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The high price of our addiction to gambling

It's never too late to get help for addiction, says Colin O'Gara in his new book that deals with what might best be described as a hidden global epidemic, writes Declan Lynch

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Just two books have been published recently about the epidemic of gambling in Ireland

Just two books have been published recently about the epidemic of gambling in Ireland

Gambling Addiction in Ireland - Causes, Consequences and Recovery by Colin O'Gara

Gambling Addiction in Ireland - Causes, Consequences and Recovery by Colin O'Gara

Declan Lynch and Colin O’Gara, consultant psychiatrist and head of addiction services at St John of God Hospital in Stillorgan. Photo: Frank McGrath

Declan Lynch and Colin O’Gara, consultant psychiatrist and head of addiction services at St John of God Hospital in Stillorgan. Photo: Frank McGrath

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Just two books have been published recently about the epidemic of gambling in Ireland

It feels like the two of us here, against the world.There are, to the best of my knowledge, just two books published in Ireland in recent times about the epidemic of gambling and the harm it can cause. And I've written one of them with Tony O'Reilly - Tony 10 - and Colin O'Gara has just written the other, called Gambling Addiction in Ireland.

If there are others out there, by all means I invite their creators to make me aware of them, but for now, it seems that's all we've got.

And here we are, in the same room, the only two men in the country with this strange thing in common. Strange, because just recently it was announced by the Gambling Commission in Britain that it is about to ban the use of credit cards for online gambling - there is no equivalent to the Gambling Commission in Ireland, though there may be something of that nature in, say, about 18 months time.

No need to rush, after all, you don't want to be too hasty about these things. And yet Colin O'Gara, no more than myself, has not exactly happened upon this issue in the last few months; he has been specialising in the area of gambling addiction for about 10 years - which, now that I think of it, is roughly around the time that I wrote the book Free Money on this subject, thinking that everyone will be on to this pretty soon, all the relevant professionals will be doing everything they can to deal with what could best be described as a global epidemic.

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Declan Lynch and Colin O’Gara, consultant psychiatrist and head of addiction services at St John of God Hospital in Stillorgan. Photo: Frank McGrath

Declan Lynch and Colin O’Gara, consultant psychiatrist and head of addiction services at St John of God Hospital in Stillorgan. Photo: Frank McGrath

Declan Lynch and Colin O’Gara, consultant psychiatrist and head of addiction services at St John of God Hospital in Stillorgan. Photo: Frank McGrath

And yet here we are, in early 2020, in the office of Colin O'Gara, consultant psychiatrist and head of addiction services in St John of God hospital, and in Ireland the body of literature in this area has not yet extended beyond our collective efforts.

The office is very plain. In the mind's eye, when we enter such a storied institution, one that has 180 beds for people in treatment for various addictions, we are perhaps expecting to find the main man in some kind of a grand book-lined study. And indeed there are books on the shelves here, but there is nothing grand about it. The desk at which the doctor sits has a computer screen on it, as strictly functional as anything you would see in a regular office.

Indeed in the halls of the hospital, as he has his picture taken for this piece by Frank McGrath, there is a friendliness between the staff and some of the patients and the consultant, that could make you completely forget for a few moments that there are people in here going through some very difficult changes in their lives - and that some of them will succeed, and some of them may not.

A father of four young children himself, O'Gara tries to cultivate a working environment that is "like a family", and in his book he maintains that one of the many stigmas and stereotypes which he must confront on a daily basis, is that the "toughest" rehab regime will somehow produce the best results - he writes that there is no evidence to support this.

I guess that the patients are intimidated enough by what is facing them, so they can do without the feeling that when they are talking to Dr O'Gara on their first visit here, they are being brought into a kind of headmaster's study.

And thus it turns out. However there is one mark of superficial distinction, the immaculate suit and white shirt and tie that he is wearing, but in this setting it seems a simple acknowledgement that very serious things are going on here, that people would expect this sort of presentation. So it feels as unthreatening as O'Gara's own office, creating an atmosphere that is collaborative, not confrontational.

