By Paula Bradley, InPsych Production Editor
How big is Australia's gambling problem?
IN THE past, problem gambling has been viewed in many ways as a disease, an addiction or a learnt behaviour. The literature mostly originated from the United States and was based on in-patient and male samples. A strong bias towards the medical model and the conceptualisation of problem gambling as compulsive was evident.
More recently, psychologists in Australia and around the world have begun to understand that there are different ways that people develop problems with gambling. "Researchers from a range of disciplines have revitalised the way we look at gambling," says Richard Spence-Thomas, PhD candidate at RMIT University's Department of Psychology and Disability Studies, "and psychology is at the forefront of attempts to understand problem gambling from a research perspective."
One explanatory model of problem gambling that has gained widespread acceptance is Sydney clinical psychologist Professor Alexander Blaszczynski's 'Pathways Model'. Blaszczynski identifies three main sub-groups in the problem gambling population: the 'normal', 'emotionally disturbed', and 'biologically based impulsive pathological gamblers'.
The 'normal' gamblers are people that develop a problem from a positive reinforcement perspective, but don't have any pre-existing mental illnesses. "Usually they are people who start gambling because their social group frequents gaming venues, or they live in an area where clubs with gaming machines are common places to go out," Richard says.
"Psychological science suggests that that intermittent reinforcement is the most powerful type of reinforcement. In the gaming machine context, a person might have a couple of random wins and get a bit hooked on it - continuing to play in the expectation that they can win again. They are further reinforced to return by the social environment (relaxing music, attentive and obliging staff, free tea and coffee, inexpensive meals)."
People in this group may go on to develop mental illnesses as a result of their gambling, most commonly depression as they lose control of their finances, relationships fail etc., which can put them into the next classification.
Blaszczynski's second subgroup, the 'emotionally disturbed', has predisposing psychological vulnerability and possibly a family history of gambling. They display depression, anxiety, substance dependence, and deficits in their ability to cope with and manage external stress (Blaszczynski, 2000). These people use gambling as an attempt to solve or avoid their underlying issues.
The third and perhaps smallest group, the biologically based group, may have biological issues that make them more vulnerable to pathological gambling. "These people are highly impulsive and therefore can't resist the urge to gamble, which is perhaps associated with a biological impulsivity," Richard says.
"They may have a range of impulsivity or attention deficit issues, which can be associated with poor behavioural control. It may also be possible that there is something about poker machines that they find relaxing - although we don't know enough about this yet."
Using an empirically validated model such as the Pathways Model is clinically very useful, according to Richard, because it means counselling services can tailor treatment to the particular types of clients. It helps to direct resources appropriately.
Psychologist and Manager at Gambler's Help (Melbourne City Office), Tim McCorriston, says that Blaszczynski's model "intuitively feels accurate" and certainly offers an acknowledgment that there is a broad range of different types of gamblers.
"It is a fallacy to lump them all in together. While there are obvious reasons for people interpreting problem gambling as an addiction (being enslaved to a behaviour), I steer away from that notion because it conjures a medicalised notion of problem gambling. The disease model does not provide a great platform for individuals to envisage mastery over the urge."
Tim says the 'normal' gamblers often respond fairly quickly to an examination of the cognitive distortions around gambling, such as the odds of winning, the truth behind the win/loss ratio, beliefs about skill in non-skills based games and the likelihood of chasing one's way back to financial security.
Tim says financial counselling is an important addition to therapy that helps to contain the gambling behaviour. "If a financial counsellor can help people find other pathways to financial recovery, this can release them from the notion that gambling is their only financial salvation," he says.
Tim says people who have stumbled into gambling can very quickly lose control of their finances. "You've had a win, gone back, got a bit behind and feel the need to chase back your losses. Maybe you have a bill you have only half the money for, and think, "Well I can't pay it, so I might as well try my luck to make it up."
"Of course the odds dictate that the more you gamble, the closer you get to the average result - that you lose. So the pattern becomes one of consistent losses and by this time, you might be in debt $2000. You are now in a mess and the option to come clean with your partner or family produces much anxiety.
"Some might be ready to fix the problem, others might not stop chasing until they are significantly more in debt, in many cases tens of thousands of dollars. This might finally be the point when a problem gambler accepts that they are not going to be able to make up the debt and seeks help; others get involved in criminal activity as a measure of their desperation."
The belief that they can still win, rather than accepting a debt cannot be won back, is a contributing factor to a significant drop-out rate in this client group. Many problem gamblers approaching counselling are notably ambivalent, Tim says. "Our centre has an intake system that is designed to engage our clients effectively - every day a counsellor is on duty to respond to new client enquiries to help people feel more comfortable with the notion of seeking assistance.
