy as well as a prescribing service if appropriate.

Ishbel works with people who are both physically and/or psychologically impacted by mental health issues or addiction. Working together with the patient to set goals through one-to-one therapies working within national guidance frameworks. Ishbel additionally has a range of onward referral pathways to ensure continuation of care. Ishbel has a keen interest in working with women with the following issues:

• Perimenopausal

• Struggling with work

• Gambling

• Relationships

• Alcohol

• Recreational drugs

• Stress

• Anxiety

Ishbel studied Psychiatric Nursing at University of Central Lancashire and gained her Masters in Prescribing at the University of West London. Over the past ten years she has held senior positions in several national organisations including Director of Nursing. Her priority has always been quality care for her patients and this is what she strives for on an individual patient basis and nationally through her strategic policy work.

Ishbel is a recognised expert in the field of Addiction and co-existing mental health problems. She writes a bi-monthly column for the national magazine; Drink and Drug News and writes a monthly mental health column for the Liverpool Echo. She is an experienced Expert Witness and is an Honorary Clinical Lecturer for Middlesex University, supporting research and the training of clinicians.

Ishbel also supervises senior nurses in various organisations which includes clinically advising on complex patients.