Consults - New York Times Blog
November 1, 2010, 11:05 am
Seeking Help for Gambling Addiction
By THE NEW YORK TIMES
Ann Johansson for The New York Times Timothy W. Fong, M.D.

Is treatment for gambling addiction different than for other addictions? What’s the best way to get the compulsive gambler to stop? What can family members do to encourage treatment, and to protect themselves? These are among the questions recently posed by readers of the Consults blog.

Dr. Timothy Fong, co-director of the gambling studies program and an associate professor of psychiatry at the University of California, Los Angeles, responds. For more information, see Dr. Fong’s earlier responses in “When Is Gambling an Addiction?” and the U.C.L.A. Gambling Studies Program Web site.

Treatment of Gambling Addiction vs. Other Addictions
Q.

What similarities/differences are there in treating gambling disorders versus treating substance use disorders? Are self-help groups like Gamblers Anonymous, or GA, effective? Less effective? Are motivational interviewing techniques and relapse prevention education part of the standard of care?
kerewin1971, Washington, D.C.
A.

Dr. Fong responds:

Treatments for pathological gambling and substance abuse disorders are similar in that they both require an integrated approach that will meet the needs of the individual patients. Treatment programs will consist of individual therapy, group therapy (like GA or AA), family therapy and other structured recovery programs.

Most treatment programs for gambling addiction are successful if the patient fully commits to treatment and does the work and recovery activities that are recommended. Gamblers Anonymous is the most widely available form of support for recovery and is part of most treatment plans.

The major difference between treatment of gambling addictions versus substance abuse is that there are no objective tests, such as random urine drug testing, to identify someone who has gambled recently. Because gambling addiction and substance use disorders commonly co-occur, treatment for both oftentimes happens in substance abuse treatment settings.

Gamblers Anonymous
Q.

Gamblers Anonymous is one program for gamblers who can admit they are powerless over gambling (once they start they can’t stop) and their life is unmanageable. I suggest googling GA to find local meetings.
Anne, New York
A.

Dr. Fong responds:

Gamblers Anonymous is available in every major city in America and has been around for over 50 years. To find a local meeting, visit the GamblersAnonymous.org Web site.

Drugs for Compulsive Gambling?
Q.

Are there medical treatments (drugs) available to treat gambling addictions?
zzishate, Alexandria, Va.
A.

Dr. Fong responds:

There are no medications currently approved by the Food and Drug Administration for the treatment of gambling addiction. Over the last 15 years, several medications have been studied, with varying degrees of success in helping pathological gamblers curb their symptoms. These drugs include antidepressants, seizure medications and medications that block opioid receptors.

Medications can reduce the urges and cravings to gamble and can also lessen the symptoms of depression or anxiety that might be triggering continued gambling. When considering treatment for gambling addiction, medications are an important part of the recovery plan, but they are most effective when used in conjunction with professional counseling.

Gambling Addiction vs. Gaming Addiction
Q.

Do you believe there is a difference between compulsive gambling and compulsive video gaming, since both work on intermittent reward systems and dopamine action in the brain? And, if you believe somebody can be treated with drugs, must there be a cognitive/social/behavioral intervention as well, for treatment to be effective?
Sumer, New York, N.Y.
A.

Dr. Fong responds:

Behavioral addictions have been shown to involve the neurochemical dopamine. The exact neurocircuitry and neurochemicals involved in pathological gambling versus video game addictions have not been differentiated. Clinically, the disorders are similar in that they involve loss of control, preoccupation and continued involvement despite harmful consequences. A fascinating question is why one person drifts toward gambling while another drifts toward video gaming.

Effective treatments for pathological gambling and any other addictive disorder require an integrated approach that combines individual therapy, medications, group therapy and restoring the ability for self-care. Treatment plans that only provide one or another form of treatment but not all of them will not be as effective.

Convincing Gambling Addicts They Need Help
Q.

How can relatives of compulsive gamblers help convince them to get help? If they cannot convince them, how can they best deal with their addiction?
Carolyn, St. Louis
A.

Dr. Fong responds:

The most important action family members of pathological gamblers can do to help the situation is to learn more about pathological gambling and how to take care of themselves. Family members who are supportive and willing to participate in the treatment process instead of making threats or judgments are more likely to see positive outcomes.

There are no magic words that family members can say to those with gambling addiction that will convince them to seek treatment. Instead, stating to the gambler how concerned and how much the gambling has impacted their own lives will often be enough to motivate gamblers to seek treatment.

Finally, family members ought to seek out professional help for themselves or seek support from a Gam-Anon meeting, a 12-step support group for family members, to help stop any behaviors that are enabling the gambler. More information is available at the GamAnon.org Web site.

Helping Family Members of a Compulsive Gambler
Q.

How can I help the spouse of a recovering gambling addict handle the aftermath of the gambling addict’s behavior (I am a relative of the spouse)? A large portion of the family’s money was gambled away, but five-plus years have passed and the spouse still retains a LOT of anger towards the gambler regarding the lost money. What resources are there for those of us dealing with an addict and the problems caused by the addict’s behavior?
P, New England
A.

Dr. Fong responds:

For affected individuals of a pathological gambler, help is available through Gam-Anon, a support group for family members of gambling addiction. In these groups, one will find emotional support and ideas on how to deal with the consequences of gambling. In addition, individual therapists or counselors are available to help deal with the anger, depression, shame, guilt that the affected individual ends up feeling. This disease leaves traumatic scars, emotionally and financially, and there are times that only professional help can manage those feelings.

Medications That Cause Gambling Addiction
Q.

A person with Parkinson’s developed a gambling, risk-taking addiction while being treated with the dopamine agonist Mirapex. The behavior stopped after the drug was removed, but is he now at a higher risk for relapsing?
Ms. R., New York
A.

Dr. Fong responds:

If the person did not have a gambling problem before taking Mirapex, and if that drug is stopped, there is a good chance that the gambling addiction will not return. There is no guarantee that the gambling will not return, though, and the best course of action would be to refer the person to a gambling treatment specialist.

In Search of a Healthy Environment
Q.

I gamble as a social outlet. I’d much rather do something to reform society, which is in a mess at the moment. A. A. Berle pointed out that we have no social. index, no system of value. Kenneth Arrow pointed out that we can’t have a social welfare function. Interesting work with a real purpose is unavailable to most of the population because capitalism has failed to produce the abundance of resources that Marx predicted. Malthus and Darwin are still strangling Condorcet. You might refer to the work of Bruce Alexander who demonstrated that rats gave up their addictions when placed in an interesting environment. If a healthy environment gave addicts the release they seek in drugs, there would be no addicts.
Richard Maxwell, Winter Haven, Fla.
A.

Dr. Fong responds:

Your comment taps into the idea that recovery from addictive disorders is a voluntarily maintained lifestyle characterized by sobriety, self-care and citizenship. The reality is that our current environment is one that promotes consumption, recreation and instant rewards, all of which are very reinforcing and compelling to the brain.

Casino Education
Q.

Las Vegas is seeking ways to fill its hotel rooms. Why not teach courses on gambling addiction control there all year round? Some of the older hotels offer amazing discounts.
Sol Biderman, Brazil
A.

Dr. Fong responds:

Many of the Las Vegas casinos do train their employees on how to spot signs and symptoms of gambling addiction and there are conferences each year on the topic of gambling addiction.

For more information, see Dr. Fong’s additional responses in the Related Posts section, below.

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