"Some problem gambers may just generally teeter in their acknowledgment that the behaviour is problematic or that they need to seek help. In many cases a crisis may trigger someone to call Gambler's Help, but often, as the immediate crisis passes, so does the acknowledgment of the problem and the motivation to address it. For us, intake is a critical opportunity to crystallise the client's motivation to make changes."
Gambling as an escape
Tim says the 'emotionally disturbed' group described in Blaszczynski's Pathways Model feature prominently as a client group at his centre. "These people gamble to manage their emotional state. The dissociative quality of the gambling experience feels like respite from their problems, but meanwhile, they are not attending to the underlying issues in their lives."
With this group, Tim says a two-tiered approach seems to work well. Firstly, cognitive behavioural approaches can help "get things under control" for the client, and once that has been achieved, he says, then intrapersonal work looking at how emotional functioning and personality characteristics link in with gambling behaviours can also assist.
"We try to understand the purpose and meaning of the gambling behaviour by looking at the client's history, issues and themes in their lives. We usually start to find formative experiences that have lead to certain coping strategies. An example is someone who might have grown up in a family in which there was a constant threat of physical violence. Running away and hiding from that could set up early patterning of escape and cacooning, which might later in life be mirrored in their gambling response."
Tim says this contextual work helps people "unhook" themselves from gambling.
If the issue is anxiety associated with demands at work and at home, treatment might involve assertiveness strategies, time-management skills and the client creating time for themselves. If the issue is depression associated with unemployment and social isolation, then CBT with some practical strategies to link with the community and work on how the client sets up relationships might be the key.
In Australia, the harm minimisation or controlled gambling approach is well accepted among psychologists working in the field. Lapses and relapses are common, Tim says, but they can't be overdramatised. "We use them to learn more about the patterns and the high-risk times. We encourage clients to be smart about high-risk situations and develop strategies to minimise the likelihood of lapses.
The practice of offering controlled gambling as a treatment goal was recently empirically validated by the PhD research of Dr Nicki Dowling at RMIT University's Department of Psychology and Disability Studies. She conducted seven experimental studies as part of her research, with her thesis entitled, 'The efficacy of a cognitive behavioural approach in the treatment of female pathological electronic-gaming-machine gambling'.
Nicki was particularly interested in women because 40% of the problem gambling population in Australia are women and over half the people presenting to problem gambling centres are women (Productivity Commission, 1999).
One of the studies compared women who selected their own goal, whether that was controlled gambling or abstinence. A 12-week outpatient treatment program was run, which consisted of a number of cognitive behavioural techniques including financial limit setting, alternative activity planning, cognitive restructuring, problem solving, communication training and relapse prevention.
The relative success of the treatment program was evaluated on a range of conceptually related measures within five areas: gambling; subjective control; psychological functioning; relationship functioning; and family functioning.
"While pathological gamblers placed on a 12-week waiting list did not show significant improvement, the female pathological gamblers showed significant improvement on all measures of gambling behaviour, subjective control and psychological functioning over the treatment period, and maintained this improvement at the six-month follow-up evaluation," Nicki says.
"There was absolutely no difference in the outcomes whether the women chose controlled gambling or abstinence. They performed equally well across the entire program and at follow-up.
"Overall, the implications of the research are that controlled gambling is a viable option as a goal of treatment and a viable outcome of that treatment," she says.
One third of the clients involved in the research chose controlled gambling as a treatment goal. "After the treatment, those women had a slightly higher level of psychological functioning because it takes coping resources to enter and leave a venue without resorting to the problem gambling behaviour," Nicki says.
Nicki also undertook a cluster analysis conducted on the women's scores on the clinical scales of the MMPI-2, which identified three homogenous groups of pathological gamblers with progressively severe psychopathology. The first was a 'normal' group with no pre-existing condition, the second was an intermediate group sitting in the sub-clinical/clinical threshold, and the third was the pathological group, which displayed a range of psychopathology.
Nicki says that this cluster solution approximated the sub-types proposed in Blaszczynski's Pathways Model, but concluded that until further research was conducted to determine the differential responses of pathological gambling sub-types to specific treatment interventions, the use of cognitive behavioural therapy was recommended as best practice for the treatment of problem gambling.
Readers who wish to make contact with their district Gambler's Help office (in Victoria), should call the Council of Gambler's Help Services on (03) 9654 3017 or go to for further information.
Blaszczynski, A (2000), Pathways to Pathological Gambling: Identifying Typologies, eGambling, The Electronic Journal of Gambling Issues, The Centre for Addiction and Mental Health, www.camh.net/egambling/issue1.
Australia's Gambling Industries (Report No 10), Productivity Commission, PC Inquiry Report (1999).