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Prevalence of Gambling Disorders in a Primary Care Setting
Arch Fam Med. 1999;8:520.
Because the study was completely anonymous, I was unable to interview any of the patients identified as having a gambling disorder to ask them more about their gambling and their reaction to the study. Since finishing the study, I have now been working as a family physician in Reno, Nev, for 1 year. During this time, I have seen patients with concerns about their gambling and have identified people with gambling problems. The following 2 cases (real names not used) will hopefully shed some light on the effect of pathologic gambling on patients and their families.
John is in his early 40s and has been addicted to video poker for the past 10 years. He is married with 2 children, and his gambling has primarily affected his relationship with his family. Two years ago, he won $40,000, but this year he has lost $60,000. Financially, he is managing to stay out of debt, but he has spent most of his retirement and savings on gambling. He has a steady job and denies losing any jobs or missing any work because of his gambling. However, on his way home from work, he would often stop by the casino to play for "just a few minutes." Unfortunately, a few minutes frequently turns into 4 to 12 hours. As a result, the time he has spent gambling has severely damaged his relationship with his family. Interestingly, he does not drink while playing as this dulls the "high" he gets from gambling. He does admit to having some headaches that he attributes to his gambling but did not find the headaches severe enough to see a physician.
Jane is in her late 30s and primarily plays slot machines. She will play mostly in binges during which she goes to the casino and gambles away everything she has saved plus money she takes out on her credit card. She only visits the casino 2 to 3 times a month as she has learned to try to avoid gambling. When she does give in to gambling, however, she finds it almost impossible to walk away until she has lost all of her money or is in debt. She is also undergoing a fair amount of emotional stress because of her gambling. In the past, she has only told physicians that she was depressed.
When I discussed the study with both patients, they were not surprised by the results. Had their primary care physician asked about their gambling behavior previously, both felt they would have been willing to discuss their problem. Like any addiction, however, they commented that they would often deny their problem or minimize it to friends and family members and may have done similarly with a physician. They also know other pathologic gamblers who still deny that they have a problem. They do feel that advice and counseling from a primary care physician could help pathologic gamblers realize they have a problem.
Andrew V. Pasternak IV, MD, MS
Reno, Nev
RELATED ARTICLE
Prevalence of Gambling Disorders in a Primary Care Setting
Andrew V. Pasternak IV and Michael F. Fleming
Arch Fam Med. 1999;8(6):515-520.
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