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a l l i g e i e o d d d g g g h h n e s e e e e e a y y c s s s t f t f f l , , , SUBSTANCE MISUSE FACT SHEETS CATEGORY III – COMMUNICATIN, TREATMENT & PREVENTION INTERVENTIONS – GAMBLING rapidly expanding online gambling industry and is awaiting the Table. 1: DSM – 5 Criteria for Gambling Disorder opening of casinos across the country. DSM-5 DIAGNOSTIC CRITERIA: GAMBLING DISORDER Problem gamblers in Britain Problem gambling is defined as gambling to a degree that Persistent and recurrent problematic gambling behaviour compromises, disrupts or damages family, personal or leading to clinically significant impairment or distress, as recreational pursuits (Lesieur & Rosenthal, 1991). When it indicated by the individual exhibiting four (or more) of the becomes more severe, and meets diagnostic criteria, it is termed following in a 12-month period: as gambling disorder (as in DSMV), or as gambling addiction / 1. Needs to gamble with increasing amounts of money in pathological gambling (previous terms for gambling disorder). order to achieve the desired excitement. In 2015, problem gambling prevalence rates were 0.7% 2. Is restless or irritable when attempting to cut down or according the DSM-IV and 0.6% according to the Problem stop gambling. Gambling Severity Index (PGSI). At a population level, this 3. Has made repeated unsuccessful efforts to control, cut equates to between 360,000 and 420,000 adult problem back, or stop gambling. gamblers in Britain. 4. Is often preoccupied with gambling (e.g., having The profile of problem gamblers persistent thoughts of re-living past gambling Data from the combined from the Health Survey for England experiences, handicapping or planning the next (HSE) 2015, the Scottish Health Survey (SHeS) 2015 and the venture, thinking of ways to get money with which to Wales Omnibus in 2015 provide some indication of lifestyle, gamble). socio-economic and demographic features that show 5. Often gambles when feeling distressed (e.g., helpless, correlations with problem gambling in the adult population. The guilty, anxious, depressed). points below provide a snapshot of the scale and distribution 6. After losing money gambling, often returns another day of problem gambling in the British population, according to the to get even (“chasing” one's losses). criteria applied by the DSM-IV. 7. Lies to conceal the extent of involvement with l 0.7% of the British over-16 population can be classified as gambling. problem gamblers, corresponding to a figure of 420,000 8. Has jeopardized or lost a significant relationship, job, or adults. educational or career opportunity because of gambling. l Men were more likely than women to be problem 9. Relies on others to provide money to relieve desperate gamblers (1.3% and 0.2% respectively). financial situations caused by gambling l Problem gambling prevalence was highest among men The gambling behaviour is not better accounted for by a aged between 25 and 34 (2.0%), falling to 0.2% for men manic episode. aged 75 and over. Current severity: Mild: 4–5 criteria met., Moderate: 6–7 criteria l Problem gambling prevalence was significantly higher met, Severe: 8–9 criteria met. among Asian and black respondents compared to white respondents. From the Diagnostic and Statistical Manual of Mental l The highest rates of problem gambling were among those Disorders, 5th Edition 2013 (section 312.31). who had participated in spread betting (20.1%), betting via a betting exchange (16.2%), playing poker in pubs or clubs Case Study (15.9%), betting offline on events other than sports or horse or dog racing (15.5%) and playing machines in John is a 42-year-old married father of two. He had recently lost bookmakers (11.5%). his job as the manager of a betting shop. He consulted his GP with symptoms of insomnia, non-specific back pain and mild l Problem gambling was more prevalent among people who depression. His drinking had escalated since he lost his job and had participated in a number of gambling activities in the he was referred to the local alcohol service, where his gambling past year (prevalence was 11.9% for those who problem was coincidentally uncovered. participated in seven or more activities compared to 0.3% of those who had taken part in just one gambling activity John started buying lottery tickets when he was in his teens. in the last year). This gradually escalated to other forms of gambling such as betting on sport, casino – based games and online gambling. l Problem gambling prevalence varied by economic activity. No full-time students within the sample were classified as He had lost his job, his marriage was shaky and he was £20,000 problem gamblers, and problem gambling was low among in debt because of his gambling. He was referred to GamCare retired people (0.2%). where he received 12 sessions of cognitive behavioural therapy (CBT). He also self-referred to Gamblers Anonymous but l The highest prevalence of problem gambling was found dropped out after two sessions. Six months later, he stopped among those who were economically non-productive such gambling but continued to seek support from Gamblers as the long-term sick, carers and those looking after home Anonymous (GA). or family but not students, unemployed or retired (1.8%).
