Pathological gambling in Romania - European Association for the ...

Pathological gambling in RomaniaViorel Lupu , M.D., Ph.D,Associate Professor to the Department of Child andAdolescent Psychiatry“IuliuHatieganu” University of Medicine and PharmacyCluj-Napoca, Romaniae-mail : violupu@yahoo.com.1

CLUJ-NAPOCANAPOCA-ROMANIA (EU)2

Introduction• The events in 1989 led to a different degree offreedom for Romanian people that was alsoreflected in an increase in the offer of gamblinggames.• Romania has a top position as far as the no. ofplaces to gamble/no. of people ratio is concerned• The pyramidal games and the televised bingogames showed their impact on millions ofRomanians, leading to their impoverishment3

Introduction• In 2000, gambling was seen by most Romaniansas the only chance to significantly improvetheir living standard. (Insomar(polls, 1,241people).• 63% of Romanians admitted to havinggambled or having won in such chance games.• 23% of the ones who hadn’t t gambled reportedthat they wanted to do so in the future.4

Postcomunist perspectives aboutgambling in RomaniaNext to the classical casinos there areapproximately 900 firms that already ownauthorized gambling devices, some of thesefirms developing real networks, thus greatlyenhancing the number of locations wheregambling becomes possible.5

Postcomunist perspectives aboutgambling• There are approximately 36,000 gambling devicesin the country, meaning 1.5 devices for each 1000inhabitants from classical electronic poker gamesin outskirt locations to the most sophisticated onesin luxury casinos.• In Bucharest only there are 10 live casinos andthere are another 10 live casinos in the largecities:IaIaşi, Cluj, Timişoara, Bacăucău,Constanţa.6

Table 1:Favorite gambling forms in 20007

Gambling opportunities• In the last few months of 2006, , there was amassive increase in the number of locations wheregambling was possible, especially in Bucharest.• The number of authorized licenses granted by theMinistry of Finances reveals two massive increasesin the number of gambling devices. The first onewas at the beginning of the 1990s and the secondone in the last two to three years.8

Gambling opportunities• In the last ten years, betting came intovogue in Romania.• In 2006, , there were 500 betting agencies inRomania of which 100 were in Bucharest.Those who bet in 2006 won 12% more thanin 2005, the winning amount of moneyexceeding over €100 million.9

Gambling opportunities• The highest amount in 2006 was of €765,000, , wonwith a combined ticket involving the Europeanand national football championship.• In months without special events, Romanians usedto bet approximately 4,000,000 tickets, , a numberthat is continually growing.• Five years ago, among the 18- to 25-year olds, 1 in10 Romanians gambled on sports-betsbets. . Thisnumber has risen sharply to 8 out of 10. . Thehighest chances of winning are on the tickets onwhich three to five events are bet, with a mean of €1.76 per ticket.10

Gambling opportunities• People of all ages bet, regardless social class, withthe amount of money bet varying between €1.5and €300.There are three types of bettors:• (i) those that go to the betting agency 2-323 times aweek and bet minimal amounts of money (€0.5(0.5-1);(ii) those who bet on a single event (e.g., footballmatch) relatively large amounts of money (€30);(and• (iii) those who bet for maximum prizes and playin a syndicate with 3-434 other individuals.11

Gambling opportunities• Another notable trend isrepresented by games which takeplace on the internet (e.g.,www.partygaming.com)12

Gambling in adults• At the moment, there are no studies regarding theprevalence of adult pathological gambling inRomania. An interview with one of the mostimportant staff members of a big casino inBucharest has revealed that this phenomenon hasbecome an increasing problem in Romania.• This is despite the fact that there are only 10casinos in Bucharest. . Besides these, there areother 10 casinos in the large cities Cluj, Timişoaraoara,Iaşi, Bacău, , and Constanţa. Each casino houses anaverage of ten gaming tables.13

Gambling in adults• Roulette is the most frequently attended game inRomanian casinos. . The average number of clientsattending a casinoinRomania isofapproximately 270, depending on the day of theweek, weekends corresponding to the highestfrequency. From the adult clients of the casinos,the majority is middle aged, including women aswell. Clients belong to all social categories.14

Gambling in adults• The pyramidal game called “Caritas” becamehugely popular in Romania between 1991 and1993. The number of individuals participating inthe game was over 250,000, , and who depositedlarge amounts of money at the “Caritas” agencieswith its centre in Cluj-Napoca, hoping that thedeposited amount would multiply by 7 to 8 times.• The game made over €38,000,000in a two-yearperiod. Based on this phenomenon, a devaluationof the notion of money and a disjunction of theconnection between earning money and honestworking has appeared.15

