9 Signs of Gambling Addiction or Problem Gambling

Hello everybody and welcome to this presentation on introduction to gambling disorder and problem gambling. I'm your host, Dr. Donnelly Snipes. In this presentation we're going to briefly define pathological gambling, gambling disorder and problem gambling. We'll explore the prevalence of gambling issues and identify people who might have a gambling problem. Then we'll explore links between gambling problems and other behavioral health conditions like depression and adhd. We'll identify tools for screening, assessing or diagnosing gambling problems. And we'll finish by identifying treatment issues and strategies. Gambling problems can co occur with other behavioral health conditions. As a matter of fact, they often do. So when somebody has a gambling problem, we can expect that they will likely also have other behavioral health issues. Depression, anxiety, trauma, adhd, maybe even bipolar disorder. So we need to be sensitive to that. Now, not all people with mood disorders or other psychiatric issues will develop gambling problems. So it's important to recognize but also screen for it because psychiatric problems or mental health issues do put people at a greater risk for developing problems with gambling or other behavioral addictions. Only about 10% of people with a gambling problem ever seek treatment. And they've estimated that of the people who have a gambling problem, about 30% of those will go into remission. They'll resolve the problem on their own, which means 70% will not resolve the problem on their own. And only 10% are seeking treatment, which means we've got 60% of people out there with gambling issues that are really struggling and not seeking treatment. A variety of other problems can be related to gambling, including victimization and criminalization. And you may be scratching your head going, well, why? Well, if you're using a bookie, then that can be a problem. And if you go into significant debt with a bookie or what, whomever else, then that can be a problem. People may engage in criminal behaviors in order to get the money that they need to pay off their gambling debts or to try to gamble another day and win back their losses. When we talk about criminalization, it doesn't necessarily mean holding up a liquor store. It can mean stealing from family, stealing from your kids college fund. So we do want to recognize the, the breadth of the term criminalization that we're using here. It can cause social problems, health issues, and when we talk about health issues, any stress related disorder is going to be more prevalent in people who engage in gambling disorder and pretty much any addiction or behavioral addiction. And there's also a higher risk for contracting sexually transmitted diseases and hiv, aids, which I thought was kind of interesting, but they have identified A correlation between risk taking behaviors in sexual behaviors and gambling doesn't necessarily mean the person's a sex addict, but there is a stronger correlation that between those higher risk behaviors. Gambling is defined as risking something of value, not necessarily money, but usually money on the outcome of an event that is decided at least partially by chance. Now, some gambling is skill based gambling, for example, and. And they refer to skill based gambling as games that you can learn and you can become better at, like poker or blackjack. And then there is chance based betting, which is more like your slot machines and game games of pure chance, the lottery, for example. Action gamblers are typically men and gamble because it's stimulating. They tend to get bored, and this is one of those things they can do to occupy their time. Action gambling requires some type of skill or knowledge. Poker, sports, when people are getting into their fantasy football leagues or they are betting on sports, it requires a knowledge of the game and the coaches and the strategies to figure out, you know, who actually probably does stand a better chance of winning. Relief gamblers, on the other hand, are often female and gamble for escape and often gamble using games of chance like bingo, lottery or slot machines. In the DSM 5, pathological gambling was renamed gambling disorder. So we've moved it from a term, you know, pathological into a full blown disorder. Now, I don't know if that's good or bad, but it is what it is. Gambling disorder is now categorized under substance related and addictive disorders. The DSM 5 and the DSM 5 TR now have added this category and they're starting to recognize, I. E. Gambling and Internet gaming addiction, which they're still kind of looking at, but they're starting to recognize the addictive nature of process and behavioral activities, as opposed to just assuming that addiction is only substance related. Problem gambling does not meet the criteria for gambling disorder. So wherever you see pathological gambling, when you're doing readings in the literature, especially pre 2018, wherever it says pathological gambling, think to yourself, gambling disorder thinking. But problem gambling is not the same. Problem gambling obviously indicates that, guess what, there's a problem. But it does not rise to the level of meeting the criteria for gambling disorder. Oh, one other interesting thing that I want to note in this updated version of this video is gambling has now been applied to things as seemingly benign, if you will, as weight loss. There are apps out there where people can place a wager on how much weight they'll lose, how fast. And that is problematic in my mind for so many reasons. Some people can be duly motivated by it and that's great. But people with a propensity towards eating disorders or extreme taking things to the extreme can obviously clearly cause themselves