Episode 14

  • What do mental health therapists need to know about gambling addiction?

  • What types of gambling are there?

  • What’s the connection to mental health?

Gambling addiction is a pretty specialized topic.  Mental health therapists are a logical place for problem gamblers to show up. I’m making the case that we should be checking in about this with each client. Even if we only find a few problem gamblers over our careers, the freedom of having that secret out in the open can make all the difference. 

**There is a sound issue about midway through where there’s a small echo. It resolves later in the podcast. I apologize for the sound issue!

In this Podcast:

  • More things “count” as gambling than we typically think of.
  • Gambling is trading something of value and hoping for something of greater value. 
  • Gambling addiction is a diagnosable condition with real tolerance and withdrawal syndrome. 
  • Loss-chasing is what sets symptoms apart from substance addictions
  • There are three types of games: games of pure chance, games of mostly chance and games of mostly skill
  • The most popular and most lucrative of all gambling (for the house that is) continue to be slot machines.
  • Slot machines are very different than the days when they had physical reels. 
  • Electronic gaming machines (a more accurate term for what passes as slot machines today) are using specific mechanics to reinforce continued play. 
  • It’s suggested that EGM’s are deliberately used to get gamblers hooked
  • Approximately 90% of a casino’s income comes from 10-20% of their patrons. These represent the problem gamblers. 
  • Casino’s are known to extend “credit” to problem gamblers in large quantities to keep them playing. 
  • Depression is highly correlated with gambling. Anxiety, personality disorders and Bipolar disorder are correlated as well. 
  • Alcohol abuse is also highly correlated with problem gambling along with use of drugs (stimulants especially). 
  • There are high suicide rates among problem gamblers. 
  • A phenomenon that is being considered for inclusion as “gambling” is loot boxes. 
  • It is suggested that gaming companies are using the same tactics for loot boxes as the casinos are. 
  • There is concern that loot boxes are creating a generation of problem gamblers and targeting people when they are at a vulnerable stage of development. 
  • There are some screeners available to help therapists assess this gambling.


Helpful Links:

All In: The Addicted Gambler’s Podcast 

How Casinos Enable Gambling Addicts – The Atlantic

Games like Fortnite use ‘predatory’ gambling techniques to make children spend, experts warn | The Independent | The Independent

“Gambling Brain” Studies Make Clear Why It’s Hard to Stop Rolling the Dice – Scientific American

Gambling addiction expert shares experience with athletes

Expert Q & A: Gambling Disorder

Gambling Addiction: An Addiction Expert Explains Signs, Unhealthy Behavior and Treatment

The relationship of loot box purchases to problem video gaming and problem gambling – ScienceDirect


eSports, skins and loot boxes: Participants, practices and problematic behaviour associated with emergent forms of gambling – Joseph Macey, Juho Hamari, 2019


Research | Wisconsin Council on Problem Gambling

Alterations in functional brain networks associated with loss-chasing in gambling disorder and cocaine-use disorder – ScienceDirect

Predictors of Problem Gambling in the U.S. | SpringerLink

Gambling Disorders Rarely Simple – charles_maurer_-_ppt_presentation.pdf

Gambling – Better Health Channel

Lottery and Gaming Taxes – NASAA

The Role of Dopamine in Gambling Withdrawal

Gambling Addiction: Blame Biology, Not the Individual

Games like Fortnite use ‘predatory’ gambling techniques to make children spend, experts warn | The Independent | The Independent

Why Should I Care?  Substance Use, Mental Health and Problem Gambling


South Oaks Gambling Screen http://www.ncpgambling.org/files/NPGAW/SOGS_RA.pdf

NODS (Gambling Screen) https://www.ncpgambling.org/help-treatment/screening-tools/

Free Treatment Planning Tool  www.betsybyler.com/treatmenttool


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler, and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and confidence needed to add substance use to their scope of practice.  So join me each week as we talk about All Things Substance.

We’re going to be talking about gambling addiction. This is this second part of a series where we’re going to be talking about behaviors that either are listed as addiction or are being considered for being listed as addictions.  Gambling use disorder is something that’s already in the DSM V as a legitimate disorder.  It used to be called problem gambling and now it’s called gambling disorder. 

In order to meet criteria for gambling disorder you need to have met at least 4 of the 12 criteria.

