Feature

Betting Your Life

The number of gambling addicts in New Zealand is on the increase, but better methods of identifying a gambling problem could offer some help.

By Sean Sullivan

Over half the adults in New Zealand gamble weekly or more often and, of that group, an increasing number are becoming problem gamblers. Better methods of detecting the development of problem gambling could offer hope of nipping problem gambling in the bud and reversing this growing trend.

Part of the problem is the mindset of the problem gambler who believes that it is the action of gambling that is all important, rather than actually winning. One heavy gambler, in encapsulating the major difference in perspective between the problem gambler and the social gambler, said "the next best thing to gambling and winning, is gambling and losing".

Gambling has become an integral part of New Zealand culture -- it is an accepted pastime of nearly every adult New Zealander. The recently released report of Drs Abbott and Volberg, commissioned by the Department of Internal Affairs, noted that over 95% of all New Zealand adults have participated in at least one form of gambling, and more than 50% of us gamble weekly or more often.

Over the past five years, along with the growth of the gambling industry in New Zealand has come a growth in the areas of problem gambling and gambling addicts. Problem gambling as a disorder in New Zealand now exceeds that of the United States.

New forms and opportunities have appeared -- Lotto, Instant Kiwi, gaming machines and, recently, Sunday track racing, complete with its own television channel. One of the developments found with increased opportunities to gamble is an observed increase in the numbers of people who lose control of their gambling.

Abbott and Volberg are concerned that the wave of problem gamblers that is likely to arise from this recent increase in opportunities has yet to be seen, due to the time that the pathology typically takes to develop. To date in New Zealand, track racing accounts for most of the pathology. In this form of gambling it takes, on average, ten years to develop from an occasional "flutter" to a pathological pastime. However, there is a compounding factor in the equation -- new forms of gambling have indicated much shorter developmental periods for the pathology.

Rapid Addiction

With gambling machines, or "one armed bandits", the progression from social to problem, then to pathological gambling may take less than three years. Over 50% of gambling problems were found by Abbott and Volberg in the under 30-year-olds, with their having most likely commenced their gambling with machines.

The profile of the problem gambler has departed substantially from that commonly held by the public. Commonly, the problem gambler is viewed as middle-class, white, middle-aged, and from a stable family and employment prior to losing control to their gambling. In New Zealand, the problem gambler is more likely to be non- white, young, unmarried, unemployed, and a male.

Recognition of the pathology of problem gambling is about where alcoholism was 40 years ago. Alcoholism is understood by the public as an addiction disease, and the lack of control the alcohol addict has with their particular psychoactive substance is accepted. There is no such substance with problem gamblers, and the problem is often attributed to moral weakness, and viewed as a self-inflicted weakness.

Because of the public perception of problem gamblers as indulgent, and the consequential stigma attached to their disorder, problem gambling has often been referred to as the "secret disorder". Problem gamblers will rarely seek treatment for the disorder, and will do so only if forced by circumstances, or they have reached a particular low point in their lives; this attempt to obtain help will quickly be lost as the addiction regains control. More likely, the gambler or their spouse will seek assistance from their general practitioner for problems associated with the gambling disorder.

Associated Problems

Such associated problems include depression, associated suicidal tendencies, stress, problems associated with alcohol, and psychiatric disturbances. In the case of the spouse of the problem gambler -- 80% of problem gamblers are male -- treatment may be sought for physical violence as a result of arguments over money, or for stress or depression due to dealing with the consequences of the problem gambler's addiction.

Suicide is particularly elevated in the case of the problem gambler and, indeed, their partners. A study of some 50 pathological gamblers hospitalised for residential treatment of their gambling addiction showed that 24% had either made a lethal attempt with definite intent to die, or had made substantial preparations for suicide within 12 months of hospitalisation. This same group, once in residential treatment, were found to have elevated instances of hypomanic disorder (38% of them) and major depressive disorder (76%).

The Abbott-Volberg study indicated between 18,000 and 32,000 New Zealand adults were pathological gamblers, with much larger numbers likely to be diagnosed as problem gamblers or potential pathological gamblers. As such it is highly likely that most general practitioners will have treated problem gamblers or their partners for some matter other than gambling addiction, but directly attributable to the disorder.

Spotting the Problem Gambler

Should the possibility of an underlying gambling problem be suspected by the general practitioner, a sympathetic inquiry and a brief self-report screen may assist the GP in determining whether further intervention may be appropriate. Such screens use a series of often self-administered questions designed to make the individual think about their lifestyle.

The development of gambling screens is not new. Gamblers Anonymous provides the new GA member with a 20-question screen, with positive answers to seven or more of the questions indicating a likely compulsive gambler. Another questionnaire is available to the partner of a gambler upon request, entitled Are You Living with a Compulsive Gambler?

However, while GA has used these screens for some time, it was not until 1977 that the World Health Organization listed compulsive gambling in its International Classification of Diseases.

Shortly thereafter, the American Psychiatric Association included it in its Diagnostic and Statistical Manual of Mental Disorders (DSM III) as a disorder of impulse control, with a short list of behaviour associated with the pathology.

None of the previous screens indicate how the loss of control develops or persists. Some clinicians have criticised the description of the disease as one of "impulse control". This implies a lack of premeditation, whereas a great deal of planning is expended by problem gamblers in some forms, such as track racing. Some say the loss of control occurs during gambling, not prior to the behaviour. DSM III is due for revision next year and these criticisms may be addressed then.

In 1987 Lesieur and Blume developed a broader screen for pathological gambling, later dividing the diagnosis into both problem and pathological gambling. They had regarded the DSM III criteria as dwelling on the late desperation stage of pathological gambling, while the Gamblers Anonymous screen was seen as eliciting too many false negatives.

The Lesieur and Blume screen was developed at the South Oaks Hospital on Long Island, New York, involving over 1,600 subjects, and is commonly referred to as the SOGS (South Oaks Gambling Screen). Questions include subjective guilt, whether the gambler has borrowed money to gamble, criticism the gambler may have received about their gambling, and other such matters not referred to in DSM III criteria. Positive answers to three or four of the 20 questions indicate problem gambling, while five or more indicate that the gambling is probably pathological.

The SOGS screen has been widely used in the United States, and was the basis of the Abbott-Volberg study. Modifications in the New Zealand study were made to ascertain a current pathology level, as the problem, like addictions, tends to wax and wane throughout a gambler's life.

It is envisaged that a screen could be made for New Zealand use, with additional questions in response to the particular aspects of the New Zealand problem highlighted by the Abbott-Volberg study. Such aspects included the disproportionate number of Maori (three times the Pakeha New Zealander level) and Pacific Islanders (six times) that are problem gamblers.

The study may have underestimated the numbers of unemployed in the problem-pathological category.

Further, a more modern screen for the partner of

the gambler than that of Gamblers Anonymous may be useful in assisting identification of a problem.

Such a screen would be of particular benefit to a general practitioner, as it is anticipated that the GP will increasingly become the first contact for the problem gambler.

As the numbers of pathological gamblers increase as a result of new and increased opportunities to gamble, screening for the problem may enable the gambler who has lost control to address their problem for the first time.

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.