The DSM-5 classifies pathological gambling as an addiction rooted in the brain, like drug and alcohol addiction. Brain imaging studies have reported that both substance use disorders and pathological gambling create similar types of dysfunctions regarding reward processing and decision making.
Other similarities between problem gambling and substance use include:
- The inability to stop, denial and loss of control
- Severe depression and mood swings
- The addiction is used to escape the pain
- Chasing that first win, drink or substance use to get high
- Low self-esteem and a dysfunctional family
- The use of rituals and tolerance increasing over time
The differences between problem gambling and substance use include:
- One cannot be tested, overdose or ingest chemicals
- The high is from internal stimuli
- There is tremendous financial debt that could be lifelong
- A person with a gambling addiction can function at work
- Families can benefit from a big win
- There is more intense shame and guilt
- Higher rates of suicide with a gambling addiction
It is important to highlight the perception of the disease is different and treatment providers have less knowledge of gambling as an addiction.
Clinicians need to be aware of the importance of screening and understanding the risk of their clients developing a problem gambling addiction. Many clinicians could be currently working with someone with a gambling addiction and may not be aware of this “hidden addiction.”
Mental health professionals should be aware there is a high rate of suicide and suicidal thoughts among problem gamblers. If left untreated, problem gamblers can experience negative consequences, such as physical illness, mental health conditions, financial difficulties or possibly criminal activity. Furthermore, an estimated eight to 10 people in the problem gambler’s social network will be directly affected.
In addition, clinicians need to screen clients that may have family members who are experiencing problem gambling. Clients with a spouse or parent with a gambling addiction report mental health problems, emotional disturbances, poorer physical health, risky drinking, lower social support and impaired social life. The children of problem gamblers are more likely to report depression and gambling problems.
There are various problem gambling screening tools. Often, clinicians are not able to add lengthy questionnaires to already existing intake processes. For those, we recommend the full NODS, NODS CLIP or LIE BET screenings. It is important to note that further assessment will be needed if someone answers yes to one or more of the questions.
DSM-5 Diagnostic Gambling Disorder Criteria – The American Psychiatric Association provides guidelines used for gambling disorders. Five or more “yes” answers indicate a possible diagnosis for a Gambling Disorder. Less than 5 but more than 0 indicates a potential problem and/or at risk indicators which may warrant further support, education and treatment services.
NORC DSM IV Screen for Gambling Problems – The NODS is based on the DSM-IV criteria for Pathological Gambling and assesses both lifetime and past-year problem gambling.
The NORC screening tool or NODS – SA was designed to assist individuals in evaluating whether to modify or seek help for their gambling behavior
The NCPGP has more than 80 trained, licensed providers across the state of North Carolina that can provide problem gambling treatment. When a problem gambler or family member calls the program helpline, they can be referred to one of the program’s network providers for counseling.
In order to qualify to submit an application to become a provider on the official registry, the individual must be licensed as a clinician in the state of North Carolina, have an office setting for counseling services and complete Sure Bet One and Sure Bet Two two-day training workshops.
The application can be submitted after the above items are completed. Please have your references contact the state administrator directly. This will speed up the application process.
- Helpline referrals and reimbursement to counsel problem gamblers or family members.
- Given the opportunity to exhibit the NCPGP table at events and conferences, and speak to groups of people or organizations in your community. By doing this, providers help build awareness of problem gambling and the services available.
- Offered one or two provider calls each year. The provider calls are GoToMeetings that can be accessed by the phone or online with presentations and discussions on a certain aspect of problem gambling. The calls provide free Continued Education Units (CEUs).
- When funds are available, access to annual training at the North Carolina Foundation for Alcohol and Drug Studies (NCFADS) summer school at UNC Wilmington. It is typically the last Wednesday-Friday of the last week of July each year. The program offers scholarships for providers to attend that includes registration, on-campus housing and on-campus meals (as funds are available). This is not mandatory, but is encouraged.
- Encouraged to attend Sure Bet Three each year and attend Sure Bet One and Sure Bet Two again every five years.
The NCPGP provides Sure Bet training workshops at locations throughout the state several times per year.
Sure Bet One and Sure Bet Two are two-day training sessions held in the Fall. The topic for Sure Bet Three changes each year and is held in the Spring. For more information on the training schedule or to receive updates on upcoming training, contact the UNC School of Social Work at 919-843-5893. Information on training can be found at bhs.unc.edu.