When is gambling an addiction?

Case 1: Mrs. A is an elderly wealthy widow with a compulsion to go to the casino every night. Her children cannot compel her to stay at home so they try to tone down Mrs. A’s gambling by limiting the money she can request from their family business office. She becomes extremely anxious and agitated when a casino night is missed.

Case 2: Dr. E is a successful urban general practitioner who was born rich. His only vice is gambling at a Manila casino. On “lucky days,” he is able to go home by early dawn. But on “unlucky days,” he tries to win back his losses by staying in the casino for almost the entire day. On unlucky days, he comes home with empty pockets, losing thousands of pesos. His biggest loss hit P3 million. His wife hired two men to guard him 24/7 with the main task of preventing Dr. E from going to the casino after his clinic hours.

Case 3: Mrs. I is married to a successful provincial medical specialist. Childless and not needing to assist her spouse in providing for their family, she learned to gamble at a Metro Manila hotel casino with her rich amigas. On her first trip to the casino, she was able to double her money after her first win. The second time she went to gamble, she had a “bad day” at the casino and went home carless. After a few days, wanting to win back her losses, Mrs. I returned to the casino but Lady Luck failed her again. She came home to tell her husband she borrowed money from a loan shark at the casino with their house title as collateral for her debt. Her husband failed to prevent her from returning to the casino and she became deeply indebted to several loan sharks who eventually sued her for non-payment. She escaped to the US leaving her distraught husband to pay in installments all her debts.

All three individuals in the cases cited have ludomania. Other names are compulsive gambling, gambling disorder, pathological gambling and gambling addiction (non-substance related disorder). Gambling becomes a disorder when it becomes a persistent and maladaptive behavior leading to economic, relational, occupational and social dysfunction.

You can spot a gambling addict when these aspects of his or her behavior become repetitive and pervasive: 1. A persistent preoccupation to gamble; 2. The urgency to gamble with increasing amounts of money in order to acquire the desired level of excitement; 3. Incessant unsuccessful attempts to control, tone down or stop gambling; 4. Allegedly resorts to gambling to escape from other problems; 5. Rationalizing gambling to raise money to recover losses; 6. The need to lie to hide the extent of the severity of one’s gambling; 7. Performing illegal acts to be able to finance one’s gambling vice; 8. Relying on others to pay for debts incurred; and 9. Sacrificing occupational, vocational and personal relationships because of an unstoppable urge to gamble. 

Ludomania is said to be more common in men and young adults than in women and older adults. The prevalence of this disorder is higher in persons with an existing substance use disorder.  

According to studies, there are three types of gambling:

1. Sports betting — office sports pool, sports with bookie or parlay cards, betting on horse/dog races or dog or cock fights and gambling at a casino.

2. Gambling that involves some aspect of mental or physical skill — cards (mental), pool (physical), speculation on high-risk investments and internet gambling.

3. Gambling that largely involves chance — Playing lotto/numbers, gambling machines (video poker) and slot machines/bingo/pull tabs.           

There are psychosocial factors that can predispose a person to develop compulsive gambling, like loss of a parent by death, separation, divorce, annulment or abandonment before the age of 15; inconsistent or inappropriate parenting, early exposure to gambling, materialistic family values and absence of family emphasis on the importance of saving, planning and budgeting.

Social gambling is different from pathological gambling because it happens with friends only on special celebrations with previously determined tolerable/limited losses.  Gambling due to a manic episode is precipitated by a history of marked change in mood and a decline in the capacity to make decisions appropriately. Gambling disorder has a tendency to wax and wane and to be chronic. 

There are actually four phases in pathological gambling:

1. Winning phase — Ends with a big win equal to or more than one’s annual salary; starts addiction to gambling.

2. Progressive-loss phase — Structures life around gambling; excellent gambler starts to make stupid moves, taking a lot of risks, borrowing money, missing work and losing jobs.

3. Desperate phase — Frantic gambling with huge amounts of money, not paying debts to loan sharks, engaging in illegal/embezzling activities, writing bouncing checks.

4. Hopeless stage of acceptance that money lost can never be recovered — Continues to gamble because of the need to experience the associated arousal or excitement during gambling; after several years (at most, 15 years), gambler becomes totally spent.

Compulsive gambling can be treated but unfortunately, gamblers seldom voluntarily seek professional help. Gamblers are brought for professional help upon coercion from the family only after legal problems set in. 

Gamblers Anonymous, patterned after the 12 steps of Alcoholics Anonymous, is a method of group therapy utilizing public confession and peer pressure with reformed gamblers as facilitators. 

Hospitalization, at times, may be needed to remove the gambler from the enabling environment. Insight-oriented psychotherapy is helpful when given for at least three months. Family therapy is also beneficial. Cognitive behavioral therapy has also proven effective in helping compulsive gamblers. Psychopharmacotherapy plays an important role in the management of ludomania.

SSRI (selective serotonin reuptake inhibitors) antidepressants, antiepileptics and atypical antipsychotics have been found to be effective. These medications help to lessen the gambling cravings and/or help abate symptoms of comorbid conditions.

If you know a person with ludomania, convince this compulsive gambler to seek professional help as soon as possible, before it’s too late. Visit Philippine Psychiatric Association Inc.’s website (www.philpsych.ph) for the list of psychiatrists in your region.

(For questions on love, looks and relationships, e-mail this author at nina.halilijao@gmail.com. Belated happy birthday to my daughter, Berna! Let’s pray for the victims and families of the Resorts World Manila attack and the Marawi crisis.)