Problem gambling in the aftermath of disaster - transcript

Hello everyone my name’s Leanne Humphreys and today we’re speaking with Dr Sean Cowlishaw who’s a senior research fellow here at Phoenix Australia.

Sean has expertise relating to gambling problems and addictive behaviours including treatments and comorbidities early identification interventions and an impressive range of other things but today’s conversation’s about gambling and in particular in the context of post-disaster mental health. So thanks so much for joining us Sean how are you?

Sean: I’m wonderful.

Leanne: Good, good. Sean when I think about all of the issues that I need to get my head around to be an effective practitioner supporting individuals following disaster gambling isn’t the first thing that comes to my mind so, why is this relevant in a post-disaster context?

Sean: So we know that people who are exposed to disaster and other types of traumatic events have a range of coping strategies some of them are helpful some of them are more maladaptive.

Gambling like alcohol is a publicly and legally available addictive product which is associated with harm, but it’s also associated with stress and trauma so people often and some people do, sort of, they drink alcohol, they gamble in order to effectively help cope with stress and distress.

But we also know that when disasters strike, you know, the availability of these addictive products also changes. So with alcohol for example, you know, in terms of the accessibility of pubs and bars can shift with gambling. The availability of land-based gambling venues such as sort of pubs and clubs pokey’s venues can shift but we’ve seen a pretty remarkable increase in in the availability of gambling, probably over the past 15- 20 years and in particular online forms example right so, sort of, addictive products that have sort of constant and high levels of availability that really didn’t exist 15-20 years ago. Now these might be the only forms of addictive behaviours that are highly accessible in the aftermath of disaster right so putting those two things together high levels of stress strain and trauma and limited accessibility for other forms of, sort of you know potential coping strategies really does sort of shine the microscope I think on gambling as a potential sort of negative and harmful male adaptive coping strategy.

Leanne: Right, okay and so do people typically go to get help for gambling problems do they do they go to their health practitioner and say I’ve got a problem with gambling?

Sean: So there are special help services for people with gambling problems as well as affected others – family members and the like. Mindful of the fact that if you have a gambling problem it’s unlikely the impacts are just limited to you. So if you lose large amounts of money, the debts, the financial problems tend to affect those in your social network as well.

So there are special services, but what we do know is that there are relatively few people with gambling problems who access those services and they also tend to access them in response to what we might call major life crisis.

So you know they’re driven to help seeking because of relationship breakdown, because of bankruptcy, they’ve accumulated what we call harms, so negative consequences of gambling that you know are pretty severe and are pretty long lasting so, so these factors mean that we’re really sort of seeing the tip of the iceberg in these, in these specialist services. However what we also know is that people with these gambling problems have lots of other co-occurring issues so they often have sort of depression, anxiety problems. Some of these things are triggering the use of gambling as a coping strategy but what it means is that they’re also often presenting probably more commonly for these other co-occurring issues.

Leanne: Right, okay, so that would seem then that the onus is on the clinician or the health practitioner to be asking directly about instances of gambling? Would that be right?

Sean: Yes, especially if we’re wanting to prevent these harms.

Leanne: Right. Again so going back to this point that the challenge is that the, that when these people present to health services it’s often very late in the game, you know already sort of experienced these life crisis?

Sean: Yes there is a major emphasis and I think a real need for early intervention. Now that means ideally being vigilant for, and able to pick up and identify these issues. But for people who are maybe experiencing sort of early stage problems but have not yet experienced and have accumulated that the major negative life consequences that can have sort of pervasive long-term impacts right now that does require vigilance you know so we might be thinking about screening or it might just be sort of you know being really sort of aware of the potential signs of gambling problems and these are things like, obviously you know changes in gambling behaviour.

Leanne: You know are people sort of betting more than they would normally?

Sean: Yes. Importantly are they betting more than they can afford to lose? But also there’s other sort of behavioural markers so people who feel guilty about gambling, people who report a pattern called- described in terms of chasing losses. So you know you maybe return one day to try and win back money that you’ve lost previously.

These are really important sort of early warning signs that’s sort of patterns of, sort of maladaptive gambling behaviour in play.

Leanne: Okay, so as clinicians there are, there seems to be some things that we can start to do differently. We can be much more proactive about asking questions about changes in gambling. What apart from that, what are the kinds of interventions that are most likely to be helpful?

Sean: Sure, so I think if we view these interventions as falling along or targeting a continuum of severity. So now we have this sort of early stage sort of gambling problems before the worst of the harms that have been accumulated but we also have interventions that are targeting people with you know quite severe, what we might call ‘problem gambling’ or sort of addictive conditions now at the earliest stage you know really just being able to ask questions, just being able to draw attention to the fact that gambling may have changed. It may be having a negative influence on someone’s life and really just being able to highlight and to increase recognition of those issues can be quite powerful at that early stage.

However for people who do have more severe gambling problems, you know as I mentioned they’re often co-occurring with depression, anxiety, often with sort of you know potentially accumulating severe financial problems which are also complicating pre-existing economic and financial challenges potentially associated with the disaster.

Now for people who have those more severe problems their need for support is also greater and we have a range of – sort of what she described as cognitive behavioural therapies, you know sort of psychological treatments that are really focusing on sort of thought patterns, thinking processes with how people you know approach risk and understand for example that the hazardous properties of different types of gambling and how they understand probability.

Yes whether they do keep chasing losses with an expectation that because they lost one day they’re more likely to win the next. So they’re sort of maladaptive gambling cognitions yes so there are cognitive and behavioural therapies that can help us sort of get those problems under control but it’s also I think a broader suite of support strategies which are really focusing on helping to manage depression, manage anxiety, but also to bring potentially some of the broader financial problems and potentially even sort of relationship difficulties under control.

Leanne: Sean thank you very much for that. That was really thought provoking. So for those of you who are watching this conversation if you’d like to take a deeper dive into the topic please feel free to explore the materials and the resources on the web page and follow the links to the recommendedreadings. Thanks very much Sean.

Sean: Thank you.