2 SUBSTANCE MISUSE FACT SHEETS CATEGORY III – COMMUNICATIN, TREATMENT & PREVENTION INTERVENTIONS – GAMBLING
Gambling and its consequences gambling are personality disorders, impulse-control disorders, Problem gamblers suffer high rates of psychiatric comorbidity, anxiety disorders and attention-deficit hyperactivity disorder. including depression, anxiety, substance misuse and personality Depression is probably the most common psychiatric disorder disorders (Petry et al, 2005). Severe gambling disorder is also comorbid with pathological gambling. Prevalence figures quoted associated with several stress-related and other medical range from 50 to 75% (Becona et al, 1996). disorders (e.g. cardiovascular, musculoskeletal, gastrointestinal), Two theories have been put forward to explain the relationship with resultant increased use of medical services (Morasco et al, between gambling and depression. One is that gambling-related 2006). Excessive gambling often results in financial losses, losses and other adverse consequences result in depression. The leading to debts and bankruptcy. Individuals may commit crime second is that gambling is an activity engaged in to alleviate a to fund their addiction. As the gambling addiction takes hold, depressed state – it is used as an ‘antidepressant’. employment and employability may suffer significantly. Suicidal ideation, suicide attempts and completed suicides are Moreover, it is estimated that for every pathological gambler, much more common in pathological gamblers than in the general between 8 and 10 others are also directly affected, including population. The rate of suicidal ideation in pathological gamblers family, friends and colleagues (Lobsinger et al, 1996). Spouses has been estimated to range from 20 to 80% and that of suicide often bear the brunt, and instances of domestic abuse and attempts from 4 to 40%. Severe gambling, large debts, coexisting violence are common (Mulleman et al, 2002). Children of psychiatric disorders and substance use have all been associated gamblers have been found to have high rates of behavioural with an increased suicide risk. problems, emotional difficulties and substance misuse (Jacobs Screening for gambling problems et al, 1989). It is seldom that patients will present to non-specialists with Psychiatric comorbidity gambling problems and we do not recommend that you screen all Research has consistently noted the very high rates of your patients for gambling behaviours. However, it would be psychiatric comorbidity in pathological gamblers. People with worthwhile screening high-risk patients such as those presenting gambling disorder were many times more likely than the with psychosomatic symptoms, stress-related symptoms and those general population to report major psychiatric disorders: major with psychiatric morbidity. Patients suffering from depression, depression, antisocial personality disorder, phobias and current anxiety-spectrum disorders and substance misuse (especially or past history of alcohol misuse (Cunningham-Williams et al, alcohol and tobacco) all tend to have higher rates of co-existing 1998). Other disorders commonly comorbid with pathological problem gambling. Table 2: Screening Instruments for Gambling Disorder Detailed Screening Instruments Name Description Number of items/Time frame Interpretation South Oaks Gambling Based on DSM-III criteria 26 items out of which Score (5 or more) – Screen (SOGS) for Pathological Gambling 20 are scored Probable pathological (Lesieur and Blume, 1987 ) Lifetime, past year, and past gambler 3 months Problem gambling Derived from Canadian 9 items Score (8 or more) – Severity Index (PGSI) Problem Gambling Index Past year Problem gambling with (Holtgraves, 2009 ) (31 items) negative consequences and possible loss of control Brief screening instruments Name Description Number of items/Time frame Interpretation NODS - CLIP? (Toce-Gerstein Evaluates loss of control, lying 3 items, Yes or No If even 1 item is positive, et al, 2009) and preoccupation Lifetime warrants detailed evaluation NODS – PERC Looks for preoccupation, 4 items, Yes or No If even 1 item is positive, (Volberg et al, 2011) escape, risked relationships Lifetime warrants detailed evaluation and chasing withdrawal, lying and borrowing money