harm as a result of placing wagers and trying to lose too much weight too fast. But I digress. The criteria for behavioral addictions is starting to be defined and it's defined as continued engagement in a behavior despite adverse consequences. Diminished self control over the behavior. Person tries to quit or cut down and they're unable to do it. Compulsive engagement in the behavior where they think about it and they, they feel like they have to do it, they feel like they have no other choice and a desire, urge or craving state prior to engaging in the behavior. The interesting thing that you don't see here is using the behavior to escape from a neg physical or emotional state. And the reason for that is because some people with problem gambling, for example, engage in that behavior not to escape from pain so much, but for relief from boredom. And it gives them something to do and it gives them a rush. It's not that they're in pain, it's not that they're in distress, but they really like that rush they get when they win. So the diagnostic criteria DSM 5tr gambling behavior leading to clinically significant impairment as indicated by four symptoms or more in a 12 month period. So the person needs to gamble with increasing amounts of money in order to get the same rush or feeling. So this is akin to using more of the substance to to get the high. Is restless or irritable when attempting to cut down or stop. We see the same thing in substances. Has made repeated unsuccessful efforts to cut back or stop. Again see the same thing with substances. Is often preoccupied with gambling. In substance use disorder we we say the person spends more time thinking about preparing to use, using or recovering from use. But the same basic principle. Often gambles when feeling distressed after losing money gambling they return to get even. And this is a little bit different than what we see in substances. But you can think of it as sort of the hair, hair of the dog that bit you. The person that needs to have a drink, have an eye opener to get going the next morning. Lies to conceal the extent of involvement with gambling. Has jeopardized or lost a significant relationship or career as a result of gambling and relies on others to relieve financial problems. Now it's important that we recognize this is not better accounted for by a manic or a hypomanic episode. If somebody has bipolar disorder and is in a manic or hypomanic episode, then we're going to defer to that diagnosis. Remember, of these nine diagnostic criteria, the person only has to have four of them in a 12 month period. Warning signs now, these are a little bit different than diagnostic criteria because they are effects or consequences of the gambling. Financial problems exist despite adequate income. So if you're bringing in plenty of money to pay the bills, but you're still not able to pay the bills, you may be scratching your head going, where's all the money going? That's it. Money has gone missing from a bank account or wallet or valuables have disappeared. There's a lot of borrowing. Cash advances or living off credit cards, retirement insurance plans, etc are cashed in or allowed to lapse. The person avoids family functions and other social events partly due to shame because they've probably borrowed money from a lot of people and potentially because they don't want to go to that because they'd rather be gambling. They neglect responsibilities or make excuses so they can engage in the gambling behavior and they drop other leisure activities to focus on gambling. Additionally, they often arrive late for work or other commitments. So they may get up in the morning and while they're drinking their morning coffee, they are also trying to place bets for that day. One area of betting that we haven't talked about yet is the stock market. And with the advent of online trading and retail trading as they call it, there are a lot of people who have lost a lot of money and have developed gambling problems as a result of quote investing in the stock market especially, well, investing in the stock market, it's important to recognize, you know, investing in the stock market, just like playing poker, can be an outlet for people, it can be a way to make some money for some people. But when you can't stop, when you're chasing your losses, when you are losing money repeatedly, then it's important to take a look at whether it's becoming an addiction. The person may disappear for up and I bring that up because the stock market opens at 6am in some areas, 7am in other areas for early trading, and then it officially opens at 9:30 EST. And a lot of people who are day traders or who are retail investors will do their investing, will place their place their orders first thing in the morning, and as a result of that, they may be late for work or other commitments at the beginning of the day and then they may be distracted throughout the day logging into market watch or stock twits or something else to see how their investments are going. They disappear for large blocks of time. They may Appear deceptive or secretive about behavior, particularly regarding money. They may seem edgy, reactive or defensive and experience changes in sleep, eating, or sexual behaviors. Now some of these changes in sleep, eating or sexual behaviors can be as a result of spending more time gambling chasing those losses. It can also be the result of persistent stress. We know when people are under persistent stress, when that HPA axis is revved is going to negatively impact their sleep. When they are stressed because they've lost their kids college fund, they are probably going to have difficulty sleeping. They also may have a change in their eating or sexual behaviors for the same reason. When the HPA axis is activated, the body