Dr. Timothy Fong: Sports betting and problem gambling

[0:00:20]

TIMOTHY FONG: Greetings. My name is Dr. Timothy Fong. I’m a professor of psychiatry here at UCLA School of Medicine. I’m the co-director of the UCLA Gambling Studies Program. Our UCLA Gambling Studies Program is a clinical research program designed to look at the causes and clinical course of gambling disorder while developing science-based evidence treatments for gambling disorder.

[0:00:51]

TIMOTHY FONG: Gambling disorder—otherwise known as problem gambling, compulsive gambling or gambling addiction—has a approximate prevalence rate in the United States about 1%. That means about 1 out of 100 people in the general population are currently suffering signs and symptoms of gambling disorder. We also estimate that there’s another about 2-3% of people already developing some signs of early gambling addiction, but not what we call full diagnostic criteria of gambling disorder. To appreciate the size and scope of that, we know that other psychiatric conditions, like bipolar disorder or schizophrenia, also carry with it about a 1% prevalence rate in the United States.

[0:01:42]

TIMOTHY FONG: By definition, gambling disorder is an addiction. It’s similar to other addictive disorders, including tobacco use disorder, cocaine, alcohol, cannabis. And the same vulnerabilities to develop those addictions—the genetics, the psychological vulnerabilities, the social risk factors—are all true for gambling disorder. When people say to me, who’s most likely to develop this disorder?—it’s often, number one, men and women who have a family history of gambling addiction—fathers, mothers, aunts and uncles who also are struggling with gambling addiction. Secondly, men and women with untreated psychiatric conditions, like depression, bipolar disorder, ADHD, other active substance use disorder—these are folks who are going to be more vulnerable to develop gambling addiction. And third, and this is very interesting on the social sides, are men and women who start gambling at a very young age and who also start gambling very frequently at a younger age. So, the earlier you start gambling and the more frequently you start gambling does elevate your risk to develop gambling addiction.

[0:02:55]

TIMOTHY FONG: As I speak to you here today, it’s March 2022. We know that right now there’s about 30 states in the United States that have legalized sports betting. Compare that to just a few years ago where that number was just two. So, we’re seeing a rapid expansion in the terms of availability of sports betting, in terms of the discussion of sports betting, in terms of figuring out, how is sports betting impacting gambling addiction, problem gambling and just gambling in the general culture? There’s a few things I’m noticing so far. No. 1, we’re seeing, obviously, more and more people gambling. We’re seeing more and more people starting to gamble that probably would not have gambled before. No. 2, we’re seeing a full-blown acceptance of gambling, not only as a form of entertainment or diversion, but almost an embedded part of our popular culture. When you add in advertising, the television, the media, just the discussions around the water cooler, gambling is now part of American life. So, add the expansion of gambling, the availability of gambling, increased acceptance of gambling, and we’re going to see more participation across America in gambling. Of course, what does that mean for the addiction world?—is that we are concerned that that could, in time, create an increased number of men and women suffering from gambling addiction.

[0:04:27]

TIMOTHY FONG: As we’ve seen increases in mobile sports betting and sports betting, we’ve also seen a parallel increase in the amount of advertising for betting and sports betting. Essentially, it’s everywhere. You look at print, media, billboards, online internet experiences, television shows—all have now increased advertising about gambling. One of the very interesting scientific questions is, what does increased advertising do to gambling behavior? Does it promote it? Does it accelerate it? Does it, for the people who are most vulnerable, create more problems down the line? Many of those questions we don’t have answers to. When we look at European markets that have studied the impact of gambling advertising, they found that it’s essentially—the advertising is a positive way of describing gambling. And when you have a positive advertising, that turns into increased acceptance, increased good feelings about gambling and, ultimately, more gambling behavior.

[0:05:36]

TIMOTHY FONG: A gambling disorder, by definition as an addictive disorder, can have a wide variety of consequences on the body, on the brain, on the mind, on families and on communities. If you were to sit with me and see the last 10 patients I’ve seen who are suffering from gambling disorder, each person would have a very unique story, a unique set of consequences. Some patients, primarily in the financial sector, they’re losing lots of money, creating generational debt. Others have profound impacts on their physical health—with insomnia, stress-related conditions like heart disease and diabetes and peptic ulcer disease—while others are enduring all sorts of problems with their family, conflicts, verbal arguments, physical arguments, increased domestic violence. So, the consequences from gambling addiction, very much like any other substance use disorder or any other addictive disorder, are wide and vast, again, on the body, the brain, psychology in terms of depression and increased anxiety. And I think that’s the difficult part for a lot of folks who don’t deal with gambling addictions, that they oftentimes say, isn’t there just a single sign? Isn’t there a, you know, clear definition of it? Isn’t there something that we can tell definitively that this is a gambling addiction? Unfortunately, it’s not. We tend to see the consequences first. And oftentimes, many health care providers and family members themselves and patients themselves don’t realize the problem they’re having in their life is directly caused by ongoing gambling behavior.

[0:07:14]

TIMOTHY FONG: One of the questions I’m asked a lot is, how do you know someone has a, quote, “gambling disorder” or a gambling addiction? We don’t have any biological tests. We don’t have any brain scans we can use. We don’t have any blood tests. So, we make the diagnosis by doing a psychiatric interview and looking for signs and symptoms of whether or not they meet diagnostic criteria for gambling disorder. And some of those diagnostic criteria are going to be things like tolerance to gambling withdrawal, continuing to gamble despite harmful consequences. For me, I have a very simple screening question. It’s basically, does your gambling behavior, does it make your life better or does it create problems in your life? If it’s creating problems in your life, and it can be any sort of problem—again, financial, social, psychological, relationship. If your ongoing gambling is creating some sort of problems in your life, then it could certainly be an early sign or a sign of a gambling disorder.

[0:08:21]

TIMOTHY FONG: One of the things about gambling disorder is that when you’re suffering from it, you oftentimes don’t know you have it, or you don’t—or you live in a state of denial about what’s actually happening. You don’t say, I have a gambling problem. I have a money problem, or I have a problem with luck, or I have a problem with my spouse not letting me go gamble. So, one of the things that we’re trying to figure out is how do we get men and women who are in their earlier stages of this disease to seek treatment? And it’s very much like cancer or diabetes or asthma, and I think it starts with a lot of education, a lot of people understanding that any time there are life problems, that they should seek treatment.

Now, how do you seek treatment? We have 24-hour help lines available—1-800-GAMBLER is one of them or 1-800-522-4700—or anyone who’s concerned about their gambling behavior or if you’re concerned about your family member or your partner’s gambling behavior, you can call the help line and get access right away to a gambling counselor or a gambling therapist. One of the things that oftentimes I say to families, if you’re at all concerned, if you’re just wondering, do I have a gambling issue, do I have a gambling problem—take the mystery out and just go ahead and make an appointment with a mental health professional for an initial screening interview or initial intake. I think we don’t do that enough when it comes to mental health. We do that a lot with physical conditions. I have a lump in my chest, or I can’t breathe, or I have some changes in my stomach pain, and you’ll go see the doctor instead to find out what’s causing it. I think that’s the thing we’re trying to encourage people to say, is that when you have any life problems or any concerns about your gambling, ask those type of questions. What’s causing this? And then seek professional help through a mental health professional.