PATHOLOGICAL GAMBLING. INTERVIEW WITH DEAN GUSTAR, RELAPSE PREVENTION SPECIALIST

What distinguishes pathological gambling from typical gambling patterns?

Pathological gambling is a pattern of disordered gambling that leads to negative consequences for a person. Maybe some people will do the lottery, or play bingo every now and again, or go to the casino – win a little money, lose a little money, walk away, and maybe they won't gamble for the rest of the year. This is most of the population. A small amount of people, this gambling will develop into a disorder where they continue to gamble, it becomes compulsive in its manner and it starts to cause them problems.

What factors make gambling addictive?

Part of the reason that gambling is so addictive is, if you drink some wine or smoke some cannabis, you know what the outcome is going to be. When you gamble, the outcome can fall one of two ways. You can win or you can lose. And there's this period of anticipation that comes before the result. So you place your bet. You have this anticipation where the feelings are rising, and then you get the result. So that anticipation moment is very powerful. All the body chemistry is changing, the adrenaline is rushing. It's a very, very powerful compulsion. Then the result comes, there’s a deflation. So generally, with compulsive gamblers, the second bet follows very quickly after the first bet. And this anticipation is what makes it so much more intense. And this uncertainty of the outcome.

What are the signs of pathological gambling?

So there are a variety of symptoms for pathological gamblers. Gambling will begin to take up more of their time. They will be preoccupied with gambling, either raising funds to gamble or spending time gambling. There may be patterns of dishonesty. They may need to increase the amount they gamble to feel the same impact. Really, the gambling becomes an escape for them. People have described to me that when they're gambling, they call it ‘to be in action,’ that when they're in action, the whole rest of the world disappears for them. So they're not thinking about anything else but gambling and betting, and that's it. So you'll generally see this huge preoccupation with gambling. One of the other things that makes gambling very different to, let's say, substance use disorder is it's very difficult to tell if someone's a compulsive gambler.

How does The Kusnacht Practice address gambling issues?

So to treat pathological gambling at The Kusnacht Practice, we have a multidisciplinary approach. There's a strong psychiatric and psychotherapeutic component to that. Gambling is a behaviour, so we look at the cognitive-behavioural therapy to address some of the cycle of addiction. We will use psychotherapy to examine some of the underlying causes that drive the behaviour. We will also do some practical things. So, often, gamblers have losses associated with their gambling. So one of the things that we would encourage clients to do is to do a full inventory of actually what their gambling has cost them and what outstanding debts need to be covered, and to come up with a plan to manage the finances, the financial impact of their behaviour.

What is the average treatment duration at The Kusnacht Practice for gambling issues?

Changing any behaviour is a challenge and it's not going to happen in two weeks. We would usually recommend a minimum of six weeks for somebody with, presenting with pathological gambling, but this is going to be a long journey as well.

What are the consequences of pathological gambling?

So the family system can get affected in several different ways. The first most obvious one is financially. Capacity of the pathological gambler to lose money is almost unlimited. I've made several comparisons to substance use disorder and alcohol use disorder. You can only drink so much alcohol, and you can only use so much drugs. But really, you can keep gambling and gambling and gambling as long as there's money in the pot. So there can be a huge financial impact for the family. There will be a constant preoccupation with gambling, so the focus will be taken away from their work, their studies, their family, their children, their spouses. Gambling becomes the number one thing, and anybody that gets in front of the gambling is likely to encounter maybe anger, maybe even rage if somebody tries to stop the gambling. A pathological gambler will be highly defensive of their behaviour.

What advice is recommended for families dealing with gambling issues?

I would recommend that families have a strategy of being honest but compassionate, and teamwork as well. They don't need to protect the individual. They need to be honest with their concerns and factual. If they're seeking external help, I would tell the person of concern, ‘you're gambling is putting a drain on the whole family system, we're going to look for some support’. They can consider things like an intervention, contacting a professional intervention company and and having a facilitated talk with the client and they can reach out and explore different treatment options and present these to the client. They should also educate themselves around pathological gambling.