Research Study on Social Work

Abstract

Gambling addiction, also referred as gambling disorder or compulsive gambling, is an impulse-control disorder. The problem persists beyond control irrespective of the consequences. Over the recent years, problem gambling has been a common threat around the world with the rising number of online gambling sites, casinos, poker machines, sports betting, among other forms. Problem gamblers are at a risk of suffering in the society as most of the people with this problem are hidden among population affected by mental disorder and substance abuse. Most of the countries lack funds and efficient and effective assessment methods. This report investigates the relationship between problem gambling and mental health. The research involved an online survey of social workers from different healthcare facilities. The participants were social workers randomly selected from the main cities comprising of a sample of 100 respondents.

Chapter One – Introduction

Gambling refers to risking a valuable commodity like money on an event or outcome determined by a partial chance of winning. Gambling is presented with a variety of opportunities such as bingo games, lottery tickets, slot machines, blackjack at the casino, night poker games, racing bets, gambling websites, animal fights, among many other forms of gambling around the world. In New Zealand, problem gambling has in the past caused a substantial problem in health and social sectors. The health sector in New Zealand revealed the problem as affecting the individual gamblers as well their families due to the addiction and lack of control. The government under the Ministry of health in New Zealand introduced Gambling Act 2003 as a move towards minimizing and preventing the already existing challenges related to problem gambling.

The Act also intended on incorporating public health approach within the policy. The approach focused on including the Ministry of Health, economic analysis, and social integration in providing guidance, counselling and education to the affected population in New Zealand. It also aimed at providing rehabilitation centres, treatment, and therapy for the mentally affected and reduces the confusion brought about by factual analysis of the problem gambling (Derevensky & Gupta, 2006).The term problem gambling refers to a range of negative experiences that can result from gambling . The literature review would establish evidence based relationship between problem gambling and mental disorders such as antisocial personality, phobia, depression, anxiety, stress, and low self-esteem (Derevensky & Gupta, 2006). The findings of the report established a positive relationship between gambling and the psychiatric disorders. The research found that 25% of the social workers reported having come across the challenges in their working conditions with clients having psychiatric disorders.

This research report investigates relationship between problem gambling and mental health through an online survey completed by 100 social workers. The survey comprised of 10 key items (each with sub-items) that focussed upon gambling addiction and methodology through which the problem affected the people in New Zealand. Constant problems associated with gambling such as increased effects of the addiction to different age groups, co-morbid connections, disorders associated with the addiction, effects on gender, the common treatment methods were some the issues focused on in the research. The main reason for conducting the research was to establish the magnitude through which problem gambling affected people in New Zealand. The research is also divided into different chapters starting with literature review, methodology, discussion, implications and recommendations and conclusion.

Chapter Two – Literature Review

Introduction

This chapter would focus on different models and scholarly perspectives associated with problem gambling. The chapter would focus on medical or disease model, psychodynamic model, and social learning model. These models explain in details the biological and psychological factors and processes that explain the etiology of gambling addiction.

Models and theories associated with gambling addictions

Social learning model views gambling addiction as a function of reinforcement history thus it is viewed as operant behaviour. In a theory explained by Skinner most of the gamblers are motivated by the initial success thus increasing the likelihood of gambling. The theory explains that behaviour such as problem gambling is acquired through complicated variety of external and internal factors. On another magnitude, the theory explains gambling as associated with arousal such as the need for financial growth (Cosgrave & Klassen, 2009).

Medical model or disease model explains that problem gambling is associated with disease. The model explains gambling as progressive but not reversible. Although the disease is irreversible, the theory explains that abstinence or self-help groups as important factors that can be used to deal with gambling problem. Psychodynamic model explain gambling addictions as due to psyche and a method or strategy for self-healing for certain conflicts that are beyond voluntary control. Most of the gamblers according to the theory are narcissistic thus living in fantasy world and felling of inadequacy.

Gambling addiction is a major problem in many countries around the world and a lot of research has been completed on the issue. However, the connection between gambling addiction to the mental health has been discussed less. In a review of some of the major findings of the issues, theories have been identified and examined regarding the relationship between gambling problem and mental health (New Zealand Psychological Society, 2007).

Over the recent years, people working at the field of gambling addiction, social workers, and mental health services have not managed to come up with a specific theory that explains the relation. However, a number of theories help provide an explanations.. One of these theories is “self-medicating” hypothesis theory that provides physiological relevance and understanding on the issue. Self-mediating hypothesis explains that people strive to keep a balanced state of satisfaction or contentedness, which is free from, fear, sadness or anxiety (Ferentzy & Turner, 2013). In a state where there is factored disturbance to that balance, through environmental, social or genetic factors, human beings usually attempt to regain the state of balance through all means available or possible (Dickerson & O’Connor, 2006). Within the healthcare level and biological state, the balance is related to efficient levels of a neurotransmitter referred to as dopamine. For instance, in the body, dopamine can be increased by substances such as nicotine, alcohol, cocaine, or any drugs. Therefore, hypothesis explains the reasons as to why some people are more likely to get substance addiction in real life are due to dopamine. According to recent studies, scientists found a connection between gambling and a state of increasing the levels of the neurotransmitter dopamine. Through these findings, scholars established another form of addiction that as not based on any form of chemical or drugs.

