Gambling Effects On Mental Health
Occasional gambling may be a pleasurable activity. But when gambling becomes addictive, it can take a heavy toll on the life, finances, health and wellbeing of gamblers and their loved ones. Compulsive gamblers can win or lose a huge amount of money within a few hours or days. Effect of gambling on Mental Health Gambling is an activity that takes place in almost all regions of the world. Indians especially love to gamble. People play it for various reasons. Some play for the fun and excitement for some people while for others it could be to enjoy the competition against other players. Gambling-related disorders.11 Therefore it is reasonable to conclude that mental health is a major risk factor in an internet gambler experiencing a gambling disorder. Additionally, online gamblers are more likely to be engaged in a greater number of gambling. Although evidence is still limited, emerging discourse on secondary impacts of COVID-19 has included substance use and gambling. Many papers take note of the effects of isolation, mental health concerns, pre-existing substance use disorders and ongoing access to online gambling and some substances (Douglas et al. 2020; Marsden et al. Current picture of mental -ill health. 1 in 4 adults experience mental-ill health in any given year. Income for mental health trusts rose by less than 2.5% in 2016/17 compared to more than 6% for acute and specialist trusts 1. Since 2012/13, funding for mental health trusts has increased by just.
Gambling addiction has featured prominently in the news recently. While it’s not usually considered a public health issue, but in the wake of the tragic events in Las Vegas, many experts have asked what role gambling addiction might have played in the tragedy.
In a 2013 court testimony, Stephen Paddock – the Vegas shooter, described himself as nocturnal, and exhibited an inflated sense of self-worth, referring to himself as the ‘biggest video poker player in the world.’ Whether or not Stephen Paddock had a problem with gambling is not up for debate, but the role his addiction played in the events that transpired on October 1st is worth investigating.
According to psychologist Dr. Phil Kronk, “individuals addicted to gambling often have a co-existing personality disorder.” Studies have also shown a link between post-traumatic stress disorder and gambling addiction. PTSD symptoms affect anywhere from 12.5 to 29 percent of problem gamblers. A further shocking link between gambling and mental health shows 5% of all suicides in the USA are related to compulsive gambling, as are 17% of emergency room admissions for attempted suicides.
Gambling addiction often disproportionately affects already at-risk groups, including those suffering from feelings of depression and anxiety, and those already engaging in risky behaviours, such as alcohol abuse or drug use. In fact, studies have shown there is a clear connection between men and women who suffer from alcohol abuse and the likelihood of developing a compulsive gambling disorder.
Casinos, slot machines and gambling advertisements are all designed to take advantage of the psychological conditioning which is a huge part of gambling addiction. The process of repetition and reward brought about by our actions releases dopamine in the brain, the same thing that keeps users addicted to hard drugs like cocaine. Even a “near-miss” on a slot machine triggers the same areas in your brain as if you had won, helping keep players hooked. It’s predicted that 1 in 8 people who gamble will develop an addiction.
Put simply, gambling is a drug-free addiction. Even though there is no external chemical at work on the brain, the same neurological and physiological reactions are occurring. When interviewed, gambling addicts liken the experience to high produced by drugs. Like drug addicts, people suffering with gambling addiction develop a tolerance, when they can’t gamble or try to stop, they also exhibit the same signs of withdrawal; headaches, insomnia, panic attacks, anxiety, heart palpitations.
At a recent conference in China, Professor Bo J. Bernhard, executive director of the UNLV International Gaming Institute highlighted the dangers of ‘convenience gambling’ in bars and retail shopping districts, in comparison to heavily tourist-focused resorts like those found in Las Vegas. “Take Japan and its Pachinko parlors for example. Lots of machines, but no tourism and no job creation.” Bernhard said.
A recent survey by the Japanese government backs up the claim, it’s findings reported around 3.2 million Japanese have likely suffered from gambling addiction, and pachinko accounted for the most money spent on gambling, at an average of 58,000 yen per month.
Worldwide, the statistics are alarming. It’s estimated there are around 400,000 problem gamblers in the United Kingdom. Approximately 3 to 4 million American’s have a gambling problem.
Australia has seen the effects of convenience gambling on communities as well, a 2016 Government study illustrated the cost of pokie machines on families within the country’s poorer suburbs.