The criteria in the DSM are similar to the criteria that you’ll find for substance use disorder.  It does seem like the criteria is pretty well thought out. The typical things for an addiction are represented like tolerance, withdrawal, inability to cut back  and jeopardizing social relationships because of gambling.  

Some of the differences are where the DSM points out things such as relying on other people to give you money in order to manage your gambling debts.  Or one of the really big ones that sets gambling apart is loss chasing the idea that you’re going to go back the next day or soon in order to get even, or make up for a loss. That’s the cycle that makes gambling really different. 

When you’re talking about substance use, when people are getting hammered drunk or getting high or whatever, they’re not typically going to go back and try to make up for it later . They might have to do some damage control of the things they did while they were using, but it’s not the same as loss chasing.

The prevalence of gambling disorders varies depending on who you ask.  I’ve seen it be as low as 0.3% of the population, and I’ve seen it at 2.2% of the population.  It sorta depends because they talk about people who meet full gambling disorder criteria, and those who meet partial gambling criteria. 

 In order to talk about gambling, we need to have a common definition.  So there’s two definitions that I want to use that I think are useful. The first definition is trading something of value with the hope of getting something of greater value.

If we want to go straight dictionary, the Merriam-Webster online dictionary says gambling is to play a game for money or property or to bet on an uncertain outcome.   I think between those three definitions, we’ve got a pretty good handle here to start from.

I want to talk just a minute about the things that are included in gambling. Because I think when a lot of people think of gambling, they’re thinking about casinos or high stakes card games, that kind of thing.  But we’ve got to take a look at the definition.  There’s a lot of things we do that counts as gambling.  It just doesn’t seem that way. 

So for instance, a white elephant gift exchange. Now, for those of you not in the US or not familiar with that phrase.   A white elephant gift exchange usually happens around Christmas time and usually in some kind of group setting.  Right?  So offices , clubs,  sometimes in families.  And you bring a gift that’s kind of odd or something that you had around the house that isn’t something really desirable  so you wrap it up and bring it to the event.

I’ve seen white elephant gift exchanges done in a couple different ways. Sometimes people get to pick at random  and then when everyone’s done, they open it.  Other times I’ve seen it done where you pick a gift or you can steal one from another person.

I experienced this kind of a white elephant gift exchange when I was at a Rotary Christmas party with my Dad when I was a kid.  This is how I wound up with a bottle of Saint Julian’s Mint, which is just as bad as it sounds like.   I think I was 13 at the time.  For some reason I got to keep that, which I suppose might be a story for a different day.  

There were probably, I don’t know, 75-100 people in the room and everybody had a gift and it was getting kind of intense, you know, people running around stealing different people’s gifts and that sort of thing.

People were betting that they might get a bigger or a different gift if they traded their gift for another.  So the outcome is uncertain. You’re trying to get something of greater value and we’re betting, in this case, with property.

There are three types of games. So there’s pure chance games, mostly chance games and mostly skill games. Games of pure chance are things like Keno and Roulette. There’s no way to influence the outcome. Wherever it stops is going to determine whether you win or lose

Games of mostly chance, is where you need some skill and choosing the right bets.  But there isn’t a ton of influence over the outcome.  So craps would be an example of that.

There’s games of mostly skill. So this would be like blackjack and poker. How you play your cards can influence the outcome.

So the California council on problem gambling separates out different games. . They classify card games in two different ways, casino card games, and then other card games.  Casino card games is just what it sounds like; the type of games you would play in a casino such as blackjack, Texas hold’em, Caribbean stud.

Other card games are things like hearts, Rummy, spades.  Then there’s dice games where dice are used to determine the outcome of a game where things are being bet upon.  So not games where you’re playing with dice for other reasons, whether it’s a tabletop role playing game or just a typical game like Monopoly or Sorry.

Then there’s electronic games like internet poker, web-based slot machines, that kind of thing. And we’ll include electronic gaming machines in this too and we’ll talk about that a little more later.  

Then there’s sports betting, lottery, raffles, bingo, things like darts or playing pool for money. These are considered games of skill. And then there are cultural games like Mahjong and kite fighting.

Gambling is pretty widespread in terms of how many of us have done some sort of gambling in our lifetime.  It could be picking a square on who’s going to win in what way, and at what time period in a game, it could be picking when someone’s, baby’s going to be due,  it could be attending a raffle. Gambling is just part of culture all throughout time. The question is whether or not it becomes problematic. 

