How to make gambling harm part of ‘that general medical conversation’

RACGP

11 October 2022

How to make gambling harm part of ‘that general medical conversation’

News

The RACGP wants to support GPs to identify patients at risk of gambling harm in order to better implement targeted specialist treatment.

One of Dr Hester Wilson’s patients recently discovered that her husband had re-mortgaged their family home. Up until that point, she was unaware he had a gambling problem. Now, with young children to look after, they were losing their family home. As Chair of RACGP Specific Interests Addiction Medicine, Dr Wilson works closely with patients experiencing addiction in various forms and the adverse impacts it has on their health and relationships.

She told newsGP that although she estimates 7% of people experience some gambling harm and 1% of those people have a gambling addiction, it is not often evident when they present in general practice.

‘Gambling does cause harm, and we are going to be seeing people that are experiencing that harm in our practices,’ she said. ‘One of the tricky things for us in general practice is that people won’t tell us because either they feel ashamed or they don’t realise they have a problem, or they don’t think it’s our area.’

To help overcome this barrier RACGP Specific Interests Addiction Medicine is presenting a responsible gambling webinar series, sponsored by the Office of Responsible Gambling GambleAware NSW and hosted by Dr Wilson.

The webinars aim to help GPs to identify management and referral strategies for patients experiencing issues with gambling, and what specialist care is required for the associated psychosocial factors. The activities will also outline how to initiate conversations with patients to investigate the potential harms, where Dr Wilson said the therapeutic relationship GPs have with patients is paramount. ‘We need to be asking [about gambling], people won’t volunteer to discuss it for a whole heap of reasons,’ she said. ‘I do it as part of my lifestyle check with patients. First of all asking permission, “I want to ask you about your lifestyle, is that okay?” ‘Then: “Do you drink? Do you smoke? Do you use any illicit drugs or pharmaceuticals that have caused you any problems? Do you gamble? Do you game?” ‘Make it part of that general medical conversation.’ Once a gambling issue has been flagged, Dr Wilson assesses whether it is causing any harm or if the patient is concerned by using ‘gentle and exploratory’ questions that can help them to reassess the role that gambling has in their lives. ‘The thing we do so brilliantly as GPs is that longitudinal relationship – we know our patients, we see them over time, we can follow up with them,’ she said. ‘[It’s about] understanding that important role GPs have in screening and raising awareness, and referring onto specialist services if it’s appropriate. ‘Once they engage, they may not be ready to seek treatment, so we can check in with them around how it’s going, do they want that referral. And once they’ve taken part in treatment and things have improved, we can support them around maintaining that change and to remain well.’ Aside from the obvious financial issues caused by gambling, the range of long- and short-term issues cause a ripple effect, according to Dr Wilson. ‘It affects you overall, the way you live your life,’ she said. ‘It’s not just those people that experience the harm, it’s their family – one person who is experiencing gambling harm will impact six other people in their lives.’ Psychological issues such as depression and anxiety, feeling overwhelmed, and a higher risk of suicide are all linked to people with gambling issues, as well as physical issues associated with the gambling lifestyle such as drinking or smoking more, being sedentary while doing the activity and not exercising, and not eating well. Dr Wilson says it is important to be aware of the co-occurring issues that can happen with people who are gambling or vice-versa, and how they interact. ‘If you can help people to change the gambling, quite often that will improve their mental and physical health,’ she said.

It is estimated around $25 billion was lost on legal forms of gambling in 2018–19 in Australia. Easily accessible and available 24-hours a day, online gambling is the fastest growing gambling setting. In 2022, Australians reported participating in online gambling in the previous six months, up from 8% in 2020.

Like with many health issues, Dr Wilson says the value of early assessment and intervention of gambling cannot be underestimated. ‘You can have someone who has a very significant gambling addiction, but we want to be catching people before they get to that point,’ she said. ‘It might be that they are just starting to experience some gambling … and they or their families are concerned or they’re starting to have some problems. Then we can actually get them into treatment, get them to think about changing that before they develop a really serious issue that means they lose their house.’ While there are no medicines or pharmacological treatment options for gambling, the psychological therapies that are available is ‘where the gold is at’, Dr Wilson says. Funded gambling services are available in every state and territory across metropolitan, rural, regional and remote areas, that can be accessed in person and online. ‘These are specialist services with psychologists and counsellors who are trained and experts in helping people with gambling,’ Dr Wilson said. ‘They are set up so that we as GPs, once we flag that this is an issue, can say to someone, “We’d really like you to come in and get some help with this”. ‘That can also involve relationship counselling and financial counselling, as well as working on how they can begin to manage their issue with gambling.’ According to Dr Wilson, the take-home message for GPs is the importance of initiating the conversation around gambling and using it as part of a lifestyle assessment and whether it is, or has the potential to, cause any harm. ‘We can’t forget our role as GPs,’ Dr Wilson said. ‘We can have a real positive impact in our patients lives, and in their family’s lives as well.’ Registration for the free, CPD-approved webinar series is available on the RACGP website: Monday 17 October, 7.00 – 8.00 pm (AEDT) Wednesday 26 October, 7.00 – 8.00 pm (AEDT)

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