Author: Bill Ursel
Email: comdvp@accesscomm.ca

For some who gamble, the impulse to wager is uncontrollable. For these people, gambling is no longer a recreational activity, or even an attempt to rationally balance risk and reward, but a problem. Whether known as problem, compulsive, pathological, or disordered gambling, this behavior has devasted many lives--but has also gotten the attention of many clinicians. This subject guide quickly summarizes many of the trends in current problem gambling treatment and study.

Perspective on Problem Gambling: Impulse Control Disorder
and Impacts on Community Life

The choice to gamble is just that . . .a choice. The majority of people in many communities choose to gamble responsibly. Gambling is one option among many entertainment and recreational options.

Problem gambling has an impact on entire communities. To better understand the impact, basic definitions will be helpful.

Problem gambling refers to any gambling behaviour, which adversely affects significant areas of a person's life, including their mental health, physical health, employment, family relationships, financial and legal status. (Saskatchewan Health, 1996)

Pathological gambling may be defined as a progressive disorder characterized by a continuous or periodic loss of control over gambling; a preoccupation with gambling and with obtaining money with which to gamble; irrational thinking; and a continuation of the behaviour despite adverse consequences. (Rosenthal, R.J. 1994)

Understanding problem gambling as an impulse control disorder provides one perspective on the nature of the condition. The American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders classifies pathological gambling as an impulse control disorder and describes 10 criteria to guide diagnoses. The criteria fall within three areas: damage, loss of control, and dependence.

The impacts on the individual and upon community life are very real. Young adults, families, older adults, women and the community feel the impacts at large. The number of people impacted varies, however a consistent prevalence rate (the percentage of a population that is affected by problem gambling) tends to be 1.2% (Gambling and Problem Gambling in Saskatchewan, January 2002) and ranges in various jurisdictions between .9% and 1.8% (Abbott and Volberg 1999, 2001 National Statistics, New Zealand, authors Paton-Simpson G.R., Gruys, M.A.., Hannifin,J.B.)

The number of lives changed by problem gambling behaviour far exceeds the number of individuals identified in a prevalence rate. Entire families and employers are directly affected by changes that they did not choose to bring upon themselves. The choice to gamble, for some, is a choice to uproot and change forever a landscape of home and community.

Older adults are a population at risk. Older adults do make choices as we all do. However, the number of older adults who seek help is relatively small when we take anecdotal reviews of caseloads of counsellors in various communities. Why is that the case? Consider the following vignette. . . .

Steve was feeling depressed and alone. Joan had been his life long companion and he wondered what he was going to do now that she was gone. His close friends were all part of a group of couples that did all sorts of things together. Since Joan had passed away, it seemed they just didn't call as much as they used to and when he did see them he felt out of place as they only single person in the group.

When the Video Lottery Terminals came to the neighbourhood, Steve found they were fun. The hours seemed to fly by when he was playing them. He was meeting new people and for the first time in months it seemed as if his troubles weren't quite so overwhelming.

Steve knew he was getting into trouble when he noticed his pension cheque didn't get him to the end of the month anymore.

(Morgan D. Bray B., 2001, Draft Handbook For Seniors)

Isolation is a common result in the life of a problem gambler. Older adults often shun external resources, choosing to deal with problems in a solitary manner.

Problem and pathological gambling directly impact women as segments of communities. A consultation process carried out in Canada ( Women and Problem Gambling: Community Consultation Final Report, February 2001) indicated that greater understanding from the medical profession was essential to assist women in seeking help. Women's shelters have since been identified as key community partners.

Action is being taken globally to respond to the needs of problem gamblers. Resources fall within several streams. . prevention, early identification, and direct clinical support.
Research continues to identify new methods of treatment. One example is the application of selective serotonin reuptake inhibitor (SSRI) citalopram, commonly used to treat OCD, in the treatment of pathological gambling (Zimmerman, Breen, & Posternak, 2002.)