says, you know, it's not really the time to eat right now. Or on the other hand, we need to eat so we can continue to fuel this engine and, and keep going. So some people overeat, some people under eat. And sexual behaviors may, libido may drop kind of through the floor or the other end of it. When people are losing a lot at, at gambling, they may engage in sexual behaviors to try to get some sort of rush, some sort of relief. In adolescence, some of the warning signs are a little bit different. Similar to adults, they can't account for missing money. They may skip school. Now, adolescents have a lot of reasons for skipping school, but gambling can be one of them. They may borrow or steal money from friends or family. They sometimes have large amounts of unexplained cash. With adolescents is a lot harder for them to gamble online. They generally don't have credit cards. And so when they do win, and a lot of them don't have bank accounts that they can easily access. So when they do win, they've got all this cash that they've got to do something with. They may have a fake id, a casino entry card, or gambling receipts in their belongings. They may be preoccupied with video arcades, Internet gambling sites, or day trading. And they've left a trail of Internet visits or credit card charges to gambling sites. Adolescents these days are a lot more savvy than adolescents of 10 years ago. So some of these Internet trails and things may not actually be as prevalent anymore as they used to be because the adolescents have gotten better at hiding it. But do look for these things. So what's the prevalence of gambling disorder? I keep talking about it, but is it really that big of a problem? Yes, it is. Approximately 1.5 million Americans have experienced gambling disorder. The prevalence of the lifetime problem of pathological gambling ranges from 0.01% to 10.9%. Now that's a Pretty broad range there. And some of the explanation for the difference in ranges is in this particular study, they were looking at different age groups and your younger age groups, your tweens, your early teenagers are often less likely to engage in problem gambling. But your teens, your 15, 16, 17, 18 year olds and even college age, they are much more likely. They're up towards the 10% mark on the prevalence of problem gambling in that group. Now this particular study was specifically looking at people who met the criteria for gambling disorder. So if you add in the number of adolescents who and other people who are have problem gambling, not just pathological gambling, you've got a pretty big freaking number. Men are more likely than women to have gambling problems. According to the research, people diagnosed with pathological gambling, 73.2% had additional addictive disorders. Now that may be a little bit skewed. For some people it was tobacco, but they also saw an increased rate of cocaine, methamphetamine and alcohol abuse. 50% had a diagnosable mood disorder and 61% had a diagnosable personality disorder. People who have both a substance use disorder and pathological gambling or gambling disorder have high rates of adhd. It's important to remember, and I've stressed this already, but I'm going to stress it again. Gambling involvement is on a continuum. Some people don't gamble at all. Some people engage in casual social gambling. They may buy one lottery ticket once a week. Some people engage in serious social gambling. And these are the people who are getting together every Saturday night to play a high stakes poker game or a moderate stakes poker game. Then you've got risky gambling where people are actually engaging, regularly engaging in gambling behaviors with more money than they should probably spend. Problem gambling takes it a little bit further. Where they are regularly having difficulties and then when they start meeting four or more of those criteria that we talked about for diagnosis, then they cross into gambling disorder. So it's all a matter of degree. How much problem is gambling causing this person in their life and how much control do they have over the behavior? Can they stop? Screening for gambling problems is important because few people seek treatment for these problems and instead seek help for other complaints like insomnia. Remember I said sleep changes, stress related problems, depression, that sense of hopelessness and helplessness, which makes sense if you've lost a whole bunch of money, anxiety, which again makes sense if you don't know how you're going to pay your mortgage or you're afraid that your significant other is going to find out. And interpersonal issues as a result of being secretive as a result of borrowing or stealing money from friends and family members. Tools so if people present in for treatment we should at least ask about gambling. And that's one thing I still am not seeing on standardized assessment tools. But I digress. Tools the South Oaks Gambling screen or the SOGs has 16 items and differentiates between no gambling problems, some problems, or probable gambling disorder. And it's freely available. You can find it online. The National Opinion Research Center's Diagnostic Screen for Gambling Problems is a questionnaire based on the DSM 4 criteria. Now the criteria really didn't change much from DSM 4 to 5 to 5tr but at the top of the questionnaire it says based on DSM 4 criteria. So I did want to make you aware of that that it does say that and other tools are available. So if you download this PDF from your classroom you can click on other tools. If you are just watching this video in the notes section, I do have a link to the all of the resources that are in this PowerPoint that you can look at for yourself. Three major routes to gambling problems Normal, healthy functioning adults who fall victim to easy access, poor