Complex needs: working across boundaries

English | Cymraeg

Dee Lally Osborne | September 2019 | 9 minutes

At our conference at Wrexham Glyndwr University on 18 September, we’ll be talking about how services can work together better to meet complex needs. Here, guest blogger Dee Lally Osborne from the Living Room Cardiff shares her experience of working with people who suffer from both alcohol misuse and gambling addictions.

In 2013, the Living Room Cardiff had two queries from parents looking for help for their sons’ gambling problems. There was little help available in Wales and despite our ‘all addictions’ approach we had seen very few gamblers. So, with financial help from our parent company CAIS, we launched the Beat the Odds Campaign. Since then we have seen more than 125 people with gambling problems. We often find that a person will have more than one addiction so we focus on the root cause rather than the ‘symptom’ which may manifest as gambling, alcohol, food or any other addiction.

The Chief Medical Officer for Wales visited our centre as part of his research into problem gambling in 2017. His paper described gambling as “an underappreciated public health issue” and added that not only could it lead to alcohol misuse, but it was also eight times more common among people with alcohol misuse disorders.

We focus on the root cause rather than the ‘symptom’ which may manifest as gambling, alcohol, food or any other addiction.

We have found that a large proportion of those with gambling problems struggle with alcohol. Many clients gravitate towards alcohol or other substances to cope with the realities of their gambling. Others may be inclined to gamble more when they are under the influence of alcohol, as alcohol and gambling technologies interact in number of problematic ways. Clients describe making poorer more impulsive decisions when drunk or have become lonelier and more isolated and as a result have resorted to gambling on phones while intoxicated. We know that drinking can negatively influence a person’s ability to remain abstinent from gambling, so I always recommend that my clients should remain sober for a period.

No addiction occurs in a vacuum. Once clients have stopped gambling and drinking, they can start to accept the nature of their problem and start to uncover the underlying issues which led to that problem in the first place. It’s no coincidence that many of my clients have suffered loss, whether it’s bereavement or loss of a future they planned. Some clients are vulnerable because of severe learning difficulties or mental health issues.

We have worked closely with experts from across the globe to ensure we deliver the best practice for people with single or multiple addictions.

The Beat the Odds steering group has organised four major conferences on excessive gambling, to share good practice and expertise from around the world. We also held Wales’ first Youth Gambling Forum, to give young people a space to talk about gambling. Raising awareness and sharing experiences is vital to helping people get the support they need.

Helping people come to terms with and overcome their addictions is highly rewarding, and I’m pleased to be able to speak at this year’s Alcohol Change UK conference in Wales about supporting people with complex needs.

Case Study ‘Client A’

Client A is 38 and lives with his wife and their two children. He has been gambling on and off since he was in his teens. He used to enjoy going to the bookies with dad and saw it as harmless fun. As he got older, he started betting on the football, like many of his friends. He enjoyed a drink and occasionally got into fights if he drank too much. When he was 26, he met his partner and he settled down. He also started working with his dad in the family business.

He still went to the pub most Saturdays to watch the football and normally put a couple of bets on. They had their first child when he was 30, but six months later his father was diagnosed with pancreatic cancer and died quite soon after his diagnosis. This was a difficult time for Client A, and he started gambling more on his phone in secret. He was also forced to take on many of the roles his father had in the business. His partner was aware that he had started drinking more but had no idea about the gambling. The moment he was most ashamed of was dipping into the company bank account. He continued gambling with the idea that once he won big, he could pay off his debts then stop.

Four years ago, he confided in his mum about the debt. He also admitted that he had spent the inheritance from his father which he could have used as a deposit for a house. His mum, although devastated, agreed to lend him money to pay the debts off if he promised that he would stop gambling. He didn’t gamble for the next two years, but then started again. Last year he tried to take his life as he felt so hopeless. His wife found the Living Room Cardiff, and both have had support since last year.

When Client A started at the Living Room Cardiff he was still drinking. This started to escalate with the guilt of what he’d done. Through attending one-to-one counselling he was able to recognise that drinking was becoming more of an issue. He decided that it would be best to stop drinking as well as gambling. This was a big step for Client A as his weekend routines had to change as the pub was no longer a suitable place. He started spending more time with his wife and children and the trust is slowly coming back.

It was important for the counsellor to start working with him to identify the root cause of his addiction. He had a difficult relationship with his mum who was still making him feel very guilty about the money she had lent him. Although he appreciated what she had done, he found her very controlling. It became apparent that he had not grieved for his father. He also felt like he had gone into the family business just to please his parents and wanted to do something more rewarding but felt obligated. Through slowly building his self-esteem and helping him to realise he wasn’t a bad person he is starting to be someone he likes.

At the Living Room Cardiff, we see addiction as a chronic illness that affects families. As such treatment is long-term, Client A continues to come to meetings and one-to-ones on a regular basis. He can help people who are new and offer them support. This gives him confidence, but also reminds him of where he’s come from.