There had been times when Colin O'Gara interacted with his clients in a much more confrontational zone, for him at least - having graduated from medical school in UCC, his further studies in London into the nature of addiction, might routinely bring him into crack houses in areas such as Brixton or Clapham, to minister to the occupants.

It seems like quite a distance from the outer edges of cocaine mania, to this evidently more comfortable venue in Stillorgan, but addiction is addiction whether you're dealing with the raw insanity of the crack house or the middle-aged person who comes to St John of God because they have been consumed by their obsession with scratch cards.

And O'Gara would have been well prepared for this trajectory, having started out in the medical "game" by washing the test tubes in the lab for his father Fergal, a "driven academic" who specialised in microbiology - indeed the "driven" bit was apparently passed on to Colin's younger brother Ronan too, who may be vaguely familiar to some as a rugby player and general national hero.

Colin is more of a windsurfing man, which you can understand as a way of communing with the elements after long days in this office with people who are probably in more trouble than they have ever been before, and are perhaps looking to him as the answer to it all.

Then again they may not realise that they're in trouble at all, they may be just coming to the treatment centre under pressure from family or friends, and are prepared to endure it for the sake of "a quiet life", as they see it.

They can be "incredibly insightless", as O'Gara puts it, and here is one of the essential difficulties with addiction - when I arrived at a treatment centre myself a long time ago, I realised that I had been drinking too much, but otherwise I now realise that "incredibly insightless" would almost perfectly describe my state of being.

So it can take a while for various pennies to drop, and perhaps the most difficult one is the concept of being "powerless" over alcohol or gambling or whatever - it can be wrongly interpreted by the addict as a kind of licence to resume whenever the moods strikes, because after all, you are "powerless".

And so it needs some moment of revelation for the truth to dawn. Sometimes that is a long time coming, and sometimes it never comes. But O'Gara is always ready for it, and he loves to see it.

"You have people who may have a very strong family history, they will be aware of people within their families dying of the illness, they will be aware of a poor prognosis given to them by clinicians… but we've worked with people who have been close to being written off… they've been to treatment centres where the general vibe is that it's terminal they're not going to get well. And they do get well."

This change that people sometimes find within themselves, was once the province of religion. It was once considered normal for an alcoholic to take himself off to a "treatment centre" such as Mount Mellary, presumably to pray for deliverance from the scourge. And of course we are sitting here in a place called St John of God.

"Ninety nine per cent of people who come here have some element of fear. And it goes from minor nerves to people being absolutely terrified. And their families are confused and equally terrified. People sit there and it is my job in the first instance to try to get the message across to people, to answer that question for them: what exactly do we do here? So the services that we provide are holistic and non-confrontational.

"There are these stereotypes that you've alluded to, that are absolutely the case to this day… and we're fighting against those stereotypes. So when we say we're holistic what we mean is we're not just adhering to the medical model, we do embrace other forms of treatments, for instance we have yoga, pilates, Tai Chi, mindfulness… there can be a sense out there that a treatment centre is no more than a spa, but what we're doing is merging the best of the empirical evidence with the psycho-social aspect, with lifestyle changes that we know are useful.

"And we do still retain some of the traditional aspect - we have a priest who gives an input that is very popular, but it isn't dogmatic or religious, it's about the spiritual aspect of addiction, and coming from somebody from that background it's very well received."

For all the nuances and the subtleties and the complexities, sometimes there has to be an acknowledgment that it just isn't working, that the penny isn't dropping. "You're giving a message to people that they don't want to hear. You can have someone who is constantly relapsing, there is depression, there is suicide ideation… but if you can get past that, it can be incredibly rewarding... the fellowship philosophy is that you have to be at rock bottom if you want to move on. For me, that's the essence of working in addiction, if you can observe that, if you can be with that, if you can be a part of that… people who come out the other side of that, there is a bond there when you work therapeutically with someone, I'm not sure you can get it in any other area of medicine - to see that evolution in the person themselves. We're dealing with highly traumatised and highly unwell individuals who need help. And the reward that comes from this work is watching people and bringing people through that journey."