Lie/Bet scale (26) Lies to others about 2 items, Yes or No “Yes” to one or both items gambling behaviours, or bets Lifetime indicates PG more and more money
Note that screening is only the initial step in the diagnostic for further assessment and specialist treatment. process, and patients who screen positive should be referred on 3 SUBSTANCE MISUSE FACT SHEETS CATEGORY III – COMMUNICATIN, TREATMENT & PREVENTION INTERVENTIONS – GAMBLING
Assessment Previous attempts to cut back or quit gambling and treatments A good assessment will help the clinician to formulate a tried should inform the clinician in planning the current comprehensive and effective treatment plan. The key areas to treatment type and setting. A sensitive exploration of the be explored are summarised in Box 1. Many gamblers feel individual’s financial situation (personal and family income and ashamed and embarrassed to reveal the true extent of their financial stability) and financial problems (gambling debts, problems. Hence, the clinician needs to be sensitive and tactful bankruptcy) will guide the clinician in suggesting feasible and in exploring the individual’s gambling behaviour. Sometimes, it realistic solutions. The clinician must evaluate the impact of might even be appropriate to obtain collateral information from gambling on work (being late, absences, job losses, etc.) and the patient’s partner, spouse or friends (with consent from the interpersonal and marital life (strained relationships, neglect of patient). It is good to ask the patient to describe in his or her family, domestic violence, etc.). own words the initiation, development and progression of the An understanding of a gambler’s reasons for consultation will gambling behaviour in a chronological sequence. The key DSM provide indicators of motivation to engage in treatment. A V diagnostic criteria for pathological gambling include useful question to ask is ‘Why are you seeking treatment now?’ preoccupation with gambling, tolerance (the need to wager The person should also be specifically asked about his or her increasing amounts to achieve excitement), inability to control expectations of treatment, in terms of its type, duration and or stop gambling and ‘chasing’ one’s losses, all of which setting. adversely affect the individual’s interpersonal, social and Despite the high rates of psychiatric comorbidity in pathological occupational functioning. Features of tolerance, craving, gamblers, they often go unrecognised and untreated. A detailed withdrawal symptoms and other diagnostic criteria, if present, psychiatric history-taking and mental state examination should will readily confirm the diagnosis, but this forms only part of the establish whether there is comorbidity. Gamblers should also be assessment. asked about their use/misuse of psychoactive substances and, even more important, their use of alcohol and drugs during BOX 1 gambling sessions. Summary of key aspects of assessment of the Assessment of suicide risk (past attempts at self-harm and pathological gambler ongoing suicidal thoughts and plans) forms a crucial part of the overall assessment. l Full psychiatric history, including history of presenting complaints, and psychiatric, family, treatment, past and Treatment of gambling disorder personal histories Pharmacological interventions for gambling disorder l Detailed assessment of gambling behaviour: No drug has been approved for use in the UK to treat gambling l initiation disorder and no clear guidelines are currently available. Trials have shown that selective serotonin reuptake inhibitors (SSRIs l progression such as fluoxetine, citalopram, paroxetine, etc.), naltrexone and l current frequency (days per week or hours per day) mood stabilisers (such as lithium, carbamazepine, valproate, etc.) l current severity (money spent on gambling are all effective, although none has demonstrated superiority proportionate to income) over others. Naltrexone in relatively high doses (between 100mg l types of games played and 200mg per day) have been found to be useful
