Have You Treated Patients with Gambling Problems That Would Be Considered Pathological? What Medications Have You Used to Help These Patients Manage Their Problems?

By Fink, Paul J. | Clinical Psychiatry News, February 2007 | Go to article overview

Have You Treated Patients with Gambling Problems That Would Be Considered Pathological? What Medications Have You Used to Help These Patients Manage Their Problems?


Fink, Paul J., Clinical Psychiatry News


Pathological gambling, also known as gambling addiction, is quite prevalent. Using the term "addiction" gives us some clues to the kind of psychopathology found in someone who cannot stop gambling. It has also been referred to as compulsive gambling, but I think that all addictions have a compulsive component to them.

In addition, the person has an intense craving for the substance or action that is the source of the psychological need. One reason addiction is so difficult to treat is that the addict is seeking a reaction he or she considers pleasurable.

As states discover the tax dollars that can be had from gambling, the activity escalates from the lottery, to off-track betting, to slot parlors, and, finally, to elaborate and garish casinos. All are often destructive to individuals. The tragedy is that these patients, like all addicts, start out with massive amounts of denial and only wake up when it is too late. Unlike alcohol and drugs, the signs of addiction are not visible and the problem is often uncovered when the family is evicted from its home or the person is fired from his or her job.

The new gambling laws in Pennsylvania, which created slot parlors all over the state, have a clause that requires support for treatment programs. Although this recognizes that there are casualties when one starts or increases the opportunities for gambling, it fails to acknowledge that few who need the help will seek it. More research is needed into the factors that differentiate people who gamble and know when to stop from those who cannot.

Several years ago, when I was the medical director of a private psychiatric hospital, I was approached by a gambling therapist from New Jersey about opening an inpatient service for people addicted to gambling. I was interested because my job was to increase the hospital census and here was a new program that I was promised would always be full. I got very little support, however, from the administrator and the board of directors who, of course, did not believe it was a legitimate psychiatric disorder and wanted a guarantee of the money up front. Tenacity won out, and we began the program with very few problems and a continuous flow of patients.

The treatment of gambling addiction needs to follow a system not unlike other addictions. First and foremost, the patient needs to spend some time under surveillance in a hospital or residential setting to start the effort of dissuading him or her from going back to the racetrack or casino. Second, the patient must be conscientious in attending Gamblers Anonymous meetings and participating in the 12-step program whether or not they are interested. Third, the support system needs to be defined to ensure that the patient understands that the dream of one great jackpot at the end of the rainbow is nonsense.

In addition, an assessment should be made of the amount of anxiety and/or depression that the patient is experiencing. The patient should be prescribed adequate and appropriate amounts of drugs to help control or alleviate these symptoms. Finally, individual and/or family therapy is essential.

Do the gambling establishments have any responsibility to stop an addict? Even if one casino withdraws the person's gambling privileges, another is down the street.

If the concept of pathological gambling becomes more accepted, we will need to be sure that psychiatry does not dismiss this as a rare illness. Having had scores of these patients in my hospital over 5-10 years, I saw first hand the devastation that can be wrought by a person caught up in the idea that one more bet will resolve all of his or her problems.

DR. FINK is a psychiatrist and consultant in Bala Cynwyd, Pa., and is professor of psychiatry at Temple University, Philadelphia.

BY PAUL J. FINK, M.D.

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