News Release

Explosion of gambling opportunities worldwide, especially online, means problem gamblers will become more visible

Peer-Reviewed Publication

The Lancet_DELETED

The prevalence of gambling disorders worldwide is highly variable, ranging from 1 in 500 people (Norway) to as high as 1 in 20 people (Hong Kong). In the USA, around 1% of the population are pathological gamblers (those with the worst problem), while a further 1% to 2% are problem gamblers (those with the next most serious level of addiction). In the UK, around one in 200 people is a pathological gambler, while in Australia the prevalence is 0.5% to 1% depending on the region studied. The explosion of gambling opportunities—especially online—will increase the visibility of gambling disorders, and people not currently exposed to gambling opportunities will increasingly have access. The issues are explored in a Seminar published Online First and in an upcoming Lancet, written by Professor David C Hodgins, University of Calgary, AB, Canada, and colleagues.

Even countries that limit gambling for religious or cultural reasons, such as China, Malaysia, and South Korea, are permitting the operation of casinos to benefit tourism. And while most gamblers in settings around the world gamble as an enjoyable social activity, the authors note that "a small group of people become too seriously involved in terms of time invested and money wagered and they continue to gamble despite substantial and negative personal, social, family, and financial effects."

Gambling problems are often accompanied by other conditions. Pathological gamblers have a four times increased risk of alcohol abuse and a 5 to 6 times increased risk of drug abuse; and also a four times increased risk of having some kind of mood disorder.

Research suggests that a number of centres in the brain are implicit in gambling disorders, including learning and reward centres. Genetic factors also play a part, with evidence from twin studies suggesting some level of shared risk between identical twins. And environmental factors are clearly part of the risk, including accessibility to gambling, location and type of establishment. Childhood exposure to gambling through parents with a gambling addiction of some level also affects gambling behavior later in life.

Due mainly to shame, denial, and a desire to handle the problem themselves, only 1 in 10 problem gamblers seeks treatment. Surveys suggest around a third of problem gamblers recover during their lifetime, and that the disorder is transient and episodic in many cases. Many gamblers choose to self-help by doing time-consuming activities incompatible with gambling, and avoiding gambling venues and exposure to temptations such as betting odds displays.

For those who do get treated, a telephone interview combined with a cognitive behavioural therapy workbook generally leads to more positive outcomes than no treatment. More intense psychosocial treatment, such as cognitive behavioural therapy, is twice as effective as no treatment once the treatment ends, and is still around 60% more effective than no treatment after around a year-and-a-half of follow-up. The authors say: "Cognitive treatment models focus specifically on modifying distorted cognitions associated with gambling, including overestimating probabilities of winning, illusions of control over the outcome of a gamble, the belief that a win is due after a series of losses (ie, the gambler's fallacy), and memory biases in favour of remembering wins."

Of the drug treatments trialed, naltrexone (used mainly in alcohol and heroin addiction) appears to be the most promising although further research is needed. Other interventions, such as Gamblers Anonymous, promote a sense of common purpose and understanding to reinforce abstinence. However, some studies have suggested that adherence to such sessions, can be poor, as can the outcomes. Family therapy, in which close family members are helped to give interventions to their loves ones, can have positive effects but can also be difficult to administer without the direct help of a therapist.

The authors conclude: "There is substantial comorbidity of gambling disorders and mental and substance use disorders. How concurrent disorders should be addressed in gambling treatment is not well understood and has not been empirically studied… Most of our progress in recognising and understanding gambling disorders has been made in the past 25 years.

Our knowledge continues to evolve in parallel with a burgeoning availability of gambling opportunities. Internet gambling, for example, is providing around-the-clock home access to several types of gambling activities to an increasing number of people around the world.

Thus, although substantial progress has been made, this evolution warrants, and is likely to encourage, more innovative research into gambling disorders and its translation into clinical progress."

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Professor David C Hodgins, University of Calgary, AB, Canada. T) 1-403-220-3371 E) dhodgins@ucalgary.ca


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