One addiction is bad enough. When problem gambling and alcohol addiction come together, your (or your loved one) may find that it hard to recognize the source of their problem. And, make no mistake about it, there is interaction between drinking and gambling. Before we look at some of the specifics of the interaction, it\u2019s helpful to first clarify what is meant by the term problem gambling. We\u2019ll then look at alcohol abuse, and finally, the interaction between problem gambling and alcohol abuse. What Is Problem Gambling? Problem gambling, according to the National Council on Problem Gambling, is gambling behavior that causes disruptions in any major life area \u2013 psychological, physical, social or vocational. The essential features of problem gambling include: \tIncreasing preoccupation with gambling \tThe need to bet more money more frequently \tRestlessness or irritability when attempting to stop gambling \t\u201cChasing losses \u201d \tLoss of control which results in continuing gambling behavior despite mounting serious negative consequences. Severe gambling is where the your gambling behavior has not only reached the addictive stage, but has been ongoing for years. According to research, severe problem gambling can result in: \tFinancial ruin \tMounting legal problems \tLoss of family \tLoss of career \tPrison time \tSuicide Problem gambling is much more than "just a financial problem" that affects the individual gambler and his or her family. A person who is a problem gambler has an obsession, one that is totally out of control. It isn\u2019t possible for the problem gambler to stop gambling on their own, even if they express a sincere desire to do so. Causes of Gambling Addictions What causes someone to become a problem gambler? There are many reasons why a person begins gambling. Sometimes a person first dabbles in gambling after a job change, retirement or divorce. Life changes are a vulnerable time. For some, once they start dabbling, they can't stop. It isn\u2019t how much money the gambler loses -- $1,000 or $100,000 -- that results in problem gambling. Problem gambling results when gambling causes a negative impact on any area of the person\u2019s life. Scientists have a pretty clear picture of what happens in the brain with various types of addiction. Problem gambling is very similar to drug use in that you get the same effect as if you consumed a drink or took a tranquilizer. The act of gambling alters your mood, making you feel alive and euphoric. In an attempt to achieve the same euphoria, you continue the same behavior \u2013 over and over again. But, here\u2019s the downside. Just as an individual develops tolerance to drugs and alcohol, the same type of effect eventually occurs with problem gambling. You resort to gambling more money and more often in the increasingly vain attempt to recapture the high. As the craving to gamble increases, you become progressively less able to resist it. Eventually your gambling leads to: \tAll-consuming thoughts of gambling \tConstantly trying to get money to gamble \tGambling larger amounts of money more often \tTaking extraordinary risks \tEven putting the lives of others in danger as a result of your gambling obsession Problem Gambling in the U.S. In the United States, it is estimated that about 4 to 6 million (2 to 3 percent) of the population are problem gamblers. About 2 million (1 percent) of the population are estimated to meet the criteria for pathological or compulsive gambling each year. Some form of gambling is legal in 48 states, plus the District of Columbia. Only Utah and Hawaii have no legalized gambling. Alcohol Abuse and Addiction Think that alcohol abuse is a not-so-terrible problem? Think again, because you\u2019d be wrong. Consider the current statistics of drinking in the United States. This is according to the 2009 National Survey on Drug Use and Health (NSDUH) conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). \tAn estimated 130.9 million Americans aged 12 or older were current (past-month) drinkers of alcohol in 2009. That\u2019s slightly more than half of all Americans. \tNearly one quarter (23.7 percent) of those aged 12 or older reported binge drinking (consumption of five or more drinks in a single setting in a short period of time) in the 30 days prior to the survey. That\u2019s 59.6 million people. \tAn estimated 17.1 million people (6.8 percent of the population aged 12 or older) were heavy drinkers in 2009. \tBinge drinking and heavy drinking were highest among the 18-20, 21-25, and 26-29 age groups. Where alcohol abuse crosses over into alcohol addiction varies. Alcohol abuse \u2013 which can lead to alcoholism \u2013 is a pattern of drinking that harms a person\u2019s health, ability to work or interpersonal relationships. Alcohol