The head of the Day Psychiatry Services Department at the RPLC Vilnius branch, V. Andrejauskienė, first draws attention to the very fact that a person has come seeking help. According to her, this is already an important step, even if the patient himself is not yet sure what he wants and how much he is ready to change.
“Sometimes it seems that I believe in the gambler more than the gambler himself, that he can take a break from gambling, reprogram himself. I believe in him. If I didn’t believe, I couldn’t work,” says the psychiatrist.
However, according to her, helping does not mean immediately laying out the entire future life plan for the person. On the contrary – excessive help can encourage withdrawal from it.
It feels like everyone around is talking about me, but not with me.
One of the phrases the doctor hears in her office is, “Don’t make a project out of me.” Relatives often have already found a psychiatrist, psychotherapist, mutual aid group, or treatment program, deciding where the person should go and what to do.
“Gamblers say: ‘It feels like everyone around is talking about me, but not with me. We decided – there will be rehabilitation, the Minnesota program, medication, etc.’ But no matter how good the intentions are, the person becomes an object of discussion and rescue. And he kind of says: ‘Hey, I’m here. Talk to me, not about me, as if I don’t exist,’” conveys V. Andrejauskienė the patients’ reactions.
Therefore, in consultation, the doctor first asks the person himself what happened to him and what he wants, not what his family members think about his behavior.
It is important to leave the possibility to choose
It is difficult for the relatives of gambling people to hear “I will handle it myself,” especially if such promises have been made before. However, the doctor emphasizes that it is important not to take away the person’s opportunity to participate in his own recovery process.
This does not mean leaving him alone. Different ways of help can be offered, but the final choice, as much as possible, should be made by the person himself. The psychiatrist’s experience shows that the path chosen by the person himself is usually more valuable than the one imposed by relatives. The problem arises when the exhausted family starts to rush: they want the person to start treatment as soon as possible, stop gambling, and life finally return to normal tracks.
Then, according to the specialist, a paradoxical thing can happen – the more active the relatives become, the more passive the gambler himself remains. Others look for help for him, plan, control, decide, while he himself participates less and less in decision-making.
“If we take away autonomy and individuality from a person, he will not start using them,” emphasizes V. Andrejauskienė.
Excessive control teaches to hide
Upon learning about gambling, constant checking often begins in the family: where the person goes, when he will return, with whom he communicates, what he buys, what he does on the phone.
However, according to the doctor, control itself does not eliminate gambling. On the contrary, the person may begin to better mask his behavior and lie about how much time or money he spends on gambling.
The same applies to the question: “How much did you really lose?” The important thing is not only the question itself but also the tone. If the conversation turns into interrogation, the person may hide the real amount. According to V. Andrejauskienė, some patients explain that they do this also out of fear of how their relatives will react to the full extent of the debt.
“Just stop” – like telling a coughing person to stop coughing
Relatives may find it incomprehensible why a person does not stop even when he himself sees how much damage gambling has already caused.
“Often gamblers say they hear: ‘Just stop.’ But pathological craving is not a rational decision. It’s like telling a coughing person: ‘Stop coughing,’” compares the psychiatrist.
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A person can promise not to gamble, but the promise itself does not eliminate pathological craving.
Reminders about lost money and debts do not always help either. The person usually thinks about them anyway, and the amount of lost money can become a reason to gamble again, hoping to win it back.
Similarly, the request to promise that “this time is really the last.” The person can promise, but the promise itself does not eliminate pathological craving. And breaking it, the shame that arises, according to the doctor, sometimes only pushes back into gambling even more.
“If you cared about your family, you wouldn’t gamble”
V. Andrejauskienė considers even more dangerous the phrase that opposes gambling to love for relatives: “If you cared about your children, wife, or husband, you simply wouldn’t gamble.”
“A person can be a truly loving father, son, or husband and at the same time be ill. When we start measuring addiction by family love – ‘either me or gambling’ – that is a very dangerous phrase,” warns the psychiatrist.
According to her, neither intellect nor education protects from addiction. Therefore, the reproach “you are so smart, how could you do this?” does not solve the problem. A smart person can get stuck in gambling just as well and even find more explanations for his behavior, change gambling tactics, and believe that next time he will outsmart the system.
When the family pays off debts
One of the most sensitive areas is financial help. When debts grow, relatives naturally want to pay them off as soon as possible and at least stop the crisis this way.
However, the doctor also sees the other side of such help. If the family settles debts, work problems, and other consequences of gambling, the person may not have time to feel the full extent of his behavior’s consequences himself.
V. Andrejauskienė recalls the thought of one gambler: if his parents had not paid off his debts when he was 18, maybe later everything would have turned out differently.
“Debt somehow becomes a support not to borrow more – the person is already in debt. And when parents or friends cover it, his hands are untied to gamble again,” explains the doctor the patient’s situation.
Therefore, in her view, help should not mean that relatives remove all the consequences caused by gambling.
He doesn’t want to stop gambling, but for the pain caused by the consequences of gambling to stop.
After debts, lies, and broken promises, family members may find it difficult to hear another request for help. V. Andrejauskienė encounters in her patients’ stories the reaction: “How can you ask us for help after what you did to the family?”
But precisely the moment when the person asks for it himself can be very important. According to the psychiatrist, the goal is not to prove once again to the gambler that he behaved badly or illogically. It is much more important to understand together why the person keeps returning to gambling, even though he knows how it ends, how craving arises, and in which situations it becomes hardest to control.
“He doesn’t want to stop gambling, but for the pain caused by the consequences of gambling to stop,” emphasizes the psychiatrist.
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