l maintaining factors http://infohub.gambleaware.org/document/guideline-for- screening-assessment-and-treatment-in-problem-gambling/ . l features of dependence The existence of comorbidity might often help determine the l Consequences: financial, interpersonal, vocational, choice of drug. For example, choose an SSRI if there is coexisting social and legal obsessive–compulsive-spectrum disorder or depression; choose l Reasons for consultation, motivation to change and a mood stabiliser in the presence of comorbid bipolar disorder; expectations of treatment and prefer naltrexone if pathological gambling is associated l Assessment of suicide risk with other impulse-control disorders. Doses of SSRIs and naltrexone required are often at the higher end of the l Assessment of Axis I and II comorbidity, including substance use disorders therapeutic range and side-effects are therefore more common. As discontinuation studies are lacking, there is no clear evidence l Comprehensive mental state examination on how long to continue treatment: at least 4–6 months initially and then maybe maintenance treatment. Although empirical As maintaining factors can often inform specific interventions, evidence is lacking, a combination of pharmacological and it is important to ask ‘What are the reasons why you gamble?’ psychological therapies might be the best option. More robust Most commonly reported maintaining factors include negative studies looking at augmentation strategies, continuation and mood state, boredom and the need to overcome financial maintenance treatment and combined pharmacotherapy and problems. psychotherapy are warranted.
4 SUBSTANCE MISUSE FACT SHEETS CATEGORY III – COMMUNICATIN, TREATMENT & PREVENTION INTERVENTIONS – GAMBLING
Psychological interventions Problematic/sub-syndromal gamblers: About 7% of the Brief intervention for problem gambling population gambles frequently or heavily. They usually gamble up to several times a week and spend more than they intended Brief interventions (BIs), are by definition, brief psychological on gambling. They do not have severe problems related to their interventions designed for use with people who use addictive gambling, but sometimes lose track of time while they are substances or engage in behaviours (such as gambling) gambling, or hide the amount they gamble from family and/or problematically but who have not yet developed a full-blown friends. Other people may tease or criticise them about their addiction. The rationale is that such brief interventions will gambling. Some of these gamblers will go on to develop prevent the progression of the addictive disorder. Brief pathological gambling. interventions in the field of alcohol misuse are well evidenced (Bien, Miller & Tonigan, 1993): a simple 5 to 10 – minute Pathological gamblers: About 1% of the adult population intervention has been shown to be very effective. A brief suffers from pathological gambling. Pathological gamblers psychological intervention model for problematic gambling usually gamble very often (every day or even several times a developed by Petry et al, (2005) is as follows. day) and spend hundreds of pounds or more each month on gambling. Pathological gamblers develop severe financial This intervention takes no more than 10 to 15 minutes, and problems and also frequently experience unemployment, legal consists of 3 steps. In step 1 using the pi chart, the person is and family problems related to their gambling. Gambling given a percentage breakdown of how people gamble – i.e. becomes the only purpose of their lives and takes precedence relative breakdown of non-gamblers, recreational gamblers, over everything else. Pathological gambling can lead to debts problematic gamblers and pathological gamblers in the general and bankruptcy, depression, and even suicide. population. Note here that these are the past 12 – month prevalence figures for Britain, as no life – time prevalence studies How do people gamble? 7% have been done in Britain. Key characteristics of each category 1% are also briefly mentioned. Recreational Gamblers Non-gamblers: 27% of the population did not gamble in the Non-gamblers past 12 months. Problem gamblers Recreational gamblers: The large majority of adults (65%) are 27% recreational or occasional gamblers. They usually gamble not At risk gamblers more than a few times a month: a flutter on the National Lottery or a scratch card, or an odd bet on a football match/horse race. They never spend more than they intend to spend on gambling 65% and usually gamble as a form of entertainment.
