Medical Matters: An American psychiatrist asked me recently: "How many gamblers do you have in Ireland?" He was not the kind of fellow to whom you could say "you have to be a bit of a gambler to survive here", so I told him I didn't know.
"It would be surprising if you don't have a problem given your alcohol issues and your recent rise in incomes," he said rather clinically.
Six to 10 million Americans have a problem with gambling, he added. Translated, this would mean that we have 120,000-140,000 problem gamblers in Ireland or 3-4 per cent of the population.
The following week a young man consulted me in the surgery with alcohol-induced gastritis which led him to miss work repeatedly over the past three years.
He told me he doesn't go to pubs any more but goes to friends' houses four nights a week, where they play poker and drink cans of lager into the small hours.
He was putting away 68 units of alcohol over the four nights - three times the limit for him.
He often loses money at gambling, goes back to recoup his losses and gets a real buzz out of it. He has lost his girlfriend, is in financial disarray but likes his life at the moment.
The outlook for him is bleak as he seems to be addicted to both alcohol and gambling and is not ready to face either of his addictions.
A person with one addiction is vulnerable to another. The individual develops an uncontrollable obsession with alcohol, drugs or gambling.
It is evident that the vast majority of people are in control of their alcohol and gambling but there are some who are not.
The games that are most addictive are the ones where the "rush" or response is closely linked to the placing of the bet - which is like the rush of heroin or of the first cigarette of the day. The rush is probably adrenalin mediated in gambling.
The people who are most vulnerable are those with an existing addiction and those with a parent who has an addiction.
There is evidence that children and adolescents who gamble are more likely to develop problems than adults.
It is easy to gamble on the internet and indeed the Eircom home page, for example, has a gambling page marked for ease of access which literally has dozens of gambling sites that don't seem age-restricted.
Other big portals are similar but are not necessarily marketing broadband to family homes.
Gambling is marketed as a harmless bit of fun that adds interest to your favourite sport, be it football or politics.
Here is a checklist used by Gamblers Anonymous, which has a very useful website (www.gamblersanonymous.ie), to check if gambling is a problem for you or a relative (most compulsive gamblers will answer "yes" to at least seven of these questions):
1. Do you ever lose time from work or school due to gambling?
2. Has gambling ever made your home life unhappy?
3. Is gambling affecting your reputation for the worse?
4. Have you ever felt remorse or regret after gambling?
5. Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
6. Does gambling cause a decrease in your ambition or efficiency?
7. After losing, do you feel you must return as soon as possible and win back your losses?
8. After a win do you have a strong urge to return and win more?
9. Do you often gamble until your last euro is gone?
10. Have you ever borrowed to finance your gambling?
11. Have you ever sold any personal property to finance gambling?
12. Are you reluctant to use "gambling money" for normal expenditures?
13. Does gambling make you careless of the welfare of yourself or your family?
14. Have you ever gambled longer than you had planned?
15. Have you ever gambled to escape worry or trouble?
16. Have you ever committed, or considered committing, an illegal act to finance gambling?
17. Does gambling cause you to have difficulty in sleeping?
18. Do arguments, disappointments or frustrations create within you an urge to gamble?
19. Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
20. Have you ever considered self-destruction or suicide as a result of your gambling?
In Ireland we have an unique attitude to alcohol which makes us vulnerable to many behaviours, tragedies and illness.
We are also vulnerable to gambling, which has received little attention in healthcare circles. It is evident we need to be more aware of it and to explain its dangers to the public and patients alike.
Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP. For more information: www.gamblersanonymous.ie