Drink and Drugs News DDN December 2019 | Page 15

Taking its toll The impact of problem gambling on individuals and families CO-MORBIDITY Studies have shown that for males with a gambling problem, alcohol consumption is heavier than for those classed as non-problem gamblers, and they are also more likely to be smokers. Statistics from an earlier Health Survey for England quoted in a 2018 Gambling Commission briefing paper, Gambling- related harm as a public health issue 14 shows that almost a fifth of male problem or at-risk gamblers drink more than 35 units per week, while a third are smokers. Clearly the links between alcohol – and other substances – and gambling are strong. People are not only more likely to gamble when their inhibitions have been lowered by alcohol, they may also turn to alcohol to cope with gambling-related guilt or stress, or ‘drown their sorrows’ after incurring a heavy loss. ‘In addition to the well- documented evidence of the potential for dependency in both drinking and gambling there is an increasing evidence base for the co-occurrence of pathological alcohol consumption and gambling behaviour,’ states the Alcohol Change UK website. 15 ONLINE ADDICTIONS The internet has revolutionised many aspects of our lives, and one of these is access to gambling. There’s no longer even a need to visit a bookmakers’ – gambling is available instantly, 24 hours a day, on the smartphones in our pockets. The internet has also dramatically increased the opportunities for advertising and marketing, with one in eight young people now reported to be following gambling companies on social media. 16 What’s more, as video games and online gaming become ever more sophisticated, it’s no longer necessary for money to be involved in order for people to experience problems. The 11th revision of WHO’s International Classification of Diseases now includes ‘gaming disorder’, 17 a pattern of behaviour characterised by ‘impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences’. WWW.DRINKANDDRUGSNEWS.COM P roblem gambling can have a devastating impact on both the gambler and their family. Gambling can become an obsession, leading people to neglect their work and their loved ones. Bills can go unpaid, debts can accumulate, and in extreme cases people can face bankruptcy, lose their job or home, or even resort to criminal activity. According to the charity GamCare, there is a ‘higher number of people identified as problem gamblers in the criminal justice system than the wider population, especially if those going through the system possess vulnerable characteristics such as ADHD, impulsivity, poor mental health, and substance abuse’. 18 While the most common offences committed by problem gamblers are ‘income- producing crimes’ like fraud, theft or drug dealing, offences can sometimes be more violent, the charity adds, including domestic abuse. FAMILY BREAKDOWN The stress associated with a gambling disorder can obviously have a devastating effect on family and other relationships, eroding closeness and trust. People with a gambling disorder can become withdrawn and isolated, or angry and defensive, and marriages and partnerships can be irrevocably damaged. Children are ‘heavily impacted’ both financially and emotionally by the gambling of a family member, says a Faculty of Public Health position statement. 19 ‘This “ripple effect” of gambling leads to a number of feelings for children which are hard to manage, including anger, guilt, helplessness, shame and feeling neglected,’ it states. The toll on mental and physical health can also be significant. ‘We know that problem gambling can have a major impact on health,’ says the government’s July 2019 green paper Advancing our health: prevention in the 2020s 20 , adding that the government now ‘has an active agenda on this’. Sleep and appetite can suffer, and the impact on mental wellbeing can be severe. As well as anxiety and depression, the psychological issues associated with addictive behaviours, such as guilt, shame and stigma, can compound feelings of isolation. In extreme cases, and often when significant sums of money have been involved, people can be driven to suicide. WHEN TO REFER The Royal College of Psychiatrists’ 2014 report Gambling: the hidden addiction 21 recommends that drug and alcohol treatment services and wider health professionals such as GPs should routinely screen ‘high risk’ patients for problem gambling issues, with anyone recording a positive score first offered a brief intervention and then referral to specialist care. Widely used for people considered to be drinking at risky levels, ten- to 15-minute brief interventions are designed to stop people moving from being ‘at risk’ to developing a full disorder. ‘They are also helpful when working with patients who are currently unwilling to seek formal or more intensive treatment for their disorder,’ the document states. WIDER HEALTH SERIES • DRINK AND DRUGS NEWS • 5