Gamblers who sought treatment getting younger, more educated: Study

Posted on 28 July 2011

Also, one in six of those who sought treatment between 2006 and 2008 had attempted suicide.

By Belmont Lay

A recent study published in the June issue of the Singapore Medical Journal showed that pathological gamblers who sought treatment at the Institute of Mental Health’s National Addictions Management Service (NAMS) between 2001 and 2008 were getting younger and more educated.

The pool of 300 patients in this study were split into two equal cohorts of 150 patients for comparison purposes: The first cohort were treated between 2001 and 2006, and the second cohort between 2006 and 2008.

Between cohorts, the average age has also gone down from 42.5 years old to 38.9 years old. As usual, Chinese are overrepresented in both cohorts: 97.3% in first cohort, 92% in second cohort (compared to 74% of residents who are Chinese).

Proportion of problem gamblers with secondary education or higher has also shot up, from 30.3% of the patients to 41.7%, showing that more with higher education are seeking treatment.

This means that approximately seven in 10 of the first cohort, and six in ten of the second cohort of patients had primary school or lower education.

This figure is consistent with the findings of a 2008 survey conducted by the Ministry of Community Development, Youth and Sports, where higher gambling participation can be found among those with PSLE and below qualifications, with 61% of them professing to one form of gambling in the last 12 months.

(To find out the diagnostic criteria for problem and pathological gambling, check out the last page of this same survey.)

Now for the somewhat startling news: In the more recent cohort, one in six patients had tried to kill themselves. And about the same number of patients were abusing or dependent on alcohol at the time when they sought treatment.

In fact, alcohol abuse or dependence was three times more likely in the second cohort of patients.

But rather paradoxically, the number of patients reported being in depression fell from 22 to 13. (Less depressed but more willing to die? Huh? What kind of overlap is there between suicidal, depressive and alcohol users? That would qualify as a research topic in itself.)

This drop is perhaps not statistically significant, but it would be interesting to find out the reasons for this. Maybe alcohol made people happier in terms of mood but at the same time more impulsive and disinhibiting so that they are more willing to slit a wrist or fall off a building or be carbon-monoxided?

Or maybe it’s just the way the cohort is divided? Why not make comparisons between 2001-to-2004 cohort and 2004-to-2008 cohort? This won’t change the data but might it skew the numbers somewhat, yes?

The study also mentioned that while the popularity of lottery betting and casino gambling have remained stable among the patients over the years, interest in soccer betting has grown.

We can’t be sure about that but this we can be sure of: About 95% of patients reported to be in debt.

Still more newsworthy titbits: The study also mentioned that while the popularity of lottery betting and casino gambling have remained stable among the patients over the years, interest in soccer betting has grown.

About 61.3% of patients from the second cohort were interested in soccer betting, compared to 43.6% in the first cohort.

Although less than one-third from both cohorts reported casino gambling as problematic, the study’s researchers predict that this proportion could potentially increase due to the availability of casino venues in Singapore since 2010.

But here’s a caveat: The younger treatment seeking age could reflect increased public awareness of both the signs or symptoms of problem gambling and the treatment service available through advertising and media campaigns.

Therefore, it should be noted that this study only reflects the demographic and clinical features of gamblers who sought treatment.

The prevalence rate of gambling among Singaporean residents in general can be found in the 2008 MCYS survey. (Even then, that survey’s limitation is that it only measures “self-professed behaviour” and not “actual behaviour”.)

Nonetheless, according to the researchers, it is likely that the overall number of patients seen at NAMS will continue to grow.

Why? Credit goes to the Singapore Government, of course, for providing timely, flexible rehabilitative facilities such as walk-in services and government-funded efforts to raise public awareness in the form of primary prevention campaigns and initiatives.

It’s not as if the Singapore Government hasn’t claimed credit for other things, among which is the dramatic reduction of suicides among the elderly in the last five decades.

Check out the inane reasoning in the last paragraph of this article.

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  • Kelvin Teo

    Dear Belmont:

    I was reading your comments. You were suggesting 2001 to 2004, 2004 to 2008 cohorts. One of the motivating reasons for cohort studies is attributed to different significant social events that impact patient subjects. The techical term for this is cohort effects, that is events which patients went through.

    The significant cohort effects that I can think of between 2001 and 2006 is the Asian Financial crisis and the SARS crisis. Between 2006 and 2008, it is the recent financial crisis. Also, the other reason is the differing trends in patients presenting with pathological gambling. Different years could have different numbers of patients presenting with pathological gambling.

    With regards to your point on alcohol, the link with suicidal tendency is actually well established. If you refer to this Continuiing MEdical Education site:

    “The MMWR editors note that mechanisms that might link alcohol use and suicide include “alcohol’s effect on promoting depression and hopelessness, promoting disinhibition of negative behavior and impulsivity, impairing problem solving, and contributing to disruption in interpersonal relationships.”

    There is actually a link between substance abuse disorders and suicide. Note that alcohol-abuse is only one of them. It also includes benzodiazepines, which is also linked to increased suicide tendency.

    Appraising such research is not easy, it requires understanding of this thing called “evidence-based medicine”. But kudos for highlighting the issue :)