During my career gambling isn’t something that comes up a lot in mental health conversations, even though it is a huge problem for mental health.  I think that we are more likely than other providers to have someone come into our office and to be able to talk about gambling.

When you look at comorbidity depression, major depressive disorder specifically, has the highest correlation with problematic gambling.  Followed by dysthymia or persistent depressive disorder.   Then by anxiety.  Now, I should note that  for someone to meet criteria for a gambling disorder.

They have to be gambling outside of the time that they’re manic or hypomanic. 

Researchers have established a link between depression and gambling.  What they aren’t sure of is whether the depression predates the gambling or the depression is caused by the gambling.  I’m guessing that that would be pretty individualized. Gambling also occurs alongside substance use a lot.  

The thing that has the highest correlation is alcohol use and then followed by stimulant use. Alcohol is served in most casinos.  Alcohol lowers your inhibitions,  helps you feel relaxed because it’s slowing down your central nervous system, which is also going to have implications for decision-making.  A lot of casinos will offer free drink coupons  and have servers come around, bringing drinks to  you  so you don’t have to leave your machine or your table.

The reason that stimulants are also listed is that the use of stimulants requires a lot of input quickly. When you’re talking about certain games,  you can make bets probably every three to four seconds if you’re using an electronic gaming machine.   The rapid outcome is up and down and up and down, and the stimulants just work really well with that kind of quick feedback.   So when you do win and your brain registers that you’ve won something, the impact of that  is to increase the dopamine level, which has already increased because of the stimulant use.

So gambling, when it comes to casinos, is really different than gambling when it comes to friends.  Because when you’re gambling at a casino and you lose the casino, is the one getting your money. When you’re gambling with friends, a friend, or an acquaintance is the one getting your money.

Typically someone who you’re gambling with who’s an acquaintance or a friend, they’re not going to have time or maybe inclination even to mess with the odds.  In a casino based system, though, that is not the case.

I don’t know how many of you have been in a casino or have stopped to think about how they’re designed or what they look like.  But all of it is designed for one thing to keep you there longer because the house knows that the longer you’re there,  the higher, the chance that they are going to win in the end.  Your chances do not improve the longer you sit there, regardless of what people might think.

So in the course of our studies, we’ve all learned about things that are subliminal, that direct us in a certain way to make decisions about things that we might not even realize; whether it’s what we buy or what we choose to watch. There are a lot of forces at work trying to guide us in this or that direction.  Just spend 10 minutes, one day as you’re driving to work or moving about your day and notice all of the brand names that you see.

Each one of those things is an advertisement and just notice it.   It starts to get a little overwhelming if you just start counting the number of times you end up seeing a brand name for something.  Those are ads and those are influencing us in a really important way.   They are really purposeful and not in the slightest accidental.  Casinos are an intense version of that.

The architecture of casinos is designed very specifically.  There are no clocks.  There are no windows to show you what time it is outside.  You cannot see an exit except for in the must post and exit sign, but it is basically dark and meant to make you feel like you’re in this cocoon so to speak.  The carpeting, the paint, everything is designed to draw your eye towards the inner part of the casino.

So from the moment you walk in, everything is built to move you in that direction. There tends to be a lot of red, a lot of brown, some yellows, very velvety colors.  The chairs are specifically designed so that you can sit in them for hours at a time.  Depending on where you are, there are servers that are willing to bring your drinks, that are stopping to chat, that are in a lot of places are instructed to come talk to you when you’re feeling frustrated and just say something simply like “you’re going to get it, you’ll win next time”.

Statistically, 90 or so percent of the income that casinos get comes from about 10 to 20% of their patrons. Those people are the problem gamblers and so the casino has a vested interest in making sure that those people continue coming back to the point that at many of them they will extend you credit.   I have read story after story of people who were extended credit when they ran out. 

There was a business woman who went to a casino one night and she was in the hole at the end, $175,000. That was in credit to the casino.  Now that isn’t just how much she lost. She lost however much she put in too.   She ran to the end of her money and couldn’t do anymore and so they extended her credit.  This happens way more frequently than you would think, because people want to win their money back.

This mechanism that’s inside of us is super powerful.  For people who have problem gambling, it is intense.   Even though we’re not dealing with a substance, the power is still there.  Remember that we’re talking about dopamine. And dopamine is our feel good chemical.  So winning gives us a spike of dopamine.   For someone who is gambling often, that thrill of winning gets addictive.  In this sense, I’m using the word addictive as they’re wanting more, even if they’re not quite addicted yet,  but that feeling of wanting more.

