HOUSTON – Relatively few adolescents develop a serious problem with gambling, so the issue may be one of “harm reduction” rather than the treatment of an addiction, said Gagan Dhaliwal, M.D., at the annual meeting of the American Society for Adolescent Psychiatry.
For most people, gambling is a form of entertainment without serious negative consequences, since it lacks the element of physical harm to the body caused by substance abuse. Yet some adolescents develop a preoccupation with gambling and find themselves unable to stop despite repeated attempts and a desire to do so. Those teens may need treatment similar to that used for other addictions, said Dr. Dhaliwal, of the University of South Alabama, Mobile.
At any age, problem gambling involves complex dynamic interactions among psychophysiologic, developmental, cognitive, and behavioral components. Given that adolescence is a developmental period marked by risk-taking behaviors, adolescents generally do not seek treatment for gambling. They have a sense of invincibility and they think they can stop anytime they choose.
Adolescents with pathological gambling problems may have comorbid psychiatric conditions, and they use gambling as a coping strategy. Common comorbidities include depression, substance abuse, anxiety, and poor academic performance.
“Gambling is considered to be a way of escaping their problems, whether it is depression, anxiety, or relationship problems in their family,” Dr. Dhaliwal said. Peer pressure often plays a role as well.
Some evidence suggests that adolescents with antisocial and impulsive risk factors who become involved in gambling are more likely to develop a serious gambling problem later in life. However, someone who does not perceive that he or she has a problem won't seek treatment, and someone who is forced into treatment won't be motivated to change, Dr. Dhaliwal noted.
Cognitive-behavioral therapy is the first-line treatment of choice for adolescents who exhibit severe gambling problems. One focus of the CBT involves erasing the erroneous belief that gambling losses will be recovered, Dr. Dhaliwal said. The probability of making money at gambling is low, but there is an illusion of control that appeals to adolescents, he noted.
Given the easy access children and adolescents have to gambling, complete abstinence may not be a realistic approach. Instead, a focus on harm reduction and education about the dangers of excessive gambling may be the logical method.
“If we want to use the principle of abstinence in adolescent gambling, it is easy to say they shouldn't engage in gambling because they are too young,” Dr. Dhaliwal said. However, some professionals argue that a “just say no” strategy for adolescents results in inaccurate information and fosters distrust of all messages from adults. “Perhaps we should say 'just say know,' and educate adolescents about the risks associated with pathological gambling, and involve them in the decision-making process, rather than simply forbidding them from doing it,” he added.
Educating adolescents about the problems associated with excess gambling will work for some of them. Another strategy involves targeting multiple risky behaviors with a general mental health prevention program that includes both abstinence and harm reduction. However, anyone with a significant gambling problem should receive a message of abstinence, Dr. Dhaliwal said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.
Future research priorities should include the rise of Internet gambling, which has made gambling more acceptable and more accessible to adolescents, and triggers for the transition from a minor to severe problem.
Dr. Dhaliwal did not have any financial interests to disclose.