Gambling and Alcohol Addiction
From Old West barroom scenes to modern-day casinos, gambling and alcohol have been linked in the social subconscious through literature and film for generations. However, they’re also strongly connected in the human brain by the characteristics of substance use disorder.
Both are associated with play and relaxation, and they’re often a means of coping with boredom or stress.
Gambling and alcohol also affect the same regions of the brain that lead to addiction. Treatments can follow similar procedures, and continued use or relapse is often triggered by the same types of conditions and events.
Is There a Difference Between a Disorder and an Addiction?
Addiction is a simple term used to describe a complex set of behaviors that are more properly termed disorders. Such behaviors can be related to overeating, drug use, or even healthy activities like running or working out at the gym. In general, a disorder is indicated if the behavior continues or worsens over a period of 12 months.
It often begins as a way of coping with life. But they can quickly transition into compulsive behaviors that control your life and affect all of your decisions.
The behavior usually starts innocently enough. You take a drink to relax or socialize. Perhaps you try drugs recreationally or because you want to fit in. Maybe the habit starts as a way of managing stress, dealing with a traumatic event, or escaping a life that’s chaotic or mundane.
Unfortunately, the pleasurable effects are short-lived and unsustainable.
In an effort to recapture the original euphoria and pleasure of the first experience with intoxicating substances or activities, you eat more, use more substances, or go to the gym more often. The right combination of genetics, social conditioning, and brain chemistry then leads to a cycle of overuse, disordered thinking, and compulsions that destroy lives.
Your brain structure and function are altered. Even the thought of quitting leads to feelings of anxiety and unease. When the problem is severe or long-term, it leads to intense cravings, personality changes, and habits that disrupt your ability to think, meet obligations, and make healthy decisions.
Your memory, relationships, and quality of life suffer as a result. The behavior will continue despite negative consequences, such as job loss, homelessness, financial ruin, and legal problems.
One of the more destructive combinations is gambling and alcohol use.
Similarities Between Alcohol Use and Gambling Disorders
Like many relationships, the connection between alcohol use and gambling is complicated. The gambling habit can begin due to lowered inhibitions from drinking. Alcoholism can worsen as a result of financial and other problems that stem from a gambling disorder.
Both disorders tend to affect men more often than women, but they share many of the same risk factors, symptoms, and behaviors.
They impact brain functioning by:
• Disrupting the reward center that regulates how we experience pleasure
• Disrupting portions of the prefrontal cortex that manage impulse control
• Embedding the brain with neural associations and memories that are triggered by sensory stimulation like sights, sounds, smells, people, or events
The symptoms of problem gambling include:
• Stress related to gambling
• An impulse to wager despite financial difficulties, odds of winning, or other negative consequences
• Becoming restless or irritable when you try to stop or cut down on gambling
• Loss of jobs, housing, or important relationships due to gambling
• Lying to cover gambling activity
• Stealing or borrowing money to cover gambling debts
• Legal problems that stem from gambling or related criminal activity
By contrast, the symptoms of alcohol use disorder (AUD) are:
• Inability to control alcohol consumption
• Inability to control or quit drinking
• Preoccupation with drinking or thoughts of drinking
• Cravings for alcohol
• Lying about or hiding your alcohol consumption
• Lack of interest in people, places, or activities that were once important or pleasurable
• Continued drinking despite negative consequences
• Needing more alcohol to experience the same effects
• Withdrawal symptoms when access to alcohol is limited or cut-off
• Risky behavior while under the influence
Gambling and alcohol use disorders are also closely related by a genetic predisposition, the social atmosphere surrounding individuals and activities, and the changes they make in the human brain.
For example, people who are raised or around people who gamble and where alcohol use is part of the social or family structure are more likely to develop disordered thinking and behavior. Alterations to brain function and chemistry make recovery prolonged and difficult.
The two conditions differ in very specific ways. For example, gamblers rarely exhibit physical signs of a disorder. People with AUD visibly stumble, shake, and slur their words. Hygiene becomes less of a priority.
While both affect impulse control, gambling also affects dopamine release in the reward center of the brain. When you’re not getting the psychological payoff by betting and winning, you’re chasing losses.
Unless treatment is sought to address root causes, treat co-occurring conditions, and cope with triggers, the behavior will usually escalate. Relapse is also likely in the absence of an actionable recovery plan and plenty of support.
Keep in mind that most people are able to gamble without it becoming a destructive habit or to have a few drinks without it becoming a life-long disorder.
However, the effects on individual lives, families, productivity, and society are exponential.
Risk Factors for Alcohol and Gambling Disorders
The risk factors for developing alcohol use and gambling disorder are the same, and they can feed into each other to exacerbate the behavior.
• Family history – People who grow up in an environment where gambling and alcohol use are treated casually have a higher risk of developing disordered behavior.
• Age – Problem drinking and gambling tend to affect those between the ages of 16 to 21 and people over 40 disproportionately.
• Age of onset – The younger you are when you first take a drink or gamble, the more likely you are to develop a problem.
