PsychMed's Dr Jane Oakes recently joined our peer support forums for a special Q&A event on the relationship between alcohol use and gambling behaviours. Jane has extensive experience treating people experiencing gambling-related issues and addictions including drugs and alcohols. She has published articles and given invited presentations and workshops in this area both nationally and internationally. Many of our members feel that alcohol is a major trigger for them, so they took the opportunity to ask lots of helpful questions. Check out her answers below.
Answers prepared by Dr Jane Oakes, supported by Dr Quentin Black and assisted by Rachel Aves.
I wonder if there is anything that you recommend for people looking to stop or cut down their gambling and their drinking at the same time?
I would firstly like to acknowledge the strength of people beginning the pathway to recovery. Just reading this section is a start to regaining control of your life.
An essential factor for recovery is support from those around you, including professionals with experience of helping people with gambling issues. When people stop gambling and drinking alcohol, they often experience a wide range of emotions, so reaching out for support at this time is essential. Just having someone to talk to about how you're feeling can help.
Furthermore, if you’re just beginning to question if gambling may be affecting you or a loved one, reaching out for support is essential, even though it may be daunting. Please do not let this stop you from reaching out. People who take this first step towards recovery admit once they reached out for help, they feel relief.
It is also important to have the correct information about issues related to gambling and alcohol. This information empowers people with essential tools and strategies to help someone or themselves.
I will discuss some other strategies in my answers to the questions below.
Could you discuss the biological association between alcohol and gambling?
It is common for people who are experiencing gambling-related problems to also have issues related to alcohol.
Alcohol and gambling have similar biological processes in common, including:
- strong urges
- overwhelming and intrusive thoughts
- impulsivity and loss of control, and
- feelings of irritability and agitation when you can’t drink or gamble.
It’s therefore not surprising that both behaviours involve the same biological mechanism where the ventral tegmentum releases the brain chemical Dopamine, which forms part of the brain's reward system. When people drink or gamble, the reward system is flooded with Dopamine, which makes the person feel good.
Dopamine is designed to make us feel good and reward positive and pro-social activities that are life sustaining so we repeat them. For example, engaging in activities such as procreating, eating healthy food, and drinking water. However, other activities like, eating a sweet dessert, listening to music, and exercising also release Dopamine.
When people engage in gambling and drinking alcohol, this also stimulates the Dopamine pathway but causes a surge of Dopamine. Over time this excessive release of Dopamine leads to cravings and a motivation to continue to gamble and drink alcohol. This creates and maintains gambling and alcohol problems because the urge to engage in these behaviours and feel the rush of Dopamine becomes overwhelming and difficult to resist.
Additionally, recent UK medical neuroimaging research has shown that alcohol and gambling behaviours light up the same regions of the brain called the Nucleus Accumbance. This region is involved in the reward centre, where emotions are processed.
With the correct psychological interventions these processes can be adjusted through the use of cognitive and behavioural techniques that can assist in reprogramming our thinking and eliminating urges.
If you are experiencing gamble-related issues, specialised treatment programs can be beneficial as they use best practice techniques that can help you to eliminate this behavioural response and regain control of your life.
How does alcohol hinder the road to gambling recovery? How hard is it to quit one without quitting the other?
Alcohol can exacerbate gambling problems by impacting on the gambler's ability to think clearly about their financial decisions and exercise their better judgement when gambling. The gambler becomes more disinhibited with poor impulse control when drinking alcohol and may gamble more than they were
initially prepared to bet.
Excessive use of alcohol further impairs the capacity for sound decision-making by damaging the parts of our brain responsible for reasoning and self-control, the frontal and prefrontal lobes. This allows the mesolimbic system, which is associated with primitive and instinctive urges, to operate without constraint. The result can be impulsive choices and behaviours, such as uncontrolled gambling and other pleasure-seeking behaviours.
It is at this time that the gambler is least likely to stop gambling once they have started until all their available money is spent. Realising they have spent more than intended often causes gamblers significant distress and they may be drawn to drink more alcohol in an attempt to escape this negative emotional distress.
Some of the feelings of shame and regret associated with these gambling harms will help fuel alcohol use.
How much of a cumulative risk does alcohol play when paired with problem gambling (mental health, relationships, the extent of gambling, recovery)?
Alcohol is strongly associated with impulsivity and increased acts of violence during use. Alcohol withdrawal and use is also strongly associated with irritability and has a corrosive effect on interpersonal relationships.
People with gambling-related problems have more significant physical and mental health problems than non‐problem gamblers. For example, they are more likely to have issues with alcohol and severe mental health disorders, including depression, anxiety, and suicidal thoughts. Gambling and alcohol can provide some people experiencing these emotions a temporary escape, but this escape leads to more problems. Without professional support to deal with these mental health issues, recovery from gambling and alcohol can be affected, as people will turn to these behaviours as a way to cope.
