Q: I am very concerned about an elderly relative who has become addicted to gambling on fruit machines. He is 88 and is spending thousands of pounds of his savings each month. This money is supposedly reserved for care-home support, if he were to need it in the future. He always believes that his winnings exceed his expenditure but his bank account tells a different story.
Is this a psychiatric problem that his doctor could help with (always assuming that he would accept help)? What do you suggest?
A: You are right to be concerned. Not only can excessive gambling lead to a spiral of debt, but it is also linked to becoming socially isolated and depressed, which affects relationships, health and quality of life.
Gambling is a growth industry with more than £7 billion spent on it every year in the UK. Inevitably, the number of problem gamblers has also increased, with the current estimate at 350,000. About 5 per cent seek help — but only 1 per cent get treatment. More over-65s are gambling too. The British Gambling Prevalence Survey of 2010 showed an increase in this age group playing the National Lottery, bingo, sports betting and slot machines from 52 per cent in 1999 to 63 per cent in 2010.
To avoid gambling becoming a problem, financial limits must be set, time spent gambling reduced and alternative activities found alongside an understanding that it is never a way to make money. However, it sounds as if your relative already has a problem, something that has implications for his future care.
Gambling affects the pleasure centres of the brain and is powerfully reinforced at a biological level by the release of the chemical dopamine, similarly to other addictions. This means that the behaviour becomes compulsive as the rush of chasing the jackpot leads to reduced behavioural and financial impulse control and increased risk-taking.
Gambling causes a negative cycle of chasing losses and problem gamblers can show withdrawal symptoms if their behaviour is blocked. The addiction to the behaviour can cause significant relationship breakdown because of lying, cheating and even, as in the person you describe, threatening relatives who try to step in.
This last point raises the issue of what those with lasting power of attorney can do. I suggest that they seek legal advice to see whether they can restrict his access to funds if it can be proved that he is unable to manage his own financial affairs because of being diagnosed with pathological gambling addiction. Indeed, in 2013, problem gambling was reclassified as a mental health disorder alongside more commonly known substance-related addictions.
Behind any diagnosis, however, is a person with their own unique emotional, social and psychological experiences that drive them towards a particular behaviour. Although I don’t know this man’s history, there are many reasons I can offer to explain why the elderly in general may be more vulnerable to developing a gambling addiction. Many gamblers are lonely and lacking in stimulation — problems often experienced by elderly people. Gambling offers an adrenalin rush, excitement and stimulation, passes time and also for some provides a place to go to and be among others, welcomed by familiar faces.
Therefore it might be useful to think about organisations, regular timetabled groups and activities that you can introduce your relative to — see ageuk.org.uk. Also perhaps friends and family can set up a consistent rota of visits and days out to replace the time spent gambling and improve his quality of life via regular social contact.
Gambling can also be a way to relieve stress or other emotional problems. Research suggests that problem gamblers are more than twice as likely to suffer from depression and 50 per cent suffer from alcohol addiction. Therefore, problem gambling behaviour can be understood as a way to “self-medicate” other difficulties. For more information, counselling support and advice see gamcare.org.uk(0808 8020133) and the charity gordonmoody.org.uk, which offers residential, online and outreach support to gamblers and those affected.
Rather than approach your relative with the notion that he has an addiction, which might make him defensive and unwilling to engage in any kind of conversation, it might be helpful to talk more generally. Ask about his mood, his sleep, his appetite and drinking — all of which are affected when you are depressed — and encourage him to visit his GP, who can then assess the broader picture and offer support or refer on.
Fundamentally, this elderly man has the right to live his life as he chooses. However, if you assess that there is a risk of decline in mental or physical health and the possibility of bankruptcy and no future provision for long-term care needs, I respect your desire to support him to challenge his gambling.