The plan to include disordered gambling under the same heading as substance use disorders in the DSM-5 supports what many studies have suggested over the years: that there is a strong correlation between substance abuse and disordered gambling. Data from the National Comorbidity Survey Replication, representing a large sample of U.S. citizens, found that among pathological gamblers, 75% also had an alcohol use disorder and 38% also had a drug use disorder. Once we are able to comprehend that the majority of people who develop a gambling problem come from a substance abuse background, we will have identified a pool of millions of people who are predisposed to become future problem gamblers.
In my work with patients being treated for substance abuse at Brighton Hospital in Michigan, I have found in conducting a gambling screen that of the 84% of patients who do not have a problem with gambling, the majority of them do not gamble at all. This finding is at odds with national statistics showing that more than 85% of the general population gambled two to three times during the past year. For the longest time I could not figure out why these alcoholics were so different from the general population. And then, one day, it just came to me. The addiction (to substances) that brought them into treatment was working just fine. It did everything for the addict that he/she needed.
I discovered that after leaving treatment, many of these alcoholics end up trading their substance addiction for gambling or another process addiction. A large number of the compulsive gamblers with whom I have worked with tell me they had experienced years of high-quality sobriety before developing a gambling problem. Most of them had no idea they were predisposed to become compulsive gamblers. During their treatment for substance abuse they had not been warned about the danger of trading their substance addiction for a gambling addiction.
The largest group of people we can reach, at the least expense, are people in inpatient and outpatient addiction treatment programs across the country. The one sure way to get the greatest number of these people to abstain from gambling is to educate them about the dangers of trading one addiction for another—before they ever start gambling.
We already do this with substance use patients. Every alcoholic leaves a treatment center with the knowledge that he/she cannot use drugs of any type. Even opiate pain medications used during surgery must be closely monitored. All we have to do is give these individuals the same education about gambling.
Anecdotally, after my lectures at Brighton Hospital I have had hundreds of patients confide that they don’t gamble, they have never gambled, and that after hearing my presentation they never will gamble. This is how we can effectively deal with compulsive gambling.
We are at the same point today with gambling as we were with alcoholism 35 years ago. That is, many people perceive a gambling problem as a moral weakness, just as alcoholism was once portrayed. Most believe that the gambler is exercising personal choice, and that he/she simply can choose not to gamble. The historical designation of disordered gambling as an impulse-control disorder has only perpetuated that belief. However, the inclusion of disordered gambling in the DSM-5 under the category of substance use and addictive disorders will most certainly help change the way people perceive this addiction.
Michael Burke is a national speaker on addiction topics. He practiced law for 25 years, and his book Never Enough: One Lawyer’s True Story of How He Gambled His Career Away was published by the American Bar Association. He is the author of the Process Addictions column in the July/August 2012 issue of Addiction Professional. His e-mail address is email@example.com.