From Today Online on Tuesday, February 9, 2010:
SINGAPORE -- Besides the artery-clogging prawn rolls and bak kwa, what I look forward to every Chinese New Year are the card games.
This Sunday, my family and relatives - children not included - will most probably gather around after dinner and indulge in a heart-thumping game of blackjack, where the bets go no higher than a dollar or two.
Like me, many Singaporeans indulge in an occasional gambling session in the spirit of the season. But in some instances, gambling can become obsessive.
Doctors Today spoke to said they are seeing more compulsive gamblers addicted to the thrill of chasing the big win.
In 2007, the Institute of Mental Health (IMH) saw only 88 problem gambling cases. In 2008, the figure shot up to 216 cases - a 145 per cent increase. Last year, from April to December, IMH saw 245 cases.
Most of them are there because their gambling problems have been exposed and their families want them to quit. Others, like Robert (not his real name), who is in his 30s, are there because the law has caught up with their gambling problem.
Robert, a university graduate, is married with children. He held a well-paying job as a sales executive when he got hooked on gambling.
As he sank deeper into his addiction, Robert began borrowing money from loan sharks and even stole money from his company to feed his soccer and lottery-betting obsession.
Robert was one of the more severe cases Dr Thomas Lee Kae Meng, consultant at the National Addictions Management Service (NAMS) and acting chief of the IMH addiction medicine department, has seen.
When does it become a disease?
"One of the tell-tale signs of a gambling problem is that you bet more than you can afford to lose. Social gamblers don't do that because they gamble only for the fun of it," said Dr Lee.
The doctor added that pathological gamblers also tend to have problems in life caused by their compulsive gambling problem. Like in people with drug or alcohol addictions, it is common for gambling addicts to experience "withdrawal symptoms" if they're unable to feed their habit.
"They start getting negative thoughts and may feel anxious that they're missing out on the chance of their life," said French clinical psychologist Dr Bruno Cayoun.
The director of the MiCBT Institute in Hobart, Tasmania, spoke to Today when he was in town last week to train NAMS staff.
Dr Cayoun added that up to 39 per cent of gambling addicts have some form of clinical mental issues such as depression or anxiety.
Besides his gambling addiction, Robert also had to grapple with severe depression. At one point, he attempted suicide.
As a gambling addiction is a "complex, multi-factorial problem", Dr Cayoun said it must be dealt with in a systematic way. He developed a therapy technique called Mindfulness-integrated Cognitive Behavioural Therapy (MiCBT), which can be used to help gamblers shake off their addiction (see box).
Traditionally, cognitive behavioural therapy (CBT) is used as part of the treatment programme for problem gamblers at IMH. CBT works by changing the way a person thinks. With problem gambling, the technique helps identify triggers to the gambling problem and helps prevent a relapse.
"Problem and pathological gamblers tend to have unrealistic cognitive distortions, such as superstitions and illusions of control, so using CBT can help them correct these distortions," said Dr Lee.
Problem gamblers can also be prescribed medication to help them contain their gambling impulses, or undergo practical approaches such as having their family take full control of their finances to nip the addiction in the bud.
"Most importantly, people must realise that a gambling addiction can be treated," said Dr Lee.
It's all in the mind
According to French clinical psychologist Dr Bruno Cayoun, who developed the Mindfulness-integrated Cognitive Behavioural Therapy in 2004, the technique helps people learn to control their thinking processes. There are four stages:
Stage 1, 2: Changing Reactive Habits
The first step focuses on the person's emotions and internal states. Understanding and regulating thoughts and emotions can help him change bad habits and the way he reacts to certain situations.
The second step is an exposure stage. It teaches the person to be "desensitised" to his emotions while preventing the unwanted behaviour. "The person will be asked to imagine worse-case scenarios while learning to cope with the frustration or distress. For instance, he may be asked to imagine how he would feel when Saturday night - his gambling night out - comes. He will be tempted to gamble but he will have to learn not to react to the emotions or sensations within him."
Stage 3: Interpersonal Mindfulness
Here, the person learns to address the "interpersonal problems" that maintains his addiction.
For instance, the person may gamble because he wants to escape work or family pressures, or sometimes does not want to lose face, or simply feels unable to say no to other gambling friends.
He will be taught to communicate better, more confidently and effectively with people. In turn, he gains a better understanding of himself.
Stage 4: The Empathic Stage
The final stage teaches him to empathise with and understand other people's feelings.
"Gambling addicts will most likely be asked to look at other people gambling, and guess what they are feeling while at the gambling table. This helps expose them to people like themselves, and indirectly strengthens their understanding of themselves and empathy for others," explained Dr Cayoun.
Need Help?
Call the Gambling Helpline (SINGAPORE) at 1800-6-668-668 or visit www.nams.org.sg.
By Eveline Gen
