‘As there aren’t ex-alcoholics, there aren’t ex-gambling addicts’
Psychiatrist Boris Mendelevich on what gambling addiction is, why it isn’t a vice but disease and how difficult it is to treat
Waitress from Las Vegas Cynthia Jay won almost $35 million against a one-armed bandit in casino 20 years ago, on 29 January 2000 — it was one of the jackpots of that time on record. In his column for Realnoe Vremya, the State Duma’s deputy from Tatarstan, Doctor Boris Mendelevich talks about another, hidden side of gambling. It is gambling addiction — a serious addiction that has broken many lives.
It isn’t a toy
Gambling addiction, ludomania or simply gambling is a disease. We, doctors, qualify it as a disease as we do those general medical conditions we have known for long — arthritis, pneumonia, gastritis and so on. Gambling that was added to the International Classification of Diseases is a diagnosis for a reason. Gambling in itself is an addiction. There is gambling addition as well as an addiction to alcohol, nicotine, drugs. Different additional mental disorders can develop when one has this disease. This disease has subdivisions depending on the severity and those mental disorders that form at the same time.
Some addictions are treated a bit better, some are a bit worse. From this point of view, gambling is one of the most serious addictions that are very hard to treat. But one should understand that not all people who regularly play slot machines, go to the casino, play online, bet on totalisator are people with an addiction, gambling addicts.
Why can some play, while others not?
Modern science can’t so far answer the question of how one becomes addicted and why some are subject to it, while others can easily play poker at weekends all their life. It is a product of the brain that hasn’t been studied yet. But there is some logic that works for all addictions. We know people who can smoke a cigarette a week and not become addicted, while others smoke packets. Also, some people can drink alcohol sometimes, and nothing will happen to them while others take to drinking within a couple of months. This likely depends on plenty of reasons. I can only assume, but there is an opinion that the hereditary factor, the psychological role of education and environment a person grew up and is in, his psychological typology also play a role. All this probably predicts what we are talking about — the aetiology of gambling addiction.
According to scientific evidence, the share of people with addiction among those who regularly gamble or bet is relatively small — from 1 to 10% of those who do it on a regular basis. The number of true addicts among them isn’t big.
According to scientific evidence, the share of people with addiction among those who regularly gamble or bet is relatively small — from 1 to 10% of those who do it on a regular basis. The number of true addicts among them isn’t big
Disease, not sin
There is a big problem: the attitude of society to people with some dependence, including gambling addiction. This is especially evident among people with alcoholism or drug addiction. We conducted surveys and found out that 90% of the population believe that an addiction — alcoholism, addiction to drugs, gambling — are a vice, not a disease. I will say even more: we did such research among doctors too. We got astonishing results. Over 60% of doctors consider it isn’t a disease but a vice, sin! And it is a very big problem.
I often argue on social media that one should treat these people as patients because they really have an addiction. And even when the return of smoking areas to airports was discussed in the State Duma, I was a fervent supporter of this bill and said from the State Duma rostrum that we couldn’t prohibit a person with bronchitis from coughing or a person with arthritis from limping. Neither can we prohibit a patient with alcoholism from drinking and patient with gambling from betting.
On the other hand, bans or the creation of conditions in which a patient has less access to his addiction influence the outcome, of course. Without doubt, prohibition is needed, but it is impossible to treat a person with prohibitions only. A gambler can be locked at home, stay there for six months, but when he goes out, he will up and go to bet. We can’t do without medical methods to fight gambling.
How to treat gambling addiction
Gambling addiction is a chronic disease. As there aren’t ex-alcoholics, there aren’t ex-gambling addicts. A person is considered recovered until he makes the first bet. Doctors can achieve remission only — a state without aggravation. As soon as the person meets the game again, the disease comes back. Like dependence comes back to the alcoholic who hasn’t smelled alcohol for years and suddenly has drunken a shot.
A person is considered recovered until he makes the first bet. Doctors can achieve remission only — a state without aggravation. As soon as the person meets the game again, the disease comes back
There are different ways of treating gambling addiction. They are divided into several types. Firstly, if mental disorders accompany gambling addiction, their manifestation is treated with medication, depending on severity. Secondly, if there is an addiction but there aren’t mental disorders, the toughest thing begins — its treatment. For this purpose, there is a wide range of mental therapy methods, psychological methods. There can be created a paradigm of another behaviour — this is possible. But in case of gambling addiction, it is a hard task.