Given that increased distress is correlated to continued gambling, how can loved ones support a problem gambler who refuses to seek outside help?
It is normal to find it frustrating and upsetting to help someone struggling with a gambling issue, especially when they refuse to seek help. Often when loved ones or close friends are caught in a cycle of dependency, it is reasonable to feel the need to be responsible for helping them. People in this position often feel helpless and powerless.
It is difficult to know how best to support those struggling with gambling, which is why it is crucial to seek support and sound advice. Talking to qualified, trained health professionals can help guide how best to assist the person in need of support without inadvertently facilitating the behaviour.
In these circumstances, when you may feel powerless to help just being available to listen and offer support is essential. At the same time, it is important to seek assistance for your own mental health if you are struggling, feeling distressed, or overwhelmed.
What surprised me was how my husband could hide his alcohol and gambling addiction in plain sight of me. We have since separated, and in hindsight, I can see clearly all the signs. Why do you think, as a partner that I was blinded to this for so long?
This is not an uncommon story. In our closest relationships we often do not want to so see the negative signs, and we naturally want to defend, make excuses, justify, and rationalise the behaviours we do not agree with or understand. It’s also a natural tendency for us to want to explain away and defend our partners, children, or even work colleagues’ behaviours.
Sometimes when support is offered we can respond negatively, leaving the significant other to be afraid to challenge or doubt their own observations.
One of the reasons we try to forgive and tolerate is that these values are an integral part of relationships and bad choices and behaviours result from dependence, poor decisions, and bad actions.
Remember that these bad choices and dependent behaviours do not mean the person is bad. We often want to be tolerant and offer forgiveness and support, as these are the good parts of a relationship. However, it is essential to remember that ultimately, we must not forget the person with the dependence needs to take personal responsibility for change.
It can take time for the person with the gambling or alcohol issue to develop insight that they have a problem and begin to take personal responsibility for seeking and engaging in help. For some, the continuing cycle of lapse and relapse becomes overwhelming for the significant other, and they come to the point where they need to consider their own mental and capacity to continue supporting the person.
It was difficult for me to come to terms with my blindness as I am one who values truth and honesty. Do you think perhaps I tricked my mind into believing everything was okay?
People sometimes say they feel that they should have noticed a problem sooner. However, remember that the person gambling may have gone to great lengths to hide it from you. This is usually because the person with a gambling problem is trying desperately to win back the money they have lost. They become caught in a vicious cycle of trying to win the money back and once started, this cycle can be hard to break without professional help. Thoughts of winning back the money lost to pay off all debts can fuel an overwhelming desire or urge to gamble. This urge becomes difficult to resist and if money is available it can become impossible for some to stop the cycle.
You may see the signs of someone caught in this cycle, as their moods may fluctuate rapidly from extreme agitation to gambling to depression after the money is lost. At this time, the gambler may be faced with the consequences of their gambling. This can become too painful to tolerate so gambling becomes a focus in an attempt to win back the money and make everything okay. However, this rarely happens and the cycle is repeated. It is at this time the gambler often admits that money loses its value. Therefore, it is important that you ensure your finances are safe. Check out some measures you can take to protect your finances and assets:
- Q&A with a financial counsellor
- Talking to a financial counsellor on 1800 007 007 they are open Monday-Friday 9.30-4.30
Self-Care is Important
When supporting someone it is important that you take time out for yourself. Therefore, if you suspect someone close to you is having an issue with gambling, I encourage you to seek some support for yourself. Just having someone to listen to your concerns will help reduce your distress and provide you with some skills about how best to help the person you are worried about.
There are some great tips on this website to get you started - https://www.gamblinghelponline.org.au/helping-others
Reaching Out for Support
You can call the Gambling Help counsellors today, it’s free, confidential and available 24/7 if you would like to have a chat or be referred to a gambling counsellor. Each state provides free and confidential support for people who are concerned about someone’s gambling. Call 1800 858 858.
Sometimes people act out of character when caught in the vicious cycle of gambling. If you need to talk to someone about domestic violence, family violence or sexual assault call the 1800 RESPECT LINE - 1800 737 732.
Thank you so much for your time and fantastic answer Dr Jane & the PsychMed team! We are all so grateful.
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PsychMed provides a free and confidential program in South Australia for people experiencing gambling-related issues. This program has shown success in helping individuals struggling with gambling to regain control of their lives. If you or someone close to you is in need of some help we encourage you to call and speak to one of our friendly team members who will assist. Please call PsychMed on 08 8232 2424.
If you'd like to talk to someone about your alcohol use, contact the Australian Drug Information Service in your state.
The Gambling Help Online forums are a place for anyone affected by problems relating to gambling, including those with lived experience, friends and family. Share your experience and strategies, connect, be inspired, and motivate others. The forums are safe, confidental, professionally moderated and free of judgment. Join the discussion today.