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Gambling with Life
24 Aug 2017

Gambling is betting something of value (usually money) on an event (sporting event, lottery, etc.) whose outcome is unpredictable and determined by chance. Gambling is a popular leisure activity in most cultures and most parts of the world. But, for some it can become problematic. Similar to substance use (like alcohol, nicotine, etc.) gambling too exists on a spectrum or continuum of escalating severity, ranging from social gambling, through problem gambling to gambling addiction/ gambling disorder.


Problem gambling is gambling that disrupts or damages personal, familial or recreational pursuits. Typical characteristics of gambling addiction include the need to gamble with increasing amounts of money in order to achieve the desired excitement, restless or irritable when attempting to cut down or stop gambling, has made repeated unsuccessful efforts to control, cut back, or stop gambling, is often preoccupied with gambling and so on.


The risk of gambling as a behaviour with potential for addiction isn’t widely known and/ or acknowledged. Hence it is often referred to as the hidden addiction. Excessive gambling can impact on the gambler’s physical and psychological health. They often present themselves with psychosomatic symptoms, and psychiatric co-morbidity is very common (especially anxiety, depression and substance misuse). It can also lead to decreased job productivity, unemployment and involvement in crime. It can also lead to strained interpersonal relationships with family members and occasionally domestic violence.Most western studies suggest that between 70 and 80% of adults gamble, and that between 1% and 6% gamble problematically. There are no such prevalence studies from India.

GAMBLING LEGISLATIONS

The Public Gambling Act, 1867 regulates gambling in India. This was brought in by the British who made a distinction between games of pure chance (for example, betting on the prices of opium or cotton, or on the amount of rainfall) which were made illegal and games that were a combination of chance and skill (card game like Rummy) which were made legal. Excessive gambling can impact on the gambler’s physical and psychological health. They often present themselves with psychosomatic symptoms, and psychiatric co-morbidity is very common.


The Centre has devolved powers to individual states to make amendments to the 1867 Act, to deregulate or regulate gambling within their own state boundaries. Hence, lotteries are legal in 13 of the 29 Indian states and five Union territories; horse racing is legal only in six states and casinos are legal only in two states (Goa and Sikkim). Lotteries and some card games are legal in Kerala. Lotteries come under the ambit of The Lotteries (Regulation) Act 1998 .  All lotteries in Kerala are run by the state government. The most popular form of legal gambling in Kerala is state-run lotteries. The State runs seven weekly lotteries including Karunya lotteries and six bumper draws. Between 4 crore and 4.5 crore lottery tickets are sold every week. For example, 40513630 lottery tickets were sold in the week 8/8/16 to 14/8/16. There are 34,417 authorized lottery agents and approximately one lakh retailers. Karunya lottery was set up by the state government in 2011 with a view to using the revenue generated for charitable purposes.


There are no estimates available on the scale of illegal gambling in the state. Anecdotally, gambling at festivals and betting on sports (such as cricket and football) are very popular in Kerala. For an in-depth account of Kerala’s various festival and fair-related gambling activities, such as Kozhikettu, ottanumber, pakida, mucheetu, kulukkikuthu, panchees, aanamayilottakam , etc.  With increasingly easy access to the internet on mobile phones and computers / laptops, I anticipate more people participating in illegal online gambling in future. Given below are data that shed light on Keralites’ participation in lotteries. These tables merely give the number of tickets sold, revenue generated and in case of Karunya lotteries the tables also give the amount of revenue that is spent on charity. There are close to one lakh lottery retailers and of this only 33,249 retailers are registered with the Welfare Fund Board. About 1% of the state’s revenue is earmarked for the welfare of lottery ticket sellers.

TREATMENT AND PREVENTION

Although various medications have been tried to treat problem gamblers, none has been licensed so far. Hence psychotherapy remains the mainstay for treating problem gamblers and Cognitive Behaviour Therapy (CBT) is the most commonly used method. CBT includes cognitive and behavioural strategies. Gambling addicts have various cognitive distortions, such as illusions of control, overestimates of one’s chances of winning, biased memories, etc. The underlying premise here is that as gambling is essentially about judging the probability of outcomes and decision making, it follows that cognitive distortions will lead to impaired judgement and poor decision making. There is also Gamblers Anonymous (GA). GA is a 12-step fellowship and self-help modelled on Alcoholics Anonymous. GA also runs support groups for families and friends affected by their loved one’s gambling (Gam-Anon).


Examples of some public health prevention measures are:


1) Primary prevention measures it aims to prevent gambling from becoming a problem. Awareness raising campaigns and social marketing programmes about various aspects of gambling, its potential for harm, signs and symptoms, how to seek help, etc., banning of gambling advertisements and promotions; and limiting the availability of gambling opportunities / venues.


2) Secondary prevention measures It aims at early diagnosis and treatment Provision of training to staff at gambling venues (lottery shops) to help them recognise problem gamblers, training non experts (primary health care staff, mental health care staff, etc.) in early identification of problem gamblers and also training them in providing brief psychological interventions for those identified as problem gamblers; and training other professionals who are likely to come across gamblers (financial/debt advisors, family counsellors, school and college staff, etc.).


3) Tertiary prevention strategies: Provision of various treatments (psychological and pharmacological) for problem gamblers and their families.

To conclude, school and college students do gamble in cities like Ernakulam, Kerala. Much more needs to be done to make people aware of the potential of gambling to harm. As regards effective treatments, policy and regulation, a wider debate needs to take place involving clinicians, academics, policy makers, law makers and other relevant stake holders.

The writer works as a senior consultant psychiatrist at Rajagiri Hospital,  Aluva. He is an international expert in the field of gambling addiction and can be contacted at  sanjugeorge531@gmail.com  or on 9895343515


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