A second explanation surrounds a connection on the high level of compulsivity and impulsivity to changes and disturbance of a neurotransmitter called serotonin. Lachance and Ladouceur identified that problem gamblers face difficulties in controlling their compulsion and impulsivity, implicating that the affected individuals suffer from a serotonin deficiency. Therefore the understanding of serotonin theory and self-mediating hypothesis thus, provides and help in explaining gambling addiction indicating that the condition is compulsion and impulsivity related issue (Ladouceur & Lachance, 2006). In the same understanding, the medical transmitters explanation of gambling addictions seems to be a complicated explanation of the subject since many people usually experience various forms of addiction that are both behavioural while others are circumstantial. The understanding and explanation of the serotonin theory and self-mediating hypothesis help in providing insight and explanation of the link between mental disorders and gambling problem. In relationship to biological formulations and explanation, low level of serotonin would be linked to major depression, anxiety disorders, and attention deficits. This means that for the patients with such concurrent psychiatric or mental disorders they might find themselves susceptible to gambling addictions (Ladouceur & Lachance, 2006).

A third explanation linking the mental disorders and problem gambling is evident in research completed at the Illinois Institute for Addiction Recovery; this established that problem gambling is seen as an addiction that is similar or appears as a chemical addiction. The problem has also been associated with hormonal imbalance (O’Brien, Kennedy, Kennedy, Ballard, & Ballard, 2012). For instance, the Institute identified that pathological gamblers showed lower levels of norepinephrine as compared to normal gamblers.

The fourth explanation of problem gambling draws a relationship with dysfunctional thinking patterns. Studies have indicated that some people identified with the disorder are highly superstitious or have the notion that they can guarantee wins during the gambling practice (O’Brien, Kennedy, Kennedy, Ballard, & Ballard, 2012). They also have distorted thinking and understanding about money, where they are identified to think that money can control their lives and provide a way for challenges affecting their lives. People diagnosed with problem gambling are said to have increased the risk of developing narcissistic, histrionic, or borderline personality disorder.

Social factors

Social changes have also been linked with the increased number of problem gambling in New Zealand. For instance, the increase in the total number of adults who were diagnosed with problem gambling disorder in New Zealand can be associated with increased prevalence of legalized gambling (Grant, Donahue, & Odlaug, 2011). Another important factor to consider is low income and increased population in the major cities. This problem is associated with lack of employment pushing most the people especially the low and middle class group to gambling.

Link to mental health

Researchers have examined the link between the problem gambling and the mental health for example the link between bipolar or mania with gambling addiction (Perkinson & Jongsma,2009). The conclusive nature and connection between bipolar and gambling addiction has been exclusively focused by (Perkinson &Jongsma, 2009) Nevertheless, mental health professionals and physicians tend to think that problem gambling might be associated with the changes in the mood linked with the bipolar disorder. For instance, among the few studies on this subject, people affected by depression tend to use gambling as a self-medicate process. The theory tries to explain that most of the affected patients gamble as a way of feeling better while going through a depressive phase. Again, according to Perkinson, gambling reflects or indicates the impulsive state of a manic phase. Therefore, individuals in the state of a manic phase have impulse control issues in their lives. Another form of the study indicates that gambling may appear as a different outlet or face of impulsive behaviour (Perkinson & Jongsma, 2009).

Identification of a gambling problem

The research also identifies different methods of diagnosis and identification of gambling problems. According to the studies, there are several reliable, simple as well as validated methods of screening of gambling addiction. These methods are available for adults and any person with pathological gambling (McManus & Bebbington, 2009). The most commonly used screening methods are the Canadian Problem Gambling Index (CPGI), South Oaks Gambling Screen (SOGS), Problem Gambling Severity Index (PGSI), Lie/Bet Questionnaire,) and finally the National Opinion Research Center DSM Screening for Gambling Addiction (NODS). However, these tools lack extensive validation in New Zealand but they are quite appropriate for diagnosis and screening of gambling disorders (Cosgrave & Klassen, 2009). For instance, a positive result indicates a presence of gambling problem. Upon identification of the problem, the affected person is recommended to initiate the treatment program carried out by a team of professionals, comprising of addiction counsellors, psychiatrists and program diagnostic evaluation and clinical assessment (Adams P. J., 2016).

The literature review has focused on the models associated with problem gambling. The main models are psychodynamic model, social model, and medical model. These scholarly theories explain the reason why most people get addicted to gambling. Another theory is “self-medicating” hypothesis theory explaining gambling addiction in association with factors such as mental disorders and other cognitive behaviours. The chapter also focused on association of the addiction to social status, link to health, and diagnosis of problem gambling (Namrata Raylu, 2010).

Chapter Three – Methods

The aim of this research was to explore the views of practitioners working with healthcare and gambling correctional centres. This chapter explains the methodological approach and outlines the research design, participants, measures, methods of data collection and analysis. The chapter concludes with a consideration of the research ethics impacting on the study and the limitations of the research (Raylu & Oei, 2010). Through quantitative research, the samples were survey online through ethical issues to guarantee the research.

Research Design

A quantitative approach was chosen to examine the views of social workers regarding the relationship between gambling addictions and the mental health.. The survey questions were designed to reflect the key themes that emerged with in the literature review. The survey would analyse the authenticity of the research question (Spapens, Littler, & Fijnaut, 2008). Another advantage of the research the approach was to provide direct link between the participants and the challenges they face on gambling addiction. This involved the use of an online survey that elicited the participants’ responses regarding the following:

• The extent of psychiatric disorders seen in problem gamblers presenting in mental health settings
• The adverse social effects of problem gambling
• The most popular modes of gambling encountered
• Common co-morbid substance abuse amongst gamblers
• Treatment modalities/interventions used to treat gambling
• Stressors for clients experiencing gambling addiction
• Dealing with gambling cravings
• The importance of general screening in early detection of gambling addiction
• The age and gender composition of clients
• Methods used by gamblers in seeking professional support

The participants responded to the questions using scales rated in percentage and 1 to 10 score. One advantage of the method was to provide a conclusive response and rate the state of gambling addiction in New Zealand. The method also provided a balance response where all the participants were provided with equal, ethical, and free method of providing their views on the gambling addiction.

