Addressing Problem Gambling: Insights from Gamblers Anonymous and Healthcare Professionals
On a recent Sunday morning in Los Angeles, a small group of ten individuals came together at a local park — not for leisure, but to confront a significant issue that often hides in the shadows of society: problem gambling. As members of Gamblers Anonymous, they shared personal experiences and essential insights, particularly aimed at helping physicians recognize and address gambling disorders in their patients. Their gathered wisdom highlights a growing public health concern that is often overlooked in medical settings.
The Importance of Inquiry
During their meeting, it became poignantly clear that, despite the increasing prevalence of gambling issues, many individuals struggling with these problems feel invisible within the healthcare system. One member noted, “If a patient talks about financial distress, spouse issues, physical issues, or has blood pressure problems, suspect gambling.” Another chimed in with a striking observation: “If a physician asks about gambling and the patient says, ‘Just a little,’ chances are that person is an active gambler.”
The group’s consensus was striking. None reported having ever been asked by their doctors about gambling behavior, yet they all expressed a willingness to engage in such discussions if prompted. This sentiment underscores the vital role that primary care physicians (PCPs) can play in identifying gambling disorders, yet far too few take the initiative to screen for such issues.
The Rise of Gambling Disorders
Gambling is on the rise, with its legitimacy as a social activity gaining ground. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) now includes gambling disorder as a recognized mental health condition, placing it alongside substance-related disorders in terms of clinical expression and treatment options. Studies indicate that between 1-2% of adults may struggle with gambling problems, while up to 15% of those visiting PCPs have identifiable issues related to gambling.
Brian K. Unwin, MD, a family medicine physician, and geriatrician, stated, “The majority of physicians do not screen for it.” In sharp contrast, Timothy W. Fong, MD, a clinical professor at UCLA, believes that actively addressing gambling behaviors in healthcare settings is too infrequent and needs to change. He emphasizes that many patients will not voice concerns about their gambling unless directly asked.
The Changing Landscape of Gambling
What contributes to the rising tide of problem gambling? Culturally, gambling has shifted from a vice to a normalized and even glamorous part of modern life. Timothy Fong highlighted, “Engaging in gambling is not only accepted but glamorized,” noting the increasing societal acceptance and availability of gambling, particularly in the realm of mobile sports betting. Legalized in 39 states and the District of Columbia, sports betting has drawn many new participants into the world of gambling, some of whom may develop problematic behaviors.
The stark reality is that the prevalence of gambling-related disorders often correlates with the opportunities available to gamble. As the technology and ability to bet have expanded, so has the number of individuals grappling with gambling addiction.
Identifying Red Flags
Physicians are encouraged to incorporate questions about gambling into their standard assessments, particularly among patients dealing with mental health issues or substance abuse. Unwin identifies key indicators to watch for, including impulsivity, depression, and a family history of gambling problems. While the stereotypical image of a problem gambler may be misleading — often painted as an older, reckless male — the reality is far more diverse.
Fong asserts, “Gambling issues cut across all demographics,” highlighting that anyone from various backgrounds can struggle with gambling addiction.
Understanding the Gambler’s Mind
Many healthcare providers grapple with understanding why some individuals become addicted to gambling. Fong explains that the compulsion to gamble can overpower rational thought. “If they could just stop, they would,” he notes. The euphoric rush associated with gambling can parallel that of drug use, making it a compelling behavior for those prone to addiction.
Treatment and Recovery
Identifying problem gambling is only the first step; actual treatment can also be complicated. Fong mentions that only 20% of problem gamblers seek help, revealing a significant gap in recovery resources. However, physicians have valuable tools at their disposal to facilitate this process.
Two quick screening tools can help identify potential gambling disorders:
- The Brief Biosocial Gambling Screen, which consists of just three questions.
- The Lie-Bet two-question screener, designed to quickly assess whether referral is necessary.
Engaging patients in these conversations often leads them to reflect on their behaviors, creating an opportunity for change. Treatment strategies can include psychotherapy, with cognitive behavioral therapy being particularly effective, and medications similar to those used for alcohol use disorder.
Beyond Abstinence: Harm Reduction
Fong advocates for a perspective that emphasizes harm reduction over total abstinence. He advises patients to identify high-risk gambling behaviors while reframing the conversation around how gambling fits within the broader context of their lives. "Abstinence is just one domain," he says, underscoring the importance of focusing on overall health, community involvement, and self-care.
A Call to Action for Physicians
The conversations at Gamblers Anonymous and the insights from healthcare professionals paint a compelling picture: problem gambling is a significant, often hidden public health issue that warrants attention. By incorporating direct questions about gambling behavior into routine assessments and understanding the complexities of this disorder, physicians can help destigmatize the subject and actively support their patients in seeking the help they may need.
Kathleen Doheny, a journalist based in Los Angeles, reminds us of the critical role each clinician plays in recognizing that beneath the surface of many health issues may lie the hidden impact of gambling addiction. Creating a dialogue about gambling could pave the way for recovery for those in need, ultimately fostering a healthier society for all.
