Guidance for clinicians
An urgent need for research and guidelines related to gambling and the pandemic exists, the authors argued.
In the meantime, aside from various validated screeners available, Dr. Kraus offered some practical advice for clinicians checking in with their patients: “Ask your patients what they have been doing to cope with this difficult time.”
Some might mention their faith, family, or friends, and others might not have an answer or mention drinking, gaming, or engaging in other activities. “We all do things to cope. Sometimes you use healthy coping and sometimes you use unhealthy coping,” Dr. Kraus said. “I would have a dialogue with my patients around, ‘How are you getting through? What’s helping you? What are some things you’ve tried that are tripping you up?’ ”
If gambling in particular is a possible concern, he encouraged clinicians to ask their patients whether they have tried to quit or what would happen if they stopped gambling.
“What we’d expect is the problem gamblers will have more irritability, crankiness, difficulty with quitting,” he said.
Dr. Hodgins agreed that checking in on how patients’ lives and activities have changed, and their emotion reactions to those changes, is prudent.
“The change in activities might be healthy or might include increased addictive behaviors, including increased use of substances, gaming, pornography, food, and gambling,” he said.
In addition, the paper authors list several examples of guidelines that might be considered in drafting guidance for clinicians, including the following:
- Limiting the extent of gambling
- Not gambling to regulate negative emotions
- Not gambling in order to try to solve financial problems or financial concerns
- Not gambling under the influence of alcohol or drugs
- Carefully monitoring gambling-related time and financial expenditures
- Maintaining and establishing daily routines involving activities other than gambling
- Minding gambling-related attitudes and behaviors in the presence of minors
- Not starting to gamble because of stressors
The research did not receive external funding. Dr. Håkansson has received research funding from the Swedish Sport Foundation, the Swedish alcohol monopoly Systembolaget, and the Swedish state-owned gambling operator AB Svenska Spel. He is working with the company Kontigo Care on devices for gambling addiction follow-up care. Dr. Potenza has received consulting or advisory compensation from several entities, including the Addiction Policy Forum, AXA Gaming, Idorsia, Opiant, and RiverMend Health. Dr. Potenza has received research funding from Mohegan Sun casino and the National Center for Responsible Gaming. No other authors or outside sources had industry-related disclosures.
SOURCE: Håkansson A et al. J Addict Med. 2020 May 18. doi: 10.1097/ADM.0000000000000690.