Participant recruitment

Potential participants were invited to complete online survey questionnaires that were distributed electronically through the Aotearoa New Zealand Association of Social Workers.

The participants were self-selected and provided with the following criteria to use in determining participation. The criteria provided the participants with an open and authentic survey where they would provide intellectual suggestions or opinions. They were also provided with an opportunity where they were supposed to follow their informed consent rules and regulation as per ethical codes of freedom of expression (Spapens, Littler, & Fijnaut, 2008). They were also provided with questions with choices within which they would openly express their main concerns.

Sample Size

The sample comprised of 100 (n) participants, taking an online survey. The online survey comprised of 10 questions each having about 4 options.

Ethical issues

A researcher must understand the ethical responsibilities while conducting research which involves the human interventions (O’Leary, 2004). Thus, approval has been gained from the Human Ethics Committee. In this study, the data has been collected through an online electronic survey therefore the identity of the participants was anonymous. The responses were stored online by Survey Monkey and were only assessable by the researcher using his unique log in details. All data collected was stored securely on the researcher’s password protected computer.

Data Presentation and Analysis

A total of 100 responses were received. As the primary aim of the research was exploratory, descriptive analysis was used to analyse the data. Descriptive statistics “describe either the characteristics of a sample or the relationship among variables in a sample” (Rubin & Babbie, 2013, p. 332). The participants responses to each question are presented in tables, augmented by commentary.

The chapter focused on the research design the study sample, recruitment of the participants, the methodology, ethical issues, data and analysis. The chapter also considered some of the ethical and specific issues associated in the research study.

Chapter Four – Results

This chapter comprises of outline of quantitative survey that involved 100 social workers from four hospitals in Hamilton and Christchurch cities located in New Zealand. The main objective of the research was to provide information through which the participants regarded to problem gambling. The results were organized into 10 sections that focused on retrieving the views of the participants regarding gambling addiction. These sections were; the most popular modes of gambling encountered, common co-morbid substance abuse amongst gamblers, treatment modalities/interventions used to treat gambling, stressors for clients experiencing gambling addiction, dealing with gambling cravings, the importance of general screening in early detection of gambling addiction, the age and gender composition of clients, and methods used by gamblers in seeking professional support

The results were as follows:

Table-I Mental Disorders Associated with Gambling Addiction

Although there is less research on the relationship between psychotic disorders and gambling addiction, this online survey provided insight on the prevalence of the common mental disorders reported in the healthcare sector. The survey represents a reflection from the social workers running into clients who show gambling problem as connected to the history of mental disorders. The research found out that almost half of the reported gambling addicts in New Zealand had mental disorders. Among the reported victims, 30% had depression and stress, 20 percent had a personality disorder, and 20% of the women reported had a mood disorder, while the remaining 30% had antisocial behaviours and phobia. Others expressed client past client experience with trauma hardship and problems related to up bring. Overall results showed high rates of anxiety and depression as the main mental condition related to the problem gambling.

2. Effects of problem gambling on client’s life

Table II-Degrees at which Gambling Addiction affect Clients

The research showed almost equal variance on the prevalence of gambling from the clients who visited the healthcare facilities. The survey examined reasons why people gamble through comparing the reported cases on issues such as challenges in the relationship, finances, working conditions, income, and study. The respondents established an almost equal number of the reported cases showing these cases. Most of the clients claimed to be going through financial problems such as job termination, illnesses, and such cases. Others of similar percentage showed problems related to working condition reporting cases of meagre salaries, threatening and harassment within the job set up, and poor management. According to the respondents, most of the young clients reported having shown gambling addictions cited reasons related to study where they needed to acquire extra earning while still in schools. Therefore, the statistics showed 20% for each category provided in the online survey as a reason or degree for the gambling. In conclusion, there was equal record on the reasons for gambling as per the survey.

3. Examining frequent mode of gambling

Table III-Frequent modes of Gambling

The results of the survey show partiality at odds with the clients said to be relating the choice of the mode of gambling as depended on experience, time, occupation, and convenience. Pokies machines, online lottery, and online betting showed high rate. On the score of 1 to 5, the three scored highly managing 5 points to indicate that most of the respondent reported having handled cases related to such modes of gambling. Playing cards and Casino games scored 4 out of five. The modes of gambling depended on the gender and age of the gambling group. The respondents reported most of the adult client as having a problem with Casino games, pokies, and online lottery. On the other hand, adolescents and young age clients were reported to dominate online sport betting and playing cards.

4. The common co-morbid substance (Drug) abuse in problem gamblers

Table IV– Comorbid Substance Abuse Associated with Problem Gambling

The results of the survey showed the substances rated highest or with wide prevalence examined from the patients were alcohol (90%), followed by cannabis (60%), cocaine was recorded as (30%), and cigarettes smoking were established to score (25%) while other clients did not want to disclose substance abuse thus recorded (18%). According to the respondents, substances were used on 60% rate of non-institutionalized days or free days such as over the weekends. However, others indicated that they have been using the substances every day thus providing data amounting to 37% of the sample. Again, 4% of the respondents revealed the clients reported use on less than 10% within the non-institutionalized days. Moreover, apart from the revealed data on the substance abuse in the Table, 70% of the victims were reported as currently smoking tobacco daily, while another percentage approximately 15%, used to smoke daily in the past (Klingemann, et al., 2012).

