Gambling and gambling problems on the increase

Gambling is becoming more and more popular throughout the world. Many people have friends or family members who have gambling problems. The reason for this increase can partly be attributed to the legalization of gambling in many countries and an associated rapid increase in gambling facilities such as casinos and slot machines. Although gambling has brought income to some groups such as American Indians, it has brought very serious problems for both individuals and society as a whole. Increasing number of people are becoming addicted to gambling, bringing a whole gamut of problems. Pathological gamblers may develop stress related medical conditions such as peptic ulcers, depression, and alcoholism. Pathological gamblers also evidence anti-social behavior, leaving regular employment and even engaging in criminal activities to support their habit. And they often cause harm to their families and friends.

Pathological gambling seriously and adversely disrupts a person's family life, his work and his own happiness. A pathological gambler usually:

• is preoccupied with gambling
• spends increasing time and money gambling
• becomes irritable if unable to gamble (a withdrawal symptom)

In light of this increase in gambling and its resulting dangers, the research scientists who authored this article conducted an in-depth horizontal review (called a meta-analysis) of published studies of known treatments for people who are pathological gamblers.

How the researchers conducted their review

The researchers used sophisticated computerized searches of electronic databases for articles and studies of pathological gambling. They supplemented their work by hand-searches of specialized journals and doctoral theses, getting information directly from other researchers and treatment/research centers, and searched the bibliographies of the studies they found. They limited their search to studies of the treatment of pathological gambling.

They located and considered 17 studies that they thought were relevant, but only four of these were found to provide data of a similar nature that could be usefully compared and analyzed.

The researchers looked for data on the positive outcome of treatment. They considered positive outcome to be:

• total abstinence from gambling
• abstinence with an occasional lapse
• 'controlled' gambling

Other factors, such as the urge to gamble, the amount of money and time spent on gambling, psychological tests, and social integration were also taken into consideration.

The researchers found from the studies they analyzed that:

• about 1.60% of the general population studied experience gambling problems during their lifetimes
• about 1.14% of the population studied suffers actively from gambling problems, with younger people suffering more

Increased frequency of gambling in Spain, Germany, Holland, and New Zealand has led to increased pathological gambling, related criminal activity, and other problems. Sixty percent of pathological gamblers commit crimes to support their habit, and up to 30% become alcoholics.

A number of methods were used to treat pathological gambling, including prescription drugs (such as clomipramine, naltrexone and fluoxetine), behavioral psychotherapy, aversion therapy, and the Gamblers Anonymous' 12-Step Program. Unfortunately, almost all the studies were poorly controlled - in other words, appropriate groups comparing the intervention with non-intervention were not used.

The results of the review

The analyses indicated that psychological therapies (behavioral or cognitive-behavioral therapy) were more effective than other approaches, although the results were not really conclusive, due to lack of good data. On average, a positive outcome was obtained in about twice as many subjects receiving these forms of treatment. In general, the researchers found that, of the new experimental interventions, cognitive behavioral therapy was the most effective. The longer the treatment lasted, the more effective it was.

These results point to a lack of good research in this important field. The selected studies had small numbers of participants and were very heterogeneous. Indeed, the researchers, clearly stated that the quality and paucity of the existing data led them to believe that their results could not be truly meaningful.

Society is probably reluctant to perceive a form of income-generating entertainment as a source of serious problems. However, since gambling is becoming more and more widespread, and associated with increasing individual and societal problems, more complete and rigorous new research is needed.