Admit gambling risks, regulate accordingly

Mental healthcare and practice evolves over time through observation and research that helps those of us in the field to improve our approach to dealing with mental ill health.

For a long time we only considered addictive disorders in the context of substances that we ingest and that observably change our behaviour or functioning, such as alcohol, nicotine, cocaine and other similar substances.

More recently we have reached broad consensus that certain behaviours could cause the same kind of disruption attributable to ingestible substances of abuse, and neuroscientific advances have demonstrated that these addictive behaviours cause changes in the brain structure and function similar to those caused by addictive substances.

ADDICTIVE BEHAVIOURS

Many potentially addictive human behaviours have some evolutionary survival value, and our brains are wired to be receptive to their repetition in order to improve our ‘fitness’ as a species.

Unfortunately, the same circuits responsible for maintaining these survival behaviours, like eating and having sex, can be easily ‘recruited’ by other behaviours with less survival value.

Behaviours such as gambling have the potential of taking over these circuits and using them to satisfy the less adaptive desires before paying attention to the important survival-related behaviours. Therein lies the danger in these potentially addictive behaviours.

GAMBLING DISORDER

Gambling disorder is the first of the repetitive behavioural disorders to be described among the substance-related and addictive disorders in the premier psychiatric diagnostic tool, the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM5). The manual describes gambling disorder as “persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress”, characterised by the individual exhibiting a cluster of symptoms including the need to gamble increasing amounts of money, restlessness or irritability when trying to cut down on gambling, difficulty stopping the behaviour, preoccupation with gambling, and problems with relationships, at work or school, or in career progression. This description exactly mirrors that of other substance-related disorders in the DSM5, reflecting that the neurological mechanisms underlying these disorders are the same.

SAFEGUARDS

The recognition of substance use as being potentially risky led our societies to put in place safeguards and interventions to reduce or mitigate the risk posed by the substances.

Laws exist prescribing everything from whether a substance may be safely used to where and when it may be used, what amounts may be consumed in a sitting, and even what one is allowed to do after ingesting the substances.

The laws and policies are so elaborate that in many places they even prescribe whether and how a potentially addictive substance may be advertised.

Many countries recognise the risk attributable to problematic gambling, and have put in place measures aimed at protecting their populations from the potential harms associated with it.

In Kenya, we are seeing an exponential rise in gambling in all its forms and manifestations, and many families are already experiencing the harms associated with it.

In much the same way we regulate potentially addictive and harmful substances, we must now acknowledge that gambling is potentially harmful to our people, and take the necessary steps to regulate everything associated with it, including advertising.

Atwoli is associate professor of psychiatry and dean of Moi Unversity School of Medicine; [email protected]