5. The common treatment and interventions used to treat gambling addiction.

Table V-Treatment and Intervention

The survey for the common treatment program was carried out through providing the respondents with five options with which they were supposed to identify the most common intervention and treatment methods. The four categories were counselling, complementary services, cognitive therapy programs, problem-solving skills, and strength-based intervention methods. On a scale of 1 to 5, the social workers would identify the most recognized system used to improve the gambling addiction. The results were analysed showing 30% of the clients prefer counselling, 30% use CBT as their intervention method, 20% seek complementary services, while 10% seek strength-based intervention. The social workers take the patients through therapy to reduce the challenges leading to addiction while replacing the habits with some other social or economic behaviour. In general, the most reliable and efficient intervention method according to the survey was counselling and cognitive behavioural therapy. 50% of the affected clients are reported to be going through mental or psychiatric disorders thus requiring cognitive behavioural therapy, while 40% had common stressors such as financial management, fear of failure, violence among other behavioural and mind setting problem that required counselling. The respondent indicated 10% as general gamblers as pushed by the desire to spend or get involved with co-morbid behaviours such as drug abuse or excessive use of alcohol. Other clients who presented the matters to the social workers needed inpatient programs, training, and rehabilitation programs. The intervention strategy focused on replacing some behaviour, training the clients on time management and other crucial skills financial management. In a scale of 1 to 5, most of the reported cases required such training especially the patients affected by substance abuse

6. Importance of these common stressors for clients experiencing gambling addiction

Table VI– Importance of Stressors

The online survey on the prevalence of stressors leading to problem gambling provided rather complicated information as almost all the categories had an equal score. The mean or the average of the statistics provided an equal response on those reporting the problem. Out of the 100 sample respondents taking the survey in New Zealand, 90% responded positively to the four common stressors provided in the questionnaire. The results were broken down as financial pressure (30%), loss of employment (25%), Alcohol dependence (25), and relationship issues (20%). Most of the clients were reported to be going through financial challenges either by job termination, lack of employment, high rate of living standards, poor financial management, debts, and such common financial stressors. According to the survey, most of this loss of employment also led to the financial problem identified as a common stressor especially to the male clients. The social workers who were nurses and health care counsellors also established a significant number of the clients as reported to be having challenges in their relationships. The most commonly reported cases being divorce, isolation, and terminal diseases. Finally, alcohol dependency was reported as common stressors especially to the addicts. An equal number of respondents reported case of other substance abuse such as cocaine, cannabis, and cigarette smoking (Southern, 2013). While carrying out the data analysis and computing the results of the survey, these variables were grouped and the information provided together with the category of alcohol dependency.

7. Ways of dealing with gambling cravings

Table VII-Ways of Dealing with Gambling Craving

The healthcare professionals used to carry out the survey provided data showing 30% of the clients were found to avoid isolation through activities such as calling a trusted member through the phone, attending anonymous gambler’s meeting, or meeting up with a friend for sports, coffee or any other activity. Others identified that 30% of the affected clients were found to engage themselves with other distracting activities such as watching movies, going to the gym, reading, listening to music, among other practices. Another group represented by 30% figure was engaged in exercises and administration of the prescribed drugs. The category applied to clients who were earlier diagnosed with mental disorder. For instance, the bipolar and depressed victims would respond by taking the medication thus controlling their emotions. Finally, 10% of the remaining population would seek professional help through calling the counselling centres and getting support. Therefore, as per the results generated, the most efficient methods of dealing with the gambling craving were identified as avoiding isolation, engaging in distracting activities, and taking the prescribed medication or exercises to control hormonal and emotions in the body (Ladouceur & Lachance, 2006). However, some percentage represented by 0.05% found it difficult and challenging to deal with the addiction and were reported to slip over and over on their intervention methods. The social workers indicated the percentage as the ones at risk of advanced effects such as suicidal

8. Importance of Screening for Gambling Addiction

General screening for gambling addiction was found to be one of the most effective methods in dealing with gambling addiction in the health care setting. In a score of 1 to5, screening according to the respondents scored 4 out of 5 meaning it is above average and effective for the social worker to perform for the clients. Screening for the gambling addiction was rated as equally important since most of the clients or victims of the gambling problem rarely seek medical treatment from the relevant bodies. However, according to the social workers in the healthcare used in carrying out the research, most of the clients do not directly seek intervention or treatment for the challenges and instead present complaints such as depression, insomnia, anxiety, stress related cases, and interpersonal issues. In addition to that, gambling problem does not have direct signs that could be associated or detected (CTI Reviews, 2016). The respondents identified more than 20 various tools used in the healthcare setting for screening, assessment, and diagnosis of gambling addiction. Some of these tools were the Lie/Bet Screening Instrument, the South Oaks Gambling Screen (SOGS), and the National Opinion Research Center’s Diagnostic Screen. Lie/Bet instrument comprises of 2 questions, and SOGS tool comprises of 16 items that differentiate between gambling addiction, some form of addiction, and the probability of pathological gambling, while NOPRCDS comprises of questionnaires based on DSM-IV criteria. The respondents identified the three screening tools as the most effectively used in the public health sector and are crucial in examination and diagnosis of the gambling addiction (Doak, 2009).

9. The prevalence of different age group and gender presenting to mental health setting with gambling addiction

Table VIII-Vulnerability on Gender

According to the results presented in the online survey, men and women had almost the same score as on gambling addiction. Men scored 50% while women scored 40% with little difference between the two genders. Transgender, on the other hand, had the lowest score of 10% citing the low number as due to their low representation in the population in New Zealand. The most cited problem to the problem gambling could have been as a result of financial pressure and responsibilities on men. Most of the women who had the problem according to the SOGS assessment tool had mental disorders and issues in their relationship. The low score for the transgender was due to their low population representation in the country. On the other hand, Adults score higher according to the survey with 50% score reported to having problem gambling, young people (18 to 25years) scored 40%, while children below 18 years scored 10%.

10. The methods the gamblers seeking professional support

Table IX– Methods of Seeking Professional Help

In a score of 1 to 5, the social workers indicated that gamblers with going through addiction mostly used online support, phone support, and external agencies. The three categories scored 5 each, that showing that those were the most reliable modes of the helpline. However, face-to-face modes of seeking help scored 2 indicating that most of the people with gambling addiction in New Zealand avoided face-to-face assessment program with the professionals. Most of the clients who reported the case face-to-face were seeking different help such as counselling due to depression, stress, or substance abuse. Therefore, online help and call centres were the most efficient modes of seeking help according to the survey.