addiction, or alcoholism, is a diagnosable disease characterized by strong cravings for alcohol and continued use despite increasing negative consequences. Don't ignore the early signs of an alcohol use disorder. Over time, with increased heavy drinking, the symptoms add up. They will increase in severity and frequency, resulting in alcohol abuse crossing over into alcohol use disorder, and then to alcohol dependence or alcoholism. Co-Occurring Disorder: Alcohol Addiction and Gambling Information from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that in individuals with a co-occurring disorder (COD), alcohol addiction and gambling may coexist as part of a broader lifestyle marked by antisocial behavior. Gamblers may use alcohol, along with illicit drugs such as cocaine, as a way of celebrating wins or alleviating depression when they lose. Sequential Alcoholism and Gambling Addictions A common clinical pattern that is seen among problem or pathological gamblers is that of sequential addiction. Frequently, a person with a history of dependence \u2013 on alcohol or cocaine, for example \u2013 may develop a gambling addiction. In fact, sequential addiction is among the more common clinically observed patterns. How does this work? Take the example of someone who struggled with alcoholism for many years. They may have had many years of effective recovery and attendance at Alcoholics Anonymous meetings. Then they develop a gambling problem. Talking with those who developed this sequential addiction, clinicians report that the individuals didn\u2019t realize that their gambling was, in fact, becoming another addiction. They also had no idea that gambling could be anywhere as addictive as alcohol or drugs. In fact, it often happens that those with sequential addiction don\u2019t seek treatment until they relapse to alcohol abuse, or are afraid they\u2019re about to relapse. Others resort to abusing alcohol again as stresses increase from their problem gambling. Once serious gambling consequences start to add up, they find themselves unable to resist the craving to drink. Alcohol once again is a way to cope with their troubles and ease the pain. Exacerbating the situation is the fact that alcohol is often free in gambling establishments. Proprietors know that alcohol running freely will keep the gamblers firmly planted in their seats and continuing to gamble. It\u2019s also a common trigger: drinking and gambling just seem to go together for many. Like alcoholism or other substance abuse problems, problem gambling can be regarded as a chronic, recurring disorder. There is the potential for relapse in both disorders, and even greater risk for those with both disorders. Treatment for Co-Occurring Problem Gambling and Alcohol Addiction In order to overcome problem gambling and alcohol addiction, professional treatment is needed. It's best if such treatment occurs simultaneously. Thankfully, there are residential treatment centers that specialize in co-occurring disorders and gambling addictions. Detox From Alcohol If you are working through alcohol and gambling addictions simultaneously, the first part of your treatment will involve detoxification from alcohol. Detox is best in an environment where you are monitored 24\/7 by medical professionals in order to ensure your safety and to minimize cravings. Identify Addiction Triggers Once you get to the active treatment phase, in individuals with co-occurring problem gambling and substance abuse disorders, it is often essential to identify specific triggers for each disorder. It is also important to identify the ways in which use of addictive substances, such as alcohol, or addictive activities, such as gambling, act as mutual triggers. Set Goals There is increasing evidence for the effectiveness of focusing on reducing or limiting gambling \u2013 especially for problem gamblers who do not meet all the criteria for the diagnosis of pathological gambling. This approach generally involves teaching money management along with using cognitive behavioral interventions to set and achieve the patient\u2019s goals for limited or controlled gambling. Potential Medications for Gambling and Alcohol Addictions Two main types of medication have been reported to be effective in reducing cravings to gamble and instances of gambling behavior. These are selective serotonin reuptake inhibitors (SSRIs), such as fluvoxamine (Luvox), and opiate antagonists, such as naltrexone, which has also been found to be effective in treating people with substance use disorders. Three FDA-approved medications are currently used to treat alcohol dependence: naltrexone (Revia and Depade), acamprosate and disulfiram (Antabuse). Topiramate, a fourth medication, is showing encouraging results in clinical trials. According to