When we think about casinos, we think about card games, right.  When we see movies that take place in casinos, or there’s a scene, we see people playing cards.   We know about like high roller games that you have to get a special invitation to those kinds of things.  Those aren’t the places where they’re making the most money. 

Think about what’s in the background, rows and rows and rows and rows. And what’s making that cha-ching noise that we all hear. Those are slot machines.  They used to be slot machines where you put in chips and you pull the lever and these reels would spin and they were physical reels and you would either win or you wouldn’t. Those have changed an incredible amount.

A more accurate name is electronic gaming machines and there are more than a million of these nationwide.  Electronic gaming machines or EGMS have highly sophisticated computers driven by complex algorithms. Old-fashioned three real slot machines consisted of physical reels that were set spinning by the pull of a lever. 

Each reel would have 22 stops, 11 different symbols and 11 blank spaces between the symbols. 

This was a total of 10,648 possible combinations.  If the same symbol was on the pay line on all three reels, the player would win a jackpot besides varied on the symbol.  The odds were pretty straightforward and not hard to calculate. This is not at all the way things are now.  

The breakthrough in this technology is called virtual real mapping and came about in about 1982.  So a computer chip within the machine chooses the outcome using virtual reels, which may include different quantities of various symbols, more blank spaces, fewer symbols for jackpots, et cetera.  There’s no physical reel that’s running until it gets out of momentum. 

The computer itself is choosing these things and it chooses them on the fly.  It changes the algorithm to have a certain specific win condition. There is no way of telling the odds at all. And I don’t know if people really know that.   I think that we assume that gambling is highly regulated, and in some cases it is , but when it comes to these machines, these machines do not fall under consumer protection acts.  

These machines are allowed to have unstated odds and in some cases allowed to give misinformation or seemingly misinformation that I would consider absolutely misleading. You can take a jackpot odd from like one in 10,000 to one and 137 million.   So it’s impossible for any slots player to have any idea what the actual odds are.  

I found this article in the Atlantic. That was really interesting. It’s quite long, but it’s, it’s pretty comprehensive.  So if you’re interested, go to the show notes, betsybyler.com/podcast and go to episode 14 and it’ll be there.  This is where I learned about this thing called a near miss.

So there’s a jackpot symbol that appears directly above or below the pay line.  The intent is to give the impression of having almost won when in fact that person is no closer to having won that jackpot than any other time.  It just says it.  

What we know from research is that a near win has the same impact as a win.  We don’t categorize it in our brains as a loss. We categorize it as a win.  So without winning, you’re getting positively reinforced.  We go back to operant conditioning, right?  

So in episode seven, I talked about operant conditioning and that’s where we have presented a stimulus to get a desired response.  In this case, the desired response is to place another bet and that you need to have some sort of reinforcement to make that happen. Those of us who studied conditioning, know that the best reinforcement schedule is variable reinforcement.

If I got a payout, every fifth pull of a slot machine, or every fifth bet that I placed, I would know as soon as I get the last one that I’m done for the night.  Otherwise it’s another five and another five. Right. So that doesn’t work. You can’t do it too long because if I go 20 bets without any kind of reinforcement, I’m going to think that “Man, I’m done” or “Oh, this machine’s not good” or whatever.

They’re finding this reinforcement without having to pay it out. So there’s a “near miss” or in some States they’re not allowed to have that wording, but they have that jackpot symbol pop-up.   It’s enough to keep someone moving forward. 

In addition, there’s this belief that eventually you have to win and yes, I guess so statistically speaking.

That in the long-term, there’s going to be some winning that happens.   But let’s say for instance, you place a $3 bet and you win a dollar and all the lights go off and the loud noises and the sound of coins (even though there’s no coins anymore, it’s just credits) but the sound goes off and it’s categorized as a win in your brain.  

Your brain thinks that’s a win, but you actually lost $2.  We don’t categorize it that way. And for a compulsive gambler or for somebody who is prone to that, that is enough to keep them moving forward. They aren’t thinking about how much they’re doing.

The other problem here is that we’re no longer talking about trading physical dollars. We’re talking about electronic money.  You don’t even have to leave a slot machine anymore to go get more money from the ATM or to get more chips. They have card readers. You can just sit there and pop your credit card in.