The research results focused on mental disorders that were associated with gambling addiction, screening of gambling addictions, methods used to treat gambling, vulnerability of gender and age to gambling addiction, connection of gambling problem to co-morbid conditions, and intervention of problem gambling. The disorders that were commonly associated with gambling problem were depression, dementia, and bipolar. I regard to both genders on the vulnerability of gambling men were mostly affected as per the results, the connection were associated with responsibilities of men in the society. Counselling was established as the reliable treatment and intervention method for the people affected by gambling addiction

Chapter Five Discussion

Problem gambling refers to people experiencing negative consequences due to gambling and has been a major problem in New Zealand with increasing number of people mostly those living in the cities involving themselves into gambling behaviours. Pathological gambling is an increasing problem causing a major concern in public health sector in New Zealand (Jia, Yang, Wang, Hong, & You, 2011). This information is evidenced by the increased number of legalized gambling in the country. The gambling problem has also prompted high costs to the society as people are reported to losing their property and health amid an increasing cost of treatment services available in the healthcare. For instance, in New Zealand, the costs of pathological gambling have ranged from $6 billion to around $45 billion per annum, compensating for the lost time as well as productivity, lost wages, legal costs, and treatment of the co-morbid psychiatric and medical conditions. Treatment for gambling addiction is usually offered locally, as well as within state level. However, there are no guidelines and set standard treatment methods (Ladouceur & Lachance, 2006). According to the research, the respondents responded positively towards having identified specific mental disorders linked to problem gambling in New Zealand.

Also, since funding for unhealthy gambling changes from country to the other, the availability and approachability of multicultural treatments linger behind what is convenient for other mental disorders. For example, insurance organizations do not typically compensate for an examination of gambling addiction, and there are few acute inpatient treatment and intervention centres and limited gambling addiction-specific outpatient intervention and treatment programs in the country. Finally, perception about the consequence of pathological gambling is contained within the healthcare system. However, this de-emphasizes the preference for screening for gambling addiction although it is an important source of psychiatric and medical morbidity, as well as mortality (Bowden-Jones & George, 2015). As a direct result, gamblers might go without being recognized in various healthcare scenarios, from main clinics to mental health treatment programs in the New Zealand. Also, in drug abuse programs and setting, screening for gambling disorder is not component the overall process, even though the states of co-morbidity are important. Besides, even when conferred with the signs or outcomes of unhealthy gambling, some social workers might not acknowledge the problem and might not understand how to handle it. In settling this notch, social workers must first become accustomed to the population portions that are exposed to developing a gambling addiction. Through this understanding, the social workers would then have the ability to employ relevant screening instruments for detecting the gambling disorders and should also form prevention strategies that can reduce the harm of untreated gambling addiction.

Another concern is the way problem gamblers have been shown to the media as well as popular culture. For example, the local media in New Zealand used to regard gambling addicts as middle-aged Caucasian people who spend their time gambling on sports and at casinos. Epidemiological work in the recent updates begun to indicate that this media stereotype cannot be relied on since it is false (Raylu & Oei, 2010). It explained that there are identifiable as well as discreet groups who pose a threat and risk to gambling addiction. In that, the media are portrayed as involved in causing stigma to the affected people in expressing their stereotype nature. Therefore, it is upon the government to regulate its policies and consider the affected people. The policies are supported the treatment and intervention programs which considering the whole that problem gamblers suffer from mental disorders and that these factors pose a risk to factors such as suicide, giving up and cause more harm than improvements (Jia, Yang, Wang, Hong, & You, 2011). Instead, the media is supposed to support the healthcare facilities in providing education and encouraging the affected people by to come out and seek assessment and intervention programs. The research established various mental disorders related to the problem gambling. The results showed major mood disorders were connected to the gambling problem. For instance, mania and depression that results due to hormonal imbalance. For instance, according to the American Psychiatric Association (DSM-IV), depression was defined as a persistent condition occurring over the day and lasting for like two weeks changing an individual normal operation (Parliament; House of Commons: Culture; Media and Sports Committee, 2012). The common characteristics of depression included diminished interest in pleasure activities, feeling of isolation, emptiness, worthlessness, and guilt towards unsubstantial evidence, weight loss, insomnia, recurrent suicidal plans, thoughts of death, and reduced libido. On the other hand, the manic disorder is the opposite of depression though it is a chemical imbalance. Mania is usually characterized by irritable or euphoric state lasting for over a week. Victims of mania show characteristics such as decreased sleep, grandiosity, slow recognition of problems or issues, reckless behaviour that might end up with painful results such as uncontrolled spending, irresponsive sexual behaviours, or dangerous driving.

Mental Disorders Associated with Problem Gambling

Depression and Mania (Bipolar)

Therefore, the research provided oversight of the relationship between those mood disorders and problem gambling. Through analysis of the information provided by the respondents, the research provided findings that almost one third of the pathological the affected gamblers in New Zealand had a history of mental disorder in the family. This provided a clear link between the pathological gambling and the psychiatric disorders. The overall finding established that approximately 20% of the victims or clients who turned up for help in the healthcare and other intervention centres were depressed. Depression affected even those who were changing their lives. The depression rate for the inpatients in most of the healthcare facility was around 50% to 75% as compared to the average of 10 to 25% (Jonathan, 2015). The social workers who took the survey indicated that the most causes of depression among the gambler was urge to forget their challenges, isolation, stress, and other external forces such as financial problem, stressful relationship, among other causes. The depressed also have increased chance of committing suicide, trauma, and unresponsive behaviours. Maniac behaviours have also been linked to the problem gambling in that the affected people tend to spend more than expected. Bipolar disorder leads to an extreme alteration of the victim’s mood, ability to execute duties, and energy levels.

