Liz Karter author of 'Women and Problem Gambling'

For those of you who are not familiar with Liz Karter’s work, she’s one of the leading authorities in the UK on addiction and has invested over a decade of her life in the study and treatment of gambling addiction with a specific focus on how these issues affect women. While I have a basic understanding of the issues, I’ve no direct experience dealing with the addictive behaviours that surround gambling and I for one am very grateful that Liz has volunteered some of her valuable time to allow readers of CasinoReviews to gain greater insight into a topic that’s becoming more and more significant as the gambling industry sees unprecedented growth.

I’d like to start off with a question about your background. You’re a qualified therapist and have been helping patients with addiction issues since 2001. Was there something specific that motivated you to specialise in addiction treatment and specifically in gambling addiction? Has your own life been touched by these problems or did the drive come from an academic rather personal place?

I fell into treating gambling addiction by accident. When in the final year of my training and needing a placement I started working for GamCare and like most people, I did not get how on earth somebody gets addicted to gambling. I soon found that I completely ‘got it’ when I discovered that far from how it seems – that is about self destruction and money- that it is more an attempt at self-medication and that the obsession with money is only a consequence of somebody having lost everything to gambling. I think my drive came from professional interest, but a little personal experience, too. I think I have a little life experience and can empathise with how sometimes we might want to get away from the pain that life can bring, at all costs. I guess if we think about it, maybe we all can have that empathy.

My knowledge in your specialist field is by no means academic, so I hope you don’t mind some less than refined questions. In layman’s terms what defines a “problem gambler”? Psychologically and physiologically how do gambling addicts differ from those members of society that can gamble without issue? Is this a problem that could affect anyone at any time or are there individuals or groups that hold a predisposition making them more likely to be afflicted? How does gambling addiction differ from other forms of addictions?

In layman’s terms a problem gambler finds that gambling to the extent that they are is causing problems in their life and their relationships. The degree of the problem may vary and it is important not to measure it just in the amount of money lost. If they are not yet in financial difficulty but their gambling is causing arguments with partners or absence at work, it is still problem gambling.

For someone who gambles without an issue, gambling feels like fun. They can take it or leave it and gamble with affordable amounts of both time and money. For the gambling addict, gambling no longer feels like fun, but despite rationally knowing it is destroying their life they are caught up in irresistible cravings to gamble, to experience another high from a sports bet or the casino table, or for escapism through total absorption in playing a slot machine, or in gambling online. They are gambling at all costs, both financially and to commitments such as relationships and work.

The findings of my practice are that gambling addiction is more likely to affect those who are stressed, depressed, anxious and using gambling as a way to change the way they feel for the better. For women, isolation and loneliness and feeling overwhelmed with responsibility, are key factors. In that sense it could affect anyone at any time. I often think with any addiction, there but for the grace of God go any of us. As I have said in my new book ‘Working with Women’s Groups for Problem Gambling’, certainly for women, both the cause of gambling addiction and the cure for it lies in relationships.

One of the big differences in gambling addiction compared with other addictions is in the long term consequences of gambling. Long into recovery, someone might still be thousands of pounds in debt and the stress of this can be a huge trigger for relapse in desperation to win their way out debt, or just to forget about it for a while.

In a general sense what are the root causes of gambling addictions? Is it simply a developed dependence on the endorphins released when winning or are their usually deeper seeded personal or sociological artefacts that contribute to the likelihood of a person developing issues with gambling?

Some people do become dependent of the endorphins released when winning. Many women become dependent on the sense of escapism offered by gambling online or on slots; they are for that time not thinking or feeling anything about day to day problems. I believe that we cannot look at addiction out of a social context. Our social groups, our relationships, and our work patterns all impact on how we feel. If we feel bad, we are more vulnerable to using gambling too much, to try to feel better. In essence, that is the root of gambling addiction.

Again in a general sense, what are the symptoms or warning signs that gambling could be becoming a problem for a person? What should an individual look for in their own behaviour patterns? What should readers watch for in friends and family? If you see something that you feel is indicative that someone you care about may be developing a problem with gambling can you suggest how best to approach the person in question or perhaps a positive course of action that could be taken if approaching the person is not possible?

Warning signs are:

If you are gambling and recognise the above, plus feeling an increased need to gamble, feeling irritable if you cannot gamble and using unaffordable money and time gambling, you may have the start of a gambling problem.

If you suspect someone has a gambling problem, sensitively share with them your concerns, but remember they are likely to feel ashamed, scared they cannot stop, and may act defensively at first. Suggest some support services if they are open to this. If they are inapproachable, leave some information on gambling addiction support services around; they may decide to seek help. Remember, if your partner or family member has a gambling addiction, it affects you too. Take care of yourself and seek help even if they are not ready to. Gamblers Anonymous offer self help groups for families, too.

Accepting that whether they should or not, people will continue to gamble, what strategies would you suggest that individuals engaged in gambling should implement to help prevent addiction becoming a problem?

The most important strategy I think is: Never regularly use gamble to manage depression, anxiety and stress. You risk becoming dependent on gambling in the same way that someone who uses alcohol in the same way risks becoming an alcoholic.

