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 Table of Contents    
GUEST EDITORIAL  
Year : 2014  |  Volume : 56  |  Issue : 2  |  Page : 111-112
Gambling addiction in India: Should psychiatrists care?


1 Solihull Integrated Addiction Services, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, B37 7UR, United Kingdom
2 Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
3 Department of Psychiatry, Cochin Medical College, Kochi, Kerala, India

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Date of Web Publication11-Apr-2014
 

How to cite this article:
George S, Kallivayalil RA, Jaisoorya T S. Gambling addiction in India: Should psychiatrists care?. Indian J Psychiatry 2014;56:111-2

How to cite this URL:
George S, Kallivayalil RA, Jaisoorya T S. Gambling addiction in India: Should psychiatrists care?. Indian J Psychiatry [serial online] 2014 [cited 2020 Feb 25];56:111-2. Available from: http://www.indianjpsychiatry.org/text.asp?2014/56/2/111/130475


To the best of our knowledge, gambling addiction, does not occupy a place within mainstream Indian Psychiatry or even addiction psychiatry. This is the case in terms of research, strategy, and treatment provision. In our view Indian Psychiatrists, treatment services and mental health policy makers are all partly or wholly responsible for this state of affairs. As further evidence to support the above inference (about the lack of a place for gambling addiction within Indian Psychiatry), albeit a proxy measure, nevertheless "valid" in the absence of any other robust research-generated evidence, we looked at the number of papers on gambling published in the Indian Journal of Psychiatry (IJP). We used the key words "gambling" and "addiction" and searched all the issues of IJP available online. Unsurprisingly, we identified no scientific papers: There have only ever been two literary "pieces." [1],[2] To explore whether gambling addiction is an issue for psychiatrists working in India or if it is a problem exclusive to the Western world, we (George 2012, unpublished) carried out a survey of 121 psychiatrists working in India. The findings of this survey (some of which will be briefly mentioned later) combined with conversations with Indian Psychiatrists have informed this paper. Here, we make the case for a wider debate about the place of gambling addiction within Indian Psychiatry.

There has been no systematic research into gambling addiction in India, in terms of its prevalence, prevention or treatment. Given this, it seems a reasonable starting point to extrapolate findings from international research. Most Western countries have gambling addiction prevalence rates between 1% and 2%, respectively. [3] Untreated gambling addiction can result in numerous and wide-ranging negative consequences to the addict, his/her family and the wider society. Ever increasing gambling opportunities and easier access (lotteries, gambling on the internet, etc.), and relaxed legislation can result in an increase in gambling problems and gambling-related harm, especially affecting the most vulnerable in society. This is, especially important for an emerging economy like India. In addition to those who already have a gambling problem, not to be forgotten are those who are "at risk" of developing gambling problems in the future: A national survey of the general population in Britain [4] found that of those who engage in gambling activities 7.3% were "at risk." So far shrouded in nosological ambiguity, Diagnostic and Statistical Manual of Mental Disorders V (DSM V) has included "gambling disorder" in the section on addictive disorders [5] alongside other substance addictions (the criterion which relates to "committing illegal acts to gamble such as forgery, fraud, theft or embezzlement" has been deleted as this on its own is rarely endorsed when other criteria are not fulfilled. The deletion of this criterion would mean that in DSM V, a diagnosis of disordered gambling can be made if four of the nine (as opposed to 5 out of 10) criteria are met). This move will help confer gambling addiction with the status of a valid psychiatric disorder and as an addictive disorder.

