Kelvin has a family history of multiple addictions. He was sexually abused as a child and attempted suicide twice in three years. Now in his late 40s, his gambling addiction started as an adolescent, betting on horse and greyhound races. During intermittent counselling over a period of nine months, Kelvin acknowledged gambling was actually a symptom of everything else he was bottling up.
For many Gambler’s Help clients, a gambling addiction masks painful mental health issues, with research estimating that nearly 75 per cent of people seeking treatment for problem gambling (as defined by the Problem Gambling Severity Index) have some form of psychological disorder. Anxiety, depression, post-traumatic stress and alcohol use disorders are among the most common.
A study by Alfred Health found 81 per cent of people experiencing problem gambling spoke to a general practitioner (GP) about their depression, but fewer than half mentioned a gambling issue. Conversely, an ACT report found GPs are the most common health professionals consulted when a person’s gambling is having adverse effects on them.
Sometimes a comorbid gambling addiction is not immediately apparent. Mary, in her 60s, presented with a history of trauma, abuse, and relationship dysfunction. A frequent user of pokies, during her 18 months of treatment, she spoke about gambling fewer than five times.
To define clients by their behaviour is diminishing. A person is more than a ‘gambler’, a ‘drinker’ or a ‘drug addict’. It is incumbent upon us, as healthcare professionals, to ask the right questions. To be curious and show an interest in the people we see beyond the most obvious symptoms.
In relation to gambling, a validated single-question screener has a 90+ per cent effectiveness rate. The question: In the past 12 months, have you gambled more than you can afford to lose?
Effective services put people at the centre of an integrated and holistic treatment approach. When treatment focuses on the underlying causes of a behaviour, the outcomes can be life changing.
Kelvin’s therapy focused on repairing relational damage from his suicide attempts and his fractured sense of self. By the end of therapy, he stopped gambling entirely, had a job, was moving into a new home and was rebuilding his life with his wife and children.
In his own words: ‘Just having someone who I knew would be there, whenever I needed them, without judging me – God knows I’ve judged myself harshly enough – to listen to all this crap coming out of me. That was enough. I might gamble again, who knows. But after therapy at least I now know that there were reasons for trying to hurt myself and my family and some of those were about the hurt I experienced.’
Mary needed a safe place to explore her addiction. As she came to understand its grip on her, Mary’s gambling behaviour receded and she was able to re-establish relationships with two of her children.
‘Without the support of my Gambler’s Help therapist I’d be stuck in a cycle of loss – losing everything every week at the pokies was my way of showing the world how much more I’d lost: a childhood, my own children and myself,’ she says.
‘I’ve got some of that back now.’
Dowling N, Cowlishaw S, Jackson A, Merkouris S, Francis K & Christensen D (2015). Prevalence of psychiatric co-morbidity in treatment seeking problem gamblers: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry, 49(6) 519–39.
Anthony de Castella, Pip Bolding, Adeline Lee, Sonja Cosic, Jayashri Kulkarni (2011) Problem gambling in people presenting to a public mental health service, Department of Justice: Victoria p.25.
Davidson T, Taylor-Rodgers E, Fogarty M (2018) Informing Targeted Interventions for People in the ACT, ANU Canberra p.41.