Magdalena Boo, Health Improvement Principal, Sheffield City Council recommends the simple Lie/Bet screen. Have you  ever lied about yor gambling? Have you ever bet more than you can afford to lose?

She provides a flowchart for screening and referral, noting:

This (embedded PDF) flow chart guides affected individuals or clinicians through the screening process and enables them to identify which support is most appropriate for them at that time. Clinicians can help engagement in support services by completing online referral forms for patients and booking follow up GP appointments to check progress and engagement. There is low engagement in help-seeking and help is often only sought in a crisis such as a mental health or financial crisis, so if someone does present for help it is likely that they are at a very low point. There are emerging links between problem gambling and suicide so it is important to assess whether there is any immediate risk and follow suicide prevention protocols.

 

Co-morbidity or Dual Diagnosis

Is someone drinking because they’re depressed or depressed because they’re drinking, or both? That’s a classic example of difficulties faced by GPs. In the case of gambling, there is plenty of evidence to demonstrate not only that gambling is often seen with heavy drinking, for instance, but that it also causes intense emotional and mental distress, and further to this there is much evidence that the activity of gambling is for many a coping mechanism, a ‘self-medication’ to escape distress. There is also a great deal of evidence to show that gambling disorders, addictions and other serious mental health disorders share a common source in adverse childhood experiences. Such complex interplays are often emedded in contexts of negative social, cultural, economic and educational inequalities. As ever, the borders between ‘personal health’ and environment are very thin if they exist at all. Add to this that a dispassionate, not overly-cynical, perspective on mental health and addiction services would have to see the need for urgent improvement, something true of all public services.

Against any pessimism arising from considerations of complexity it can’t be said often enough that the best quality of human interaction can rise above constraints (and the ‘best’ service design will be useless without that prime quality). Cliches exist because they are true, and it is an historical record of individuals in all walks of life reporting thatt their lives changed for the better because of meeting somebody with that quality. It is equally true that an individual in the greatest of distress and hardship owns powers to endure and overcome. Similarly, communities in ‘data zones’ showing dreadful indicators of health, poverty, all-round deprivation are made of individuals and each is as much a unique individual as one in a leafy suburb: there can’t be one-size-fits-all solutions to the unique individual’s needs.

Also against pessimism, we should remember that many people ‘recover’ with little or modest intervention. Often their needs are more straightforward, and perhaps they are supported by family and other close people, with employer support, good levels of social and cultural capital. We need to remember too that a third of people with behavioural disorders recover spontaneously with no support: this is most prominently seen in young adults who ‘mature out’ of harmful behaviours as they start a family.

Finally, having mentioned the leafy suburbs it is crucial to remember that people of any background can develop dosorders on the addiction spectrum. Priests, teachers, doctors, politicians all share one thing with us: they are human. It’s important to identify that gambling disorders are more likely in individuals from communities impacted by inequality but we need to be wary of stereotyping and stigmatising ‘addiction’ as located only in communities already heavily stigmatised by all the markers of deprivation.

The details below show the possibilities arising with comorbidity:

Comorbidities and Gambling Disorder

Nurses and healthcare personnel working in any setting should be aware of the comorbidities that may accompany a patient’s problem gambling: alcohol/substance abuse (Black & Shaw, 2008; Lorains et al., 2011; Rash et al., 2016; Rodda et al., 2012, 2016; Streich et al., 2020; Wareham & Potenza, 2010); anxiety (Black & Shaw, 2008; Lorains et al., 2011; Rodda et al., 2012); ADHD (Black & Shaw, 2008); depression (Black & Shaw, 2008; Lorains et al., 2011; Quigley et al., 2015; Rodda et al., 2012); panic attacks (Lorains et al., 2011); severe legal and financial issues, such as job loss, lost time and lost productivity, theft, fraud and embezzlement, bankruptcy, divorce, healthcare problems due to high stress, prison time and homelessness (National Endowment for Financial Education & National Council on Problem Gambling, 2000); suicidal ideation/attempts (Goldman, 2013; Hills, 2010; NorthStar Problem Gambling Alliance, 2013; Russel, 2014); obesity (Streich et al., 2020); nicotine dependence (Lorains et al., 2011; Rodda et al., 2012; Streich et al., 2020); binge eating disorder (Yip et al., 2011); ACES or adverse childhood experiences (Sharma & Sacco, 2015); manic depressive disorder (Black & Shaw, 2008); homelessness (Stein & Stinchfield, 2020), using or taking dopamine for Parkinson’s Disease which may increase the incidence of GD (Stein & Stinchfield, 2020); domestic violence (NorthStar Problem Gambling Alliance, n.d.) and PTSD (Najavits et al., 2011).

Genetics definitely play a role in gambling disorder, with some twins studies elucidating exactly how genetics and GD relate. Studies show that there is considerable evidence for the influence of genetic factors on GD, along with complex interactions with both environmental factors as well as other psychiatric disorders. Lobo and Kennedy (2009) argue for the further study of genetic and biological factors and their impact on GD in order to develop more specific and finely targeted prevention and treatment strategies.