Quick Dips

A Gambling Gamble

Sean Sullivan

New Zealanders have always been keen punters. The last decade has seen a veritable plethora of new and exciting forms of gambling, including video gambling machines, casinos, and national lotteries broadcast live over peak hour television. Internal Affairs research confirms 90% of adults gamble in one form or another, and that the amount wagered has increased during this time by 600%.

Along with the increase in gambling has come a rise in gambling-related stresses and health problems. Researchers at the Auckland School of Medicine have been working on developing a suitable screening procedure designed to help identify and assist people with gambling problems.

Increased participation has followed increased availability of gambling, which in turn has seen an increase in those seeking help for gambling problems. The Compulsive Gambling Society saw an increase of 100% in clients in 1996, followed by a further 20% on that figure in the following year.

Because of the financial and health costs of problem gambling on both the gambler and his or her family, there appears to be merit in early intervention rather than waiting until the person seeks help for an established "disorder". The extreme form of gambling known as "pathological gambling" (and most of those gamblers contacting the Compulsive Gambling Society met this criteria) is a recognised chronic mental disorder.

Doctors in general practice appear to provide an opportunity to intervene early in the progression of the behaviour, as well as having the advantage of identifying an established gambling problem. Almost 80% of New Zealanders visit their GP each year for assistance. It appears that the stress associated with problem gambling behaviour may contribute to health problems such as depression, anxiety, sleep disorders and physical problems such as chest pains, gastro-intestinal problems and the like.

Unfortunately, the connection between gambling behaviour and health problems is poorly recognised, especially by the gambler, and research suggests that few problem gamblers will seek help until the problem behaviour has advanced to the point that it can no longer be ignored.

Current research is seeking to identify which health problems people with gambling problems will present to their GP with, and test whether there is a greater likelihood for these disorders to be associated with problem gambling. If so, this may suggest to GPs that they consider further inquiry with the possibility of "case finding" a problem gambling disorder, or perhaps identifying gambling behaviour that is at risk of progressing to a disorder or is presently causing distress.

Problem gambling is not an obvious behaviour and doesn't provide the clear signs of alcohol and drug abuse. However, research has suggested that almost one in three problem gamblers may also be either harmfully or dependently using alcohol, often as a means of escaping intolerable stress when unable to gamble (the preferred stress-avoiding behaviour). This suggests that those primarily dealing with alcohol abuse should also consider gambling behaviour in order to avoid relapse due to depression or "switching" of addictions during or after therapy.

Selective screening of patients by GPs for problem gambling behaviour seems to be an appropriate step. Research has indicated that a strong majority of GPs in New Zealand see the identification and assistance of patients and their families experiencing problems with gambling as being within their mandate. The availability of a brief screen, supported by information as to other indicators that may suggest it appropriate that the screen be offered to the patient, appears to be an important resource in this relatively new field.

The Department of General Practice at the Auckland School of Medicine has over the last five years carried out research and raised the awareness amongst GPs of problem gambling as a health-related behaviour. Final tests of screen questions are currently being trialled with the intention of providing a brief, user-friendly instrument that can be available to a patient in an environment that can externalise the behaviour as a health problem and so avoid defensive responses so often raised by those experiencing difficulties in self-control.

The provision of sensitive screening followed by an offer of immediate assessment and brief intervention, with referral to specialist treatment providers where appropriate and desired, continues the prevention and early intervention focus of general practitioners as first contact health professionals.

Sean Sullivan is the staff psychologist with the Compulsive Gambling Society of New Zealand and works in the Department of Public Practice in the University of Auckland School of Medicine.