A Safe Bet: Treat Pathologic Gambling Like Alcohol Addiction

Deborah Brauser

March 07, 2013

Practice guidelines to identify, prevent, and/or treat pathologic gambling should mirror those for alcohol addiction, according to a new report from the United Kingdom.

In the report, experts from the Royal College of Psychiatrists (RCPysch) in Wales and the charity Alcohol Concern call for routine screening for gambling problems in substance abuse services, creation of a national database to record problems associated with gambling, and more research examining new treatment and prevention strategies.

"Research has shown that people with gambling addiction have a much higher activation of the reward areas in the brain than those without, and these are similar to the areas of the brain that are involved in alcohol use disorders," coauthor Raman Sakhuja, MRCPsych, DpM, chair of the RCPsych in Wales' Faculty of Addictions, said in a release.

The report notes that public health practitioners who encounter problematic gambling "can learn lessons from approaches adopted in the alcohol field" to limit misuse and protect communities from harm. These could include imposing tougher marketing restrictions and decreasing product availability.

Dr. Sakhuja also notes "it is vital that access to appropriate advice and treatment is available and well-funded, especially when considering that often people with alcohol problems participate in unhealthy gambling, and vice versa."

Pathologic gambling will fall under "addiction and related disorders" instead of "impulse control disorders" in the soon-to-be-published Diagnostic and Statistical Manual of Disorders, Fifth Edition, from the American Psychiatric Association.

The report was released February 21.

Similar Disorders

The new report notes that recent US studies have shown that persons who gamble pathologically and those with alcohol addiction have similarities in brain chemical makeup, including dopamine, serotonin, and noradrenaline levels.

Recent findings from a small imaging study presented at the 2012 European College of Neuropsychopharmacology Congress (ECNP) and reported by Medscape Medical News at that time showed that compared with a group of control participants, pathologic gamblers had significantly more activation in the brain's reward areas, making them overly optimistic about gambling outcomes.

The current report cites this study and notes investigators' recommendation that repeated transcranial magnetic stimulation might reduce the responsiveness of the brain's response system in this patient population.

"Studies are already being conducted in alcohol dependent patients to explore this," the authors write.

They go on to note that because many of the features of alcohol misuse mirror gambling addiction, strategies that address excessive alcohol consumption need to be examined to determine whether they are effective for gambling problems.

Key Recommendations

The report also calls for greater protection of children through effective marketing restrictions and better monitoring and more research into ways to curtail gambling opportunities.

"Particular attention must be paid to technological advancements, namely the emergence of gambling via the internet, interactive television and mobile phone," the authors note.

Other recommendations include the following:

  • Provide suitable access to addiction treatment and support for anyone who needs it;

  • Offer routine screening for gambling problems;

  • Research the impact of treating gambling and alcohol problems at the same time;

  • Raise public awareness of the dangers of problem gambling; and

  • Develop new government policies.

"Alcohol Concern believes that...the immediate and long-term benefits of services to individuals and society justify supporting, developing and investing in them," writes report coauthor Mark Leyshon, policy officer for Alcohol Concern Cymru, a branch of Alcohol Concern in Wales.

As Prevalent as Illicit Drugs

The report also shares findings from a small 2012 survey study of 66 users of substance misuse services in Wales. The results show that 1 in 6 of the respondents who sought help for alcohol misuse also reported experiencing gambling problems. Of these, 94% said that addiction services should consider also providing gambling addiction–specific treatments.

"Gambling Watch UK welcomes this report and fully endorses its recommendations," said Jim Orford, PhD, professor emeritus of clinical and community psychology at the University of Birmingham and a founder of Gambling Watch UK, in a release.

"Problem gambling is now as prevalent as the problematic use of illicit drugs but gets minimal attention by comparison. We need to start taking it far more seriously," added Dr. Orford, who also served as an academic advisor for the British Gambling Prevalence Survey (BGPS) of 2000, 2007, and 2010.

The 2010 BGPS showed that 73% of adults in Great Britain older than 16 years — approximately 35.5 million adults — had gambled during the past year. And approximately 360,000 to 451,000 adults had experienced a gambling problem.

It also showed that the participants who reported drinking the highest amount of alcohol were more likely to be problem gamblers than those who drank moderately.

This association has been reported in other international academic research, including studies from the United States, New Zealand, and Australia.

Complicated Issue

"Whilst fewer people suffer gambling problems than they do with alcohol, such problems can destroy their lives and their families," said Dr. Sakhuja.

"Both alcohol misuse and excessive gambling can be regarded as significant public health problems, with adverse consequences to individuals and the wider society," added Leyshon. "Without the necessary restrictions, there is a real danger that this will be matched in the future by more people suffering alcohol and gambling problems."

Rachel A. Volberg, PhD, president of Gemini Research in North Hampton, Massachusetts, an organization that specializes in reporting on international studies of problem gambling, told Medscape Medical News that the report's recommendations "are very reasonable," especially those that focus on the need for more research.

"In the United States, there are some jurisdictions that provide significant funding for the treatment of gambling problems, somewhat less is provided for prevention, and almost nothing is provided for research," said Dr. Volberg.

"The complication in the US is that gambling is very much viewed as a state's rights issue. As a result, states are quite variable in terms of what they have and have not done as they have proceeded to legalize various kinds of gambling over the last 25 years that I've been in the field."

Universal Screening?

She added that, in contrast, in Australia, New Zealand, and Canada, significant proportions of funding that flow from gambling activities are dedicated to minimizing potential harm.

"It's very unfortunate that even when states in this country have done a good job in terms of reassessing funding for public gambling services, they've been limited in treatment and prevention efforts because of legislation that has been passed."

At last year's gambling panel at the ECNP Congress, Jon E. Grant, MD, from the Department of Psychiatry and Behavioral Neuroscience at the University of Chicago, Illinois, told Medscape Medical News that all clinicians should start screening all patients for a potential gambling disorder.

"We already ask patients if they're smoking, drinking, or using drugs. And it's very simple to ask if there are other behaviors they feel are out of control," said Dr. Grant at the time.

"This seems like such an obvious thing to do. But in some cases, I'm not sure if there is some level of discomfort about asking people about gambling, especially if they don't have specialized training. However, there are certainly some well-known, valid, and reliable short screens that are out there," added Dr. Volberg.

Alcohol Concern Cymru and RCPsych in Wales. Published online February 21, 2013. Full article