Gambling addiction: where does treatment belong?

By Tony Clarkson

For many people who see a gambling counsellor, therapy focuses on underlying causes: ‘What happened to make me want to do something I know is so damaging?’

People often talk about wanting to ‘zone out’ or ‘disappear’, sometimes as much from themselves as from the wider world. This desire can echo a sense of feeling somehow lost, unknowable, inaccessible or difficult to be around.

Perhaps it's no surprise that the gambling treatment sector is also adrift within the broader suite of mental health and alcohol and other drug (AOD) services.

While Victoria's Gambler's Help services have been built up over decades and are the best funded of their kind in Australia, they are separate from mental health and AOD services. Is this in the best interest of people who need treatment for multiple issues or would an integrated service stream model be more appropriate?

People who seek support from Gambler's Help services rarely present with a single issue. Gambling harm frequently co-occurs with substance use, family and relationship issues or mental ill-health. This means that Gambler's Help counsellors must be aware not only of the existence of these issues, but how and to whom they can refer clients for assistance.

Gambling harm frequently co-occurs.

Referrals to other services do occur, but there is currently no formal pathway, partly because of the distinct nature of gambling services. This suggests a need for more integrated service delivery across mental health, AOD, gambling, family violence and other community services.

Prioritising which issue/s to address first can be challenging. It is not uncommon for a person who presents for treatment at a Gambler’s Help service to also be experiencing symptoms of higher-prevalence mental health conditions such as depression and/or anxiety.

Referral to other services in the first instance may be appropriate, depending on factors such as the severity of a person’s symptoms, their capacity to tolerate and make use of the gambling counselling, and the counsellor’s ability to treat them. Gambling may be a secondary issue to address when higher priority issues are managed.

Gambling may be a secondary issue to address.

It’s common, however, that a person’s gambling behaviour is a symptom, perhaps of an earlier trauma or another issue, such as unresolved grief. Cause and effect in relation to gambling and co-occurring issues is often a two-way street.

This is another reason that gambling, AOD, mental health and family and relationship services need to work together. There is a pressing need for research into the psychopathology or origins of gambling and co-occurring issues. The lack of clinical research into how gambling issues develop, interact with and influence co-occurring issues contributes to the difficulty of knowing which to treat first.

During the Royal Commission into Victoria’s Mental Health System, commissioners heard again and again from people who had been required to retell their stories to different services, often with re-traumatising effects.

The enacting of some of the Royal Commission’s recommendations, particularly the establishment of a statewide addictions service, will provide opportunities to streamline the process for people seeking support for mental ill-health, gambling and other addictions.

Such a service is to be developed and delivered by Turning Point.

The Victorian Responsible Gambling Foundation has established an inter-departmental committee to review screening and referral systems across state government-funded services. To be effective, a couple of key things will need to occur:

• training for Gambler's Help counsellors and clinicians from related services on identification, screening and referral for co-occurring issues
• agreement on referral pathways between all related services.

Underpinning a streamlined service will be SBIRT: screening, brief intervention, referral and treatment. Boosting the capacity of practitioners in gambling and other services will enable the provision of a more coordinated experience within the service system for people who need support for multiple issues.

…a statewide addictions service will … streamline the process.

The Foundation is currently piloting the use of a one-question gambling screening question developed specifically for use in primary care by time-poor allied health practitioners.

If someone answers ‘yes’ to the question, ‘In the past 12 months, have you had an issue with your gambling?,’ research tells us there is a higher than 92 per cent probability the person has experienced harm from gambling.

This is one step in a journey towards ensuring gambling treatment services intersect more effectively with other community services.

The Foundation’s Principal Clinical Advisor Tony Clarkson was a keynote speaker at the 2022 Australian and New Zealand Addiction Conference.