Step 2 involves highlighting some of the risk factors for WHAT ARE THE RISK FACTORS FOR GAMBLING? problematic gambling such as a positive family history of gambling behaviours, co-existing psychiatric disorders , 1. People with a history of substance misuse (alcohol or comorbid substance misuse disorders and major life events. drugs) and those with some psychiatric conditions (obsessive-compulsive disorder, bipolar disorder, ADHD) are at greater risk of developing gambling problems. 2. Being male, young, smoker, belonging to an ethnic minority group and people whose parents regularly gambled and had experienced problems with their gambling behaviour. 3. People who gamble frequently or heavily may be at risk for developing gambling problems. 4. People who report strong superstitious behaviours, such as a preferred slot machine/s, lucky numbers, or a feeling of ‘knowing’ when they are ‘due’ a win may be at greater risk for developing gambling problems. 5. Major life changes (divorce, death in the family, retirement, children leaving home) may be associated with development of gambling problems.
5 SUBSTANCE MISUSE FACT SHEETS CATEGORY III – COMMUNICATIN, TREATMENT & PREVENTION INTERVENTIONS – GAMBLING
Step 3 (see below) consists of discussing simple, practical is currently one of the most popular and extensively accessed measures to reduce the risk of developing gambling problems. treatment models for pathological gambling. Gamblers These consist of the following: limiting the amount of money Anonymous uses a medical model of pathological gambling available to gamble, restricting the time and days spent and views total abstinence as the treatment goal. The ‘12-step gambling, not seeing gambling as a means to make money, and recovery program’ forms the cornerstone of this treatment and spending more time in alternative recreational pursuits. gamblers are assisted in working through steps 1 to 12 by regular attendance at and active participation in group What can you do to reduce the risk of developing gambling meetings. 1. Limit the amount of money you spend gambling. If you Generally, despite its high rate of attrition, those who regularly go to the casino, take a set amount of cash. Leave your attend Gamblers Anonymous groups benefit from this bank and credit cards at home. Never buy more than a intervention. From a clinical perspective it is more pragmatic to limited number of scratch cards or lottery tickets. If you offer Gamblers Anonymous in conjunction with other gamble online, set a small limit. When the money runs treatments. Gamblers Anonymous also run support groups for out, stop gambling. families and friends affected by their loved one's gambling. 2. Limit the amount of time and days you gamble. If you Barriers buy scratch cards or lottery tickets, don’t buy them Problem gambling often goes unnoticed, not least because of every day. If you bet on sports, watch some games the lack of physical manifestations that are often evident in the without betting on them. If you go to the casino, make a case of drug or alcohol misuse. This objective ‘invisibility’ is in commitment to your partner or a friend to meet them turn compounded by low rates of self-presentation to health later that day so that you must leave at a reasonable practitioners by problem gamblers. At the same time, the time. When the time runs out, leave whether you are existence of co-morbidities can mask the existence of gambling winning or losing. problems. It is estimated that most people with gambling 3. Don’t look to gambling as a way of making money. problems in Britain do not seek help and even when they do, Remember that the house is always guaranteed to win they present to non-gambling support services with symptoms in the long run. The more you gamble, the more likely that may not be directly attributable to gambling. Most problem you are to come out behind. gamblers go unrecognised and their health needs arising from 4. Spend time pursuing other recreational activities. Many their problem go unaddressed. This may be for various reasons, problematic gamblers gamble as a way of relieving such as a reluctance to disclose the role of gambling in boredom, anxiety or depression, or for fun. Find other contributing to negative health impacts. Healthcare activities that you enjoy and that fill these needs for professionals' low awareness of problem gambling is linked to you. Join a sports club, take a further education class, or