Identifying the ripple effects of problem gambling

‘For some people it’s just a bit of fun, but for others it actually causes real problems in their lives.’
 
That is Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine, discussing problem gambling’s impact on the community.
 
‘Many of us in general practice haven’t thought to ask about gambling, but it’s common … with around one in seven people experiencing harms,’ Dr Wilson said.
 
‘And people often don’t seek help, because they don’t know where to go. They feel ashamed.’
 
Alongside gambling expert Professor Sally Gainsbury, Dr Wilson recently published an article in the Australian Journal of General Practice (AJGP) aimed at raising GPs’ awareness of problem gambling and how it presents in general practice.
 
According to the paper, patients do not often present to general practice seeking help for gambling, which makes screening ‘essential’ to identify harms. Dr Wilson believes the most effective approach GPs can take is to simply ask, or use validated screening tools to help people talk about their gambling.
 
‘We as GPs have a really amazing role,’ she said.
 
‘It’s super easy for us because we can ask, as part of our lifestyle review which we do all the time, “Do you gamble? Has it caused you any problems? Have you noticed anything?”
 
‘It’s really just around flagging those simple questions.’
 
While not everyone who gambles has a problem, early intervention can allow people to maintain low-risk gambling. The article discusses the related impacts of gambling on people’s physical and mental health, and financial and relationship issues.
 
‘These can be huge, and can present physically, particularly for cardiovascular health,’ Dr Wilson said.
 
‘So if you’re seeing someone who’s got [for example] cardiovascular issues or gastrointestinal symptoms, GPs have this opportunity to ask, and our patients then realise that it’s important that we care about it, that we can assist.
 
‘I would always say things like, “As your GP I’m aware that certain behaviours and things you do in your life can have health issues, like your nutrition, weight, exercise, alcohol, drugs, gambling – can I ask you about these, and are any of them an issue for you?”
 
‘You can do it as part of your general screen, or you can do it when you have a person presenting with these issues – could gambling be part of what’s causing it?
 
Often, it’s not just the person experiencing the gambling issues, but the extended impacts to family, friends and colleagues, Dr Wilson says, who had one patient who triggered her awareness.
 
‘They came in saying, “I’m really tired and stressed and I feel depressed”, but it turned out that it was a partner’s gambling and they were taking on that extra load,’ she said.
 
‘That patient wouldn’t have told me if I hadn’t asked, so it was it was a bit of a lightbulb moment for me to do more about this as a GP – which is why I teamed up with Sally [Gainsbury] who is an expert in gambling to write this really practical, simple paper for GPs.’
 
For each person affected by gambling, six other people in their lives may well be affected, according to Dr Wilson.
 
‘Gambling has a ripple effect and not just for the individual … and it’s around stress, anxiety, depression, insomnia, tiredness,’ she said.
 
Resources such as free and effective gambling-specific psychological treatments are available across Australia, and GPs can familiarise themselves with referral options.
 
‘One of the issues that happens for us is where to send them [patients with gambling issues],’ Dr Wilson said.
 
‘There are expert gambling services available around Australia in all states and territories that are free, but also cater to people’s families that are affected as well.
 
‘This is important. It’s common. We will be seeing people that are suffering gambling harm or their families … and we can let them know that there is support and expert treatment that works.’
 
Taking a non-judgmental collaborative approach is also key, according to Dr Wilson.
 
‘As GPs, when we say, “I’m going to help you, let’s get this happening, let’s follow up”, that works really well to get people engaged in thinking about changing their behaviour,’ she said.
 
‘Or if somebody says, “My gambling is not a problem, I don’t want to seek any help”, then you’ve at least flagged that it can cause problems in the future.
 
‘It’s a super important thing that we can really make a difference with, with minimal time and effort.’

The RACGP recently approved a screening tool for gambling as an Accepted clinical resource, of which Dr Wilson provided feedback on and will be presenting with the Victorian Responsible Gambling Foundation
at WONCA in October. 

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addiction medicine Australian Journal of General Practice gambling mental health