A lot turns on the patient’s motivation. Like in case of any dependence, the patient’s desire to get rid of it, his motivation matters. It is impossible to treat a person by force when he doesn’t want to do it — here I can’t help but draw an analogy between this and alcoholism again. Now a lot is said that it is necessary to return occupational therapy rehabilitation centres for alcoholics and create compulsory treatment. But here I always ask: “How are you, in fact, going to treat them if they don’t want it?” The same thing happens here. It is impossible to treat anybody from ludomania by force. And the creation of steady motivation for treatment is a task of a psychotherapist who works with the patients and this person’s circle — his relatives, family.
Addictology yesterday and today
Dependence in itself has existed always. When casinos didn’t exist, people played cards, bet at hippodromes in the Soviet era. The problem existed. But official science addictology — science about addictions — was born in the West. We were not taught such a subject when I studied at university. We heard of such science in passing, but nobody taught methods of work with it. Everything came to us from abroad — both the theory of addictology and all possible methods of treatment — but all this did dirt to our country in the 90s.
When the level of patients with different addictions was over the top in the 90s, the addictological service wasn’t very developed in our country. Treatment methods weren’t elaborated. Ways that can’t be called medical blossomed: different shamans, fortune tellers, quack old women in the countryside operated well. Hypnosis in general is, of course, a psychotherapeutic method, but it completely lost its scientific evidence in the 90s. Over 90% of the treatment that was offered in our country 30 years ago was fraudulent.
Fortunately, addictology seriously develops now, including in our country. A lot of educated doctors, psychotherapists, psychologists appeared who successfully use modern methods and fight different types of addiction. But, of course, the percentage of recovery from gambling addiction isn’t as high as we would like it to be.
The most important thing is that the person understand that there is a problem and it must be solved with the help of a medical worker. A doctor examines a patient and then makes conclusions: if there is an addiction, and what to do next
When is it time to see a doctor?
I am often asked how to know when it is time to see a doctor, what are the signs when a usual liking became a problem. Unfortunately, it is hard to advise something specific here: only a doctor gives a diagnosis. This is why if you see something is wrong with your close person, the game begins to win him, it is necessary to try to persuade him to seek a specialist.
The most important thing is that the person understand that there is a problem and it must be solved with the help of a medical worker. A doctor examines a patient and then makes conclusions: if there is an addiction, and what to do next, if a person needs medication or psychotherapy. A person can turn out not to need anything — just change the lifestyle because, as I already said, not any excited gamer is an addicted gambler.
Gambler and law: how to fight online casino
The number of people who have had this problem in the last decade has reduced, I saw it myself. Perhaps, this happened because at one point the wide spread of casino and places with slot machines were prohibited in Russia by law.
But the Internet provides great opportunities for gambling now. There is no need to go somewhere now to make a bet or play an analogue of the machine. And if we stick to the paradigm of what we did, of course, the same legislative norms need to be established as for offline casinos and gambling venues. And not only because of what we talked with you about.
For instance, we have been discussing a project of online sale of medication in the State Duma for long. And I have always said that the same legislation must be created for online pharmacies as legislation that was created for usual pharmacies. Another example is that different modern tobacco substitutes — IQOS, hookah and such things — must be regulated like tobacco, in the same way! And I am convinced that everything that has to do with online gambling must comply with legislation regulating the offline sphere.
There is no need to go somewhere now to make a bet or play an analogue of the machine. And if we stick to the paradigm of what we did, of course, the same legislative norms need to be established as for offline casinos and gambling venues
Time passes by: we banned beer commercials, non-alcoholic beer instantaneously started to be advertised. It is a catch, I think. And it is necessary to fight it legally. Or, for instance, the much-suffering ban on “on-tap” alcohol, which is still created — it is also designed to fight catches. All these night “cafés” with no sign of public catering selling alcohol for the lowest extra charge at any time is a way of bypassing current legislation.
Online casino is a catch too. Registration of such resources and their licensing is banned in our country, but they bypass this ban obtaining permission in other countries. And something has to be done with it.