Research offers hope for problem gamblers

By Liz Benston (contact)

Wednesday, Aug. 21, 2002 | 11:09 a.m.

Gambling and drinking problems don't necessarily get worse once symptoms emerge, a sign that problem gamblers may be able to recover more easily than previously thought, a new Harvard Medical School study shows.

The two-year study of casino employees, published this month in the Journal of Social Psychology, reveals more examples of people whose gambling problems changed for the better relative to people whose symptoms worsened.

The results break from previous research suggesting that problem gambling is a progressive disease that can only worsen with time, said study co-author Dr. Howard Shaffer, a researcher at Harvard Medical School's Institute for Research on Pathological Gambling and Related Disorders.

"We would have guessed that more people would have changed for the worse if we'd accepted the conventional wisdom," Shaffer said.

Another study co-authored by Shaffer in 1999 found that casino employees had a higher prevalence of pathological gambling behavior -- along with evidence of smoking, alcoholism and depression -- compared to the general population. The results pointed to the popular yet unproven belief that gambling addiction can lead to a variety of other problems.

But this month's study found little evidence to support that theory.

The study, along with previous research in the field, is an attempt to determine what factors cause gambling problems and how the disorder progresses over time. Further research is needed to make that determination, Shaffer said.

"We don't really have any sense of the course of this disorder," added Christine Reilly, the institute's executive director.

Researchers have long known that people with gambling problems are likely to suffer from other disorders, such as depression.

At issue is whether other problems are the cause or the result of a gambling problem.

"(Multiple) disorders makes it very tricky to diagnose," Reilly said. "Is a person drinking because they have a gambling problem or are they an alcoholic who started gambling?"

Physicians often treat disorders simultaneously, a technique that has worked for some sufferers, she said. Gamblers with severe depression have been treated successfully with Prozac, for example.

The Harvard Medical School study is the first to follow casino employees for an extended period of time, Shaffer said.

Some results showed that problem gamblers -- prior to the emergence of symptoms -- possessed certain characteristics that were different from those who didn't develop gambling problems. But some evidence also pointed in the other direction, showing that problem gamblers developed differences from non-gamblers after their gambling disorders became apparent.

Evidence exists for both positions, which is inconclusive for proving a cause or effect relationship to disordered gambling, Schaffer said.

"(M)eaningful predictors of gambling and drinking problems among casino employees remain to be identified," he wrote. Another, yet to be identified personal factor may also be a contributor, he added.

The study measured demographic and psychological characteristics such as age, gender, length of casino employment, physical condition and psychological health for both disordered gamblers and those without gambling problems.

Of those categories, only two variables -- depression and dissatisfaction with life -- yielded changes in gambling and drinking problems. Their effect was limited, however, explaining only 1 percent of the variance in drinking habits and only 3 percent of the variance in gambling habits.

Dr. Rena Nora, a clinical professor of psychiatry at the University of Nevada School of Medicine and chief of psychiatry at the U.S. Department of Veterans Affairs' ambulatory care clinic in Las Vegas, agrees that gambling disorders don't necessarily lead to other disorders.

"I have had (patients) who do not move on to other problems" beyond gambling, Nora said.

Nora has also witnessed many more cases in which patients with gambling and alcohol problems eventually declined rather than improved.

"Over time, the longer this dual diagnosis occurs, the worse the problems get," she said. "It increases their impairments, increases their family and relationship problems, it interferes more with their work."

Casino workers were chosen for the Harvard study because of their proximity to gambling, which raises the question of whether industry employees are more likely to develop gambling problems than the rest of the population, researchers said. Workers in the study had been exposed to gambling for an average of four years.

Employees may serve as an important harbinger of gambling patterns that other people may experience as legalized gambling spreads, a tendency that has concerned public policy makers and anti-gambling groups, the study said.

The study isn't intended as ammunition for or against legalized gambling, Shaffer said.

"We did this to understand the nature of the disorder ... so that we can improve the health and well being of casino employees."

The Institute for Research on Pathological Gambling was established by a grant from the National Center for Responsible Gaming, an industry-supported organization formed in 1996 to promote educational programs for the prevention and treatment of problem gambling and fund independent research on the disorder.