Outside of these institutions, the public awareness of the nature of addiction has perversely increased due to the fact that most people are now addicted in some way to their phones.

"There's no question the smartphones have opened up the concept of overuse. Ten years ago I would not have envisaged getting referrals from general practitioners saying, please see this young gentleman who spends far too much time in his room and is in conflict with the rest of their family, who are all very concerned about the extent of the person's device usage. In the next paragraph, the GP elaborates that they're using YouTube and social media platforms and also some gaming. Other referrals will be plain straight gaming and now we're seeing the interface between the device and traditional substances, so to speak.

"So cannabis usage in young people, plus gaming or device usage as a combination, in future that's going to be part of the addiction landscape and we haven't even mentioned gambling."

Indeed in his book, O'Gara writes that "gambling disorder is a diagnosable brain disorder, characterised by deficits in key risk-processing areas of the brain.

"This illness should be treated like any other. When one attends for treatment of gambling disorder it should be the same as attending a general hospital for treatment of epilepsy, high blood pressure, or diabetes."

Yet he first got into it largely "by default" - he has personally never walked into a betting office and had a bet across the counter, but at least a decade ago he could see that a major phenomenon was brewing.

He was the first to write about it in learned journals in this country, having noted that there were no treatment centres for gambling, the HSE wasn't dealing with it, and yet he was seeing spectacular examples of it coming into his office.

In 2014/15 he tried to organise a national survey to get some sense of the size of the problem, a project which he now regards as naïve, realising as he does, how difficult it is to get people to fill in a survey about something that happens largely in secret.

By the time the problem gambler or their families get to Colin O'Gara's office, they may believe that it is already too late.

But it is never too late.

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Gambling Addiction in Ireland - Causes, Consequences and Recovery by Colin O'Gara

Gambling Addiction in Ireland - Causes, Consequences and Recovery by Colin O'Gara

Gambling Addiction in Ireland - Causes, Consequences and Recovery by Colin O'Gara

'Gambling Addiction in Ireland - Causes, Consequences and Recovery', by Colin O'Gara is published by Veritas


Surveys show the high price of taking a punt

* Surveys have shown that Ireland has the third highest per capita rate of gambling losses in the world, behind only Australia and Singapore.

* As a nation we are losing in the region of €500 per adult per year on different forms of gambling.

* Total gambling losses in Ireland per year are more than €2bn.

* About half the losses in Ireland come from online gambling.

* Last year in Ireland we gambled an estimated €9.8bn, spending €4.7bn in casinos, at bingo and on gaming machines. We spent €4.3bn on horse racing and other sports betting. We spent €808m on lottery draws and scratch cards.

* In relation to the dependence of the industry on problem gamblers, a UK survey found that 78pc of revenue from online gambling came from 4pc of customers.

* Figures continue to rise every year.


Surrender to win: where to find help

* There are unique difficulties about gambling addiction, due to the fact that it is easier to conceal it from family members and friends than any other problem such as drinking or drug-taking which have obvious physical signs.

* Online gambling in particular enables the secrecy of the addiction, since most of us are spending a lot of time on our phones or laptops. It's easier to conceal losses through the use of "plastic" money than it was in the days of cash handed over the bookie's counter.

* Young men are especially vulnerable to online sports betting. Many of them love sport anyway, they are competitive, and an early win can persuade them that there is easy money to be made.

* Problem gamblers tend to be of above average intelligence, which is part of the problem - they think that someone as smart as they are, will never be sucked into a spiral of losing.

* Warning signs include: borrowing for gambling; lying about how much time or money is spent on gambling; hiding bills or unpaid debts; being restless or irritable when not gambling; bragging about winning, exaggerating wins and/or minimising losses.

* Apart from St John of God hospital, help is available from: Gamblers Anonymous, gamblersanonymous.ie; or Problem Gambling Ireland (089) 241 5401, or Rutland Centre (01) 494 6358.

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