Problem gamblers don't have to quit

Pathological gamblers may often be able to recover from their destructive habits without giving up gambling altogether, a new study suggests.

Researchers found that among nearly 4,800 Australian adults they surveyed, the 44 men and women who appeared to be recovering pathological gamblers had largely beat their problems without completely giving up the habit.

As many as 90% were still sometimes playing the lottery, hitting the casino or betting on sports - despite no longer screening positive for problem gambling.

Harm reduction

The findings, reported in the journal Addiction, are in line with what has been seen in the treatment of alcohol abuse. That is, some people in recovery can successfully cut back on drinking, rather than abstaining completely. This approach is sometimes referred to as "harm reduction."

And the results suggest that problem gamblers, too, can recover even if they do not quit altogether, lead researcher Dr Wendy S. Slutske, of the University of Missouri in Columbia, told Reuters Health.

Traditionally, abstinence has been the cornerstone of treatment for pathological gambling, being strongly espoused, for example, by the support group Gamblers Anonymous. But recent research has suggested that therapy aimed at "controlled gambling" can be effective.

Reaching treatment goals

This is important, Slutske's team notes in the report, because if controlled gambling, rather than complete abstinence, is a treatment goal, it's possible that more pathological gamblers will seek help.

The current findings are based on phone interviews with 4,764 Australian twins who were part of a national registry used for health-related research. All completed a standard questionnaire that screens people for lifetime and more-recent gambling problems.

Some signs of pathological gambling include a preoccupation with gambling, feeling the need to take increasingly bigger risks, taking time from work or family life to gamble, and hiding the habit from others.

In this study, 104 participants, or about 2%, screened positive for a lifetime history of pathological gambling. Of those men and women, 28 screened positive for the problem in the past year, while 32 met only some of the criteria for pathological gambling in the past year, and were considered problem gamblers.

Another 44 men and women did not report any symptoms in the past year; they were considered the "recovery" group.

Reducing addiction

Of that recovery group, 90% said they still gambled at times - though considerably less often than their counterparts who did report symptoms in the past year. For example, people in the recovery group gambled on an average of 54 days in the past year, versus 176 days among those who screened positive for pathological gambling in the past year.

The study has its limitations, including the fact that it assessed participants at one time point. A study that follows people over time, Slutske and her colleagues note, could help uncover the factors that allow some gamblers to recover "in the absence of abstinence." It could also show whether their recoveries last for the long haul.

"I don't think that we know yet how people (in recovery) are able to continue to gamble without problems," Slutske said, "and more research might be needed to answer this question."

The current study lacked information on how people in the recovery group had gotten to that point. In general, Slutske said, some pathological gamblers are able to cut back without any formal therapy - though they may well do so with the support of family and friends, she added.

Problems 'spontaneously remit'

Some others, Slutske noted, see their gambling problems "spontaneously remit" owing to changes in their lifestyle or environment.

Formal treatment often involves cognitive behavioural therapy, which aims to identify a person's unhealthy thinking patterns and replace them with more positive ones, as well as offer practical ways to alter negative behaviour. Studies have shown that certain medications, including antidepressants or drugs called narcotic antagonists, which are used to treat substance abuse, can be helpful for some people.

Slutske said that if more studies continue to support the effectiveness of controlled gambling as a treatment goal, it should lead to wider acceptance of the approach. - (Amy Norton/Reuters Health, October 2010)

SOURCE: Addiction, online September 20, 2010.

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