their limited knowledge regarding how to identify and assist volunteer somewhere. Go to a movie, out to dinner, or patients experiencing gambling-related harm. It is likely that take a walk. Plan these activities during times you are even where health or social care practitioners do identify the most likely to gamble. existence of gambling-related harm, they regard this as a personal or ‘social’ problem, rather than a health issue, meaning that the needs of relevant individuals are largely unaddressed. Psychotherapy remains the mainstay of treating problem So all in all, gambling disorder remains largely ‘hidden’ and gamblers and Cognitive Behaviour Therapy (CBT) is the most ignored. commonly used. CBT includes cognitive and behavioural strategies. Gambling addicts have various cognitive distortions Current treatment provision for gamblers in Britain such as illusions of control, overestimates of one’s chances of At present, almost all dedicated funding to address gambling- winning, biased memories, etc. The underlying premise here is related harm is provided by voluntary contributions from the that as gambling is essentially about judging the probability of gambling industry and the level of service provision is far from outcomes and decision making, it follows that cognitive adequate. distortions will lead to impaired judgement and poor decision Treatment services for those with gambling problems, in Britain, making. CBT aims to address these cognitive distortions and, are at best patchy and at worst non-existent. And where they do through functional analysis of gambling triggers, helps manage exist, it is limited to a few, predominantly non – NHS specialist them and cope with cravings. Cognitive–behavioural treatment services. Furthermore, these services only cater to the very few, approaches often involve identifying high-risk situations severely addicted gamblers – the very tip of the ‘iceberg’. So too, (through functional analysis) or internal and external triggers treatment interventions for gamblers, in the UK, have so far that lead to urges to gamble and then working on effective almost exclusively focussed on relatively medium to long-term coping strategies. Treatments often incorporated in cognitive– psychological interventions. behavioural packages include training in assertiveness, For the nearly half a million problem gamblers and the 6.5% at problem-solving, social skills, relapse prevention and relaxation. risk, as well as those in their social networks who are affected, Gamblers Anonymous there is only one National Health Service (NHS) clinic the Gamblers Anonymous is a self-help group modelled on National Problem Gambling Clinic (NPGC), which is part of the Alcoholics Anonymous. It was founded in 1957 in California and Central and North West London NHS Foundation Trust). There 6 SUBSTANCE MISUSE FACT SHEETS CATEGORY III – COMMUNICATIN, TREATMENT & PREVENTION INTERVENTIONS – GAMBLING are some of third-sector agencies that provide treatment. References The charity GamCare ( www.gamcare.org.uk ) provides support American Psychiatric Association. Diagnostic and Statistical Manual of Mental and treatment for problem gamblers. An industry that generates Disorders (5th edn) (DSM-5). APA, 2013. billions of pounds in revenue every year, and growing year on Becona, E., Del Carmen, L. M. & Fuentes, M. J. (1996) Pathological gambling and depression. Psychological Reports, 78, 635–640 year, voluntarily donates approximately 0.1% of that to fund Conolly, A et al (2017) Gambling behaviour in Great Britain in 2015 Evidence gambling treatment, research and education in Britain. In Britain, from England, Scotland and Wales, NatCen for Social Research the government takes no responsibility for the commissioning http://www.gamblingcommission.gov.uk/PDF/survey-data/Gambling-behav - of gambling treatment services, as strikingly made evident by iour-in-Great-Britain-2015.pdf the Department for Culture, Media and Sport having Cunningham-Williams, R. M., Cottler, L. B., Compton, W. M., et al (1998) Taking chances: problem gamblers and mental health disorders – results from the responsibility for gambling rather than the Department of St. Louis Epidemiological Catchment Area study. American Journal of Public Health. Health, 88, 1093–1096 Those with gambling problems are best treated in specialist Bowden-Jones, H. (2017). Pathological gambling. BMJ 2017; 357:j1593 Griffiths M (2017) How to tackle problem gambling gambling treatment services if such services exist. If not, these https://theconversation.com/how-to-tackle-problem-gambling-85552 patients are best referred to the more generic addiction (drugs Holtgraves T. (2009) Evaluating the problem gambling severity index. and alcohol) services. Contact with the local addiction service Journal of Gambling Studies. 