the National Institute on Drug Abuse (NIDA), naltrexone blocks opioid receptors involved in the reward effects of drinking and in alcohol craving. The medication reduces drinking relapses. It is highly effective in some but not all patients, a phenomenon likely related to genetic differences. Acamprosate is believed to reduce protracted withdrawal symptoms, such as anxiety, dysphoria (an unpleasant or uncomfortable emotional state), insomnia and restlessness. Acamprosate may be more effective in patients with severe alcohol dependence. Disulfiram interferes with how alcohol degrades. This results in the accumulation of acetaldehyde, which then produces a noticeably unpleasant reaction that includes flushing, nausea and palpitations if the patient drinks any alcohol. It may be difficult to enforce compliance, but in patients who are highly motivated, use of disulfiram can be very effective. Other Co-Current Diagnoses With Problem Gambling and Alcoholism It is estimated that up to 70 percent of people with a gambling addiction also have another psychiatric problem. Clinical observations of people with substance use disorders and problem gambling disorders show that they may be more likely to suffer from a broad range of additional mental disorders. They may require psychiatric medication to address these challenges. If that's you, addressing all your issues through integrated treatment is best. A strong rehabilitation program will allow you to address alcohol abuse, problem gambling and mental health disorders together. Such treatment may combine 12-Step, psychoeducation, group therapy and cognitive behavioral approaches. Support for Gambling Addictions and Alcoholism Recovery experts caution that patients suffering from both alcoholism and problem gambling attend separate support groups for gambling and alcohol abuse. The two groups can act as supplements for each other, but they are not a substitute. Gamblers Anonymous Gamblers Anonymous (GA) is the main support group for those with a gambling addiction. This self-help group may be a bit different from other 12-step groups. Many people who have attended GA and other 12-step groups say that in GA groups there is less emphasis on the step work, sponsorship and structure. However, GA groups provide a unique fellowship that can help you address your gambling issues. GA also has a process, known as \u201cPressure Relief,\u201d which may help you and your family learn how to cope with money management, debt and reputation issues. Alcoholics Anonymous Alcoholics Anonymous (AA) participation is one of the largest and most supportive networks an alcoholic can participate in. AA\u2019s emphasis is different than Gamblers Anonymous. In AA, it\u2019s all about working the steps, securing and working with a sponsor and gaining the strength and mutual support from fellow AA group members. Make a Plan for Gambling and Drinking Relapses In the long-term, since alcoholism and problem gambling are chronic and recurring disorders, it is best for the individual to have a plan ready for a return to treatment if relapse occurs. Continuing care groups that are professionally facilitated and focus on maintenance skills in recovery may be helpful. This is especially true when such continuing care group participation is combined with 12-step groups. The problem gambler\/drinker\u2019s family members are encouraged to participate in Gam-Anon, the family support group offshoot of GA and in Al-Anon\/Alateen, the family component of Alcoholics Anonymous. Will Problem Gambling and Alcoholism Ever Go Away? An alcoholic can\u2019t will himself or herself out of drinking. Neither can a problem gambler just walk away and quit gambling forever. Even once in recovery, the addictions are lifelong. Professional help is the best way to overcome both problem gambling and alcoholism. The individual in recovery also needs to be diligent in avoiding the triggers for drinking and gambling, and to continue to work on coping skills to deal with stress. There's Hope in Recovery Bottom line: Learning healthier ways of living that do not involve drinking or gambling is critical to your long-term recovery and happiness. If relapse does occur, there should be a plan in place to go back into treatment to further strengthen your ability to withstand triggers and solidify coping skills that work. It may be you will need more than one time in rehab before you are confident enough and practiced enough to be able to function effectively in recovery. This isn\u2019t always the case, but it is true sometimes. The reality is that millions of Americans have gone through treatment for alcoholism and problem gambling. Today they are living healthy, happy and productive lives that are alcohol- and gambling-free. This is definitely an achievable goal.