Drug therapy and the 'school' of pharmacology is gaining ground as a treatment option with individuals living with problem gambling. This approach should not be considered in isolation, however. Community based alternatives (awareness building) and clinical counselling continue to be effective tools in responding to the needs of people living with problem gambling.

The choice to gamble is a healthy and enjoyable option for many people. However, for some, the choice to gamble may strip away energy and options from a person's life. His/her family and community will feel the repercussions for a lifetime.

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Sources

Richard J. Rosenthal, MD., Pathological Gambling. 1994. University of California, Los Angeles School of Medicine

American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington , D.C.

Gambling and Problem Gambling in Saskatchewan, January 2002. Prepared by Harold J. Wynne, Ph.D. Canadian Centre on Substance Abuse, Ottawa, Ontario. (Available on line at http://www.health.gov.sk.ca/ps_fin_rep_prev_of_prob_gam.html

Problem Gambling Counselling in New Zealand, 2001 National Statistics, April 2002.
Paton-Simpson G.R., Gruys, M.A.., Hannifin,J.B. Problem Gambling Purchasing Agency.
Available on Department of Internal Affairs website http://www.dia.govt.nz

Morgan, D. Bray, B. Draft Handbook about Responsible Gaming for Saskatchewan Seniors. 2001. CMHA.

(Draft available from B. Ursel, email: comdvp@accesscomm.ca)

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Search UNLV's Online Catalog for these books or others.

Responsible Gambling Council (Ontario)
http://www.responsiblegambling.org/

Gambling Problems Resource Center - Minnesota Institute of Public Health
http://www.miph.org/gambling/index.html

Problem Gambling Community Program - Canadian Mental Health Association, Saskatchewan Division
http://cmhask.com/gambling/

Australia's Gambling Industries Inquiry Report
http://www.pc.gov.au/inquiry/gambling/finalreport/index.html

National Centre for Responsible Gaming
http://www.ncrg.org/

Problem Gambling Services - Nova Scotia Department of Health
http://www.gov.ns.ca/ohp/gambling/

Gambling Studies - North American Association of State and Provincial Lotteries
http://www.naspl.org/studies.html

Alberta Gaming Research Institute
http://www.abgaminginstitute.ualberta.ca/

Saskatchewan Health, Problem Gambling Services
http://www.health.gov.sk.ca/ps_fin_rep_prev_of_prob_gam.html

Gamblers Anonymous
http://www.gamblersanonymous.org/

Gaming Problem Helpline - New Zealand
http://www.gamblingproblem.co.nz/

Problem Gambling Bibliography - North American Association of State and Provincial Lotteries
http://www.naspl.org/bibliog7.html

Gambling and Gambling Problems in Norway
http://www.bks.no/warsaw.htm

The Institute for Research on Pathological Gambling and Related Disorders
http://www.divisiononaddictions.org/institute/index.htm

Gambling Addiction Help and Information
http://www.soberrecovery.com/links/gamblingaddiction.html

The Wager - Worldwide Addiction Gambling Education Report
http://www.basisonline.org/wager/

International Centre for Youth Gambling
Problems and High Risk Behaviour
http://www.education.mcgill.ca/gambling/

Gambling Impact and Behavior Study, 1997-1999: [United States]
http://webapp.icpsr.umich.edu/cocoon/SAMHDA-STUDY/02778.xml

Inter-University Consortium for Political and Social Research
http://www.icpsr.umich.edu/index.html

The Odds of Gambling . . .
Excerpted from True Odds by James Walsh,
Merritt Publishing, 1996.
http://www.pbs.org/wgbh/pages/frontline/shows/gamble/odds/

Electronic Journal of Gambling Issues
http://www.camh.net/egambling/main.html

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Bill Ursel
Director, Problem Gambling Community Program
Canadian Mental Health Association, Saskatchewan Division
Email comdvp@accesscomm.ca

Bill has chosen a focus on community development in his career. The process of building community requires communication and a focus on solutions that are based in the grassroots. Bill holds a B. A. (Hons.) and a Masters Degree in Community Development.