The problem is also affecting younger people in larger numbers, a 2010 US survey by the Annenberg Public Policy Center indicated that the that the monthly use of mobile gambling sites among male college students had increased to 16%. A 2008 survey by the University of Buffalo’s Research Institute found that as many as 750,000 young people, between the ages of 14 and 21 had a gambling addiction in the US alone.
According to some experts, part of the problem lies in the ease of access that the internet has brought about. In the United Kingdom, the National Problem Gambling Clinic (NPGC) said 63% of its patients struggled with mobile gambling in 2016-17, compared to just 24% in 2013. Now, someone suffering from a gambling addiction can access a casino online from their computer or mobile device. Making it even easier for those trying to recover, to relapse.
Online gambling can be particularly difficult to monitor and has begun to infiltrate other forms of online-gaming. Take for example, e-sports betting – that’s placing bets on professionals playing computer games in front of live audiences. Or even ‘skins’ betting, roulette-style games on third-party sites that allow users to bet on the real-world value of in-game bonuses such as ‘skins’ for weapons and avatars. While this sort of gambling might initially seem innocent, the fact of the matter is it still activates the same dopamine receptors within the brain that are responsible for addictive behavior.
So far it seems education is the best way to tackle the scourge of gambling addiction, recent research from the University of Waterloo showed that rookie gamblers who were shown a short video about the ways slot machines disguise losses as wins had a better chance of avoiding developing an addictive behavior.
Gambling Effects On Mental Health Disparities
Approaching problem gambling as a health issue must also include the cooperation of medical professionals. General practitioners will routinely ask patients about smoking, drinking, even drug-use to make a diagnosis, yet gambling is not something that is often discussed. Changing the perception of gambling addiction as a health issue, the same as any other addiction, could go a long way towards minimizing the harm that it can cause.
Addiction
Decisions about building casinos in the UK have not given enough weight to the potential health effects, argue John Middleton and Farid Latif
Gambling Effects On Mental Health Services
In March the House of Lords threw out government proposals to build the UK's first Las Vegas-style super casino in Manchester and build 16 other casinos around the country.1 This decision reflects polarised views about the costs and benefits of liberalised gambling in the United Kingdom, but the health dimension of the debate has been lacking.1 The UK currently has a low prevalence of problem gamblers, estimated to be 0.6%.2 By contrast the rate in the United States is about 2.8%, although rates vary across states. In New Jersey, the home of Atlantic City, the US's second largest casino resort, the prevalence of problem gambling is 4.2%.3
However, the UK's low rates seem likely to increase when the Gambling Act 2005 is implemented. The act will give the British public more access to gambling facilities than ever before. In the year after a casino was opened in Niagara, not only did gambling rise but the percentage of residents reporting two or more gambling problems rose from 2.5% to 4.4% and those having one or more problems increased from 9.6% to 12%.4
What is problem gambling?
Gambling refers to any game of chance or skills that involves a financial risk. Problem gambling is defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders as “persistent and recurrent maladaptive gambling behaviour that disrupts personal, family or vocational pursuits.”5 It describes a progressive disorder characterised by continuous or periodic loss of control over gambling; a preoccupation with gambling and money with which to gamble; irrational thinking; and continuation of the activity despite adverse consequences. This psychiatric definition focuses on impaired ability to control gambling behaviour; adverse social consequences that disrupt personal, family, or vocational pursuits; and tolerance (need to gamble with increasing amounts of money in order to achieve the desired excitement) as well as withdrawal. For a diagnosis of pathological gambling, the person's behaviour must satisfy at least five of the 10 criteria and not to be better accounted for by a manic episode.5
Gambling affects physical, mental, and social wellbeing as well as creating debt. The strategies used to gain more money to gamble have serious effects on many determinants of health and can cause marital conflict, child neglect, poor work performance, multiple addictions, stress related physical ailments, crime, and even suicide.6 Problem gamblers and pathological gamblers are more likely than others in the general population to have been divorced, had physical and psychological problems, lost a job, been receiving welfare benefits, been declared bankrupt, and been imprisoned.7
Problem gambling is also associated with juvenile delinquency and family problems.8 Adolescents who have high rates of gambling are far more likely to drink alcohol, smoke cigarettes, or consume drugs.9 Children of pathological gamblers are twice as likely to attempt suicide, have lower academic grades, and have higher rates of substance misuse than their peers.10 A Quebec study of college students found that 27% of pathological gamblers had attempted suicide compared with 7% of students with no gambling problem.10