1; 25(1):105. should be the first port of call, and if this yields no success, Jacobs DF, Marston AR, Singer RD. Children of problem gamblers. J Gambl patients could be signposted to GamCare and/or Gamblers Behav 1989; 5: 261-7 Anonymous. Patients can self-refer to both. Ladouceur, R., Sylvain, C., Boutin, C., et al (2002) Understanding and Treating the Pathological Gambler. Chichester: John Wiley & Sons. The policy context in Britain Lesieur HR, Rosenthal MD (1991) Pathological gambling: a review of the literature (prepared for the American Psychiatric Association Task on DSM-IV Britain has liberal laws regulating gambling and this has resulted Committee on disorders of impulse control not elsewhere classified). Journal in some significant new trends in this field. First is the clustering of Gambling Studies (1987) 7: 5–40. of betting shops on the high streets. Second, the introduction Lesieur HR, Blume SB. The South Oaks Gambling Screen (SOGS): A new of 33 000 fixed-odds betting terminals into betting shops across instrument for the identification of pathological gamblers. American journal of Psychiatry. 144(9). Britain. Third, a rapid expansion in remote gambling (i.e. internet Lobsinger C, Beckett L. (1996) Odds on the Break Even: A Practical Approach to and telephone betting), which is currently a fifth of the ‘offline’ Gambling Awareness. Relationships Australia. gambling (where the gambler needs to be physically present) Morasco BJ, Pietrzak RH, Blanco C, Grant BF, Hasin D, Petry NM (2006). Health market. Fourth, a large increase in exposure to gambling problems and medical utilization associated with gambling disorders: results advertising on television (the number of gambling advertising from the National Epidemiologic Survey on alcohol and related conditions. Psychosomatics 68: 976-84. spots on television increased from 152 000 in 2006 to 1.39 Mulleman RL, Denotter T, Wadman MC, Tran TP, Anderson J. (2002) Problem million in 2012). gambling in the partner of emergency department patient as a risk factor for Gambling-related harm tends to sit fairly low on the list of intimate partner violence. J Emerg Med 23: 307-12. National Research Council, National Academy of Sciences, Committee on the priorities of healthcare providers, policy makers and treatment Social and Economic Impact of Pathological Gambling (1999) Pathological commissioners who will therefore prioritise allocation of time Gambling: A Critical Review. National Academy Press. and other resources on more obvious public health issues such Petry NM, Stinson FS, Grant BF (2005) Comorbidity of DSM-IV pathological as drugs, alcohol, smoking, diet, and risky sexual behaviour. gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Resources Psychiatry 66: 564–74. How to get help: Roberts, A. et al ( 2017) Gambling and negative life events in a nationally representative sample of UK men; Addictive Behaviors National Problem Gambling Clinic Vol 75, pp 95-102 https://doi.org/10.1016/j.addbeh.2017.07.002 69 Warwick Road, London, SW5 9BH. Royal College of Psychiatrists' information leaflet https://ww w.rcpsych.ac.uk/ United Kingdom healthadvice/problemsanddisorders/problemgambling.aspx Toce-Gerstein M, Gerstein DR, Volberg RA (2009). The NODS–CLiP: A rapid Telephone: 020 7381 7722 screen for adult pathological and problem gambling. Journal of Gambling Fax: 020 7381 7723 Studies. 2009 1; 25(4):541-55. Email: [email protected] Volberg RA, Munck IM, Petry NM (2011). A quick and simple screening method Website: https://www.cnwl.nhs.uk/service/problem-gambling/ for pathological and problem gamblers in addiction programs and practices. The American Journal on Addictions. (2011) 1; 20(3):220-7. Gamcare: Helpline: 0808 8020 133 (Freephone) Wardle H, Moody A, Spence S, Orford J, Volberg R, Griffiths M, et al. British Gambling Prevalence Survey 2010. Gambling Commission. Gordon Moody Association: Tel: 01384 241292 Gordon Moody in the South East: 020 8778 3331 July 2018 or email: [email protected] GA (Gamblers Anonymous): Tel: 020 7384 3040
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