judgment and a misunderstanding of the odds. And and this is really important. There is a lot of magical thinking that happens in gambling and superstitious reinforcement as behaviorists would call it. So it's important to recognize that some people may start gambling and they win a few times and they think hey, I'm on a roll and I can't be stopped. Well, guess what, it's going to come to an end. The you're going to gravitate towards the mean, as they say. Mood disorders, according to some studies, are often the result of gambling and not the cause, especially for people who are biologically male who often engage in gambling in as a means of socialization and as a means of relieving boredom. For relief gamblers, obviously they're engaging in gambling for relief. The second route is the emotionally vulnerable population. And these are people who gamble to escape from negative moods. These are your relief gamblers. Now some people who are biologically male are also going to be relief gamblers. We don't want to assume that just based on biology, one person is going to be a certain type of gambler and then there is biologically based impulsivity. This is the third major route. These people tend to be action gamblers. They want to be involved in something that requires a certain amount of skill or knowledge. As many as 20% of people with gambling problems, not just gambling disorder, but gambling problems have adhd. They are also likely to have a number of concurrent issues such as addiction, emotional lability or emotional dysregulation, chronic boredom and inadequate social skills. These are all things that we can screen for when people present in our office. People who regularly emotionally disregulate, people who have emotional ability are at a high risk for a lot of issues, so we should be screening for that. People who are chronically bored are at a high risk for addiction and addictive behaviors, among other things. So we do need to screen for that. Just because it's not an official diagnosis in the DSM 5 TR does not necessarily mean we don't need to screen for it. Risk factors for developing problem gambling or gambling disorder if somebody has a big early win, that surge of endorphins and dopamine is just incredibly powerful and it can drive a person to chase that high. It's the same sort of thing that happens when people use drugs for the first time. They get this surge and forever after. They're often trying to chase that high. They're trying to get that same feeling they had the first time. A susceptibility to boredom, a poor understanding of randomness. And randomness is a mathematical concept that people need to understand that you're going to win sometimes, you're going to lose sometimes. But ultimately all of these games, even the skill ones, as well as the ones that are totally chance, have an element of chance in them. People who tend to use escape as a way of coping are also susceptible to gambling problems. Another risk factor is a stressful life with a lack of support and direction. Around the time that the gambling began, some people have said, okay, you know what? I see that alcohol is destroying my family, I'm not going to drink. Or they may not be able to access alcohol or drugs or something else, but they can access gambling. They can get online and, and play games of chance. And it may start out as something that they're not actually betting money on, especially for the younger people. They may get an app that they are playing with fake money, they get tokens or whatever, but they're not actually using real money and they get hooked on that. And then they move on to finding ways to spend actual money to, to increase the tension and release. And another risk factor is a history of mood, substance or process addictions, intermittent explosive disorder or ADHD protective factors. It's not all doom and gloom. People who have financial security are at less risk of developing gambling problems. Now that can be a double edged sword. If somebody has financial security Then they may feel a little bit more cocky about spending money and gambling and then problems can develop. But a lot of times people who have developed financial security in order to get to that place have had to use a lot of self control and wisdom to get to that point. The people who are with financial security who are at risk tend to be the people who didn't have to work for their, their financial security. If they received a big inheritance, they are at a lot higher risk than somebody who has budgeted and saved all their life to get to that place. If somebody has supportive friends, that's a protective factor. It protects against boredom as well as distress. If they have hopes and dreams for the future, if they can focus on something in the future, that can be a protective factor because it gives them something to work toward. However, some people, again it double edged sword, they can have hopes and dreams for the future because they're watching these influencers and they're watching whatever shows online and they're thinking, I want to have this $10 million mansion and this Lamborghini and this whatever. And the those are the dreams for their future which they know they're not going to be able to ever afford based on their current job. So that may put them at a little bit more risk. So if they have realistic hopes and dreams for the future, that's a protective factor. If they're doing well at work, if they're getting some of their esteem needs met at work, if they are financially secure as a result of doing well at work, then they may be less tempted to gamble. They're using support or other coping skills rather than escape to deal with distress. If they know about randomness and if they're able to set limits on betting, if they're able to