GAMBLING DISORDER: WHAT EVERY PSYCHIATRIST NEEDS TO KNOW

Volume 10 Issue 7 July, 2019

DEFINITION: Gambling refers to betting something of value (usually money) on an event whose out come is unpredictable and determined by chance. Problem gambling refers to gambling that disrupts or damages personal, family or recreational pursuits.

Akin to substance use, gambling too exists on a spectrum of escalating severity (ranging from social or non-problem gambling, through problem gambling, to gambling addiction or gambling disorder). Problem gambling is seen as a less severe form of gambling disorder, where the full set of diagnostic criteria for gambling disorder are not met.

DIAGNOSIS:‘ Gambling disorder’ as a distinct entity was added in DSM5 in the section of addictive disorders, along with substance addictions, and is the only behavioural addiction to have been included. The diagnostic criteria for gambling disorder include the following nine of which at least four need to be met for a diagnosis: need to gamble with increasing amounts of money in order to achieve the desired excitement; restless or irritable when attempting to cut down or stop gambling; has made repeated unsuccessful efforts to control, cutback, or stop gambling; is often pre occupied with gambling; often gambles when feeling distressed; chases one’s losses; lies to conceal the extent of gambling; has negatively impacted on a job, relationship or work; and relies on others to provide financial help to relieve desperate financial situations caused by gambling.

ADVERSE CONSEQUENCES: They have higher rates of various psychosomatic symptoms (cardiovascular, musculoskeletal, gastrointestinal), and psychiatric problems such as depression, anxiety, substance misuse and personality disorders. Problem gambling can often result in large debts and even bankruptcy, and some resort to crime to fund their gambling. It can also adversely affect the gambler’s interpersonal relationships and can result in neglect of the family, domestic violence and child abuse.

LEGAL FORMS OF GAMBLING IN INDIA: Currently, most forms of gambling are illegal in India except for the State-run lotteries (and that too only 12 States and 5 Union Territories), horse racing, rummy card games and casinos (in only two of the twenty-nine States). However, many Indians gamble illegally. The Public Gambling Act of 1867 remains the only law that regulates gambling in India Gambling at festival fairs is also very popular in India, as they offer a range of legal and illegal gambling opportunities, collectively refer red to as ‘festival gambling’.

Public health prevention strategies to minimize risks of gambling include:

1. Primary prevention measures(aiming to prevent gambling from becoming a problem):
   •Awareness-raising campaigns
   •Social marketing programmes (about various aspects of gambling, its potential for harm, signs and symptoms, how to seek help, etc.).
   •Banning of gambling advertisements and promotions
   •Increasing in-counter-advertising (advertising focusing on gambling-related harm/ negative consequences)
   •Limiting the availability of gambling opportunities.
2. Secondary prevention measures (aimed at early diagnosis and treatment):
   •Providing training to staff at gambling venues such as lottery shops (to enable them to recognize problem gamblers)
   •Training non-specialists (primary health care staff, mental health care staff, etc.) in early identification of problem gamblers and training the min providing brief psychological interventions for problem gamblers
   •Training other groups who are likely to come across gamblers (financial/ debt advisors, family counsellors, school and college staff, etc.)
3. Tertiary prevention strategies:
   •Provision of a range of appropriate treatments (psychological and pharmacological) for problem gamblers and those affected by someone else’s gambling.

TREATMENT: Treatments for gambling addiction can either be pharmacological or psychological (delivered 1:1 or in groups, face to face, online or over the telephone) or both. No medication is licensed for use in this condition although SSRIs, mood stabilizers and naltrex one have all been tried with some success. Psychological treatments (1:1 or in groups) are the main stay of treating gambling addiction, with cognitive behavior therapy being the most commonly and effectively used(8). Gamblers Anonymous is another popular psychological intervention.