“Addiction means that the entire realm of thoughts, feelings, and desires, indeed the entire way the life is being conducted, is exclusively geared towards gambling.”
Interview with Prof. Reinhard Haller, MD
Prof. Reinhard Haller, MD, was born in Vorarlberg in 1951, is a medical specialist in psychiatry and neurology and is among the most renowned forensic psychiatrists of Europe. Reinhard Haller has published more than 400 scientific studies on addiction, suicide, depression, and forensic psychiatry and teaches at the University of Innsbruck.
Dr. Haller, you are head of department at Maria Ebene Hospital and at the same time you lecture at the University of Innsbruck. What was your reason to focus on addiction research in your work?
Haller: Within the area of psychiatry, pathological addictions with their many roots, complex pathology, and comprehensive therapeutic requirements to me seemed to be one of the most interesting special fields. No other clinical picture interferes this strongly with physical, psychological, and social healthcare and affects as many people from the environment of the patients. Addiction is one of the seven most important diseases of today and unfortunately has a shining future ahead of it. This is why I chose it.
How many people addicted to gambling do you treat at Maria Ebene Hospital?
Haller: The share of compulsive gamblers treated in our hospital has made a quantum leap since the turn of the millennium. This is not only due to the increase in the number itself, but also to our specially developed outpatient and inpatient therapies. People who suffer from compulsive gambling as singular addiction account for 6% of our patients. In about 15% of cases that are treated for alcohol or prescription drug addiction, there is at least an aspect of problematic gambling.
Does the typical gambler exist? Or asked differently, is there a correlation of socialisation, education, gender, age, and susceptibility with compulsive gambling?
Haller: The typical gambler is neither mentally incapacitated nor does he or she suffer from a psychological illness. But he/she would often suffer from neurotic episodes, personality disorders, or social and personal burdens. Emotionally unstable, anxious people with self-worth issues are more prone to compulsive gambling. Burnout patients often search out the atmosphere of casinos in order to flee into an artificial world from their overburdening daily routine. As far as young people are concerned, the main motives can be traced to feelings of pointlessness and emptiness; they often look for the kick of “fear – lust – thrill”.
Are there any signs that would help a person realising whether a spare time activity has turned into an addiction?
Haller: Man is also a “homo ludens”, i.e. a being that likes games and gambling. Gambling per se is not pathological; it serves to prepare for life, for picking up various sills, and for competition and fun activities. Gambling turns problematic only if it is aimed at avoiding problems and turns into the flight to addiction. Addiction means that the entire realm of thoughts, feelings, and desires, indeed the entire way the life is being conducted, is exclusively geared towards gambling.
Can a compulsive gambler make a full recovery or is he/she likely to relapse throughout his/her life?
Haller: Addiction is always an epiphenomenon, i.e. a disorder that is based on underlying psychosocial problems. Therefore, therapy is always focused on said underlying disorders, i.e. exhaustion, depression, anxieties, or a lack of self-worth. Therapy will be successful if the patient does not need gambling any longer in order to handle his/her problems. The goal of addiction therapy is therefore not healing, which is indeed sometimes not even possible, but the creation of an ability to live with the risk while managing it.
How does the statement “nobody is being forced to gamble” chime with you?
Haller: Like every pathological addiction, so compulsive gambling, too, always depends on the personality of the consumer, on the sociocultural circumstances, and on the supply or availability of the addiction-inducing substance or the behaviour that causes the addiction. At the beginning, no gambler has the feeling of compulsion. For a small share of the gamblers, the urge becomes a compulsion and sometimes even does away with free will.
What sort of responsibility do gambling companies bear – what role should the regulator play?
Haller: Statutory measures will never solve an addiction problem, but they will only ever regulate it. Actual solutions are only possible if they are tailor-made for the individual case. The statutory protection, however, has to support above all minors, people at risk, and people already addicted. It is the gambling companies’ responsibility to recognise people at risk and to deny them access. Also, a share of the large profits should be earmarked to fund prevention, therapy, and rehabilitation.