say, okay, I'm going to gamble with this much money and then if I lose it, I'm done. That can be a great protective factor. My dad and my stepmom used to go to Las Vegas every single year for their vacation and they would go with a set amount of money and they would gamble until either it was time to go home or until they lost. And then they would stop. There was no, you know, let me just withdraw some more money and try to make up my losses. They were able to set their limits on their bedding and those limits were realistic based on their income and where they were. So what can we do for people who have problem gambling or gambling disorder? Well, first, financial difficulties. We want to help them address those debtors. Anonymous can help people learn how to budget their money and rein in their spending. You can also encourage them to call United Way Information and Referral. A lot of times communities will have financial counselors or financial consultants that are available to help people who are having difficulty budgeting their money, making ends meet. Maybe they've gotten into a place where they can't afford, They've lost everything, and they need to figure out, how do I dig myself out of this? United Way Information and referral is a great resource for connecting people with services that are in your particular location. We also want to recognize that gambling does not occur in a vacuum. So there are likely a lot of marital, family and relationship issues the person is dealing with. They found that there is an increased risk, an increased rate of child and spousal abuse or domestic violence among people with gambling disorder. Well, let's think about why that might be. They're gambling, and when they're with their family, they're not able to gamble, which makes them irritable. So that's one thing. But they also may have lost money, which is more common than actually being super successful at it. So they've lost money and they're stressed out. And then the spouse or may question where the money went or just they're on edge. They are totally stressed out about the financial predicament they're in, and they tend to emotionally dysregulate. It's not an excuse, it's just we're talking about the neurobiology of what's happening. So we want to recognize that when people are already under significant stress, that it's going to increase the risk of child and spouse abuse. They may be struggling with issues related to separation or divorce. Their significant other may have said, I'm done. I. I can't do this anymore. Which can lead them to feelings of anger, of grief, of guilt, of depression, anxiety. There's a whole host of feelings that may happen when the separation or divorce they know is the result of. Of at least partly the result, direct result of their actions. But even if it hasn't gotten to the point of abuse or divorce, there is almost always chaos and dysfunction within the family because just like with other addictions, the person with gambling disorder is hiding what they're doing. They are being secretive, and that causes a lot of turmoil within the family. Additionally, just like with substances, a lot of money's going somewhere and the rest of the family doesn't know where it's going. Just like with other addictions, the gambler may have stolen or borrowed a lot of money from various family members. And created tension and resentment. Disclosing the gambling secret can be devastating to relationships, leading to resentment and loss of trust. Sometimes people will come into therapy and they'll say, my significant other doesn't know what's going on. They have no idea that I took a second mortgage out on the home, out on our home, and we're getting ready to go into foreclosure because of my gambling. They have no idea we're broke. And so the clinician may have to work with the client to help them figure out how they're going to disclose that. It's helpful if people are willing to embrace the 12 step philosophy. There's not a lot of gambling support groups out there besides the 12 steps. Gamblers Anonymous is great for people who have gambling disorder or problem gambling, and Gamma Non just like Al Anon is a great support group for the loved ones of people who are problem gamblers. And there may also be legal issues. Whether it's unpaid taxes or theft or whatever else. There can be a lot of legal issues that occur when somebody starts getting in financial trouble. Obviously as clinicians we are not lawyers, so that's another thing you want to refer to United Way Information and Referral A lot of states, the state bar association will, requires or strongly encourages attorneys to take on a certain number of pro bono cases every single year. So consult your local bar association if you've got a law school in your area. Law schools very often will have legal clinics and that might be another resource to help people figure out how to navigate their legal issues, including bankruptcy treatment strategies. Since there is a high preponderance of co occurring issues, it's going to be important to address those issues. Motivational interviewing is helpful for just about everything. Motivational interviewing helps people recognize that they have a problem, helps people recognize that there is hope and there are options for them to recover from that problem should they want to. It helps them develop the want to change, it helps them develop the motivation and it helps them take those steps. So motivational interviewing really helps nudge the person along when they might already be feeling helpless, hopeless, overwhelmed, dejected. Once you have the person where they are ready to enter treatment trauma informed solution focused counseling is going to be a staple for for treatment. It's going to be really helpful to address concurrent