Although gambling addiction affects 2 million Americans a year, it often remains unrecognized and overshadowed by other addictions, disorders and social issues. About 3 to 7% of our population can be classified as problem gamblers, and 1 to 3% meet criteria for gambling addiction.
The lack of awareness of the disorder makes it difficult enough to identify problem gamblers and connect them to treatment, much less address the impact problem gambling has on loved ones. Spouses in particular experience depression, trauma, anxiety and the extreme stress associated with maintaining family stability.
The effects of problem gambling on family members are immense. Spouses and families are innocent victims immersed in the emotional turmoil that problem gambling presents. Seemingly out of nowhere, spouses and families are stunned by lies, deceit, overwhelming debt, abandonment and guilt. Spouses present symptoms that are traumatic in nature and can prevent both them and the problem gambler from recovering. These symptoms need immediate attention but are largely not recognized or treated.
Trying to understand
Spouses, loved ones and even therapists have a hard time understanding why problem gamblers behave the way they do. These gamblers pursue the high of a win, an excitement rarely if ever paralleled. In pursuit they become completely self-absorbed, seemingly unaware of the widespread impact of their actions until the rush is over.
They gamble to reach the high. They gamble to escape emotional pain for hours, for days, until the money runs out. They quickly relish the winnings, investing nearly all of it back over the next days and weeks. They slowly destroy their lives. They get caught in the cycle.
They may have started innocently 20 years ago engaged in a friendly poker game for which they soon would learn strategy to win. They may have started last year on an innocent social evening at the casino, where they fell in love with the atmosphere, the glamor, the escape. Now they are in a desperate time where they are consumed with thoughts of gambling as a way to cope with pain and their unfortunate financial situation.
They desperately hold on to the fantasy that the next series of wins will finally rescue them from their suffering. However, with the next win or series of losses, they end up again consumed by invasive thoughts that wear them down one by one, eventually cascading into impulsive and deceitful acts. They place another sure bet that instead further damages trust and emotional intimacy, forcing their only support system into feelings of spousal contempt, distrust and tough love.
The gambler becomes consumed by panic, desperation and paranoia, resulting in self-centeredness and isolation. The spouse feels powerless because previous attempts to help have been unsuccessful, fought off by the gambler's denial. The gambler has lost his/her identity, empathy and priorities in life. The spouse has become angry, sad and unable to give support, and feels exhausted, hurt and alone.
The gambler again escapes to the bet to avoid the increased pain, spousal disconnect and financial stress, only to end up cycling further into debt and desperation. The gambler wants to stop, is remorseful, and vows never to bet again. Despite trying through sheer will to stop, the gambler falls victim to an urge that has rendered him/her powerless as he/she lacks tools, experience, confidence and, if the spouse is traumatized, support. This is gambling addiction.
As is the case for drug and alcohol addiction, once one stops gambling, recovery has just begun. If the compulsive gambler has not entered into a treatment program, chances are high that he/she has not been able to address adequately the thoughts and behaviors that can induce a relapse. Treatment that seeks to teach emotional and behavioral management tools is required for adequate long-term relapse prevention.
Through my experience as a nationally certified gambling counselor, and based on case studies and research over the past 10 years, I have the following recommendations:
Train staff to identify gambling addiction. There is a significant shortage of therapists who are qualified to assess and treat problem gambling. According to Keith Whyte, executive director of the National Council on Problem Gambling, there are only about 700 nationally certified gambling therapists in the U.S. It is estimated that there are only about 1,500 to 2,000 counselors with at least 30 hours of training through state-specific boards.
Screen for problem gambling. A common scenario repeatedly uncovered in assessments is that in previous residential or outpatient therapy, the counselor did not ask the client about problem gambling. Problem gamblers can be notorious for requiring direct questioning before disclosing their secrets. A simple assessment tool is the Lie/Bet Questionnaire, which asks: “Have you ever had to lie to people important to you about how much you gambled?” and “Have you ever felt the need to bet more and more money?” These questions have been proven to differentiate between pathological gambling and non-problem gambling.
Involve the spouse early and often. Include the spouse in both assessment and treatment. The spouse is an integral part of recovery. Consideration of traumatic stress from problem gambling and the emotional impact on the relationship and family members can help overall client recovery.
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