Fighting gambling addiction: Pause and observe to fight urge

PHOTO: Fighting gambling addiction: Pause and observe to fight urge

SINGAPORE - Your friend calls you on the phone and asks if you want to place a bet on an upcoming football match.

The word "yes" is at the tip of your tongue. You have said it automatically, hundreds of times before.

But this time, you catch yourself. You have been practising something called mindfulness.

You observe the urge to say yes in yourself coolly, as you would an itch you want to scratch badly. You accept the urge calmly - in a non-judgmental manner - and you decide you will not act on it. You know that like all other urges, it will soon go away.

Mindfulness therapy, which is derived from meditation practices, is recommended in the Health Ministry's first clinical practice guidelines on gambling disorders as an adjunct therapy for such disorders.

It can be used with the primary treatment of medication and psychological counselling.

Studies have shown that mindfulness therapy can weaken a gambler's impulse to react to his thoughts, especially gambling-related thoughts, said Dr Thomas Lee, a psychiatrist in private practice who chaired the workgroup which drafted the guidelines.

The National Addictions Management Service (Nams) at the Institute of Mental Health has incorporated mindfulness practice into its inpatient addictions programme since July 2010.

Mr Low Mun Heng, the principal therapist and acting head of Allied Health Service of Nams said: "Often, patients are not aware of what triggers them to engage in the addictive behaviour, their habitual patterns and their 'automatic reactions' to their triggers." Practising mindfulness changes this.

Mr Low said: "Mindfulness trains the patient's ability to pause, observe his present experience and come to an awareness of the range of choices before him. The therapist guides patients by teaching them to focus their awareness on the thoughts and emotions they are experiencing, such as depressed feelings, without reacting to them."

Feedback from patients has been positive, with comments that mindfulness helps them feel better and, hence, cope better while in treatment, he said.

The therapy complements the main approach adopted by Nams, which is cognitive-behavioural therapy (CBT).

Mr Low said: "CBT focuses on changing thought patterns that have a negative influence on behaviour, while mindfulness helps the person to be more aware of the triggers of the thoughts."

The Health Ministry guidelines state that CBT has the best results so far among psychological treatments for pathological gambling. Other useful complementary measures include mindfulness therapy and self-help support groups.

Those who are ambivalent about quitting gambling or starting treatment should be given face-to-face or telephone counselling to motivate them to change their behaviour.

There is increasing evidence that medication is also useful for treating gambling disorders.

Recent clinical trials have shown several drugs to be effective in reducing gambling-related symptoms. However, as these trials are relatively recent, no medication has yet been approved by the United States Food and Drug Administration for treating pathological gambling.

Currently, they are being used off-label in countries such as the US and Singapore, which means they are prescribed by doctors at their own discretion.

One of them, naltrexone - approved for treating dependency on alcohol and opoids such as heroin - has been shown to be effective in reducing the severity of gambling disorder, such as the amount of time spent on gambling.

It prevents the body from responding fully to endorphins, the "pleasure" hormone, said Dr Lee.

But the medication dulls not just the pleasure of gambling, but also the pleasure of, for instance, watching a good movie or having a good conversation with a friend.

It may also potentially damage the liver, although it is generally safe for those whose livers are healthy, Dr Lee said. So, it is usually prescribed for only about three to six months.

The treatment outcome of gambling disorders using a combination of medication and psychological counselling is promising.

A survey by Nams found that 77 per cent of newly diagnosed patients showed a 30 per cent reduction in the severity of their symptoms on the Gambling Symptom Assessment Scale, within the first three months of treatment.

This article was first published on September 22, 2011. Get a copy of Mind Your Body, The Straits Times or go to for more stories.