Redefining gambling addiction
Completing the series of Packed Lunch talks at the Wonder Season, Dr Henrietta Bowden-Jones, founder and Director of the National Problem Gambling Clinic based in Soho, spoke about gambling, addiction and impulsive behavior. Emma Rhule was in the Barbican’s conservatory to hear what she had to say.
Did you place a bet on last week’s Grand National? It is estimated that over a third of British adults took a punt on the horses, while over the course of the year nearly three-quarters of Britons will indulge in some form of gambling, from the occasional Lottery ticket to online bingo. For around 1 per cent of us, however, gambling is not restricted to the odd flutter but is an uncontrollable urge.
When the National Problem Gambling Clinic opened in Soho in 2008, no one could have predicted the number of patients that would arrive. “When I planned the clinic, I thought it would be just me working two days a week. Now the team is made up of psychologists, psychiatrists, a money management expert and family therapist,” clinical neuroscientist, Dr Bowden-Jones says. With over 700 referrals a year, she believes the secret to success is to look beyond the addiction – in order to help beat the addiction, it is vital to make an emotional connection with the person.
This approach stems from her experiences growing up: “I am originally from Milan. In the 1970s, Milan was suffering from a heroin epidemic. Walking to school every morning I saw lots of addicts shooting up on the side of the road. We would go to the park and kick syringes or collect them for fun. By the time I was a teenager many of the people that I grew up with had hepatitis B or C and were addicted to heroin. Walking by, I would be told not to look, that they were bad people. I used to ask why – people are not born ‘bad’.”
When the odd bet is not enough.
Those who gamble compulsively or suffer from addictions to drugs or alcohols are often seen as being weak-willed or lacking in moral fibre. Bowden-Jones, is quick to point out that addiction, including gambling addiction should be viewed as an illness. What’s more, studies of twins, an experimental approach often used to help tease out the impact of genetic and environmental factors, have revealed that some people have a genetic predisposition to pathological gambling.
Another significant factor in addiction illnesses is how impulsive a person is. Bowden-Jones explains: “Impulsivity is not just about the time it takes to make a decision but also the type of decision made and the steps that are taken. A person with pathological impulsivity will not take the sensible steps.” A common way to investigate this process is to ask people to weigh up two outcomes where one involves a delay in gratification. For example, would you rather have £10 now or £100 next month?
Most people can see the increased reward from waiting and will select the latter option. It becomes more difficult when the payoff from waiting is less obvious, for instance, would you rather have £50 now or £70 tomorrow? “Some people are unable to wait, even when the rewards are clearly necessary in terms of life quality,” says Bowden-Jones. This kind of impaired decision making could explain why an addict relapses after trying to give up the cause of their addiction or after spending time on a rehabilitation program.
Bowden-Jones’s Soho clinic is next door to one of the UK’s largest casinos. When asked whether she thinks living in London, a city filled with temptation, encourages gambling and impulsive behavior, it is clear the answer is not that simple. “Availability is one issue but boredom is a big factor in addiction. Cities are filled with so many fantastic opportunities – talks, galleries, sport – maybe in cities those people who are vulnerable to addiction are too busy running marathons?”, she replies.
With the rise of online casinos, the opportunities to gamble are increasing, wherever you live. The ability to place a bet from the comfort of the sofa means social attitudes that may have put someone off entering a bookmakers are no longer so important. With greater numbers of people gambling, there is the risk that more people will develop an addiction problem. Bowden-Jones believes that it is important to promote the concept of ‘responsible gambling behaviour’.
In the fifth edition of the influential Diagnostic and Statistical Manual of Mental Disorders, due for release next month, gambling is due to be reclassified. Currently listed as an impulse-control disorder it will join alcoholism and substance-abuse in the ‘Addiction and related disorders’ category. Bowden-Jones pressed the need for a shift in cultural attitudes and the recognition of problem gambling as a mental health issue: “Viewing gambling as a moral illness is very off the mark.”