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At least argue about these .....................http://www.bmj.com/cgi/content/full/329/7474/1055 ....................................... BMJ 2004;329:1055-1056 (6 November), doi:10.1136/bmj.329.7474.1055 ......................................... Betting your life on it ................................ Problem gambling has clear health related consequences .......................................... Gambling has not been traditionally viewed as a public health matter, and research into the health, social, and economic impacts of gambling is still in its infancy.1-3 Just under 1% of the British population have a severe gambling problem, although the rate is about twice as high in adolescents, particularly as a result of problematic slot machine gambling.4 5 Pathological gambling is characterised by unrealistic optimism on the gambler's part. All bets are made in an effort to recoup losses. The result is that instead of cutting their losses, gamblers get deeper into debt, preoccupying them with gambling, and they are determined that a big win will repay their loans and solve all their problems. The social and health costs of problem gambling are large at both individual and societal levels. Personal costs can include irritability, extreme moodiness, problems with personal relationships (including divorce), absenteeism from work, neglect of family, and bankruptcy. Adverse health consequences for the gambler and his or her partner include depression, insomnia, intestinal disorders, migraine, and other stress related disorders.6 w1 In the United Kingdom, preliminary analysis of calls to the national gambling helpline also indicated that an important minority of callers reported health related consequences as a result of their gambling. These include depression, anxiety, stomach problems, and suicidal ideation.w2 ............................................................ Other worrying trends relate to problem gambling and may have medical consequences. A recent study found that violence against intimate partners was predicted by pathological gambling in the perpetrator.7 A study of 286 women admitted to the emergency department at a University Hospital in Nebraska showed that a woman whose partner was a problem gambler was 10.5 times more likely to be a victim of violence from her partner than partners of a non-problem gambler. Furthermore, in 2003, the National Coalition Against Legalised Gambling reported that, with the opening of casinos in South Dakota, child abuse and domestic assaults rose by 42% and 80%, respectively.8 This was attributed to the increase in casino gambling. .................................................................... Gambling is without doubt a health issue, and an urgent need exists to increase awareness in the medical and health professions about gambling related problems and to develop effective strategies to prevent and treat problem gambling.2 w4 The rapid expansion of gambling represents a serious public health concern, and medical practitioners also need to research the impact of gambling on vulnerable, at risk, and special populations. Inevitably, a small minority of people will become casualties of gambling directly as a result of the deregulation of gambling in the United Kingdom, and therefore help should be provided for the problem gamblers. ............................................. References........................................... Griffiths MD. Pathological gambling: a review of the literature. J Psychiatr Mental Health Nurs 1996;3: 347-53. Korn DA. Expansion of gambling in Canada: implications for health and social policy. CMAJ 2000;163: 61-4.[Abstract/Free Full Text] ................................. McKee M, Sassi F. Gambling with the nation's health. BMJ 1995;311: 521-2.[Free Full Text] ........................... Sproston K, Erens R, Orford J. Gambling behaviour in Britain: results from the British gambling prevalence survey. London: National Centre for Social Research, 2000. ............................... Griffiths MD. Adolescent gambling: risk factors and implications for prevention, intervention, and treatment. In: Romer D, ed. Reducing adolescent risk: toward an integrated approach. London: Sage, 2003: 223-38. ................................ Lorenz VC, Yaffee RA. Pathological gambling: psychosomatic, emotional and marital difficulties as reported by the gambler. J Gambling Behav 1986;2: 40-5. .............................................. Muellman RL, Den Otter T, Wadman MC, Tran TP, Anderson J. Problem gambling in the partner of the emergency department patient as a risk factor for intimate partner violence. J Emerg Med 2002;23: 307-12.[CrossRef][ISI][Medline] National Research Council. Pathological gambling: a critical review. Washington, DC: National Academy Press, 1999. Rosenthal R, Lesieur H. Self-reported withdrawal symptoms and pathological gambling. Am J Addict 1992;1: 150-4. Setness PA. Pathological gambling: when do social issues become medical issues? Postgrad Med 1997;102: 13-8.