Gambling & Mental Health

Gambling & Depression

Gambling and depression commonly occur together, and gamblers are much more likely to suffer from severe mental illness than people who do not gamble to excess. People commonly use gambling to escape depression, reality, or other negative feelings and situations, but gambling can also contribute to more feelings of depression. Those with a history of mental health conditions including depression are at risk of developing problem gambling and may also find it harder to stop problem gambling once it starts. Gambling can provide a way to connect with others or  boost someone’s mood.

Most people would understand the experience of feeling excited when they win something and upset or disappointed when they lose. For problem gamblers what comes after losing, is often feelings of depression, despair, shame, and guilt. A Study of Gambling in Victoria from a Public Health Perspective (2009) found that more than 27% of problem gamblers and 6% of moderate risk gamblers admitted to considering taking their own lives.

Signs of depression may include:

  • Increased irritability and frustration
  • Loss of interest in activities and friends
  • Feeling tired and worthless
  • Struggling to sleep or finding it difficult to get out of bed
  • Loss of appetite
  • Negative or hopeless thoughts

Gambling & Anxiety

Gambling and anxiety commonly occur simultaneously. While gambling may help to alleviate anxiety and stress, this is usually temporary and instead, anxiety usually increases overtime. People often describe the feeling while gambling as being excited or in the “zone”, where they are distracted and fully immersed in the gambling. This temporarily relieves anxiety and other stressors, and this cycle can become part of everyday life. People with gambling issues find it difficult to control the urge to gamble, regardless of the damage it brings. The “zone” increases the risk for people to spend more time and money than they realized or intended. However, once the gambling session has stopped the anxiety and stress of gambling or other circumstances return in full force. Therefore, a good starting point is to start controlling anxiety levels before changing gambling behaviours. Fortunately, there are many resources and supports that can assist in this process.

Signs of anxiety include:

  • Insomnia
  • Irritability
  • Heart palpitations
  • Sweaty hands
  • Feeling out of control
  • Constantly feeling overwhelmed
  • Feeling fearful
  • Butterflies in stomach
  • Persistent unwanted thoughts.

Gambling & Smoking

Nearly half of problem gamblers smoke cigarettes. Those that smoke report that it makes them feel better and relaxed when they are stressed. Stressful situations including financial pressure, relationships issues or stressing about gambling and thinking about the next big win can increase the risk of smoking. When people attempt to cut down or stop gambling, the urge to smoke may increase. If you or your client are concerned about their smoking it is encouraged to discuss it with them and offer support.

A conversation about smoking may include giving advice about health and smoking, asking how they feel about their smoking and determining if they are ready to change their habits. Support and referral options including for Quitline (hyperlink) should then be offered. Find more information HERE.

Your client may have a strong link between gambling and smoking and maybe it has become a habit. Encourage the client to increase their self-awareness about their smoking and find if it relates to their gambling and stress levels. If the client decides they want to change their habits, you can encourage them to:

  • Take fewer cigarettes when they leave the house.
  • Take regular breaks and set limits for smoking and gambling.
  • Practise deep breathing.
  • Engage in light exercise to reduce the urge to smoke.
  • Seek professional help.

Gambling & Alcohol

Gambling and alcohol are highly related as alcohol can increase the risk of gambling getting out of control and vice versa. People that like to gamble in venues have easy access to alcohol while they are gambling. The alcohol has the effect of lowering their inhibitions and control, making it difficult to control both their gambling and alcohol intake.

People that use alcohol and gamble tend to:

  • Have difficulties understanding how the game works, the rules and odds,
  • Drink more than they intended.
  • Spend more money and time gambling.
  • Lose control over their gambling.
  • Feel negative effects on their mood including anger.
  • Have relationship problems.
  • Drinking more over time.
  • Experience memory issues.

If your client wants to change their habits with drinking you can encourage them to:

  • Increase their self-awareness about their drinking and pattens of use.
  • Reach out to their supports.
  • Engage with professional help.

Affected Others

Not only does excessive gambling affect the person gambling, but it may also have a range of negative impacts on their families and friends. Those families and friends can feel desperate and discouraged and may need help for their own issues regarding depression, anxiety, relationships issues and domestic violence. A stigma exists around problem gambling which affects others may feel and could find some benefit if they are able to share what they are experiencing. They may also feel a sense of shock if the gambler has been hiding it for some time or if there has been a large amount of money lost.

Excessive gambling can increase arguments, anger and violence and family neglect among other issues. Some families can continue with relationships after the gambling problem is identified but others may resort to separation and divorce. It is important that you assess intimate partner violence. There are many gambling services that offer help to affected others. However affected others seldom seek support for themselves but rather seek support for how to assist the problem gambler. When seeking help, affected others are looking for respect, recognition, their own needs assessed, psychoeducation about gambling, financial and legal support, help with future planning, and how to help their loved one practically while respecting their autonomy (Roberts, 2013).

Supporting family members in the health care setting can be approached with The Five Step Model that has been adapted into a problem gambling resource based on the Stress – Strain – Coping – Support Model.

  •  Listen, reassure, and explore concerns.
    • Let the person describe the situation, identify stressors and need for further information, communicate realistic optimism and identify need for future contacts
  • Provide relevant, specific, and targeted information
    • Increase knowledge and understanding, reduce stress arising from unawareness or misconceptions
  • Explore coping responses
    • Identify current coping responses, explore advantages and disadvantages of current coping responses, explore alternative coping responses, explore advantages and disadvantages of alternative ways of coping
  • Discuss social support
    • Draw a social network diagram, aim to improve communication within the family, aim for a unified and coherent approach, explore potential new sources of support
  • Discuss and explore further needs
    • Is there a need for further help? Discuss possible options with family member, facilitate contact between the family member and other sources of specialist help

A Message of Hope and Recovery: Engaging with Clients who Gamble

Research has shown that although distress needs to be acknowledged, it is also crucial to provide a sense of hope for recovery when engaging with clients who gamble. Options for treatment can also then be explored collaboratively and with the idea of hope for recovery. After you have screened clients in routine assessment, as described above, you can optimise motivation for change with empathetic curiosity and explore the links between gambling and distress. 

Motivational Interviewing:

Motivational interviewing is an evidence-based strategy in addiction that non-judgmentally and constructively encourages clients to think about their behaviour and about positive behaviour change. 

Express empathy and avoid arguments

It is important to express empathy by appreciating that a client’s gambling issue may have developed in an attempt to fix or mask other issues in their life. You can also maintain focus on the problem rather than the person and give them the autonomy to explore their issues while letting them know you are able to support them. If you try to argue your point of view, they may become less willing to change. Instead, talk about what might be stopping him quitting or cutting down on gambling.

Develop discrepancy

Aim to emphasize the discrepancy between where the client is now and where they want to be. This will bring consequences or pros and cons to light and picturing where they want to go, may help to motivate change and try new things to change their behaviour.

Roll with resistance 

Clients may be questioning whether they are ready for change. If a health professional is to try and facilitate the process too quickly it may be met with resistance. Rolling with the resistance involves being non-judgemental and listening to the client who has a different opinion. There is a chance to reflect the resistance and highlight the choice to change as being with the client. 

Support self-efficacy

Supporting the client as an autonomous and individual person will mean allowing them to make their own choices and decisions about their gambling, without telling them what to do. The client has the responsibility to decide what they are willing to do or not do to help their gambling. However, you can encourage them to think about what will help them and what won’t. As you finish up the conversation, the client’s self-awareness may have increased and if a gambling problem was identified, motivational interviewing may help to promote change. Leave the client the opportunity to return should they want further information or support in the future.