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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

  • Recovery from problem gambling

    In this 30-minute film Dr Henrietta Bowden-Jones, Founder and Director of the National Problem Gambling Clinic, talks to Owen Baily about his past experiences and problems with gambling.

Problem gambling

 

About this leaflet

This leaflet is for:

  • anyone who is worried about their gambling
  • the family, partner and friends of anyone whose gambling has become a problem.Problem gambling

In this leaflet you can find out about:

  • Is problem gambling common?
  • Is my gambling a problem?
  • How can someone lose control of their gambling?
  • Potential harms of problem gambling
  • Steps to reduce gambling - helping yourself
  • What help can I get?
  • How to get help
  • Living with a problem gambler - advice for family, partners and friends
  • Further reading.

What is problem gambling?

This is defined as gambling that disrupts or damages personal, family or recreational pursuits.

How common is problem gambling?

Many of us like to place the odd bet or play the lottery - but it’s only a problem for about 9 people in every 1000. However, a further 70 people out of every 1000 gamble at risky levels that can become a problem in the future.

 

Who is most likely to get this problem?

Across the world it seems to be common:

  • In men – but this might just be because women gamble less than men.
  • In teenagers and young adults - but problems of this sort can start at any age. Children as young as 7 may find it difficult to control the amount of time they spend on computer games. Older people may have too much time on their hands.
  • If someone else in your family - particularly one of your parents - is a problem gambler. This may be partly due to genes but can be learnt – by seeing a parent gamble or being taught to gamble by them.
  • In people who work in casinos, betting shops or amusement arcades.
  • In certain types of gambling:
  • Internet gambling
  • Video poker
  • Dice games
  • Playing sports for money
  • High-risk stocks
  • Roulette
  • If you drink heavily or use illegal drugs.
  • If you have depression, anxiety or bipolar disorder (manic depression).

Is it a problem for me?

Answer 'yes' or 'no' to each of these 10 questions:

  • Do I spend a lot of time thinking about gambling?
  • Am I spending larger amounts of money on my gambling?
  • Have I tried to cut down or stop gambling - but not been able to?
  • Do I get restless or irritable if I try to cut down my gambling?
  • Do I gamble to escape from life’s difficulties or to cheer myself up?
  • Do I carry on playing after losing money - to try and win it back?
  • Have I lied to other people about how much time or money I spend gambling ?
  • Have I ever stolen money to fund my gambling?
  • Has my gambling affected my relationships or my job?
  • Do I get other people to lend me money when I have lost?

If you have answered 'yes'

  • Just once - May be a problem - this one thing may be enough of a problem to need help.
  • Three times - Problem gambling - your gambling probably feels out of control - think about getting help.
  • Five or more times - Pathological gambling - your gambling is probably affecting every part of your life - get help.

How do you lose control of your gambling?

You may gamble:

  • to forget about responsibilities
  • to feel better when you feel depressed or sad
  • to fill your time when bored (especially if not working)
  • when you drink or use drugs
  • when you get angry with others - or yourself.

Or, you may have:

  • started gambling early – some people start as young as 7 or 8
  • never been able to control your gambling
  • one or both parents who are problem gamblers.

Potential harms associated with problem gambling

Problem gamblers are more likely than other people to experience the following harms:

  • Financial harms: overdue utility bills; borrowing from family friends and loan sharks; debts; pawning or selling possessions; eviction or repossession; defaults; committing illegal acts like fraud, theft, embezzlement to finance gambling; bankruptcy; etc...
  • Family harms: preoccupied with gambling so normal family life becomes difficult; increased arguments over money and debts; emotional and physical abuse, neglect and violence towards spouse/partner and/or children; relationship problems and separation/divorce.
  • Health harms: low self-esteem; stress-related disorders; anxious, worried or mood swings; poor sleep and appetite; substance misuse; depression, suicidal ideas and attempts; etc...
  • School/college/work harms: poor school, college or work performance; increased absenteeism; expulsion or dismissal.

Should I stop gambling or try to control it?

The first thing is to decide to get help -  you can then work out whether you are ready to stop or just want to control your gambling better. Many people just want to control their gambling, but then decide to stop completely.

 

Steps to reduce gambling - helping yourself

Although there is no substitute for professional help, here are some simple and practical measures to reduce gambling:

1. Limit the amount of money you spend gambling

  • Set a limit from the start on how much you are willing to spend on gambling in a session or in a week. Stick to it!
  • Leave credit/cash cards at home when you go out to gamble.
  • If you use a betting account, ask them to place a limit on it - say £50 - this works for online casinos too!
  • On pay day, aim to pay all your priority debts first (mortgage, rent, council tax, food, etc...)

2. Reduce the amount of time and days that you gamble

  • Set yourself a limit on how many times a week you will gamble (e.g. twice a week)  - be specific and name the days.
  • Avoid those "I'll just have a quick go" scenarios.
  • You can set your alarm on your watch or phone to remind you - even your PC will have a calendar reminder alert you can use.

3. Don't view gambling as a way of making money

  • Always remember that you are buying entertainment.
  • Always be prepared to lose - if you win, know that it will happen by chance.
  • Never spend your savings or investments on gambling.
  • Ask friend and family not to lend you money if you ask them.

4. Spend time doing other activities

  • Spend more time with family or friends.
  • Take up a new hobby or interest or revisit one that you enjoyed before gambling took over.
  • Join a social group or organise events with friends who don't gamble.
  • Talk to other about your worries or concerns rather than 'bottling' them up.

Where can I get help?