Gambling in adults• A considerable number of participants are losinglarge amounts of money in this way withoutsufficient deliberation. The tendency to increasethe stake at registration also exists, with playersfalsely believing that this may lead to prolongingthe participation at the game, thus controllingprofit. This was one of the ways in which the largeexpansion of gambling happened both at the socialand individual level.16

Gambling in adults• Finally, the entire gambling business proved to bea huge financial swindle, the ‘game’ ending inJune 2003, , leaving behind a large number ofvictims, while the executive of the agency IoanStoica was arrested on August 25 th1994, andreceiving a six-year prison sentence. Afterscamming hundreds of thousands of people allover the country, the legislative body ratified thelaw regarding gambling, which regulates, forbids,and punishes the creation of financial pyramids.17

(Pathological) gambling: Evidencewith regard to adolescentsLupu, Onaca and Lupu (2002) have carried out researchregarding the prevalence of pathological gambling inRomania on 500 high-school students in three counties(Cluj, Sălaj, , and Bacău),with ages between 14-19 19 years,56.6% being girls (n=283) and 43.4% being boys (n=217).An anonymous questionnaire included a standardizedscale called “20 Questions of Gamblers Anonymous” andanother 20 questions about age, gender, family, income,school, drug abuse, gambling preferences, the frequencyand the amount of money they use in gambling, etc.18

Results• 6.8% of the subjects could be diagnosedwith pathological gambling, with a sexratio of 4.66M/1F .• The mean age in starting gambling thatthe study revealed was 13.25±1.51 1.51 years.• 82.35% gambled in groups, while 17.64%were individual gamblers .19

Results• 47.05% were highly frequent gamblers (almost daily),and 38.23% were frequent gamblers (at least once aweek).• The gambling games that were chosen at the highestfrequency were: pool (55.88%), poker (35.29%), bingo(32.35%), basketball on a bet (5.88%), black-jack androulette.• The maximum sums gambled that the study revealed:USD 0.5-5 5 (32.35%); USD 5-105(32.35%); USD 10-100100(20.58%), and USD 100-1000 1000 (14.70%), the meansalary in Romania being around USD 80/ month at thetime .20

Results• 41.17% belonged to families with low incomes, while58.83% belonged to families with high and very highincomes.• 64.70% were identified with absenteeism because ofgambling; 52.94% showed modest results at school.• 76.47% of the gambling subjects believed they couldcontrol the game; 26.47% stated that, in their vision,chance had no influence on the gain.21

Discussion of results• The results indicate a clear prevalence of pathologicalgambling in males, with a sex ratio of at least 4.66M/1F.This finding is in agreement with the data in DSM-IV(1994), which points out the fact that only 1/3 of thegamblers are females.• The disorder starts more frequently earlier in malesand later in females.• The 6.8% prevalence of pathological gamblers amongRomanian teenagers is very close to that found byProimos (1998) in UK, of 6,0%.22

Discussion of results• The explanation of the high prevalence ofpathological gambling in Romanian teenagerscan be found in the desire to gain money,teenagers associate with social status, with isseen as highly valuable in the context of thegeneral impoverishment of the population.• The fact that the majority of teenagers(82.35%) practise group gambling is explainedby the typical wish to be found at the age ofadolescence: integrating into groups ofindividuals of the same age.23

Discussion of results• The study shows that an important part of thegambling teenagers neglect school, which graduallyleads to their social dysadaptation.• An extremely high percentage of gambling subjects feltthat they could control the game, which confirms thediagnosis. This fact was already observed by Langer in1975. He stated that gamblers develop an illusoryperception of the game control, facilitated by thecontact with the game, the degree of competition andinvolvement and the complexity of the game.24

Discussion of results• At present, the most popular gambling games are pool,poker and bingo.• Almost 15% of the teenagers gambled in one sessionsums that are higher than the value of the mean incomein our country. (Lupu(et al 2001a).• The gamblers belonged to both social environmentswith modest incomes and social environments with highand very high incomes in similar proportions. (Lupu(etal 2001b).25

Discussion of results• Buchta(1995) recommended the inclusion of thisdisorder in the prophylaxis programs of mental healthcenters for teenagers, upon finding a high incidence ofpathological gambling in American teenagers.• This could also be applied in Romania, considering theexpansion and seriousness of the problem amongRomanian teenagers.• We consider that this objective requires theimplementation of a national program for theprophylaxis of the development of gambling addiction,similar to the present national program for theprevention of alcohol and drug use among youngpeople.26

