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Gamblers Anonymous: Overlooked ARTICLE and Underused? Sanju George, Onuba Ijeoma & Henrietta Bowden-Jones

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Gamblers Anonymous: Overlooked ARTICLE and Underused? Sanju George, Onuba Ijeoma & Henrietta Bowden-Jones Advances in psychiatric treatment (2013), vol. 19, 23–29 doi: 10.1192/apt.bp.111.009332 Gamblers Anonymous: overlooked ARTICLE and underused? Sanju George, Onuba Ijeoma & Henrietta Bowden-Jones domestic violence, detrimental effects on children) Sanju George is a consultant SUMMarY and society (e.g. crime, loss of employment). For a and senior research fellow in addiction psychiatry at Solihull Gamblers Anonymous (GA) is perhaps the least review of what the non-specialist needs to know used of the twelve-step approaches to dealing Integrated Addiction Services in about gambling addiction, read George & Huang Birmingham, UK. Onuba Ijeoma with addictions. This relative lack of visibility and (2011a) and for an overview in this journal of is a specialist doctor in addiction use, at least in the UK, is reflected in healthcare the assessment and treatment of pathological psychiatry at Birmingham and professionals’ lack of awareness and knowledge Solihull Mental Health NHS of gambling addiction and its treatment, including gambling, read George & Murali (2005). Foundation Trust, UK. Henrietta GA. In this article, we introduce the basic tenets Despite all of the above, current treatment Bowden-Jones is a consultant of GA and discuss how these translate into pro vision for gamblers in the UK is at best psychiatrist and lead clinician at the National Problem Gambling treatment. patchy and at worst nonexistent, as previously Clinic, London and honorary senior reported in Advances (George 2011b). Gambling DeclaratioN OF INterest lecturer in the Department of treatment is provided almost exclusively through Neurosciences and Mental Health None. the third (voluntary/charity) sector and only at Imperial College London, UK. Correspondence Dr Sanju George, one National Health Service (NHS) provider Solihull Integrated Addiction Conceptual and nosological ambiguity has long supplies such specialist services (the National Services, Birmingham and Solihull shrouded pathological gambling. It seems that Problem Gambling Clinic, London: www.cnwl. Mental Health NHS Foundation nhs.uk/gambling.html). Considering treatment, Trust, Birmingham B37 7UR, UK. gambling addiction will at last find its rightful Email: [email protected] ‘home’ in the section on addictive disorders in it is especially worth noting that despite some DSM-5 (Petry 2010), rather than the section on success with trials of selective serotonin reuptake impulse control disorders in which it currently inhibitors (SSRIs), mood stabilisers and opioid resides. This is, finally, an acknowledgement antagonists, there is no licensed drug in the UK that pathological gambling is conceptually for treating gambling addiction. Hence, it follows akin to substance addictions, except that it is a that psychological interventions are the mainstay behavioural addiction (Orford 2001). for treating gamblers. The British Gambling Prevalence Survey In this article, we present an overview of one of (Wardle 2010) notes rates of problem gambling (a the most popular and widely available (and free) term preferred in the UK) to be around 0.9% of the psychological interventions for gambling addiction general adult population (an increase from 0.6% – the Gamblers Anonymous fellowship. in 2007) and those at risk of developing problem gambling in the future to be 7.3% of the adult The Gamblers Anonymous fellowship population. Although precise estimates of gambling What is Gamblers Anonymous? problems among those with mental health difficul- ties are lacking in the UK, international evidence Gamblers Anonymous (GA) describes itself as suggests that comorbidity rates are high. Despite ‘a fellowship of men and women who share their all of the above, gambling problems both in the experience, strength and hope with each other general population and among psychiatric patients that they may solve their common problem and often go unrecognised and unaddressed. Reasons help others to recover from a gambling problem’ highlighted for this include gamblers’ reluctance to (Gamblers Anonymous 1984). It is important to seek help (enforced by issues of perceived stigma) note that GA states that ‘any betting or wagering, and that many healthcare professionals are for self or others, whether for money or not, no unaware of the problem. The negative consequences matter how slight or insignificant, where the of unrecognised and untreated problem gambling outcome is uncertain or depends upon chance or are numerous: related harm adversely affects “skill” constitutes gambling’. the individual (including psychiatric problems, comorbid addictions, physical ill health, financial Origins of