DDN May2021 May 2021 | Page 19

you ’ re seeing with alcohol or drug misuse have much more in common with gamblers than you might think . A gambler will suffer withdrawal , for example , and they ’ ll also develop tolerance .’
HIGH-RISK GROUPS More than 95 per cent of people with a problem gambling disorder also have a psychiatric disorder , whether anxiety , depression or co-existing problem drug or alcohol use , she said . ‘ There are some high-risk groups – individuals from black communities , people with past histories of trauma , and , as with drugs and alcohol , it ’ s also linked to disadvantage . You ’ re more likely to have a gambling problem if you ’ re brought up in socioeconomic deprivation or have a family history of abuse .’
The sheer level of comorbidities – whether substances , psychiatric disorders or the very high proportion of gamblers who smoked – meant that ‘ these are very sick people ,’ she stressed . ‘ That ’ s why , especially with male gamblers , they ’ re so prevalent when we look at suicide rates .’ One key difference that had emerged was that while men were more likely to gamble in the belief that they may win , women were more likely to report engaging in ‘ non-strategic ’ gambling , which they tended to do as ‘ negative reinforcement ’, such as to try to stop depression or anxiety .
TIME FOR PARADIGM SHIFT Having spent 15 years running a shared care drug service she felt that the time had come to ‘ do a paradigm shift around how we can manage gamblers ’, she said . ‘ There ’ s absolutely no point telling GPs to do a screening test if , having screened patients for the problem , there ’ s nowhere to take them .’ She ’ d helped to set up the new , integrated Primary Care Gambling Service ( PCGS ) in London with her colleague Emma Ryan , which is supported by GamCare . ‘ We ’ ve tried to create a very simple referral pathway , and we try to bring people into treatment as quickly as we can . What our patients want is to be treated with dignity and compassion , and that ’ s what we try to provide .’
When it came to comorbidities , gambling was also making existing problems worse . ‘ People are spending all their money and not looking after themselves ’, she said . ‘ We ’ re picking up many , many people with gambling problems who have serious physical health problems , so gambling shouldn ’ t just be seen as an isolated health problem – it really has to be seen in the context of people with multiple co-morbidities .’ The system that best able to manage those patients was GPs and primary care , she told the conference .
‘ I ’ m not suggesting that every GP in the country manages patients with gambling addiction ,’ she said . ‘ But what I am suggesting is that we ensure that GPs are equipped to identify those with gambling problems , and that in the future we do what we did with intravenous drug users – create the network of doctors and nurses willing and able to run local services or bolt it on to their existing services , so we actually start to get gamblers seen as quickly as possible in a skilled service .’
JUST ASK One key measure that could make a huge difference was simply to ‘ get GPs asking the question ’, she stressed . GPs needed to be asking about gambling whenever anyone presented with debt , or was a smoker , or who had schizophrenia or bipolar disorder . ‘ It is a sensitive question , but just ask . It ’ s the most important independent factor for suicide amongst men , and yet how many GPs ask about gambling when they see men who are depressed ?’ There were also simple , practical interventions that GPs could recommend , such as Gamstop , a free self-exclusion service that blocked people from using gambling sites and apps for a set period that they chose themselves .
PEER SUPPORT VITAL As with drugs and alcohol treatment , peer support also had a vital role to play , she said . ‘ They help by really holding people ’ s hands and bringing them into treatment .’ However , when it came to treatment to help stop gambling , it was ‘ still in its infancy ’, she acknowledged , ‘ whereas there ’ s so much research into how to stop opiate addiction going way back into the 1960s .’ The mainstay of treatment remained CBT , plus a range of other psycho-social interventions . ‘ On the whole it ’ s
Since 1991 Dr Gerada has worked as a principal in general practice although she has maintained her interest and expertise in the addiction field . Dr Gerada writes , teaches and lectures widely on the subject of the role of general practitioners in the care of substance misusers . Since 1993 Dr Gerada has been the lead clinician for the Consultancy Liaison Addiction Service which provides support to general practitioners so they are able to deliver effective care to people who use drugs .
Dr Gerada has held a number of national roles , including , senior policy advisor Department of Health , Drugs and Alcohol , director of RCGP substance misuse use unit and was chair of RCGP national expert group on substance misuse .
She was awarded the DBE in the 2020 Queens Birthday Honours for services to general practice .
Biography at practitionerhealth . nhs . uk
‘ More than 95 per cent of people with a problem gambling disorder also have a psychiatric disorder , whether anxiety , depression or co-existing problem drug or alcohol use .’ very similar to drug use – you can manage the addiction , but then you need to manage the other bits . If you just manage the heroin bit with methadone you ’ re not going to get anywhere – you ’ ve got to manage the homelessness , the worklessness , the self-esteem . We manage our patients in a holistic way , and sometimes success isn ’ t about getting them to stop gambling , it ’ s about a harmreduction approach .’
Issues around advertising and promotion also needed to be addressed , she stated , but as with alcohol , the vast majority of people who gambled did so safely . Stigma however remained a major barrier to people seeking treatment for problem gambling , especially among ethnic minority communities and women .
HARM REDUCTION Overall , the problem was much more prevalent than had been acknowledged , she believed , and there was now a ‘ normalisation ’ of gambling . ‘ Spread betting on the stock market is gambling – you can lose hundreds of thousands if you don ’ t cap it – as is Bitcoin . It ’ s everywhere around us – on the TV , in the “ loot boxes ” on your children ’ s video games .
‘ We know that most of what we do is harm reduction ,’ she said . ‘ We know we can ’ t make better a traumatic , troubled childhood or abusive parents , but what we can do is nudge somebody back into health . A tiny bit of attention can make people so much better .’ DDN