There is no specific psychiatric expertise available to deal with compulsive gambling in Ireland, writes Paul Cullen.
DRINK TOO much, and you'll fall over. Take too many drugs, and you'll overdose. But gamble too much, and no one - apart from your bank manager - is likely to notice very much.
Compulsive gambling is the least understood and least researched addiction in society and, addiction counsellors say, the hardest to cure.
It is less common than alcoholism and attracts less attention than drug addictions, yet tens of thousands of Irish people suffer from this crippling disease, with many more family members, friends and employers indirectly affected.
Because of the lack of research we do not really know how many suffer from problem gambling, but one former addict says: "Gamblers Anonymous should hold their meetings in Croke Park, there's so many people with gambling addictions out there."
Pubs close and drug dealers can be hard to find, but gambling goes on day and night, at home and in commercial establishments, online and on the phone. Gambling is ubiquitous, and correspondingly difficult to avoid for a person prone to excessive indulgence.
The vast majority of people enjoy gambling as harmless fun - mind you, the vast majority also lose money - but for the addictive minority and their families it can be a destructive pastime.
Compulsive gambling is classed as a psychiatric disorder, yet there is no psychiatrist in Ireland with the specific expertise to deal with it, according to Prof Patricia Casey, head of psychiatry in UCD. "We'd see it, but not very often. I don't know when I last saw a pathological gambler."
People with other forms of addiction can generally go through a process of detoxification, but in the case of compulsive gambling there isn't anything from which to detoxify them. Dr Casey refers patients to the Rutland Centre, which specialises in treating addictions through residential courses.
According to Stephen Rowen, director of the Rutland Centre, between one and three out of every 100 people will turn out to be a compulsive gambler - that's anywhere between 40,000 and 120,000 Irish people. He defines a compulsive gambler as "a person who is chronically and progressively unable to resist the impulse to gamble, with consequent disruption and compromise in personal, family, social and work life".
In any one year, 20-25 gambling addicts will attend one of the centre's rolling five-week residential courses, far fewer than the number of alcohol or cocaine addicts, though some gamblers will suffer from these addictions too.
The vast majority are male, middle class, firmly in the mainstream of society. "They're not the type to jump out of an alley and rob you. If they commit any crime, it's white-collar crime," Rowen remarks.
"They're very bright, manipulative, scheming people. They appear to be cool, calm and in control. Even at their worst, they will consider themselves successful and just say they're having a bad run." Family members are often the last to know about their problem because "unlike alcoholics, gamblers can fool everyone".
"Someone in the workplace can be gambling heavily online and never miss a meeting or never misspeak, so they appear to be capable. In contrast, an alcoholic will have breath issues and show other telltale signs," says Rowen.
Gambling has the highest rate of suicide of any addiction, he says. "This doesn't happen because someone has lost a few quid on the Grand National; it arises from the serious consequences of the actions of compulsive gamblers. People don't stop until they've hit the wall."
Writer Declan Lynch, who was one of the first to flag the growth of gambling in recent years, has likened its attractions to those of heroin: "Gambling is an immensely difficult addiction to break because, by its nature, it's about playing God, it's about having your judgment vindicated, it's about being proved right."
Despite all the money bet each year, there is little support for initiatives to deal with problem gambling. The Irish Bookmakers' Association says it is "investigating" the setting up of a support service for problem gamblers. The National Lottery says it doesn't know whether any of its proceeds have been used to fund initiatives in the area.
The Irish Times has spoken to a number of addicts who say they at times compulsively purchase lottery tickets or scratchcards.
Yet lottery executives say they
are unaware of any problems surrounding the misuse of their products. Unlike its UK equivalent, there is no notice on the National Lottery website stating that young people may not buy lottery tickets. Neither is there any reference to responsible gambling on the website or in its annual report.
Treatment for compulsive gambling consists of helping sufferers deal with the issues underlying their behaviour. "People fill the holes left by trauma and depression with addictive behaviours. They comfort themselves with these behaviours to gain temporary relief," explains Rowen.
Of those who seek treatment at the centre, he estimates that about one-third will never gamble again. Another third will relapse on the way to an eventual recovery and the remaining third will suffer a complete relapse.
For the vast majority of people, gambling is an affordable and enjoyable pastime. But Rowen wonders whether we aren't "a nation in denial" over the extent of the problem and our freewheeling attitude to money.
"There's something about the way we seek entertainment; we're looking for escape, a buzz, and we're all too uninhibited in the pursuit of a thrill."
For more information on Gamblers Anonymous see www.gamblersanonymous.ie or phone 01-8721133 (Dublin) or 087-2859552 (Cork).