Although there are no population prevalence studies of gambling in India, there is no doubt that Indian people gamble. Here we wish to emphasize that the vast majority of people who gamble do so without problems, and for most it remains merely a leisure activity. In terms of the size of the gambling industry (legal and illegal) in India, a precise picture is lacking. We use Kerala (a state hosting 30 million of India's 1.2 billion people) as an example, purely for the reason that accessing relevant statistics was easy. The Kerala state-run lottery (the most easily available and the most commonly engaged in gambling activity in the state) was set up in 1967, currently has "more than 35,000 authorized agents and over 100,000 retail sellers" (http://www.keralalotteries.com) and is currently (2010/2011) generating a revenue of Rs. 557.69 crores, with a profit for the government of Rs. 92.02 crores (http://www.keralalotteries.com/index.php/revenue-a-profit). Note that, we only have the figures for Kerala state-run lotteries; there are numerous other lotteries, a range of private betting activities, online gambling and various illegal gambling activities. And by no means is gambling limited to one part of the country. It is important here to note the caveat that not all participation in lottery need necessarily be a gambling act. The recent emergence and extreme popularity of "Karunya (meaning kindness) lottery" is one such example. This state-run lottery, as far as we know, gives all its proceeds to the care of the sick and seriously ill. This is promoted and conducted more like a charitable act than engagement in gambling. That said, it could also be argued that some who buy these lottery tickets, in addition to wishing to engage in a charitable act, could also be hoping to win a prize, like in any other lottery.

In 2012, George (unpublished) surveyed 121 Indian Psychiatrists who attended the 2012 Annual National Conference of Indian Psychiatric Society in Kochi, Kerala. The survey sample, albeit a convenience sample, was representative in terms of age, gender, place of work, setting of psychiatric practice and years of experience in psychiatry. 79% (96/121) of those surveyed said that they see gamblers in their clinical practice, and 62% (75/121) said they also see those affected by someone else's gambling habit. However, 89 of the 121 (74%) psychiatrists admitted that they had never received any teaching in the management of gambling addiction. More encouragingly, the large majority of those surveyed (109/121) saw gambling addiction as within their remit, and most (105/121) also considered it feasible to treat gambling addicts within their mainstream psychiatric practice. 77% (93/121) said that they would like to receive more training.

It follows from the above that there are significant gaps in the training of psychiatrists, if they are to be adequately equipped to treat gambling addicts and their affected families. Given the willingness expressed by psychiatrists, it will be a shame not to seize this opportunity and act. In addition to the obvious education and training psychiatrists, and provision of treatment, at a more strategic level there is a desperate need for further research in this field in India. It is here, that in addition to psychiatrists, mental health policy makers and academics too have key roles and responsibilities in conceiving and driving a coherent gambling harm prevention strategy, which looks comprehensively into its research, education and treatment.


   Conclusion Top


It is clear that Indian Psychiatrists come across gambling addicts and affected families in their day-to-day clinical practice. However, the large majority of these psychiatrists have had no training/teaching in this field. However more encouragingly, most psychiatrists we surveyed expressed a desire to improve matters and they saw identification and treatment of gambling addiction as being within their remit, and perceived this to be feasible. Hence we believe that Indian Psychiatry can no longer avoid this issue, and based on the encouraging results of our survey we call for more education, treatment and research into gambling addiction in India. Indian Psychiatrists have a crucial role to drive this agenda forward, drawing on international evidence and collaborations, while waiting for Indian Psychiatry to embrace gambling addiction.

 
   References Top

1.Bhide AV. Compulsive gambling in ancient Indian texts. Indian J Psychiatry 2007;49:294-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.George S. Allure of dice. Indian J Psychiatry 2012;54:290.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Shaffer HJ, Hall MN, Vander Bilt J. Estimating the prevalence of disordered gambling behavior in the United States and Canada: A research synthesis. Am J Public Health 1999;89:1369-76.  Back to cited text no. 3
    
4.Wardle H, Moody A, Spence S, Orford J, Volberg R, Griffiths M, et al. British Gambling Prevalence Survey 2010. Gambling Commission; London.  Back to cited text no. 4
    
5.American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, 5 th edition. Washington, DC: American Psychiatric Association. 2013.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Sanju George
Solihull Integrated Addiction Services, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, B37 7UR
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5545.130475

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