Pokies gambling relapse: the (not-so) merry go round

*Warning: this article mentions suicide.

By Dr Jane Oakes

Understanding relapse and why people continue to gamble, despite the harmful consequences they experience and the negative effects on those close to them, can help us to improve therapeutic treatment.

I have identified three important factors contributing to relapse.

Thought processes that give a person permission to behave in a certain way, including by denying reality and dismissing memories, are called ‘facilitatory cognitions’.

They enable people who gamble to disregard financial constraints or selectively overlook the harms from gambling they have previously experienced. Examples include:

• underestimating debt or overestimating one's capacity to repay it
• underestimating the impact of gambling on family and friends
• forgetting previous losses.

These cognitive distortions hamper a person’s ability to think critically, objectively and rationally. They cloud judgment, making it difficult for the person who gambles to accurately assess risk and make informed choices.

In my research, participants who gambled on pokies consistently reported losing their ability to think objectively and resist urges to gamble. They described this altered state as being ‘in the zone’, where perceptions of time and money became distorted.

Being in the zone provided temporary relief from painful emotions …

When in the zone, participants' critical thinking, self-observation, realistic appraisal of the use of money, recognition of the consequences of their actions, and ability to exercise the will to cease gambling or learn from harm were compromised. Memory, decision making and the capacity to make rational choices all suffered.

Being in the zone provided temporary relief from painful emotions such as depression, guilt related to gambling, and the distress of financial difficulties. This respite contributed to a cycle of seeking further relief in the zone, despite the detrimental effect on the person’s overall wellbeing.

Relapse in gambling involves the complex interplay of mutually reinforcing and conflicting cognitions, urges, and emotions. This cycle persists when the person who gambles has access to funds or believes they can acquire them.

Repeated relapse serves as a coping mechanism, offering an escape from the despair and harm associated with gambling. The avoidance of negative emotions through repeated relapse creates an endless merry-go-round. Relapse becomes a habit; a means of evading the depths of despair.

Repeated relapse serves as a coping mechanism …

Recovery from gambling involves confronting the harmful consequences, learning from them and making a commitment to cease gambling through effective treatment. Positive support can help clients gradually face their negative emotional states. Learning to tolerate distress enables a person who gambles to actively engage in the process of change and work towards sustained recovery.

Most people only seek help when they are in crisis. While effective engagement aims to reduce the distress of the help seeker, experiencing some distress keeps them mindful of the seriousness of the situation and the critical need for behaviour change.

Most people only seek help when they are in crisis.

Once their distress is sufficiently reduced, the help seeker gains the mental clarity to engage in constructive problem solving and approach recovery with a sense of hope, especially with professional support.

Acknowledging their courage in seeking help and identifying their immediate gambling concerns is an important first step. The focus should be on establishing a foundation for positive change and fostering a therapeutic alliance that supports their recovery.

When people are overwhelmed by gambling harm, there is a heightened risk of suicide. This is especially the case if the person is asked to confront the full extent of their financial losses and associated consequences. To address this risk, it is important to conduct a comprehensive risk assessment after each therapeutic session.

The therapeutic process can be emotionally distressing …

Relapse can occur when those who gamble find themselves in intense negative emotional states. The therapeutic process can be emotionally distressing and may lead clients to feel overwhelmed. This heightened emotional state increases the risk of relapse and may explain why many clients discontinue treatment prematurely.

During this critical period, the counsellor should not only evaluate potential risks, but ensure the presence of protective factors such as effective financial management.

This comprehensive approach fosters a safe therapeutic environment, minimises the risk of relapse and facilitates the help seeker’s continued engagement in the treatment process.

Dr Oakes has held senior clinical positions, including the Gambling Services Coordinator for Turning Point’s National Telephone and Online Services, a consultant role at Alfred’s Gambling Minds program, clinical leadership roles at the South Australian Intensive Gambling Help Service and the Statewide Gambling Therapy Service in South Australia. Her academic positions include the gambling topic coordinator within the Master of Addictive Behaviours at Monash and Flinders universities.

For free and confidential support, Gambler’s Help is available 24/7 on 1800 858 858. Lifeline crisis support is available 24/7 on 13 11 14.