These bets aren’t taking very long.   So before with the physical reels, they would take some momentum. Like there was time in between while you’re waiting for it to slow down.  These bets happen, I don’t know, every 10 seconds and possibly less than that.  You can bet tons over the span of five minutes.

You can keep betting and betting.  You watch people when you go into a casino, and they’re hitting these buttons and it’s a little reminiscent of hitting levers and it is brilliant technology that is literally bankrupting people and in some cases ends up contributing to someone’s death when they ended up committing suicide because of their gambling losses.

The same mechanisms in substance abuse are at play here. We’re talking about the reward system that’s in the nucleus accumbens and the dorsal striatum. Where your brain gets used to a certain hit of dopamine. So average experiences don’t excite you the way a gambling win would, or the fact that you get used to dopamine and you don’t get the same feeling from that hit any more.  So you have to gamble more and have the stakes be more exciting. 

We have the withdrawal part that’s involved in the extended amygdala.  Where we have the negative effect stage.  There is an actual withdrawal feeling that comes from not being able to gamble and trying to refrain for people who have problem gambling.

Gambling is also related to issues in the prefrontal cortex, where we have impulse control problems. Gambling typically starts around the mid teens to early twenties. Now that’s not to say that  people can’t develop problem gambling later in life because they absolutely can. Casinos are absolutely cashing in on that.

We have all seen driving by a casino,  busloads of seniors.  They do a lot of stuff to host those seniors.  They take them on bus trips across the country.  They give them free food and cheaper lodgings or in some cases, free lodging.  They have loyalty cards that they use.  These loyalty cards, they track every movement you make in terms of how often you bet, when do you pull back, how much are you willing to lose?   When do you do this?  What time of day? 

They’re tracking all of these data points on all of these people and they are using them. It is not hard anymore for them to make changes in the algorithms. There have been reports of credit card companies that have sold information about people who have used their credit cards for gambling, two casinos, and the casinos had then targeted those people with special ads.   

Remember that gambling is about trading something of value for something of greater value.  So the offer of free dinners and free lodging and free drinks. That means something because everybody believes that they are going to beat the system.  Again, this is the optimism bias that we seem to just have as humans. We really believe it’s not going to happen to us. All of us fall victim to this.

When I’m driving and I’m speeding, I’m pretty sure that I’m going to be able to see a cop before he sees me. That’s not logical.  I’m not watching like a hawk every single time I drive. But the odds are, I won’t get pulled over this time because if you think about all the times you’ve driven and all the times you’ve been pulled over. It’s a pretty small percentage a nd so it’s a risk that I calculate that apparently I’m willing to take. 

So in addition to dopamine, there’s this really interesting finding.  There’s a region in the brain called the supplementary eye field.  S.E.F. and it regulates eye movements and it’s also involved in decision-making. 

So the studies were done with monkeys who have a similar brain structure and function, and they like us are also risk-takers.  They found that when they were able to cool down this part of the brain, the supplementary eye field, , the monkeys were 30 to 40% less likely to make risky choices.

So SEF contributes to our brain’s  ability to predict opportunities and dangers.  It shapes our attitude towards risky behavior.   So I want you to remember what I said about going into the casino, the lights, the colors, no windows, all the things trying to distract you and draw your eye.  That is all really intentional. 

In that Atlantic article, I mentioned there is a tragic story of a man;  midlife, kids, family, financial advisor.  Started out their marriage by insisting that his wife pay off all her credit cards because credit was the most important thing.   Ends up mid career developing a very serious gambling problem.

The article says that he “caught the bug”, so to speak in 2006  and in August of 2012, he committed suicide after losing an incredible amount of money.  He felt like this was the only way that he could undo this damage.  Because even if he stayed alive and stopped gambling, the amount of money that he would owe and likely spend time in prison for embezzlement was so intense that he couldn’t face that.

So he left instructions for his family and was very methodical about it.  There’s actually a lawsuit similar to the tobacco lawsuits that the makers of these machines and the casinos are well aware of what makes these things addictive and that they are increasing that on purpose to get people hooked.

There is no standard on these machines that says the odds are fair or even lists what they are.  It changes them and people don’t know that.  What is happening on a subconscious level or unconscious level is powerful.  I know that we as humans, all of us want to think that we are more than just our impulses.

