Fall 1996

While there are certainly similarities between gambling and chemical dependency there are also several differences. It is important for helping professionals, as well as concerned friends or family members, to understand both similarities and differences in order to take appropriate action to help a person suffering from either or both disorders.

A number of professionals in both the gambling and chemical dependency fields were asked to describe the relationship of compulsive gambling and chemical dependency based on their experiences and perspectives. We wish to thank Judy Benson, Bill Bergwall, Lynn Kistler, Mike Marcotte, Loren Novak, and Kelly Reynolds for taking their time to share their thoughts and observations. Similarities Most of these clinicians found compulsive gambling to exhibit some of the same features commonly seen in chemical dependency. Included were: progression of the disorder; preoccupation with the problem behavior; chronicity; potential for relapse; tolerance; and withdrawal symptoms. Both disorders have elements of denial and rationalization for the addictive behavior. Depression, anxiety, low self-esteem, loss of spirituality and life management skills are also regularly observed in both types of client. One expert saw individuals often switching addictions, substituting one drug of choice or a set of addictive behaviors for another while continuing a pattern of addiction.

Differences
A key difference that surfaced was the secrecy of compulsive gambling. Compulsive gambling is simply not as evident or visible as chemical dependency. This fact can allow a compulsive gambler to continue to gamble and experience negative consequences without detection by friends, family members or co-workers. Another difference can be seen in how the person views her/her addiction. "The person who is chemically dependent tends to view his/her drug of choice as remarkable while the person who is caught up in gambling may view himself/herself as remarkable."

The progression of compulsive gambling also seems to be more swift than the development of chemical dependency. Lastly, financial problems are much more severe for the compulsive gambler. There are also notable differences in societal understanding of these disorders. Chemical dependency has become fairly well accepted by the general public as a treatable disease. Compulsive gambling is still considered, by many, to be a moral weakness, reflecting poor judgment, irresponsibility, or greed. The general public seems more informed about, as well as more willing and better able to intervene with chemical dependency, than compulsive gambling. One possible explanation is that gambling is more difficult to understand as an addiction because it doesn't involve the ingestion of any substance. Another reason may simply be that legal gambling options have expanded so rapidly that the general public has not had time to learn about the social costs connected to problem/compulsive gambling.

Assessment and Treatment
When both disorders occur concurrently, all of the clinicians emphasized the importance of conducting an assessment to determine the primary disorder and develop treatment plans accordingly.

A number of clinicians noted that there was a high degree of shame and diminished self-esteem with the admission of gambling problems. One clinician commented that the increase in shame among recovering chemically dependent clients now in treatment for compulsive gambling led to an inability to transfer the recovery skills they used to deal with chemical dependency. Another therapist noticed that those skills can become useful later on in recovery from pathological gambling.

Therapeutic strategies and relapse prevention efforts for both disorders are often very similar. Both disorders seemed to be helped by a 12 step mutual help program.

The Gamblers Anonymous Pressure Relief Group was identified as a strategy to deal with debt restitution and financial management issues for compulsive gamblers.

In Conclusion
When dealing with clients who appear to demonstrate characteristics of both disorders, the clinicians offer the following suggestions:

1. Conduct an assessment of both gambling behavior and chemical use in developing a treatment plan.
2. Inform the client about the high prevalence of cross addiction.
3. Incorporate both gambling and chemical use in after care plans.
4. Arrange for immediate transition to other treatment modalities to ensure continuity of care.

Being aware of the relationship between chemical dependency and gambling problems may enable helping professionals to help their clients from relapsing and/or developing another addictive disorder.