“do you smoke…do you bet?” »

The prevalence of addiction to games of chance and gambling is increasing and sporting events such as the Euro and the Olympic Games risk aggravating risky behavior. How to detect this type of addiction? What should be done in practice? Just as we ask our patients if they use tobacco or narcotics, should we now ask them “do you bet?” “. Update with Dr. Gauillaume Davido, psychiatrist

TRANSCRIPTION

Benjamin Davido ― Hello everyone, welcome to Medscape. I have the pleasure of receiving Dr Guillaume Davido, and as you can see, there is a family resemblance. Guillaume, hello, can you present your discipline and your field of expertise?

William Davido ― Hello everyone, I am an addiction psychiatrist and I work at the Bichat-Claude-Bernard hospital in Paris. I deal in particular with the addiction liaison, but also with consultation for behavioral addictions, and in particular those concerning games of chance and money which I am going to talk to you about today.

Benjamin Davido ― So precisely, we will soon enter the very special period of the Olympic Games, and who says “games” also says “games of chance and money” [et je vous invite d’ailleurs à regarder la vidéo précédente sur le sujet des risques sanitaires liés aux JO 2024].

First of all, Guillaume, what defines addiction to gambling?

Definition and identification of gaming addiction

William Davido ― It’s, in a way, a new addiction. It has been recognized since 2013, and brings together what we already knew about classic substance addictions. There are very specific criteria in the psychiatry manual (DSM) which make it possible to classify different mental illnesses, including addictions and in particular addiction to games of chance and money. You must have 4 very specific criteria related to games of chance and money to make you “an addict”. But before being an addiction, it remains a behavior (playing). So the behavior itself isn’t problematic until you need to play consistently to feel euphoria.

These are almost the same criteria as with a drug, with signs of withdrawal and being in withdrawal. When patients say they are anxious, that they have obsessive thoughts around gambling and between gambling practices, these are already signs which can alert, which can lead to the diagnosis of an addiction, and in particular the fact that they do not not to control themselves, to stop this gaming practice. The fact that on a daily basis, they have so many intrusive thoughts about the game and that they try to remember different past gaming experiences or even to plan the different attempts games. Punters will try to find out about the evening’s match, with the online players, etc. So these criteria should alert you to an addiction.

There is also the fact that patients may suffer negative consequences. It’s something very broad, it can be in relation to those around you (a loss of job, a divorce, a separation, difficulty getting to work, etc.). Lying is also a sign and factor of addiction. Moreover, there is a very simple screening scale, the Lie/Bet questionnaire : “lying” and “betting” are 2 factors which are signs of addiction to games of chance and money. Also, the fact of wanting to “remake yourself” after a big loss of money, or that you rely a lot on others to lend you money.

Benjamin Davido ― It’s still crazy that without taking substances like toxins or alcohol, there is this same notion of addiction, but with something psychological!

Risk factors for pathological gambling

Benjamin Davido ― What are the risk factors that make some people more vulnerable than others to developing gambling addiction?

William Davido ― The risk factors are quite similar to those we know in substance addictions. This is why we wanted to classify them.

• Being a man is in itself a risk factor, especially for sports betting.

• Extreme ages (as for other addictions): therefore youth, being an adolescent, being in full cerebral growth, since the brain matures until the age of 25 which means that the decision-making is even more difficult. And for older people, it’s an age where we start to perform less cognitively, they are often people who have difficulty making decisions, difficulty solving problems, poor self-esteem, and who may have experienced traumatic life events. So as with substance addictions, age is a factor of fragility.

• Psychiatric comorbidities: having other addictions, mood disorders or poor self-esteem (depressive disorders), but also personality disorders (someone who has a very narcissistic personality will necessarily have low self-esteem which will be different, and this may constitute a risk factor).

Impact of new technologies

Benjamin Davido ― Concerning the risk factor of age and in particular youth, do new technologies (with the development of the Internet, online betting, mobile applications, etc.) mean that young people are more inclined today today to be influenced? Isn’t that a factor of gravity? For example, during the World Cup, we saw advertisements for sports betting like Winamax all the time… Isn’t that also an issue to manage as a specialist?

William Davido ― Indeed, before we didn’t talk about sports betting as much, we talk about it a lot more since the advent of the internet and new technologies. And who goes on the Internet? The entire general population of course, but who is most often affected by advertising, social networks, influencers, and everything that is sporting and which gives a good image of this or that sport? A young person will be more sensitive to Mbappé or Neymar if they advertise a sports bet… So yes, young people will be sensitive, there is not only the environmental and genetic factor, there is also the fact that these people are more affected by the Internet.

There is also the fact that on the internet it is easier to play. You don’t need to go to a tobacco shop, nor leave your home, nor have cash – there is a dematerialized side where there is no longer any notion of money. These are therefore often people who are ultra-connected (and therefore often young people), and who have very few responsibilities, have difficulty making decisions… We come back to the same problem: rapid decision-making. , all digital with in-app purchases. Because it’s not just sports betting. Now, in new video games, especially free games, there is also an addictive potential with the various in-app purchases. For example, when you “buy” a football player in FIFA, you have a probability of not getting the one you want, so there is always a link with chance, it is also a form of games of chance and money.

The behaviour to have

Benjamin Davido ― This addiction to sports betting is therefore a new specialty, and perhaps we will discover other addictions in the coming years, including how to hijack artificial intelligence. With the Euro 2024 Cup and the Olympic Games approaching, what should be the course of action for these affected people? Can we give advice to avoid falling into this trap and know when to consult?

William Davido ― Unfortunately, very few people feel concerned or go to see it. It is a problem. We must therefore try to do everything so that they are challenged by this possible problem.

Normally, the National Gaming Authority which regulates games in France, whether sports betting or not, is already supposed to challenge excessive gamblers. It’s always very complicated in practice to have contact with them, but she’s supposed to come to the player and challenge him to say “we can’t let you continue like this, we’re closing your account or we’re advising you to close your account”.

These are people who are concerned about this practice and who recognize themselves in the criteria that I mentioned at the very beginning of the interview. There are very simple things to put in place: banning games (on the website of the Ministry of the Interior, you can prohibit yourself to play, it lasts 3 years and you can renew it).

But of course, you can also consult specialists. For addictions, there are outpatient treatment centers for addiction prevention (CSAPA ).

Benjamin Davido ― As for alcohol?

William Davido ― Yes, they are the same structures. CSAPAs have been supporting more and more players in recent years, it’s something that has become a little more democratized. This allows for multidisciplinary care. If there is a need for social support, it is possible, in addition to having support with an addictologist, possibly with a psychologist ― since I previously spoke about comorbidities.

As for general practitioners, to detect these people, you must refer to the criteria described previously and ask these questions almost systematically: start with “have you ever gambled or not?” » and depending on the answer, find out if the practice is excessive, repeated, and if it has negative consequences. But also, see if the person has been able to think about stopping and if they really have difficulties with this. If yes, then we must redirect patients and offer them this assistance.

Benjamin Davido ― Alright. If I understand correctly, from the moment when, as a doctor, we are going to detect someone who has addictive behavior, we must not forget, beyond toxic substances, to ask the question of games and in particular betting.

Just like “do you smoke?” “, you have to ask “do you bet?” “.

Guillaume Davido ― Yes, just like “do you smoke?” “, you have to ask “are you talking?” “.

Benjamin Davido ― Exactly. Thank you very much Guillaume, it was very clear. With the Olympic Games there are several risks ahead and we have our work cut out for us.