We feature an expert in the mental health and substance use disorder field to answer questions. This issue we talk to Dr. Timothy Fong of UCLA Gambling Studies Program.
Q: What is your role at the UT Gambling Studies program and what inspired and led you to work on problem gambling?
I’m a professor of psychiatry and I’ve been here at UCLA since 1998. I’m board certified in addiction psychiatry. Back in 2002, I started to see a rise in gambling activities in Los Angeles: cardrooms, tribal gaming, expansion of Las Vegas, the poker craze—it was really interesting to me to see all this gambling expanding, particularly on the Internet, but not seeing a lot of patients present at the hospital or our outpatient clinics because of gambling problems.
Now, we knew that in 2002, that gambling addiction existed. It was certainly a condition of interest, but it just wasn’t showing up. So that led me to a very basic question: Where are the men and women with gambling disorders and if they’re suffering from this condition, but we’re not seeing them and then then they’re not calling, what is actually happening to them? This then led me to, Dr. Richard Rosenthal, who authored the DSM-IV criteria for gambling disorder. We began to ask questions such as: What are the causes, the reasons, why people are developing gambling disorders and, more importantly, how do we develop treatment for that?
Q: Can you share a bit about the gambling studies program and the wider role in education and confronting problem gambling.
We started officially in 2005, so we’ve been around almost twenty years. Our mission has been to understand what causes a gambling disorder, develop effective treatment and really figure out how do we do better in public health and in health care regarding prevention and treatment of gambling disorders.
I think that the biggest accomplishment in our program really was in 2009 when the California State Office of Problem Gambling partnered with us to develop a state funded treatment program. This was where we got a wider footprint by getting state funds to really do all the work related to gambling disorder prevention, education, and treatment.
Q: Are you seeing a trend in types of problem gambling and gaming?
In our state of California treatment program, about a thousand men and women present for a no-cost treatment every year. And ever since 2009, when the program started for treatment, it would be people experiencing harm from slot machines and casino games. Most are in their late 40s, and there is a wide variety of racial ethnic and cultural groups. But over the last three year, in parallel with the rise in sports betting we’ve definitely seen more and more young men coming into treatment. We’ve seen problems with sports betting rise up as almost on par and equal to slot machines as the main form of gambling causing harm. If you listen to my voicemail, you’ll find that probably about eight percent of the folks calling for treatment and support now are related to sports betting and interestingly enough, mainly almost all sports betting is in the online space. So it makes sense, right? We expand sports betting, we normalize it. It’s on our phones. You see advertising everywhere. COVID-19 certainly impacted a lot of people’s desire to travel and go anywhere.
Q: What are some of the signs that gambling has become problematic?
It’s very similar to any other addictive behavior. Does your gambling behavior add to your quality of your life, or does it create harm in your life? Gambling is meant to be entertainment. It’s meant to be recreational. It’s meant to be fun. It’s meant to bring you closer together with people regardless of whether you win or lose money. Signs that someone has a gambling problem can vary from person to person but there are going to be some common things. It’s going to create emotional pain and it’s going to be a financial stress; it’s going to lead to increased physical stress on your body because of the strain of worrying about gambling. There’ll be signs of interrupted sleep, decreased job performance, skipping school, arguments with family, not taking care of yourself, not working out or skipping meals. These are all potential signs that gambling has become harmful.
Q: Who is at risk for gambling disorder?
This is a biological, psychological social condition and the risk factors fall along those lines. People with family histories of disorders, people with active addictions, alcohol, tobacco, cannabis addiction, people with untreated and active mental health problems like ADHD or bipolar disorder, mood disorders. We know that folks at the extreme ends of life, either the young or the old, are at risk. We know that in certain communities of color and certain communities, like Asian American communities or Latino communities, or communities with a very poor economic status are at risk. And lastly, we know that people who gamble frequently, like daily, with escalating levels of bets are at risk.
Q: Does mental health and substance use disorder tend to go along with gambling disorder?
Absolutely. As I just recently mentioned, we know that this is the rule, not the exception. So, if you have one hundred people entering addiction treatment programs for alcohol and tobacco, we know that about fifteen of them are going to have issues related to gambling. That’s certainly a lot higher than the one to two percent in the general population. Vice versa, if you have hundred men and women entering treatment versus a mood disorder or ADHD treatment or an anxiety disorder, they’re also going to have a higher rate than two percent. So, we know that these things go hand in hand. Is it the chicken or the egg situation? It’s a little bit or both. You can imagine someone with a major depression turning to gambling as a way of self-soothing and numbing themselves out and then developing a gambling disorder. Vice versa, just by developing a gambling disorder creates a lot of emotional pain and a lot of financial pain that can end up resulting in significant mood problems.
Q: What are some actions that a family member or friend could take if they are concerned about a loved one’s gambling?
It’s the same story if you’re concerned about someone’s drinking or their smoking or their vaping or their spending habits. You have to start by saying how that behavior is making you feel. So instead of saying, “Hey, you are gambling in a bad way” or “You’re a bad person for gambling, I encourage family members to say, “Hey, I’m noticing that you’re not exercising as much and I’m worried” or “I’m noticing that you’re spending a lot of time on your phone gambling”, or “I’m noticing a lot of money being spent on gambling and I’m concerned and worried about how that is impacting you.” You can also say, “I’m stressed. I’m not getting a lot of sleep because I’m worried about your gambling.” Those are the beginning statements: Non-judgmental, non- critical. They are meant to spark a conversation.
I think for a lot of family members, it then goes to a level where they’ll say something like, “I’m so worried about your gambling. Would you be willing to go with me to see a gambling specialist together?” So, it’s basically saying, “I don’t think you’ve got a problem, I don’t know, but I’m so worried, I’m willing to take my time and energy to go see a specialist with you.” For a lot of family members, we also encourage them if they’re not sure, to get more information to go to Gam-Anon meetings, by going online, or going to trusted sources. For instance, in the state of California, we actually see family members of gambling disorder clients for free, so they can come in and see psychotherapists, learn about the condition, and learn ways that they can support their loved ones without enabling them.
Q: Anything else I’d like to mention about what you’re doing?
People can take a look at our website www.uclagamblingprogram.org for the latest updates and information. We have videos, we have information, and we have links; As we see gambling become mainstream and embedded in our daily life that we really ought to have these conversations, with much younger people. It needs to be folded into the same conversations with tobacco and alcohol prevention, and even in the recovery community, we shouldn’t dismiss the power of gambling addictions. So, if you are recovering from alcohol, tobacco or substance use disorder it’s very important to also talk about gambling and make sure that people don’t switch conditions, such as substitute alcohol, tobacco and cannabis, for gambling. We need to be very mindful of that.
Timothy W. Fong MD is a Professor of Psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. He is board certified in adult and addiction psychiatry. He is the co-director of the UCLA Gambling Studies Program. The purpose of this program is to examine the clinical characteristics of gambling disorder in order to develop effective, evidence-based prevention and treatment strategies. Dr. Fong is also a member of the Steering Committee of the UCLA Center for Cannabis and Cannabinoids whose mission is to address the most pressing questions related to the impact of cannabis legalization through rigorous scientific study and discourse across disciplines. He is a member of the UCLA Sports Psychiatry Service and is part of the UCLA Sports Medicine Mental Health Team. Lastly, he is the President-Elect of the American Academy of Addiction Psychiatry.
Last Updated on March 12, 2025