Withdrawal effects can also cause problems. One study found that at least 65% of pathological gamblers reported at least one physical side effect during withdrawal, including insomnia, headaches, loss of appetite, physical weakness, heart racing, muscle aches, breathing difficulty, and chills.11
Problem and pathological gamblers often turn to crime to support gambling habits when all other resources are exhausted. Studies show that two out of three pathological gamblers commit crimes to pay off debt or to continue gambling, although the majority of crimes are non-violent and include embezzlement, cheque forgery, stealing credit cards, tax evasion, fencing stolen goods, insurance fraud, bookmaking, or employee theft.10
Pathological gambling is also a predictor of violence against intimate partners. A study of 286 women admitted to the emergency department at a university hospital in Nebraska showed that women whose partners were problem gamblers were 10.5 times more likely to be a victim of violence from their partner than women whose partners were not problem gamblers. Furthermore, in 2003, the National Coalition against Legalized Gambling reported that, with the opening of casinos in South Dakota, child abuse and domestic assaults rose by 42% and 80%, respectively.13 This was attributed to the increase in casino gambling.
Population effects
But most casino customers will not be compulsive or problem gamblers. The levels of problem gambling reflected in these studies suggest only a small minority are affected, although the resulting social effects may be wider. More pervasive, however, will be minor effects on large numbers of the population previously unexposed to casino gambling. The purpose of the enterprise is to take money off customers. Even the most generous of slot machines in working men's clubs pay back on average only 80% of the taking; for commercial enterprises the pay back is much less. So poor communities face a slow leakage of funds they can ill afford, with further overall impoverishment of their local economies.
Sandwell Council in the West Midlands has become the first in England to use the no casino resolution of the Gambling Act 2005 to prevent any new build casinos in the area. The decision was largely based on risk of poverty and related health consequences presented in the report of the director of public health.14 The act requires local authorities to have a statement of principles that covers their duty to prevent gambling becoming a source of crime and disorder, ensure gambling is conducted in a fair and open way, and protect children and other vulnerable people from gambling. While most local authorities seem to have looked at casino building as a regenerative opportunity, Sandwell has taken the view that any development is likely to further impoverish local people. Experience with national lotteries supports this view.
Lotteries tend to gather money from poor people to be spent on amusements for wealthy people.15 If a lottery widens inequalities of income it will have important implications for health, as shown by evidence of an association between inequality of income in industrialised countries and lower life expectancy. Much of the evidence on the effect of lottery sales comes from the United States. One study concluded that lotteries are “some what” regressive and the highest level of participation was among the middle income group.18 A large household study in Oregon found the middle income group to be the most frequent purchasers, but poor people spend a substantially higher proportion of household income on lottery tickets than the middle class and that lack of education was the strongest predictor of purchase.19 A time series analysis showed that lottery sales increase with increasing unemployment.20 A study in New York showed that lotteries consume a high proportion of household income—4.4% among heavy users.21
Doctors' role
Problem gambling is an addiction that can destroy families and can have medical consequences. Medical professionals should be aware of it in just the same way they are with other potentially addictive activities, such as drinking alcohol and smoking. General practitioners routinely ask about smoking and drinking, but gambling is something not generally discussed. A possible doubling of problem gambling rates is unlikely to become apparent overnight, and health consequences are likely to be insidious. Many of the health consequences present at generalist services—general practices, accident and emergency departments, and mental health services. The UK has few specialist services available for problem gambling, and the demands on such services are likely to increase. 22
The wider public health effects of an increase in gambling in the population are even more hidden but ultimately more damaging. Anything that makes the poor people in Britain even poorer, especially if they do not derive benefits in kind, will damage their health, further increasing inequality in health.
The UK government is reconsidering its policy and intends to bring forward new proposals for developing casinos next year. A prospective programme of properly funded assessment of health effects must be part of any new proposals.
Notes
Competing interests: None declared.
Provenance: Non-commissioned, not peer reviewed.
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