• Gender – Both problems affect men more often than women, and the behaviors surrounding the disorders exhibit differently.
• Mental health conditions – Both disorders affect those with depression and anxiety more often than others. It’s also more common in people with conditions like OCD and anti-social personality disorder.
• Peer pressure – Drinking and gambling are very susceptible to peer pressure, especially if an individual has low self-esteem, impulse control problems, or trouble making decisions.
• Stress – People who are under pressure are at higher risk of developing alcohol or gambling disorder. Boredom and loneliness also play a role.
One risk factor that’s related to gambling alone is an early win. The rush of winning a big pot at bingo, hitting the lottery, or taking the jackpot at the slot machines makes it more likely that the individual will continue to gamble in order to win again. This behavior can even continue despite high odds or a series of losses in an attempt to repeat the experience.
The most effective course of action begins with a proper diagnosis of the problem and a personalized recovery plan.
What Is Dual Diagnosis?
Dual diagnosis also called concurrent or co-occurring health/mental health conditions, is a situation that occurs when one is diagnosed by a qualified medical or mental health professional with two or more conditions. Commonly, the dual diagnosis is something like substance use or binge eating disorder and a mental health condition like depression.
Another common concurrent diagnosis is alcohol use and gambling disorder.
More than 73% of those diagnosed with gambling disorder also struggle with AUD. In order for a lasting recovery to take hold, the underlying conditions must be properly diagnosed and treated according to the length and severity of the problem, the underlying factors, and the individual’s support system during and after treatment.
Approaches to Dual Diagnosis Treatment
Although some therapeutic approaches to treatment can address many elements of co-occurring conditions, certain distinct differences in the nature of each disorder require individualization. For example, medication can curb cravings for alcohol but has little effect on gambling disorder. Those with problematic gambling respond more favorably to motivational interviewing techniques and behavior modification.
With both, it’s essential to learn coping mechanisms to deal with triggers and the social aspects of gambling and alcohol use.
Outpatient care is the recommended course of treatment for those with gambling use disorder in most cases. It’s also indicated for substance use disorder if:
• The condition is short-term and less severe
• There’s a strong motivation to quit drinking
• The client’s employment, housing, and relationships are stable
• There are work, school, or family obligations that prevent inpatient care
For both disorders, outpatient care is available through hospitals, community groups, non-profit organizations, and mental health facilities. Programs run from 30 days to six months on average.
Usually, the client will attend meetings ranging from one to five days per week and three to six hours per day. During this time, there will be gambling and/or alcohol education classes, individual therapy, and group sessions. The length of time and number of sessions per week depends upon whether the client is undergoing standard outpatient treatment or intensive outpatient treatment (IOP).
Intensive outpatient treatment is a little more rigorous and could also include family counseling and medical maintenance if indicated by the diagnosis and severity of the condition.
Although inpatient treatment isn’t usually warranted for gambling disorder, it can be part of the therapy if the client needs residential care for a dual diagnosis.
In this case, the individual therapy sessions can:
• Address the root causes of gambling disorder
• Use guided self-help interventions and motivational interviewing techniques to retrain the impulsive behavior
• Uncover triggers
• Learn new tools and coping mechanisms
Group sessions at a residential rehabilitation facility usually don’t specifically address gambling disorders but focus on accountability and issues surrounding addiction in general.
The inpatient alcohol treatment program will include many of the same options outlined above but could also include medication for detox and to deal with withdrawal symptoms. Therapy will include ways to deal with psychological problems associated with drinking as well as cognitive behavior therapy. Education programs, family therapy, and group counseling are also par for the course.
Inpatient care programs usually last from 30 days to one year and include an aftercare plan for relapse prevention.
Aftercare is a system for continued support and education with the goal of preventing a relapse. It can be as simple as attending 12-step programs like Gamblers Anonymous (GA) and Alcoholics Anonymous (AA) or complex and ongoing for a year or more.
Aftercare can include:
• Continuation of individual therapy might be needed if the underlying problems are long-term and complex.
• Health services would be indicated to deal with medical problems resulting from prolonged alcohol use.
• Job counseling and housing assistance help build stability.
• Medical maintenance might be required for severe alcohol use disorder to keep the client from drinking in the future.
If the family or life situation is unstable, the client might transition into residential treatment or a sober living facility. These provide home-like settings that allows the client to work or attend school after leaving an inpatient facility. There’s a little more freedom of movement during the day but a secure and sober living environment for those who need more stability as they transition back into life.
Where to Get Help for Alcohol and Gambling Disorders
When you or someone close to you is struggling with an addiction-related disorder, help is as close as a phone call to your local treatment center. In nearly every community, public and private mental health and rehabilitation facilities offer help and support for short-term intervention and long-term recovery.
The first step toward freedom from the pain and destruction of gambling and alcohol use disorder is simply asking for help. It won’t be easy, but you can live a life that’s based on healthier choices.
Don’t hesitate to reach out to your primary care physician, mental health professional, or community resource center to learn more about coping with addiction and other disordered behavior.