And in many ways we are.  But we are not without our impulses and drives. We have those things and this man, who knew all of the pitfalls that people make with their money, fell into it anyway.

In the U S most places aren’t allowed to have drug rep “swag” anymore, for lack of a better phrase.   So drug companies would bring catered lunches. They would bring items like pens or clocks or tape dispensers or pads of paper.  I mean, I have a tape dispenser that says Adderall on it. 

This was a common practice and it’s largely stopped at least in a lot of areas that I frequent.  Because they finally did the research  that proved what we already know, that these items, that hearing about the drug, getting presentations,  did influence doctors to prescribe these medications over others. These are doctors we’re talking about who would not have believed that this was influencing them.  It is not that they are bad doctors. We cannot discount the ways that our brain picks up these things and reminds us of them later. 

So last week when we talked about internet gaming disorder, I brought up the idea of micro-transactions  and referenced gambling.   What I’m referring to is a thing called loot boxes.  And by loot I’m spelling that L O O T . These boxes are digital items that you purchase. 

Now in order to be a loot box, you don’t know what you’re buying. So you’re not trading this dollar for that specific thing. Instead, you’re paying however many dollars or however many in game currency for a chance at winning certain prizes.  A lot of games have loot boxes and the gaming community, so the people who play video games, have strong feelings about loot boxes.  Initially loot boxes were coming out and they were providing items like powerful weapons or new characters that gamers would refer to as “pay to win”. Meaning that if you paid money, you had an edge over other players because you had these powerful things.

A lot of the loot boxes though, they’re just cosmetic items.  I  know it might seem funny to people who don’t game at all, why you would buy a cosmetic item.  That is a digital thing, you’re never going to see, just for your character.  

As we talked about, these video games become a community-based thing a lot of times.  The character that you’re playing is someone that you are looking at a lot and around other people.  So having armor that you like, or a style that you appreciate is kind of important.

There’s also peer pressure to get these really neat skins, they call them,  or other types of items in the game. It’s sort of a status thing.   And yeah, it’s just cosmetic stuff, but that kind of stuff can be fun.

The problem with loot boxes isn’t that they in, in and of themselves are bad. It’s about the mechanics that they’re using.  There’s a huge debate on whether or not these loot boxes constitute gambling.  If we use our definition, they are gambling.  It is trading something of value, hoping to get something of greater value in some cases.

So you get a loot box and in it, you’ll get a certain number of items.  There’s a chance that one of them might be rare or more special than another and you have no idea what the odds are.  You could get duplicates too and so it’s kind of like with baseball cards where you could get repeats of baseball cards, but you’re always hoping to get a more rare card to add to your collection.

The mechanics that are being used by the companies are eerily similar, if not exactly the same, to the mechanics used in the electronic slot machines.  There is a hidden algorithm, you have no idea what the odds are and they’re designed to keep you buying more until you get the outcome.  

When you’re in a game, there are ads for loot boxes, everywhere.   Every time you have a load screen, things that pop up, special deals, you really can’t get away from them.  There is no ad blocker or a way to turn that off.   So even if a person is determined to not fall “victim to that” they can’t get away from that constant barrage of advertisement.   

I can tell you from personal experience, those ads are really insistent and really tempting when you’re enjoying a game.  The idea that you’re going to get something really cool to add to your collection is kind of exciting.  I’m a sucker for all things turtles, right? Like turtles,  swim in the ocean.  So when I was playing a game I could get a pet turtle for my character, that would walk around with me.  You better believe I wanted that turtle.

Some of the loot boxes are built for convenience. Some of them for novelty.  Oftentimes loot crates are sold in packs where if you buy more, they’re cheaper and so well, spend a few more bucks and you’ll get more chances at getting the thing you want.

One of the main problems they’re looking at in the research is how this impacts people who have problematic gambling behaviors anyway, people who are predisposed to gambling behaviors, and lastly about kids and the fact that they’re being exposed to this at really young ages.

If you recall from the internet gaming disorder episode, we talked about Fortnite  being one of the most popular games.  Remember I said, it’s free to play. Well, it’s free to play, but there are tons of micro-transactions and they have a large amount of loot crate business that’s attached to their game.  So what impact is this going to have on kids as they want these loot crates and they see their friends getting these items?