issues like family issues and relationship issues and mood issues. Cognitive behavioral therapy can be an adjunct to that if they are really embracing cbt. But cognitive behavioral therapy is the treatment of choice as far as psychotherapy goes for specifically treating problem gambling and gambling disorder Cognitive behavioral therapy when treating gambling disorder involves identifying and changing cognitive distortions about gambling. And generally these are sort of different than what we typically think of with the cognitive distortions such as magnification and personalization and mind reading. With gambling, what we're talking about is minimization. They're minimizing the risk, they're magnifying the chances that they're going to be successful. They are ignoring the selective abstraction, they're ignoring the risk, they're ignoring the losses. So we want to look at their, the mental gymnastics that they're using to convince themselves that continuing to gambling, continuing to gamble is going to be in their best interest. CBT also reinforces non gambling behaviors. What are you going to do instead when you get stressed out? When you get bored? What are you going to do instead? And how can you ensure that that is rewarding to you and it recognizes positive and negative consequences? And that's important in behavior change. Too often clinicians want to focus on the negative consequences. Look at all of the disaster you've caused by your behaviors. Look at how it's harmed you. How could you not want to change? Well, let's look at the positive people do. What has the people do the things that are most beneficial when they have to make a choice. So we have to say, why was this gambling most beneficial? What were the positive aspects of it? And are there other ways that you can meet those positive aspects? So if they're gambling because of boredom, okay, well, what else can you do to relieve boredom? If they're gambling in order to escape, okay, what other strategies might be helpful for you to deal with whatever you're trying to escape from? And cognitive restructuring is going to be important, helping them adjust how they think about gambling, how they think about themselves, how they think about money, and potentially how they think about belongings. A lot of people by the time they come to treatment don't have a lot of money. And one of the reasons that they started gambling in the first place or continued to gamble was because they had these champagne dreams on a beer budget. Helping them restructure their cognitions, their self esteem, so their self esteem is based more on who they are than what they own, can be another huge step in terms of relapse prevention. We need to help people learn to identify and avoid risky situations that can trigger or cue feelings or thoughts that can lead to relapse to gambling. What triggered it in the past? When you encounter those triggers, what can you do instead? From day one, whenever I work with somebody with an addictive behavior and pretty much any other behavior too. From day one, we start developing a relapse prevention strategy. When you get triggered, when your desire to gamble gets triggered, when your depression gets triggered, when your anxiety gets triggered, what can you do? What are at least three strategies you can do to at least hold your ground? If not continue to move forward? You know, I don't want people feeling helpless, feeling like they're going to be swept away by every wave that comes along in, in life. And help them learn how to prevent vulnerabilities. We know that part of addictive behavior involves obsessing about something, thinking about it a whole lot, and feeling the need, feeling a compulsion to engage in the behavior. We also know based on recent research that sleep deprivation contributes to ruminations. When people are sleep deprived, they are sleep significantly less able to stop unwanted thoughts. So one of the vulnerabilities that we really need to address in people with addictions is sleep. And that's not only developing good sleep hygiene and, you know, trying to get good sleep, but also addressing things like sleep apnea. If your clients are at risk or might have sleep apnea, if they are significant snorers, it is important to have them referred to a physician for an evaluation to address sleep apnea. Because that good night's sleep, that good restful night's sleep, not only is going to help them heal their stress response system or their HPA axis, but it's also also going to help them more effectively suppress unwanted thoughts, including unwanted thoughts about the addiction. Gambling is a large problem for millions of people. It not only impacts finances, but also relationships, health and mental health. Remember I said stress related illnesses. That includes autoimmune issues as well as addiction and mental health. People gamble for two main reasons, excitement or escape. It's important to remember that money is not always the end goal for gamblers. Although it's a potent reinforcer, it tends to be the end goal, maybe for excitement or escape. Like I said, there are some people who gamble because they want to have a yacht and a 10,000 square foot house and whatever else, but for a lot of people, there's more to it. Gamblers often have distorted cognitions or thoughts about the likelihood that they will win. They think if they do things in a certain way that they're going to win, or if they study this book, that they're always going to win and it's just, you know, not going to happen most of the time that way. Adolescents who develop a problem with gambling are more likely to develop gambling disorder in adulthood. Protective factors include social support, healthy coping skills, setting limits on bets and having other hobbies, interests and go.