It all looks so very glamorous

…and of course he doesn’t realise it – but he’s in huge danger…..

 

…I’m not talking about the assassination skills of the SMERSH Agent about to attack 007, but about something that is much, much, more insidious – his gambling problem.  We sometimes call it a “silent” addiction, or even a “silent killer” addiction. It’s an addiction that often goes almost unnoticed for many years while causing immense and slowly increasing emotional and financial harm, before anyone realises that it’s even a problem. Addiction to gambling is definitely not harmless for the person affected. However, the real harm is often to their families: on average an additional 5-10 people are affected by every addict. So think of children being left hungry, homeless – or even abandoned. You might think of that in terms of drug addiction – but that is gambling too…. So perhaps it’s not that glamorous after all.

Let’s talk about the scale of the problem

Approximately £7 billion – that’s a 7 with nine zeros after it – is spent on gambling activities each year in the UK. Of course, some of it is harmless fun – but a very significant proportion comes from people with problems. As many as 600,000 people in the UK would be diagnosed with a gambling problem if they sought help: but sadly only 1 in 20 of them do, and only 1 in a 100 actually get the sort of help they need.  So that’s a big problem – It’s a serious problem too. You have to add in that 60% of problem gamblers also suffer with depression – and 1 in 7 attempt suicide. Substance misuse and other mental health problems are very common too – the gambling is often only the outward manifestation of their inner issues. The truth is that people with any addiction are unlikely to be happy and healthy in other ways.

What are the signs? Who’s at risk?

Though not everyone who starts to buy a Euro Millions ticket every week will develop a problem; being young and male, having members of one’s family who also struggle with gambling and having an early big win (a significant win early on in gambling career) all increase the chance of someone developing problems with their gambling. Certain kinds of gambling, like playing dice or roulette on the internet, or buying high risk stocks and shares, appear to be more likely to lead to problems.

Then, of course, there are FOBTs (fixed odds betting terminals). Since they were first allowed in 2001, over 35,000 have been installed into every betting shop in the country. These machines are the gambling equivalent of crack cocaine. They have been perfectly designed to hijack your brain’s rewards mechanism and so cause gambling addiction. Under huge pressure from those of us who can see the damage being done, the government, at last, is starting to talk about controlling them. They recently announced that they were reducing the maximum bets in FOBTs from £100 to £2 – but said the change would not take place until sometime next year. However, since the announcement, the gambling industry lobbyists seem to have managed to extend that until 2020 at the earliest now. The truth is that the government are very reluctant to do it. There is a lot of money at stake here – and a huge chunk of it goes to them – so it’s not really in the interest of the treasury to control the problem properly – not until we get that huge Brexit dividend anyway…..

So there are going to be a lot more addicts getting hooked on FOBTs over the next couple of years – and the question you have got to ask yourself is – are you one of them? To quote from another iconic film image – do you feel lucky – punk? Yes? – then you probably have a gambling problem.

Like other addicts, problem gamblers often need to use increasing amounts of money to achieve the same excitement. They are irritable when trying to cut down and make repeated unsuccessful attempts to stop. Their thoughts can become obsessively preoccupied with gambling, or they can be using gambling in a sort of perverse way to try to relieve anxiety or to lift their mood. Often, they are lying to everyone around them to try to hide the extent of the problem – and the burden of guilt results in anger and other escapist behaviour such as alcohol misuse. Gambling not only has a catastrophic effect on their finances, it destroys relationships and ends careers.

So who can help me?

I would say it, wouldn’t I – but the fact is that psychiatrists who specialise in addictions to substances like cocaine or heroin also work with gambling addictions. We are probably the best place to start if you really want to deal with your addiction. We are the people to help you recognise what are the core problems and advise you as to where to start to deal with the mess you are in.

What can we do?

There are no easy answers to being addicted – if it was easy to give up it wouldn’t be addictive! The most important thing is to recognise and admit to an addiction problem – and to make that decision to get help. Gamblers who know they are addicted and seek help are taught how to take control; to reduce how often they play and how much money they spend (family help with control of money can be very important). Identifying and then doing other pleasurable activities also has a positive effect. It sounds ridiculous for a doctor to be encouraging someone to do something really dangerous, but thrill seeking replacement activities – hang gliding – or racing motorbikes – can work!

However, for many, the most important step is finally recognising that the glamour is an illusion. You are not lucky – and 007 isn’t cool – he’s a sucker – a mark – a punter – and a loser. The fancy lighting, the mirrors, the free bets or the complimentary drinks are only there to get you to lose more money. Gamblers are tricked by cynical, unscrupulous and manipulative businesses to carry on losing and, despite any weasel words of concern, it is in those companies interest to keep you addicted. Unless you are that business, gambling isn’t a way of ‘making money’ and the odds are never in your favour (even if one occasionally wins).

Of course the big betting companies pay some lip service to helping those playing in their venues with voluntary self-exclusion schemes. Similarly if one plays online, there are blocking software which can be installed to help. There are also a number of charities and GA (Gamblers Anonymous), similar to the support groups available for people with drug or alcohol problems. However, to do things properly an addict needs specialist psychological treatment, often based on Cognitive Behavioural Principles or longer term psychotherapy – and they need to deal with the causes and the consequences of their addiction: the depression, the anxiety, and the losses.
If you are worried about your own gambling, or about someone close to you, we can help with a proper medical assessment of the problem. The two main ways we can help is with advice, including identification of the best sources of support, and with the identification and medical treatment of any other co-existing or underlying mental health conditions. Once these are addressed, it always makes it far easier to overcome the addiction itself. The sad fact is that often, as is the case with addictions in general, these underlying mental health problems are just not recognised. Of course, then the problem for us psychiatrists is that an addict can be in even greater denial of that underlying issue than of their addiction.

Wiktor Kulik is an Addictions specialist with Psychiatry-UK.