25 Jan Is Abstinence Required for Problem Gamblers?
Problem gamblers are people who develop dysfunctional, addictive patterns of behavior centered on one or more forms of gambling. Doctors use a diagnosis called gambling disorder to identify individuals affected by this problem. In a study published in 2014 in the journal International Gambling Studies, researchers from Canada’s University of Calgary investigated whether dysfunctional gamblers can still participate in certain gambling activities without triggering addiction-related behavior. The answer to this question may help determine if people with serious gambling problems need to avoid all forms of gambling and maintain strict abstinence in order to avoid an addiction relapse.
Symptoms found in people with gambling disorder include the need to participate in increasingly risky forms of gambling, devotion of large amounts of time to the reliving of past gambling experiences, an inability to rein in gambling participation, use of gambling to avoid depression or other unpleasant emotional states, use of deceit to hide gambling participation from others, and a reliance on others to fund gambling activities. Guidelines issued by the American Psychiatric Association (APA) require the presence of at least four symptoms before a doctor can make an official diagnosis. The APA only began identifying dysfunctional gambling as an addiction-related matter in 2013; before that time, the organization identified dysfunctional gambling as a form of lost impulse control. Recognition of the addictive element in serious gambling problems follows a general trend among doctors and researchers toward acknowledgement of non-substance-based addictions called behavioral addictions.
Abstinence vs. Harm Reduction
There are two general schools of thought regarding the long-term goals of addiction recovery. Some addiction specialists believe that people in recovery need to establish a new lifestyle that completely excludes involvement in addiction-related behavior. Doctors and public health officials commonly use the term abstinence to refer to this approach. Other addiction specialists believe that the main goal of recovery is reducing the chances that an individual will cause significant harm to the self or to others. Experts in the field refer to this approach as harm reduction. In a program that features a harm reduction orientation, recovering addicts can pursue a goal of abstinence if they wish; however, they can also aim to lower their addiction-related risks without completely curtailing their involvement in addiction-related behavior. Generally speaking, treatment programs in the U.S. pursue abstinence-based approaches more often than harm reduction-based approaches.
Are There ‘Safe’ Gambling Activities?
In the study published in International Gambling Studies, the University of Calgary researchers used an assessment of 169 people diagnosed with gambling problems to help determine if abstinence is a necessary goal for individuals with gambling disorder. The researchers asked these problem gamblers to identify the types of gambling in which they previously participated; possible options included playing casino games, betting on horse races, participating in traditional or scratch ticket lotteries, playing bingo, playing video slot or poker machines, and playing poker or other gambling games with family members or friends. In addition, the researchers asked the study participants to identify which types of games triggered their addictive gambling behaviors.
Sixteen percent of the study participants stated that none of the indicated forms of gambling triggered their problematic behavior. Forty-five percent of the participants stated that one form of gambling did not trigger their addictive responses, while another 28 percent stated that two forms of gambling did not lead to problems. Ten percent of the study participants stated that three forms of gambling were unrelated to their symptoms; in addition, 1 percent stated that four forms of gambling did not trigger problem behaviors. When the researchers conducted follow-up testing to verify these claims, they concluded that several key measurements (including severity of gambling-related symptoms, time devoted to gambling and money lost while gambling) largely supported the participants’ statements. However, they also concluded that two forms of gambling—playing bingo and playing casino games—sometimes caused problems even when the participants believed their involvement in these activities had no negative effect.
Based on their findings, the authors of the study determined that people diagnosed with gambling disorder (pathological gambling) may indeed be able to participate in some types of gambling without triggering addictive behavior. However, the authors did not make a definitive statement on the subject, and no person with a gambling disorder diagnosis should ever participate in a gambling activity without consent from the doctor responsible for treating or managing his or her condition.