Compulsive Gambling

BY THOMAS C. HALL, Ph.D., CHAIR

I am often asked what a gambling problem has to do with PTSD or substance abuse. If you remember how it was when you first came back, you probably also remember how life was back in the World: It felt like watching paint dry. From that perspective, slots, card games, roulette, and other forms of gambling can seem an exciting, attractive use of time.

Heather A. Chapman, deputy director of the Veterans Addictions Recovery Center at the Louis Stokes Cleveland VA Medical Center, doesn’t have enough room to treat all the veterans who seek refuge in her gambling treatment program. From the adrenalin thrill of winning to the simple escape from the reality of their lives, gambling can become the invisible, undetected, self-prescribed medication that glosses over symptoms of PTSD, depression, and anxiety. Think about it: Veterans with problem gambling tend to zone out in front of slot machines because they provide a numbing electronic morphine.

According to the National Council on Problem Gambling, between 1 and 3 percent of the general population experiences a gambling problem in a given year. Studies consistently find that rates among veterans are significantly higher. Rates are even higher among veterans seeking treatment for another disorder:

• 10 percent of veterans using VA treatment services are problem or compulsive gamblers.
• Veterans in treatment for PTSD may be as much as sixty times more likely to have a gambling problem as age-matched members of the general population.
• Among veterans hospitalized in VA inpatient psychiatric units, 28 percent were classified as problem gamblers and 12 percent as pathological gamblers.
• Rates of depression among veterans with pathological gambling problems have been shown to be as high as 76 percent.
• Suicide is extremely common; 40 percent of veterans seeking treatment for gambling have reported suicide attempts.
• Gambling problems also are reported to be frequently seen in medical settings, with up to 25 percent of people in medical clinics reporting problems with gambling.

“Gambling, just like drugs, allows you to keep distress, depression, and anxiety at bay and remain in control of you own mind,” said Minneapolis VA Health Care System staff psychiatrist Joseph J. Westermeyer.

Charles Hoge, in his excellent book on PTSD, Once a Warrior Always a Warrior, notes that there is no silver bullet for PTSD. While gambling may mask some of the symptoms of PTSD, problem gambling exacerbates other symptoms of PTSD and disrupts treatment and recovery.

From Vietnam to Afghanistan and Iraq, the toll of battle comes home. The only difference is that now, we, as a nation, must open our eyes to the full costs of war, the visible and invisible wounds of war. The evidence that gambling can become a destructive attempt to cope with these wounds is clear. What we are going to do about it is not clear.

As John Tucker notes in the Riverfront Times of St. Louis, “In 1992, 1998 and 2002, surveys suggested elevated rates of probable pathological gambling among active-duty servicemen.” Tucker also reported that the reaction by the Department of Defense was to omit gambling questions from the survey. Not asking the question is not dealing with the problem.

Precisely because each person and each situation is unique, we need to prod the DOD and the VA to focus on the identification and treatment of problem gambling among veterans and active duty personnel now.

I suggest we consider supporting the National Council on Problem Gambling in its efforts to address the findings of the 2012 Report for the House Military Construction, Veterans Affairs, and Related Agencies Appropriations Committee regarding gambling addiction among veterans. To wit:

“The committee requests that the VA conduct a study to assess the extent of problem gambling among VHA patients, and subsequently develop assessment and treatment approaches for problem gambling in the VHA patients.”

Keith S. Whyte, executive director of the National Council on Problem Gambling, said: “We think the evidence is pretty clear that gambling addiction is underdiagnosed and undertreated among vets. The VA might say they don’t have many patients who present for gambling problems. But they’re not asking.”