Gambling: the wins, the losses and the treatment to addiction

Earlier this week, Gary Enos, Editor-in-Chief of Addiction Professional, hosted a panel discussion with experts from around the country on the topic of gambling addiction and related co-morbidities.  The discussion was held at Maggiano's Little Italy restaurant in Beachwood, Ohio.  The three panelists included Coleen Moore, marketing and admissions manager for the Illinois Institute for Addiction Recovery; Dr. Chris Tuell, EdD, LPCC-S, LICDC, coordinator of addiction services for the Lindner Center of HOPE and adjunct professor of addiction studies in the department of counseling at the University of Cincinnati; and Robert Cabaniss Jr., founder and executive director of Williamsville Wellness. 

Moore began the first round of answers by saying, “If you aren’t putting a screening in front of somebody, or at least asking the question about gambling behaviors, I would start including it in your screening and assessment process.  They’re not going to just come out and start talking about it.”

She also offered advice saying, “When asking the questions, and getting a history of their behaviors, it’s really important as a clinician, especially if the compulsive gambler is beginning to talk about their big wins, it’s very important to stop that interaction in regards to the winning.  You’ll see them actually getting in action as they talk about it and kind of relapsing in front of you. It’s really important, if they start talking about those big wins and not talking about the losses at all, we need to move to the losses.”

Cabaniss, having some special insight as he is a recovering compulsive gambler, agreed and said that the level of denial and illusion is extremely great.  “You need to break that,” he said, “they need to understand the damage they’ve done.”

Another issue that was discussed by the panel was subpopulations, such as adolescents and the elderly.  With the elderly, the panel unanimously agreed that they gamble due to boredom and/or loss of their partner.  Moore said that a lot of times the elderly population feels a sense of entitlement -- they’ve worked hard their entire lives and now they are going to spend their money however they choose, even if that means gambling.

Tuell said that the elderly are very vulnerable to gambling.  He said that individuals over the age of 65 make up 7.2% of people who have problems with gambling and he thinks that number is continuing to grow.  

In regards to adolescents, Moore said that at her organization, they have been doing educational programs to teach students, parents and teachers outcomes of gambling and possible ways to prevent it.  She said they also conduct a screening on children ages 10-18, and since 2004, they have screened about 24,000 students.  Of this population, she says that 10% have shown at-risk behaviors for pathological gambling.  “Gambling doesn’t always have to be with money,” she explained, “we describe it to them as ‘risking something of value when the outcome is uncertain.’”

The panelists also discussed the difference between action and escape gamblers.  Action gamblers are typically men, but not always, and have characteristics such as high egos, narcissism, and competitiveness. You will see this group cheering on others, participating in sports gambling, and games like poker.  The escape gamblers are typically women, but not always, and are generally isolated.  They are usually zoned out, not necessarily interacting with anyone, and participate in games such as slot machines and bingo. 

Moore commented that she was excited for disordered gambling to formally be recognized in the DSM5 and her fellow panelists agreed that this will help greatly with insurance funding treatment so patients no longer have to pay as much out of their own pockets to get help.  Along with this, Moore also said that she does think there is a benefit to having patients pay for treatment on their own.  “I have this philosophy that it’s okay to pay for treatment because there’s some accountability to that.”

Tuell said that he is glad that gambling will be under the behavioral addiction area, and this gives him hope for the future.  “I wish the DSM-5 would’ve taken it a little bit further and included internet and sex addiction but at least I think this opens the doorway for other behavioral addictions to be recognized, and we know that when that happens, better services and research increase.”

The Addiction Professional panel event was made possible with the support of the following sponsors: Lindner Center of Hope, Rogers Memorial Hospital, Williamsville Wellness, and the Illinois Institute for Addiction Recovery.