Where gambling addiction has been identified and the individual has acknowledged the problem, what different treatments are available? How do the treatments differ? Do you personally feel that certain methods are more effective than others? What external resources would you recommend for individuals who are worried about their gambling?

What works best depends on the individual; how long they have been addicted to gambling and what the underlying motivation is. For someone who has just got out of control and into loss chasing for a few weeks, a short course of CBT might be enough to get back on track. If someone has been gambling for years and is depressed they may benefit from longer term support aimed at addressing the addiction and the reasons for their depression.

You specialise in the treatment of gambling addiction in women – a rapidly growing problem in the UK and globally. How does gambling addiction in women differ from men? Are the approaches to treatment different?

Men are much more likely than women to talk about addiction to the ‘buzz’ or the ‘high’ from gambling in the betting shop or at the casino table. Women are much more likely than men to talk about addiction to ‘zoning out’ going into a ‘bubble’ by total focus on a slot machine or the computer screen. Men often have complex reasons for their gambling addiction, women almost always do. It is almost always about relationships at home or work, that are too much pressure. Or not enough supportive relationships so that they are isolated and lonely. This causes mental health problems such as stress and depression, so there is much greater need to treating not only the addiction, but develop better relational skills too. The women’s groups for problem gambling which I established in 2006 are highly successful in doing just that.

In the last decade the availability of gambling has increased massively. Online gambling is a market that’s expanding at a rapid rate and in the UK we’ve seen a recent change in legislation that’s allowed online casinos to advertise on TV. How do you feel the growth of the online market and the exposure to gambling advertising has impacted the rates of addiction? Will a person likely to develop gambling issues seek out available opportunities regardless of advertisement or easy access or have these changes in turn created a host of new gambling addicts that would likely never have developed a problem otherwise?

Every day sadly, I see and hear the negative impact of the huge advertising increase on gambling addiction recovery. Early recovery causes cravings every bit as distressing as those from drug or alcohol addiction and it is vital that someone avoids thinking about gambling and keeps occupied. Nowadays, turn on the TV and there are 24/7 reminders of what they are trying so hard to forget.

As one woman in women’s Group for Problem Gambling once said to me “Liz, I have finally realised, if we weren’t gambling we would be drinking or taking drugs, because the problem exists because of our life problems” But, of course, the more opportunities exist to try anything potentially addictive, the more chances that more people will develop addictions. My experience is that online gambling for example has leapt the social divide and I now see middle class professional women, with addiction to gambling on bingo and slots online whereas they would historically be unlikely to enter those land based venues.

Looking at the online and offline gambling industries, how do you feel they could improve their practices to better protect vulnerable people from the risks associated with gambling. Do you feel that there’s anything these industries are doing well at the present time?

On 1st October 2014 new measures are being introduced by the gambling industry, including banning advertising of free bets before 9pm and dedicating 20% of betting shop windows to responsible gambling advertising. I welcome any steps to improve care to customers who develop problems. Based on my professional findings however, advertising after 9:00pm is likely to hit those who are home alone, isolated, lonely and depressed and so at high risk of addiction. And increased responsible gaming advertising in shop windows I fear will have little positive effect; addiction is not a rational decision. The industry is exploring options and is open to dialogue with customers and treatment providers, so that is a great thing.

What do you feel that sites like CasinoReviews.com could do to help minimise the risks that our readership will end up developing gambling problems? Are there specific resources that you’d like to see us give greater exposure to? How about best practice strategies that we could put in place onsite?

What I hear from my clients with addiction is what a difference it makes if they receive a positive and warm response to requests to restrict or close their account. It can inspire courage to go on and seek help for their addiction. I strongly suggest having in place obvious and easy steps to restrict or self exclude from their account and ideally that there is an option to do so via email and not only via telephone. Your customer at this point may be feeling too ashamed, upset and vulnerable to make a telephone call.

You’ve written two books on gambling addiction amongst women (‘Women and Problem Gambling’ and ‘Working with Women’s Groups for Problem Gambling’). Not having read these works I’d assume that the latter is more targeted at professionals working within the addiction support industry and your new book is targeted at sufferers of addiction (and given the one review I’ve read on Amazon.co.uk is very helpful regardless of your gender). Do you have plans to write any more books on this topic? If so what facets of the subject would you like to discuss at greater length?

Both books are written in plain English to appeal to a wide audience.’ Working with Women’s Groups for Problem Gambling’ is the inspiring story of a real life recovery group. It explains how to get long term recovery and shows how good healthy relationships and relational skills are key. It is jam- packed full of suggestions for recovery. Women with the addiction, professionals working with the problem, or anyone who wants to understand what causes and cures gambling addiction in women will find it an easy and informative read. I do have plans to write more and in fact am working on a proposal at this time... but I have to keep a little anticipation, so watch this space... : - )

Seriously, there is so much more I could write. Gambling addiction is so complex and complicated. And that’s mainly because, at the core, it really is all about life and relationships.

You can read more about Liz at her website - http://www.lizkarter.com/. Having read a good number of the articles on the site I can genuinely say that the advice Liz gives is constructive, non-judgemental and positive in every way.