All of the following provide free support to help you cut down or stop gambling:

  • NHS: The CNWL National Problem Gambling Clinic in London has doctors, nurses, therapists, psychologists, debt counsellors and family therapists with special experience in helping problem gamblers.
  • Gamcare  - runs the national HelpLine and its online equivalent, the NetLine, to offer help and support for people with a gambling problem, their family and friends. GamCare also provides face-to-face online counselling in many parts of the UK.
  • The Gordon Moody Association - a charity which provides treatment and housing for problem gamblers.
  • The 12 step meetings of Gamblers Anonymous.
  • Gamanon: groups for relatives of problem gamblers.

What sort of help is there?

Cognitive Behavioural Therapy (CBT)

Research has shown that CBT can:

  • reduce the number of days a person gambles
  • reduce the amount of money they lose
  • help a gambler to stay away from gambling once they have stopped.

How does CBT work? If you are a problem gambler, you will think differently from other people about your betting. You will tend to believe that:

  • you are more likely to win than you would expect by chance
  • in a game with random numbers, like roulette, certain numbers are more likely to come up than others
  • winning twice in a row means that you are on a 'winning streak' – so you bet larger and larger sums
  • you are more likely to win at a game of chance if you are familiar with it
  • certain rituals can bring you luck
  • having lost, you can somehow win back your losses by gambling more.

CBT is given in around 10 one-hour sessions. The sessions focus on these ways of thinking, but also on how you feel and behave when you want to bet or when you are gambling. CBT helps you to work out more helpful ways of thinking and behaving. A diary helps you to keep track of your improvement. In the months following treatment, follow-up CBT sessions in a group seem to help people stay away from gambling longer.

How does CBT compare with other treatments? We don’t know yet - there have not been enough large studies to be clear about this.

 

12 Step Programmes

This is an approach which assumes that a dependence on drink or gambling is a disease, and that the best people to support you are those who have had similar experiences. Regular meetings are held in which people can share the problems they have had and the ways in which they have overcome them. They also have a 'buddy' system, where each member has another member whom they can contact if they feel that they are about to drink or gamble again. The 12 Step Fellowship, Gamblers Anonymous, offers meetings throughout the UK and many problem gamblers find these meetings helpful. You may also need practical help:

  • managing your debts
  • dealing with family problems
  • treat other psychological/psychiatric problems, e.g. depression.

Medication

No medication is licensed for the treatment of problem gambling in the UK, but antidepressants can be prescribed to help with low mood.

 

What if I don’t get help?

About a third of problem gamblers will recover on their own, without treatment, and about 2 in 3 will continue to have problems, which tend to get worse.

How to get help and when

Don’t wait until life does not seem worth living. If you get help, you will feel better and avoid many problems with your life and health.

You can refer yourself by calling or emailing the contacts below:

Living with a problem gambler

  • Being married to or a partner of a problem gambler – or being their parent or child - is hard and can be distressing.
  • Your loved one will probably have tried to hide the size of the problem from you, while they have at the same time borrowed or stolen to pay off debts.
  • If, with the help of the 10 questions above, you can see that gambling is a problem for someone in your family, it's best to be honest with him or her about it. They need to know about the pain and trouble they are causing other people and that help is there for them.
  • If your gambling relative doesn't take any notice, you can get support for yourself from one of the services listed at the end of the leaflet. There are groups and individual sessions to support family members.

References

  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders 5 Washington, DC.
  • Black D et al (2003) Quality of life and family history in pathological gambling. Journal of Nervous  and Mental Disease, 191, 124-126.
  • Blaszczynsky AP et al (1991) A comparison of relapsed and non-relapsed abstinent pathological gamblers following behavioural treatment. British Journal of Addiction, 86, 1485-1489.
  • Griffiths MD (1990) The acquisition, development, and maintenance of fruit machine gambling in adolescents. Journal of Gambling Studies, 6, 193-204.
  • Ladouceur R et al (2002) Understanding and treating pathological gambling. New York, Wiley.
  • Lesieur HR, Rosenthal MD (1991) Pathological gambling: A review of the literature (prepared by the American Psychiatric Association Task Force on DSM-IV Committee on disorders of impulse control not elsewhere classified). J Gambling Studies 7:5-40.
  • Petry N (2005) Pathological Gambling. American Psychological Association.
  • Shaffer HJ, Bilt JV and Hall MN (1999) Gambling, drinking, smoking and other health risk activities among casino employees. American Journal of Industrial Medicine, 36, 365-378.
  • Wohl MJA et al (2002) The effects of near wins and near losses on self-perceived personal luck and subsequent gambling behaviour. Journal of Experimental Social Psychology, 39, 184-191.
  • Wardle H, Moody A, Spence S, Orford J, Volberg R, Jotangia D, et al (2010) British Gambling Prevalence Survey. National Centre for Social Research. London: The Stationery Office.

Further reading

  • Orford J (2010). An unsafe bet?: The dangerous rise of gambling and the debate we should be having. Wiley-Blackwell, UK.
  • Orford J (2003). Gambling and problem gambling in Britain. Brunner – Routledge
  • Bowden-Jones H, Clark L (2011). Pathological gambling: A neurobiological and clinical update. British Journal of Psychiatry, 199: 87-89.
  • George S, Copello A (2011). Treatment provision for Britain’s problem gamblers: present gaps and future opportunities. Advances in Psychiatric Treatment, 17:318-322

This leaflet was produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Original Authors:

  1. Dr Henrietta Bowden – Jones, National Problem Gambling Clinic & Imperial College, London
  2. Dr Sanju George, Birmingham and Solihull Mental Health NHS Foundation Trust

Expert review: Faculty of Addictions' Users and Carers Group

Illustration by Lo Cole: www.locole.co.uk

This leaflet reflects the best available evidence available at the time of writing.


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© February 2014. Due for review: February 2016.  Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the RCPsych is properly credited and no profit is gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked to directly.
 
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Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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