Conclusions• 1) A high prevalence, 6.8%, of pathological gamblingis found in Romanian teenagers;• 2) The majority of gamblers are males (82.35%) andpractise games in groups, preferring especially pool,poker and bingo.• 3) Approximately 2/5 of the gamblers gamble in asingle game session sums of money equal to or higherthan the mean salary in Romania.27

Conclusions• 4) 3/4 of the teenagers believe that they can controlthe game• 5) The majority of the teenagers also present schooldysadaptation, along with marked absenteeism andmodest results.• 6) We propose the inclusion of the problem ofpathological gambling in the prophylaxis programsof mental health centres from all over the country.28

(Pathological) gambling: Evidencewith regard to adolescents• Another study (Lupu, Boroş, Miu, Iftene &Geru, , 2001) analyzed the risk factors forpathological gambling in Romanianadolescents who were high school andvocational-school children (n=231),withages between 14 and 18 years, in Cluj, , Satu-Mare, and Argeş counties.29

The most important risk factors forpathological gambling were:• divorce/the separation of parents;• a serious physical illness of one of the familymembers;• the death of a family member;• family break-up;• the psychological disorder of one of thefamily members, and• participation in a severe accident.30

(Pathological) gambling: Evidencewith regard to adolescents• In 14% of the pathological gamblers, co-morbidity with the use of illegal drugs wasalso revealed, while sexual abuse ofadolescents had also been identified as apotential risk factor for pathologicalgambling.31

Two profiles of adolescentpathological gamblers• 1) adolescents of 15-16 16 years of age, from anunfavorable family and social environment, whereshe/he has to deal with stressful, traumaticexperiences, such as neglect, physical, and/orsexual abuse. In these cases, one may interpretdependency on gambling as a coping mechanismof chronic stress;32

Profiles of adolescent pathologicalgamblers• 2) adolescents of 15-16 16 years of age, from afavorable family and social environmentwith a medium to high income, where themost frequent reason for neglecting theadolescent is the parents’ extremely busyschedule. In these cases gambling may be away to spend time and/or to attract aparent’s s attention.33

(Pathological) gambling: Evidencewith regard to adolescents• As in the study conducted by Lupu et al. (2002), the “20Questions of Gamblers Anonymous” were used to assessgambling-related problems. However, the authors changedthe scoring of the items by including a category of sub-clinical diagnosis, which offered more information aboutthe frequency and proportion of gambling. This led to thefollowing categories:a) non-gambling/recreational gambling and occasionalgambling (0-1 1 positive answers = level 1);b) problem gambling (2-6 6 positive answers = level 2); andc) pathological gambling (7-20 positive answers = level 3).34

Risk factors for (Pathological)gambling• The data revealed that 34% of the participants do notgamble at all, or only gamble occasionally, 54%represented problem gamblers, , and 12% could beclassified as pathological gamblers.• Cluster analysis disclosed a grouping of risk factors forgambling in three categories:• 1)personal risk factors(physical/psychological illness,severe accidents),• 2)family environment (physical abuse, neglect, education,separation of parents, number of siblings), and• 3)stressful events (the break-up of a romantic relationship,social mobility, number of schools attended, familytraumas, sexual abuse).35

For problem gamblers, the mostimportant risk factors were :• change of residence (61%);• the existence of psychological (60%) orsevere physical disorders in one of thefamily members (59%);• the death of a family member (57%);• severe physical illness (55%), and• being an only-child(50%).36

Risk factors for pathologicalgamblers• witnessing severe accidents;• the psychological or somatic illness of a family member;• the break-up of a romantic relationship;• the death of a family member, and the divorce of theparents.• The number of pathological gamblers was significantlyhigher (29%) in those who suffered a severe accidentcompared to those who did not (10%).• Sexual abuse was twice as frequent in the case ofpathological gamblers compared to problem gamblers, andsignificantly more frequent when compared to non-gamblers.37

Risk factors for pathologicalgamblers• The analysis of a synthetic index, whichadditionally comprises sexual abuse (stressfulevents), showed a significant difference in meanfrequencies between pathological gamblers andnon-gamblers.• The same significant difference was also found inthe case of another synthetic index (unfavorablefamily environment), with frequencies between 5.8(in the case of non-gamblers) to 7.3 (forpathological gamblers).38