Bipolar Disorder

Bipolar disorder can also be referred as manic-depressive disorder, suggesting the changes in the mood of the affected person. According to the research, most patients suffering from the disorder tend to get overexcited and seem extremely joyful while going through the manic episode. Researchers in the field of psychiatric disorders have found particular connections between gambling addiction and bipolar or mania (Namrata Raylu, 2010). According to the national survey, almost half of the people with problem gambling in New Zealand have mood disorder. In trying to get the connection, Canadian researchers found that people affected with bipolar disorder were more likely to have problem gambling addiction as compared to the general population. Therefore, this study found that among the clients reporting for help in the healthcare facilities run by the respondents, 80% of the clients with the mood disorder were women while 58% represented men population in New Zealand (Jonathan, 2015).

Antisocial Personality Disorder & Personality Disorder

A personality disorder refers to enduring patterns of behaviour and inner experience, which changes from the expected culture of the person. The disorder leads to impairment or distress and it is a distress, a pervasive, inflexible, and stable over time as it onsets from early adulthood and adolescence. Basically, the condition is based on thought on the environment which is maladaptive and inflexible. Antisocial Personality Disorder (ASPD) is the more researched and associated with problem gambling. According to the studies, an individual with ASPD has a pervasive behaviour that does not regard violation of rights or offence. For instance, the individual might have a history showing behaviours such as conning, lack of future plans, law-breaking, poor judgment, has an interaction mostly based on manipulation or power, and can have history filled with criminal activity cases. In these incidences if the person is successful, there is a probability of having narcissistic characteristics and form of antisocial behaviours.

The research indicated that personal disorder and antisocial Personal Disorder as highly prevalent in New Zealand according to the survey. The research provides an oversight that a third of the examined people indicated that ASPD was one of the reported mental disorders associated with gambling addiction. Social workers indicated that most of the victims of the disorder were adolescents, mostly high school students. Among the healthcare facilities examined, the results indicated that 15 to 40% of the people with ASPD were diagnosed with gambling addiction (1% female, 3% male population). Psychologists under the field of study found significant deficits on problem gamblers intolerance for ambiguity, adaptability, and inhibition of action while need (Abramowitz, McKay, & Taylor, 2011). The form of behaviour leads to uncontrolled form of living where the affected person does not regard the risk involved in gambling and can lose almost all earning without any regret.

Anxiety Disorders

Anxiety disorders refer to various conditions which share features such as avoidance, inhibition, severe stress, compulsion, and nervousness. People affected tend to be anxious and thinking fearing or worrying about things that are beyond their control. Research indicates that anxiety and stress may increase or lead to gambling activity. Psychologist also found out that pathological gambling could be associated with unresolved or complications in the trauma-related anxiety. There is average assistance for the association between these factors (McCown & Howatt, 2007). For instance, within the neurochemical level, there are certain relationship between anxiety disorders and a number of neurotransmitters, which are genetically influenced (Ladouceur & Lachance, 2006). However, within a large-scale research, studies have found evidence on an increase in agoraphobia, panic disorder as well as generalized anxiety disorder in relationship to gambling addictions as compared to non-gambler controls. Again the studies have also shown that pathological gamblers had an optimum increase in anxiety disorders, a fivefold increase in agoraphobia, as well as a six fold increase in obsessive-compulsive disorder. However, the connection between problem gambling and OCD remain a challenge to the psychologists.

Screening for Gambling

According to the research over 20 different tools and methods are usually available for screening and diagnosis for gambling disorder. The research would focus on the National Opinion Research Centre’s Diagnostic Screen, South Oak Gambling Screen (SOGS) and the Lie/Bet Screening Instrument (Jonathan, 2015). The Lie/Bet Screening Instrument usually has two questions. The first question checks on the reasons for gambling while the other question examines whether the individual has ever lied on gambling subject. If the client responds positively to these questions, the social workers or the healthcare provider is required to contact further investigations on the matter. On the other hand, SOGS comprises of 16 categories explains and differentiates serious gambling addiction, developing gambling addiction, and a case of serious or already existing gambling addiction (McCown & Howatt, 2007). The process is usually taken online as it is already on the internet. Thirdly, National Opinion Research Center’s Diagnostic Screen on Gambling addiction is a general screening process that examines the probability of gambling addiction or an already existing problem depending on the magnitude of the issues. Diagnosis and screening for the gambling addiction is a crucial task since it helps in the identification of the gambling problems thus prompting the responsible healthcare workers to progress with the healing process. In most the cases the recovery program comprises of counselling, training, replacement of the vice, or professional cognitive therapy. The screening program is usually taken by professional counsellors, behavioural therapists, or experienced and trained psychologists. In the process, certain mental, behavioural and social problems are identified such as stress-related problems, insomnia, depression, anxiety, or interpersonal issues (Singer, Anselme, Robinson, & Vezina, 2014). Physical observation can also be required in identification of marks that are used for administration of drugs such as cocaine.

Methods of Treatment

According to the healthcare professionals working with the gambling addiction, all gamblers are unique and require a system of recovery and treatment that does not cause physical or mental harm. According to the social workers, the most important step is the detection and diagnosis of the problem (CTI Reviews, 2016). According to the healthcare programs on the problem gambling identification of the vice is a challenging issue since most of the gamblers do not agree on the addiction rather choose to keep the behaviour as a secret. Therefore, the healthcare professionals who comprise of counsellors are faced with a challenge in the identification of the addiction and getting the client or the patient to understand and admit the issues. Understanding and compliance of gambling addiction usually allow the responsible healthcare worker to have an easy time in facilitation of the healing and recovery program. It takes enormous strength and courage to admit and allow for the therapy program (Nguyen, 2016).

