Interaction Between Problem Gambling and Alcohol Abuse
Before we look at some of the specifics of the interaction, it’s helpful to first clarify what is meant by the term problem gambling. We’ll then look at alcohol abuse, and finally, the interaction between problem gambling and alcohol abuse.
Problem Gambling – What it is
Problem gambling, according to the National Council on Problem Gambling, is behavior that causes disruptions in any major life area – psychological, physical, social, or vocational.
The essential features of problem gambling are well documented and include:
· Increasing preoccupation with gambling
· The need to bet more money more frequently
· Restlessness or irritability when attempting to stop gambling
· “Chasing losses ”
· Loss of control which results in continuing gambling behavior despite mounting serious negative consequences.
Research studies show that in the most extreme cases of problem gambling, where the individual’s gambling has not only reached addictive stage but has been ongoing for years, problem gambling can result in financial ruin, mounting legal problems, loss of family, career, incarceration, and even suicide.
Looking at the larger issue of problem gambling, then, it 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 it totally out of control. It isn’t possible for the problem gambler to stop gambling on his own, even if he expresses a sincere desire to do so.
What causes someone to become a problem gambler? There is any number of reasons why a person first begins gambling. The first foray into gambling may be precipitated by a change in behavior, such as the type of stress caused by a job change or loss, retirement, or other change in personal or family circumstances. But it isn’t 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’s life.
Scientists have a pretty clear picture what happens in the brain with various types of addiction. Problem gambling is very similar to drug use in that the individual gets the same effect as if he or she consumed a drink or took a tranquilizer. The act of gambling alters mood, making the gambler feel alive and euphoric. In an attempt to achieve the same euphoria, the gambler continues the same behavior – over and over again. But, here’s the downside. Just as an individual develops tolerance to drugs and alcohol, the same type of effect eventually occurs with problem gambling. The gambler resorts to gambling more money and more often in the increasingly vain attempt to recapture the high. As the craving to gamble increases, the gambler becomes progressively less able to resist it until he or she is consumed by thoughts of gambling, trying to get money to gamble, gambling larger amounts of money more often, taking extraordinary risks, and putting the lives of others in danger as a result of gambling obsession.
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 Dependence
Think that alcohol abuse is a not-so-terrible problem? Think again, because you’d 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). Date from the annual survey, the latest available, show that an estimated 130.9 million Americans aged 12 or older were current (past-month) drinkers of alcohol in 2009. That’s slightly more than half of all Americans.
But it gets worse. Nearly 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’s 59.6 million people.
An estimated 17.1 million people (6.8 percent of the population aged 12 or older) were heavy drinkers in 2009.
Binge drinking and heavy drinking were highest among the 18-20, 21-25, and 26-29 age groups.
Where alcohol abuse crosses over into alcohol dependence varies by individual and according to several contributing factors. Alcohol abuse – which can lead to alcoholism – is a pattern of drinking which results in harm to a person’s health, ability to work, and interpersonal relationships. Alcohol dependence, or alcoholism, is a diagnosable disease characterized by strong cravings for alcohol and continued use despite increasing negative consequences.
For information on signs of an alcohol use disorder, see the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (//rethinkingdrinking.niaaa.nih.gov/WhatsTheHarm/WhatAreSymptomsOfAnAlcoholUseDisorder.asp). The site lists 11 symptoms which may indicate the presence of an alcohol use disorder. While a few may seem mild and not indicative of a growing problem with alcohol, they’re often easily dismissed and not recognized for what they are. Over time, with increased heavy drinking, the symptoms add up, 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: Substance Use and Gambling
Information from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that in individuals with co-occurring disorder (COD), alcohol abuse 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.
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 – on alcohol or cocaine, for example – may develop a gambling problem.
There are several interaction patterns that may emerge for individuals who are dependent on alcohol and are problem or pathological gamblers. Alcohol abuse and problem gambling (especially pathological gambling) may be either concurrent or sequential addictions. In fact, sequential addiction is one of the more common clinically observed patterns. How does this work? Take the example of someone who has been dependent on alcohol for many years. He or she may have had many years of effective recovery and attendance at Alcoholics Anonymous meetings. Then he or she develops a gambling problem.
Talking with individuals who developed this sequential addiction, clinicians report that the individuals didn’t 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.
And it often happens that those with sequential addiction don’t seek treatment until they relapse to alcohol abuse, or are afraid they’re about to relapse.
