Gambling Help provides confidential online, telephone and face-to-face counselling. The website contains useful information for people with gambling issues and their families. They can be contacted 24 hours a day on 1800 858 858 or at: www.gamblinghelponline.org.au
Treating problem gambling
- A number of screening tools are available to assess the presence and severity of problem gambling.
- Cognitive behavioural therapy (CBT) is the recommended psychological treatment for gambling problems (PGTRC, 2011).
In Australia, the term 'problem gambling' is used to refer to a condition when an individual has difficulties (Neal, et al., 2005) limiting the money and/or time spent gambling, which leads to negative consequences for:
- family and friends
- the community
Problem gambling is also characterised by the individual’s struggle to control gambling impulses despite adverse consequences in other areas of life.
Australia has a highly accessible gambling environment by international standards, with large numbers of electronic gambling machines (‘pokies’) located in pubs, clubs and casinos, as well extensive advertising of online sports betting.
A study of currently serving military personnel from Australia indicated around 8% who reported at least some gambling problems (including problem gambling and sub-clinical ‘at risk’ gambling) in the post-deployment period (Cowlishaw et al., 2020).
Although there is very little information regarding Australian ex-service personnel, a study of veterans in PTSD treatment indicated that gambling problems were an issue for around 29% of patients (Biddle et al., 2005).
Studies of the Australian general community indicate that young males aged 18-24 report particularly high levels of gambling problems and harms (Armstrong and Carroll, 2017).
Problem gambling is high among people with other mental health problems, including mood, anxiety, and substance use problems (Cowlishaw et al., 2014; Lorains et al, 2011).
Screening and assessment
Practitioners are advised to screen and assess for problem gambling in veterans with mental health problems. A one-item screen recommended in the current Australian guidelines Problem Gambling Research and Treatment Centre (PGTRC, 2011) is:
- Have you ever had an issue with your gambling?
If the veteran answers ‘yes’ to this question, further assessment of his or her gambling habits is recommended.
A number of screening tools are available to assess the presence and severity of problem gambling. Scales that have been tested and validated in the Australian context include:
- Canadian Problem Gambling Index (CPGI), and its abbreviated form, the Problem Gambling Severity Index (PGSI)
- Victorian Gambling Screen (VGS)
Psychoeducation and self-management strategies
Providing information on problem gambling and encouraging the client to use self-management strategies is useful, while undergoing more targeted treatment. For example, the practitioner can:
- discuss the problem gambling in a non-judgemental and non-threatening manner
- listen carefully to the veteran’s reactions and concerns
- advise the veteran about the degree of risk and consequences associated with his or her gambling. Refer him or her to information that dispels the myths related to gambling, e.g. odds of winning, how pokies work (www.gamblinghelponline.org.au). Ask the veteran to outline the benefits and costs of continuing to gamble at the current level.
- help set goals that are realistic and involve a reduction or elimination of gambling.
- discuss and help implement strategies to reduce gambling. The veteran may have already used some strategies with success. Begin with his or her suggestions then add others.
Cognitive behavioural therapy (CBT) is the recommended psychological treatment for gambling problems (PGTRC, 2011). CBT is used to reduce:
- gambling behaviour
- gambling severity, and
- psychological distress
Cognitive behavioural therapy (CBT)
Practitioner delivered CBT may include some or all of the following elements:
- motivational interviewing – to increase the veteran’s readiness for making changes to their gambling behaviours
- cognitive therapy – to challenge and modify any cognitive errors related to gambling (e.g. misunderstanding of randomness and the odds of winning)
- identification of triggers and high-risk situations for gambling, and coping strategies to use in these situations.
- exposure therapy – techniques such as imaginal desensitisation, in vivo exposure and response prevention
- activity scheduling – encouraging the veteran to schedule enjoyable activities as an alternative to gambling
Psychological treatment setting and duration
Problem gambling can usually be treated in an outpatient setting. There is currently insufficient evidence to recommend an optimal duration of psychological treatment, or to suggest whether therapy is best delivered in a group or individual format.
There is a modest body of research regarding pharmacological treatments for problem gambling. This provides preliminary evidence which suggests that opioid antagonists and mood stabilisers can be potentially helpful in the short-term, although the duration of effects are unknown (Dowling et al., 2020). The potential side effects and risks of any particular pharmacological intervention for problem gambling are important to consider.
Almost everyone gambles from time to time. However, gambling can become a problem for some people when they have trouble setting limits on the time and money involved. If you’re worried about your gambling, find out more about gambling problems and how you can get them under control.
Regularly making risky or dangerous choices - such as getting into fights, drink driving or unsafe sex - can indicate an underlying problem that should be addressed. If you are worried about your risky behaviour, or that of a loved one, help is available.