The concern that experts have is that we’re going to be creating a generation of problematic gamblers  or people who have a predisposition towards that because of their early experiences.  We’re talking about dopamine  and brain changes here that include creating habits.

Complicating this as we’re talking about electronic money.   When you went in to buy Yu-Gi-Oh cards or baseball cards or whatever, you’re physically handing over some form of payment, right?  Either you’re handing over cash or somebody is using a card, but you have a physical representation in your hand for the thing you bought.

Although the research is still pending. There are other places that have already decided.   In the EU they have declared loot boxes as gambling.  In order to do that in a game, you have to change the rating and you have to have a gambling license in a lot of countries.   There are games who have chosen to just pull their loot boxes rather than apply for a gambling license. 

Loot boxes and microtransactions are here to stay.  That’s not going to change. Companies want to make money.  They have a right to make money for the things that they’ve created.  A lot of gamers would support paying for something that an artist had to do.  So if they created some new skin for your character, that took somebody some time and they want to support that.  It’s the way that the companies are doing this.

One of the things I would love to see in regulation of loot boxes is that you could turn off the advertisements because in some games they are super prevalent. To the point that it’s almost flashing in your face all the time and we are just susceptible to that.  Kids are especially susceptible to that in ways that they aren’t even aware of.

Overall gambling itself isn’t the problem.   I personally don’t have an issue with gambling.   People want to gamble, like, all right.  In some senses, if they want to gamble and lose money here and there they can.   The problem is that we’re talking about an addiction that actually forms, actual withdrawal, actual tolerance changes in the brain.

Along the way, casinos look like they’re being helpful and want you to have fun and are going to extend you money, knowing that there is no way that you can afford it.   I know that there’s personal responsibility and I will absolutely support personal responsibility.  I also want the gaming industry to be more responsible and not deliberately try to cheat customers out of money.

They’re not after the average person who comes in and just has a few dollars to spend, or even a couple hundred, or maybe even a couple thousand.  That’s not where they make their money.  They make their money from these problem gamblers and there is a high suicide rate among problem gamblers.  That puts us in public health crisis mode.

So it is absolutely in our wheelhouse to be able to ask people about their gambling and their finances. 

I really want gambling to become something that we all ask about in all of our assessments. It’s not something that we need to go into depth with  if it’s pretty clear that somebody is not problematically gambling, but I think it’s something that it would be wonderfully freeing for someone who has a problem to be able to start to address it with us.  

You could find out about gambling in just a few questions. There are a couple measures that you could use that are really well validated. One is called the South Oaks Gambling Screen.   It’s kind of long;  it can be about three pages printed and so I don’t always use that one first. There’s a second one called NODS that’s about 10 items that you can use pretty quickly  if you think someone might have problem gambling. 

There’ll be a link in the show notes  just in case some of you want to incorporate it into your assessment.

I know that the idea of adding something to an assessment can seem difficult, if not impossible at times.   A lot of you work in a situation where you have to have your diagnostic assessment done the first time you meet somebody and you only have an hour to see them. It’s a lot of information. This is something though that you can continue assessing. So the second time you see them, you can follow up on the questions that maybe you didn’t get to.

The reason to identify gambling is not about whether we’re checking a box for the agency or for whoever’s regulating diagnostic assessments.  We’re doing it because we want to bring more freedom to our clients. Oftentimes people are not going to bring those things forward. 

Having a gambling problem carries a lot of shame with it. We just know that shame is paralyzing for people and that they do what they can to hide things that cause them shame.  Financial hardships are hard to talk about anyway, for a lot of people. But having financial hardship because of a gambling problem, that’s going to be even worse.

In the show notes, I’ve put a lot of links because I know that there are a number of questions about gambling. And because this isn’t a gambling podcast, there’s just way more than I can get into. 

Next week, we’re going to be talking about food addiction. This is going to be a two part series. The first part is an interview with a personal trainer, Kelly Coffey.  A woman that I respect greatly and who I think has a really interesting message about food,  the diet industry, and addiction in general.

Hope to see you next week. 

If you’re ready to take the next step in addressing your client’s substance use head on over to betsybyler.com/treatment tool. The treatment planning tool I created will help walk you through the process of evaluating your clients use and deciding how and when to intervene. The tool is completely free and will be delivered to your email so that you can use it right away.

Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist, friends, and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to podcast@betsybyler.com. I’ll see you on next week’s podcast and until then have a great week.

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