Others resort to abusing alcohol again as stresses resulting from their problem gambling increase. Once serious adverse consequences start to build up due to problem gambling, they find themselves unable to resist the craving to drink to wipe away their troubles and ease the pain. Exacerbating the situation is the fact that alcohol is often free in gambling establishments as proprietors know that alcohol running freely will keep the gamblers firmly planted in their seats and continuing to gamble. It’s also a common trigger: alcohol and gambling, along with smoking, just seem to go together in the mind of the problem gambler.
Like substance abuse, 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 Problem Gambling and Alcohol Abuse
In order to overcome problem gambling and alcohol abuse, professional treatment is the preferred – and often most effective – route. Most addiction experts recommend that such treatment occur simultaneously although it may take place in a variety of treatment settings. There are residential treatment centers that specialize in co-occurring disorders and gambling addiction, as well as other intensive treatment care facilities that provide such treatment.
Before the individual with alcohol abuse and problem gambling can enter the active phase of treatment for alcohol abuse, detoxification from the alcohol in his or her body has to take place first. Detox is best accomplished in an environment where the patient is monitored 24/7 by medical professionals in order to ensure the individual’s safety and to minimize cravings.
Once the person gets to the active treatment phase, in individuals with co-occurring problem gambling and substance use disorders, it is often essential to identify specific trigger 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.
There is increasing evidence that suggests a greater effectiveness of treatment approaches that focus on the goal of reducing or limiting gambling – 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’s goals for limited or controlled gambling.
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) (//www.drugabuse.gov/infofacts/treatmeth.html), naltrexone blocks opioid receptors involved in the reward effects of drinking and in alcohol craving. The medication reduces relapse to heavy drinking and 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, such as depression, anxiety, or irritability), 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.
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 affective disorders, attention deficit hyperactivity disorders, and anxiety disorders. Integrated treatment of a multimodal nature is recommended to treat alcohol abuse and problem gambling. Such treatment may combine 12-Step, psychoeducation, group therapy, and cognitive behavioral approaches, among other treatment modalities.
Recovery experts caution that patients suffering from both alcohol abuse or addiction 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 (GA) is the main support group for those with problem gambling or gambling addiction. This self-help group may be a bit different from other 12-step groups many people may be familiar with, such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Cocaine Anonymous. Many people who have attended GA and other 12-step groups say that in GA groups there may be less emphasis on the step work, sponsorship and structure than the other types of support groups. But the fact is that GA groups do provide a unique fellowship that helps the individual address his or her gambling issues. GA also has a process, known as “Pressure Relief,” which may help the gambler and family members learn how to cope with money management, debt, and reputation issues.
Alcohol Anonymous (AA) participation is considered to be one of the most critical of the support networks an individual can develop – along with family support – in recovery from alcohol abuse, dependence or addiction. AA’s emphasis is different than Gamblers Anonymous, as previously mentioned. In AA, it’s all about working the steps, securing and working with a sponsor, and gaining the strength and mutual support from fellow AA group members.
In the long-term, since substance abuse and problem gambling are chronic and recurring disorders, it is probably 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 can prove effective. This is especially true when such continuing care group participation is combined with attendance in mutual self-help groups such as GA. The problem gambler/drinker’s 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 it Ever Go Away?
When discussing problem gambling and alcohol abuse, it’s a little like the chicken and the egg. It doesn’t matter which came first, without treatment, neither one is going away anytime soon. An alcoholic can’t will himself or herself out of drinking. Neither can a problem gambler just walk away and quit gambling forever.
Professional help is the best way to overcome both problem gambling and alcohol abuse. Since relapse is common with both disorders, the individual who’s in recovery also needs to be diligent in avoiding the triggers to drink and gamble and continue to work on coping skills to deal with stress that may precipitate relapse.
Bottom line: Learning healthier ways of living that do not involve cocaine use or gambling is critical to the individual’s long-term recovery and happiness. If relapse does occur, there should be a plan in place to go back into treatment to further strengthen the ability to withstand triggers, overcome cravings, and solidify coping skills that work.
It may be that a person who is a problem gambler and abuses alcohol will need more than one time in rehab before he or she is confident enough and practiced enough to be able to function effectively in recovery. This isn’t always the case, but it is true sometimes. The reality is that millions of Americans have gone through treatment for alcohol abuse or dependence and sought help for problem gambling and are today living healthy, happy and productive lives that are alcohol- and gambling-free.