Excessive gambling and substance abuse: is there a relationship?

Recent research has highlighted that around three-quarters of the UK population (72%) have gambled within the last year and that just under 1% are problem gamblers (National Centre for Social Research 2000). Problem (‘pathological’) gambling is characterized by unrealistic optimism on the gambler’s part. All bets are made in an effort to recoup their losses (often referred to as ‘the chase’). The result is that instead of ‘cutting their losses’, gamblers get deeper into debt preoccupying themselves with gambling, determined that a big win will repay their loans and solve all their problems. Family troubles begin – both marital and with relatives – and illegal borrowing and other criminal activities in an effort to get money usually start to occur. At this point in the pathological gambler’s career, family and/or friends may ‘bail out’ the gambler. Alienation from those closest to the pathological gambler, characterizes the appearance of the final desperation phase. In a last ditch frenzied effort to repay their debts, illegal criminal behaviour reaches its height and, when there are finally no more options left, the gambler may suffer severe depression and have suicidal thoughts (Griffiths 1996). Traditionally, gambling has not been viewed as a public health matter (Griffiths 1996, Korn 2000). However, it is clear that the social and health costs of problem gambling are large on both an individual and a societal level. As already outlined, personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, family neglect, and bankruptcy. There can also be adverse health consequences for both the gambler and their partner including depression, insomnia, intestinal disorders, migraines, and other stress-related disorders (Lorenz and Yaffee 1986, 1988). Health-related problems can also result from gambling withdrawal effects. Rosenthal and Lesieur (1992) found that at least 65% of pathological gamblers reported at least one physical side-effect during withdrawal including insomnia, headaches, upset stomach, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty and/or chills. Their results were also compared to the withdrawal effects from a substance-dependent control group. They concluded that pathological gamblers experienced more physical withdrawal effects when attempting to stop than the substance-dependent group. Preliminary analysis of the calls to the UK’s gambling helpline also indicate that a significant minority of the callers report health-related consequences as a result of their problem gambling. These include depression, anxiety, stomach problems, other stress-related disorders and suicidal ideation (Griffiths et al. 1999). Pathological gambling is very much the ‘hidden’ addiction. Unlike (say) alcoholism, there is no slurred speech and no stumbling into work. Furthermore, overt signs of problems often do not occur until late in the pathological gambler’s career. It is evident that problem gambling is a serious disorder and can have many negative consequences. Furthermore, recent deregulation measures will lead to an increase in opportunity for, and access to gambling. This will lead almost certainly lead to an increase in the level of problem gambling (Griffiths 1999). Despite the widespread popularity, research into the causes of problem gambling is still at a relatively early stage. Furthermore, it is clear that excessive gambling resembles many other addictive behaviours and that it results from an interaction between many different variables (e.g. environmental, social, psychological and biological) (Griffiths 1995, 2002).