INTRODUCTION

Tobacco use is widespread, and although consumption overall appears to be reducing in New Zealand[1], some 18% [2] of the population over 15 years of age continue to smoke tobacco in varying amounts. The consequences of tobacco use appear to be considerable: an average loss of 7.5 years of expected life can be attributable to tobacco use, while between 4,300 and 4,700 deaths a year has been directly attributable to tobacco use in New Zealand. In addition to this a further 350-500 deaths have been attributed to the inhalation of second-hand smoke or so called ‘passive’ smoking. This second hand smoke also contributes to the risk of heart disease and stroke.[3]

NICOTINE AND GAMBLING DEPENDENCE

That people continue to use tobacco despite these consequences suggests a powerful addiction is operating that reduces control over behaviour (inability or difficulty in stopping). The addictive neural pathway appears to be the dopaminergic system that rewards and reinforces behaviours (Camberino et al 1999; Comings et al 1996). Similar activations in the ventral tegmental area (where core neural connections exist between dopamine neurons) were found for both cocaine and problem gambling, and has been implicated in nicotine dependence (Henningfield et al 1995).

Some theories suggest neuro-adaptation and that addictive behaviours develop as a way to re-establish homeostasis (Jacobs, 1989) or to compensate for genetic irregularities that may make the sensation of reward more difficult to experience (Blum et al 1996).

For late stage problem gamblers, the effect sought either consciously or subconsciously, may be avoidance of negative effects (negative reinforcement rather than positive reinforcement), a commonality with nicotine dependence. Dissociation may also enable this to occur (Diskin et al 1999).

PROBLEM GAMBLERS TEND TO SMOKE

Counsellors commonly report a higher incidence of smoking behaviour for their clients. This is supported by the common provision of buttons alongside gambling machines in casinos to call for cigarettes from casino staff, and oversize extractor fans in casinos. In addition, clients anecdotally indicate increased rates of smoking when gambling.

Many gambling environments will have a pervasive atmosphere of tobacco smoke and there is considerable pressure overseas for smokefree gambling options, particularly in casinos.

A SMALL PROSPECTIVE STUDY

Problem gambling clients attending day clinics were invited over a consecutive period of time to answer a questionnaire around their smoking habits. Eighty-two clients (no declinatures) completed a brief questionnaire. Three significant others of gamblers participated but were not included in the study. Of the remaining 79, 53 (67%) were current smokers and two (2.5%) had given up. Some 91% smoked prior to gambling becoming a problem while one (2%) started smoking at the same time as their gambling began.

SMOKING ON A NON-GAMBLING DAY

Although comparisons between the clients surveyed and the general smoking population are different in significant variables (age, gender, ethnicity) it was noted that the survey participants were heavy smokers, and likely to smoke up to one packet a day when not gambling. Smokers in the general population were more likely to smoke between one and ten cigarettes per day than heavier categories.

PERCEPTION OF EFFECTS OF SMOKING

Participants were asked to select one of three categories that best described the effects of their smoking. Just over half responded that their smoking made them more relaxed, a quarter that not smoking made them more tense if they couldn’t smoke while a further quarter answered yes to both.

Just over half thought they smoked more when gambling while over 40% thought there was no relationship between their gambling and smoking.

SMOKING ON A GAMBLING DAY

Perceptions of smoking on a gambling day were measured in two ways: selection of a category of smoking rate (numbers of cigarettes smoked daily, when gambling) and selection of a point on a Likert scale. Questions were separated on the questionnaires to minimise comparisons and attempts to coordinate responses.

There was a significant shift upwards in the rate of smoking on a gambling day, with the lowest category more than halving, while the highest categories increased by a factor of more than 500% for the second highest (up to two packets) and 300% for the highest (more than two packets). Heavy smoking categories increased from less than 8% of participants to over one in three on a gambling day.

EFFECTS OF BANNING SMOKING

Views were equivocal around frequenting of gambling environments if they were to become smokefree. Just under half stated they would not continue to frequent these smokefree sites while just over half would continue to attend.

Feedback from some of the participants who chose to provide additional feedback varied provided some insight as to cognitions around smoking and gambling.

CONCLUSIONS

A number of outcomes suggested that further research was warranted in this field. They were:

• That smoking may be a risk factor in the development of gambling problems (91% of the 67% of participants who smoked, were smokers prior to becoming problem gamblers)
• Problem gamblers are heavy smokers who increase their rate of smoking considerably when gambling
• Problem gamblers, because they participate in lengthy gambling sessions, smoking at high rates, may be at high risk for tobacco related disorders
• Problem gamblers may also put non-smokers attending the gambling sites at high risk for tobacco related disorders due to passive smoking of (nicotine and other chemical) dense atmospheres
• The increased rate of smoking when gambling for these problem gamblers suggest that nicotine plays a mediating role in process of problem gambling behaviour, and,
• Tobacco smoking may have a (classically) conditioned role in problem gambling that may have to be addressed contemporaneously in treatment to reduce relapse rates.

References

[1] 24% in 2001 (Ministry of Health: Tobacco Facts: May 2001)

[2] The Health of New Zealand Adults 2011/12: Key findings of the New Zealand Health Survey. Wellington, Ministry of Health 2012

[3] Tobacco Facts: May 2001 Ministry of Health 2001

Blum K, Cull J, Braverman E & Comings D. Reward Deficiency Syndrome. American Scientist 1996; 84:132-145.

Jacobs D. A general theory of addictions: rationale for and evidence supporting a new approach for understanding and treating addictive behaviour. pp35-64 in Compulsive Gambling: Theory, Research & Practice. H Shaffer, S Stein, B Gambino & T Cummings Eds. Lexington MA; Lex Bks.

Camberino W & Gold M. Neurobiology of tobacco and other addictive disorders. The Psychiatric Clinics of North America 1999; 22:301-313.

Comings D, Rosenthal R & Lesieur H. A study of the dopamine D2 receptor gene in pathological gambling. Pharmacogenetics 1996; 6:223-234.

Henningfield J, Schuh L & Jarvik M. Pathophysiology of tobacco dependence. Psychopharmacology. In Psychopharmacology: the fourth generation of progress. F. Bloom & D Kupfer eds. Raven Press: NY; 1995.

Diskin K & Hodgins D. Narrowing of attention and dissociation in pathological video lottery gamblers. J Gambling Studies 1999; 15: 17-28.