Risk factors for pathologicalgamblers• The third synthetic index circumscribespersonal risk factors and registered adifference in the same direction (non-gamblers vs. pathological gamblers).• The analysis of the data (see Table 2) showssignificant differences between non-gamblers and pathological gamblers.39

Risk factors for pathologicalgamblers• The most important consequences of pathologicalgambling appear to relate to the deterioration ofthe parent-child relationship. The pathologicalgamblers had a significantly higher number ofarguments with parents because of gambling(parents usually forbade gambling).• Pathological gambling strongly correlated with thenumber of school absences, a fact underscored bythe significantly higher number of pathologicalgamblers (25%) whom the grade for conduct waslower, compared to non-players (3%).41

National politics to approach pathologicalgambling• At present in Romania, there is no coherentstrategy regarding the prevention andtreatment of pathological gambling. This isdespite the fact that the disorder isrecognized by the Romanian specialists,being diagnosed, coded and reportedaccording the WHO-ICDICD-10 classification,both at the level of psychiatric hospitals,ambulatories, and private offices.42

National politics to approach pathologicalgambling• Taking into consideration the fact that there is anempirical correlation between drug/alcoholaddictions and pathological gambling in Romania,the inclusion of gambling into the actionsundertaken by National Anti-Drug Association(NAA)is extremely welcome, particularly aspathological gambling can be seen as a form ofnon-pharmacological dependency. The proposal ofits inclusion was presented by Lupu, Boroş, Miu,Iftene and Geru (2001).43

The treatment methods currently available inRomania used for pathological gamblinginclude:• 1. Selective serotonin reuptake inhibitors(Fluvoxamine, Clomipramine, , Prozac);• 2. Mood stabilizers (Carbamazepine(Carbamazepine);• 3. Individual and group cognitive and behavioraltherapies (including rational emotive andbehavioral therapy);• 4.Counseling the gambler’s s family;• 5.Family therapy;• 6.Psychological counseling.44

Treatments• These forms of therapy are available bothfor inpatients and outpatients. The vastmajority of patients prefer to be treated asoutpatients in private offices. Unfortunately,in Romania, self-help groups (such asGamblers Anonymous) do not exist yet.45

Prevention• Taking into consideration the fact that theetiology of pathological gambling is multi-factorial, including family/genetic,sociological, and individual factors, all theseelements have to be attentively analyzed inorder to conceive an efficient primaryprevention, as well as a secondary andtertiary program in order to controlpathological gambling in Romania.46

Prevention• Promising examples of such attempts are thebroadcasting“Renaşterea”(“Rebirth”)from2001, , and an interactive live television programorganized by Lupu in 2002, at the “TeleEuropaNova”, and in 2007 at “NCN TV”onthe issue ofpathological gambling.• These programs have had a huge impact on thepublic in Cluj-NapocaNapoca.• A large number of individuals, family members ofpathological gamblers called on air, wishing tofind out more about the possible forms oftreatment in these disorders.47

Prevention• Consequently, the access to treatment hasgrown drastically, pathological gamblersbeing brought to specialized private officesby family members. This is an extremelyimportant aspect, since pathologicalgambling is an ego-syntonicdisorder, whichleads to a low direct access to therapy.48

CONCLUSIONS• Taking into consideration the fact that thenumber of adolescents and young adultswho gamble has been dramaticallyincreasing in Romania, urgent regulation atnational level of this issue has become amajor issue.49

CONCLUSIONS• These observations should initiate the beginning ofcomprehensive empirical research in order toreveal the prevalence of gambling in adults andthe monitoring of such tendencies in adolescents.These needs become more and more stringentespecially because of the ‘explosion’ in the numberof locations where gambling has become possiblein the last two to three years in Romania.50

CONCLUSIONS• For this intervention to be efficient, onemust obtain adequate financing, whichmight come from the taxes paid by thegambling industry in Romania.Besides sensitizing the population,intervention has to be closely integratedwith the legislation and specialists in thedomain of mental health.51

CONCLUSIONSThus, the Romanian population may findout when, where, and how one may ask thehelp of a professional in this regard, inorder to get treatment.52

CONCLUSIONS• Nevertheless, the urgent setting up of supportgroups such as Gamblers Anonymous is essential.In this way, Romanian patients will benefit fromall types of intervention available in Europe andaround the world.• Empirically validated forms of interventionshould be implemented, as soon as possible,targeting primary, secondary, and tertiaryprevention of pathological gambling in Romania.53

THANK YOU FOR YOURATTENTION!54