Statistics on the gambling problem in New Zealand indicate that about 60% of the population affected by gambling lives with the problem without disclosing. 40% of these people are said to have a mental disorder (Doak, 2009). Therefore, the biggest challenge for the healthcare professional is diagnosis and identification of the problem.

One of the most effective programs used by therapists in New Zealand is identification and linkage of the affected person with a friend formerly affected by the issue. The partners are usually referred to as sponsors, and since they have a history of overcoming the problem, they can assist the affected gambler in the identification and slow way of recovery. They often provide invaluable support and guidance through the treatment and healing process. One of the most used healing methods is Cognitive-behavioural therapy (Freeman, 2006).

Cognitive-behavioural therapy

Cognitive-behavioural therapy (CBT) is one of the most effective and widely used treatment methods for gambling addiction. The method is widely used across the world. The therapy program is focused on transforming or alteration of unhealthy thoughts and behaviours associated with gambling addiction such as false beliefs and rationalizations (Namrata Raylu, 2010). It also trains gambling addicts on efficient methods used to fight gambling addictions such as psychological methods of dealing with issues to avoid stress and depression. Such methods include therapy on dealing with and solving challenges emerging from work, financial, and relationship problems that are common stressors (Raylu & Oei, 2010). The main objective of the therapy is replacing the gambling practice with an efficient activity and changing the mode of thinking to include constructive methods of living. There are other methods that have been in use that are related to problem gambling. However, CBT has been the most effective. Mostly the therapists are supposed to help the clients in refocusing, re-labelling, re-attribute, and revalue their life. It also provides the affected people with various methods in dealing with stress and handling having a constructive living.

Therefore, Cognitive-behavioural therapy is usually a psychotherapy used by professional especially therapists in reconstructing mental issues towards efficient and effective behaviours.

Gambling in New Zealand involves different activities. Some of the available gambling practices include the casino, electronic machines, instant kiwi, lotto, dog and horse betting, online betting, telephone gambling, among others (Jonathan, 2015). According to the statistics, almost half of the people in New Zealand within the age of 15 and 35 were found to have involved in gambling activities by 2012. However, the Gambling Act has helped in the reduction of the gambling activities in the recent years. Within the same year, the government reported equal proportions of the gender participation in gambling. However, these results were strongly criticized by a psychologist with different figures on the gambling addiction in the country. According to the New Zealand government, the most vulnerable group involved in the gambling activities was the adolescent and young adults within 15 to 24 years. These groups are seen to be involved in gambling due to increased levels of technology amid employment problems in the country. According to the survey contacted on the prevalence of the gambling in the country, 90% of the respondent from the two towns in New Zealand indicated lotto as the widely used form of gambling in the country. Other activities that were common in the country were instant kiwi and scratch cards. On comparison of the results provided by the respondents and the actual statistics by the New Zealand Health Survey (NZHS) were similar. However, according to the NZHS, most of the New Zealand gamblers (70%) preferred lotto as compared to the other gambling activities. 10% preferred playing Kiwi, scratch tickets, while 8% responded positively in the involvement of dog racing, horse racing, and other sports. The remaining 8% preferred gambling in Casinos, pubs, and clubs. The majority of the people involved in gambling in New Zealand were recreational gamblers (Jia, Yang, Wang, Hong, & You, 2011). However, their gambling activities had a negative recommendation since most of the recreational gambler would end up getting addicted. The most affected group of people affected by gambling was adolescents and people aged between 18 and 35 years. New Zealand health survey indicated that older people (approximately 65 years old) were less likely to get addicted to gambling. However, the higher group that expressed problem gambling was those involved in sports, horse and dog racing and those involved in the club, pub or casino gambling (Freeman, 2006).

Vulnerability by Age

According to the research by the New Zealand Health Survey, Adolescents are the most vulnerable group t gambling addiction. This is because at their age, their brains are maturing and that have low mechanisms of self-control. According to the research, the respondents indicated increased number of early adults and adolescents involved with gambling. The survey indicated that influence and immature behaviours showed by the adolescent were the main reason for the addiction. The problem cited numerous and popularity of regular poker tournaments in schools. The NZHS indicated that approximate of 80% of the adolescent between the age of 12 and 17 years had involved in gambling in their lifetime (Jonathan, 2015). The report also indicated that the most popular method of gambling among the group as board games, dice, online sports betting, and internet gambling. The reports also indicated that gambling as encouraged by the society and illegal as in the case of substance abuse thus encouraging the adolescents. The one reason explaining why adolescents are susceptible pathological gambling is that there are probabilities of increased cases of problem gambling with negative consequences which can arise quickly. The adolescents cannot manage themselves and thus they can maintain small amounts of debts leading to deception, lying, and guilt to get some money for gambling.

A secondly the increased prevalence rate among the adolescents is that it can show the actual course of gambling addiction as it peaks at the adolescence stage while it tapers during adulthood. According to the research conducted on the prevalence among the gender and age, the report evidence indicated that reports that gambling addiction is usually transitory and episodic. However, the some of the adolescents usually recover from the vice explaining the reason why the prevalence is controlled by the adults. Just like substance abuse, the problem can be controlled through the intervention methods indicated in the research. Therefore, the problem is well evidenced in New Zealand by the adolescent and cases of episodic and transition from adolescents to adults (Jonathan, 2015).

According to the survey, the prevalence is low among the elderly. However, the information is contradicted by the scholars and other researchers who cite gambling addiction as increasing among elderly people. The studies indicate that most of the elderly people tend to get involved in recreational gambling that can advance to gambling addiction. The New Zealand national survey speculated that senior citizens as the group sing online and phone calls for the help on the gambling addiction. The research found out that gambling addiction among the elderly as increasing due to the higher comorbid conditions (Nguyen, 2016).