Gamblers Anonymous problems, involvement in crime), family (e.g. The fellowship of GA was founded by Jim W in impaired relationship with partner/spouse, 1957 in Los Angeles, USA. He was a drinker and 23 George et al a gambler. He joined Alcoholics Anonymous (AA) BOX 2 The twelve steps in 1946 and, seeing its benefits, applied similar principles to help himself with his gambling 1 We admitted we were powerless over gambling – addiction. A few years later, with three fellow that our lives had become unmanageable. drinkers/gamblers, Jim set up the forerunner of 2 Came to believe that a power greater than ourselves GA – the Algamus Society. This survived just two could restore us to a normal way of thinking and meetings and Jim too relapsed into gambling. living. However, through sheer perseverance and support 3 Made a decision to turn our will and our lives over to from his wife, whom he had met through AA, Jim the care of this Power of our own understanding. organised the first-ever meeting of GA, with one 4 Made a searching and fearless moral and financial fellow addict, at his apartment in 1956. inventory of ourselves. Gamblers Anonymous in the UK 5 Admitted to ourselves and to another human being the exact nature of our wrongs. After starting up in the USA, GA soon took off in several other countries and now has chapters 6 Were entirely ready to have these defects of character removed. in the UK, other European administrations, Australia, New Zealand, Brazil, Israel, Africa (e.g. 7 Humbly asked God (of our understanding) to remove Kenya and Uganda) and Asia (including Korea, our shortcomings. Japan and India). It appears to have arrived in the 8 Made a list of all persons we had harmed and UK in 1964 and there are now meetings around became willing to make amends to them all. the country on most nights of the week. Box 1 9 Made direct amends to such people wherever lists key guiding principles of GA, and further possible, except when to do so would injure them or information about the organisation is available at others. www.gamblersanonymous.org.uk. 10 Continued to take personal inventory and when we were wrong promptly admitted it. The Gamblers Anonymous recovery 11 Sought through prayer and meditation to improve our programme conscious contact with God (as we understand him) praying only for knowledge of His will for us and the The GA recovery programme, in essence, power to carry that out. consists of the twelve steps of recovery (Gamblers Anonymous 1984), which is the foundation on 12 Having made an effort to practise these principles in all our affairs, we tried to carry this message to other which the fellowship of GA is built. Hence, we first compulsive gamblers. present the twelve steps (Box 2) and then discuss the structure and nature of GA’s group meetings, (Gamblers Anonymous 1984, with permission) which are the operational core of the fellowship. As it is hoped that the steps in Box 2 are self- BOX 1 Basic guiding principles of Gamblers explanatory, no further discussion is provided Anonymous here. However, it is worth re-emphasising that GA Gamblers Anonymous: had its origins in Alcoholics Anonymous and so • is a fellowship programme is very much modelled on the same twelve-step approach. Working through these twelve steps is • uses a disease model for compulsive gambling integral to the gambler’s recovery. Although the • believes that no cure, only recovery/control, is emphasis, at least initially, is very much on getting possible the gambler to attend 90 meetings in 90 days, the • recommends total abstinence, not controlled gambling first 90 days are merely the start of their recovery • is not religious but spiritual journey. For further reading, refer to the ‘The Blue • considers belief in a higher power to be essential Book’ (Gamblers Anonymous 1984). • is a lifelong endeavour • maintains that anonymity is key The group meeting • encourages personal and spiritual growth It is through group meetings that the fellowship’s principles are translated into action. Meetings are • focuses on repeatedly working through the twelve steps usually held weekly and may vary in length from • has no fees for membership 1 to 2 hours. Most meetings are held in venues • has no sociopolitical or religious affiliation such as churches or hospitals and although • is a way of life. individual groups have some flexibility in how their meetings are run, the essential workings of 24 Advances in psychiatric treatment (2013), vol. 19, 23–29 doi: 10.1192/apt.bp.111.009332 Gamblers Anonymous: overlooked and underused groups are similar across the world. Most group BOX 4 Gamblers Anonymous 20 questions meetings are open only to GA members, although with prior permission ‘observers’ can attend some 1 Did you ever lose time from work or 12 Were you reluctant to use ‘gambling meetings. After each meeting, coffee is provided school due to gambling? money’
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