Vulnerability by Gender

According to the survey conducted on the social workers, the data presented indicated a higher number of gambling among men as compared to women. However, studies indicate that the difference between the two genders as decreasing with time since the state allows women participation in gambling. The New Zealand Health Survey indicated that gambling addiction among women ranges between 32% and 43% (McCown & Howatt, 2007). These figures were collected through comparison of the reported cases in the healthcare facilities around the most populated and busy town such as Hamilton and Christchurch. The survey reported gambling among men as ranging between 60 and 70% of the total population. The reason for the increased number of male gamblers can be associated with roles such as provision, financial obligations, co-morbid conditions, and substance abuse. However, another form of explanation and understanding of the problem indicate that women populations can advance faster to gambling addiction as compared to the male counterparts (Derevensky, Merrick, & Shek, Youth Gambling, 2011). Biological researchers indicate the increased vulnerability to pathological gambling as a result of greater stigma associated with women on the problem. Other reasons provided by the biological researchers are that women have lower access to finances, are faced with the stress of childbearing and care, among other significant reasons. Also, there are differences in the genetic makeup indicating the women in response to substance abuse (Bowden-Jones & George, 2015). For example, healthcare providers point out the difference in metabolism between the two genders indicating that women can become alcoholics within a short period as compared to men. The differences between the two genders on gambling addiction are due to psychiatric co-morbidities, genetic makeup, and biological sustainability and resistance to disorders such as stress and depression.

Connection with co-morbid conditions

Research conducted by using the social workers and in reporting the prevalence of the gambling addiction in connection with substance use shows a strong relationship between the two problems. The report indicated that most of the patients who reported gambling addiction and also from the Studies, Substance Abuse, and Mental Health Administration. The respondents responded positively to increased prevalence of substance abuse noted within the patients having problem gambling (Marlatt & Donovan, 2007). Statistics show a direct relationship between drug addiction and gambling addiction in that the more the use of the drug the higher the risks involved in gambling addiction (Ries, Miller, & Fiellin, 2009). The patients or clients were said to have increased impulsivity, inability to control anger, and antisocial tendencies. The social workers indicated that adolescents or the early age individual were the most reported people having the problem. The victims of the co-morbid substance use were said to have poor methods of making decisions (Perkinson & Jongsma, 2009). Most of the urban gamblers would end up spending more than they expected due to lack of control and making of tough decisions (Doak, 2009). The clients would also have risks in relapses if the situation were not controlled. Research also indicated that people with the problem were more likely to report cases of mental disorders such as depression, stress, bipolar, mania, or antisocial personality disorders. About 50% of the people with co-morbid substance use were at a risk of coming suicide. However, senior citizens were at higher risk of suicide as compared to the young generation. The respondent identified cannabis use as the most abused drug (Raylu & Oei, 2010).

Intervention of Problem Gambling

One the most used intervention and treatment for pathological gambling is the cognitive-behavioural therapy which involves various stages (Donovan & Marlatt, 2007).

• The First stage involves history taking and formulation of goals for the practice. The social workers run assessment and take the history of the client. The information would help in making a treatment plan.
• The second stage of the therapy involves providing the affected person with gambling information and self-management techniques. The session aimed at providing the affected person with facts, help in identification of the main triggers and provide techniques that focus on addressing such triggers. For instance, the social workers train the victim on strategies such money management and involvement in other activities.
• Thirds the social workers would help the patient in identifying challenges in carrying out the treatment program. The patients are trained on problem-solving skills.
• Finally, the patient is assisted in ways of avoiding future relapse.

Implications for practice and recommendations

According to the findings from the research, gambling addiction, and mental disorders are closely related. Problem gambling affects people from adolescents to the elderly and thus the problem requires interventions. The findings indicate that the affected people are less likely to disclose the addiction to the people, and thus there is a need for increased awareness. The New Zealand’s National Survey should conduct more research and collaborate with the government and gambling foundation in providing civic education to the people (Doak, 2009). There should also be increased assessment centres and call centres in the country to facilitate the growing number of the problem gamblers. Gambling addiction and its implication should also be taught in schools and other institutions. The affected population should receive intervention treatment methods. This information includes strategies for dealing with the problem, activities to replace gambling, and efficient strategies for time financial management (Nguyen, 2016).

Conclusion

Gambling addiction is a major problem in many countries around the world in including New Zealand. Over the recent years, scholars have carried out research regard gambling addiction. However, less has been discussed the connection between gambling addiction to the mental health. In the review of some of the main findings of the issues, certain theories have been identified and examined to identify the relationship between gambling problem and mental health (CTI Reviews, 2016). The paper focuses on the relationship between mental disorders and gambling addiction. Among the disorders discussed are mania, depression, stress, and bipolar. Researchers have found a strong connection between the two. The main objectives of the study included establishing the frequency of the reported cases of a mental disorder related to gambling and examining the degree within which problem gambling affects people at various aspects of life (Perkinson & Jongsma, 2009). It also focused on establishing modes of gambling that are frequently reported to the health professionals and understanding the common co-morbid substance abuse associated with problem gamblers. Other objectives were establishing the most effective treatment or intervention modalities that are used to in the treatment of the gambling addiction according to the respondent and studying and understanding the importance of the stressors show by the clients or patients affected by problem gambling (Freeman, 2006). The research used participants (Social workers) from New Zealand working in the area of mental health and addictions in different healthcare facilities. The sample participants of 100 respondents participated in a survey conducted online through emails. The survey comprised of 10 questions where the respondents were answering the question through a scale of 1 to 5 and on the relevance of the question. The data was then analysed quantitatively. The literature review contains theory and studies on the problem gambling and mental disorders.

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