Gambling, says Health Minister Kováč, is a "defect in behaviour".
photo: Ján Svrček
Ján looked for a moment as if he might protest or walk out, but in the end he just hung his head.
It's an experience shared by the seven other patients in Ján's therapy session. During their seven week treatment at the special wing for pathological gamblers at central Slovakia's Banská Bystrica hospital, the patients are constantly reminded that no one pities them - not even their closest relatives. They are also taught not to pity themselves, despite the personal devastation many have experienced, and the rigour of the daily therapy they must undergo.
Life in the gambling addicts' wing in many ways resembles military boot camp. Reveille is before seven, followed by callisthenics and cleaning chores (showers, toilets, floors). Performance of these tasks is supervised by a grim-faced nurse, who awards demerit points for the slightest infraction. Patients who collect three demerit points in one day - for additional faults such as failing to say 'please' or 'thank-you' - are banned from smoking for several days, have their free time reduced, and are not allowed to write letters.
Ján, who smokes but has not been allowed a cigarette for four days, says he now includes a 'thank you' and 'please' with every sentence in order to be on the right side of the law. "At the beginning it was so tough I didn't know if I could handle it, but I've realised this course is the only way to stop gambling," he said, speaking in an undertone to avoid attracting the nurse's gaze.
But it's still bitterly tough. On this Valentine's Day, when Ján's daughter has travelled 200 kilometres to visit him, the group therapist who spoke so harshly to him in session also forbids him to spend any time alone with her.
"I'm not going to let you, Ján, because I want you to really feel what it must have been like for her when she needed you, but you were out gambling."
Ján's chin quivers slightly as he manages a husky "yes, thank you ma'am."
The lucky ones
As unhappy as he is, Ján never forgets that he is one of the lucky few - the waiting list for the Banská Bystrica gambler's clinic is three months long.
The clinic was founded in 1993, the first of its kind in Slovakia. Since then, over 400 gamblers have been treated there; since the gambling ward is only a small part of the hospital's psychiatric wing, the number of beds is limited to eight.
No statistics in Slovakia are kept on how many gambling addicts there are, but doctors say that demand for treatment at the clinic is steadily increasing. To avoid wasting time on hopeless cases, Banská Bystrica takes only those patients who are firmly convinced they need treatment.
"If gamblers have any doubts about the need for treatment, the whole process is a waste of time," said Ludvík Nábělek, the director of the clinic. "It takes gamblers a long time to realise they are addicted and that they need specialised help. Family members can play an important role here, especially when they are tired of being stolen from, lied to and tormented."
Nábělek added that most gamblers don't come to their senses until they "hit bottom" - which, for over 25%, involves attempted suicide.
For Ján, suicide seemed the only option after a month-long orgy of gambling left him, his wife, son and dog without a home. When the anti-depressants and vodka he swallowed failed to kill him - one senses this, although Ján never says it - he was finally ready to admit he had a problem he couldn't control.
Although gambling addiction is classified by psychiatrists as an 'impulse control disorder', along with kleptomania and compulsive arson, it has far more in common with drug or alcohol addiction, says Nábělek.
But until now, he claims, the state has virtually ignored gambling addiction as a problem, not considering it on the same level as drug and alcohol dependency. Nábělek describes the state as "a passive observer of the group of fanatics who are trying to fight gambling addiction and other dependencies", and accuses the government of not taking drugs, alcohol and slot machines seriously enough.
"The state fights addiction only formally," he says. "It doesn't have money even for the basic care and drugs. The environment is corrupt, and with the state insurance firms being stripped of assets, money doesn't even come for hospitals, never mind clinics. Anti-drug funds are distributed among various pseudo-organisations which pretend to be fighting addiction."
The doctor also blames weak law enforcement for much of Slovakia's addiction problems.
"If someone here finally decided to enforce the law, according to which kids under 18 can't use alcohol, we wouldn't be seeing 15 year-old alcoholics. And if we really wanted to prevent kids from playing on slot machines, we could prevent them - and then I wouldn't be treating 16 year-old gambling addicts. But it seems that the state doesn't care about anything any more."
Health Minister Roman Kováč, responding to questions from The Slovak Spectator by fax, said that the country had been successful in fighting drug dependencies, but added "pathological gambling is a defect in behavior. It is clearly a behavioral issue that has many similar characteristics to this group [drug and alcohol addicts], but is a part of a different group of psychological defects.
"Our psychiatric health institutions help people with this problem in general," he continued, "especially in cases when the gambling is combined with alcohol."
Back in Banská Bystrica, Ján has three weeks of treatment to go, before he is released to an uncertain future. "I'm never going to play again," he says with evident emotion. "It's taken my whole life. But it's going to be hard - getting a job, finding somewhere to live. I've screwed it all up, and I'm afraid."
According to Nábělek, he has reason to be. "For recovering gamblers, like alcoholics, it's enough to slip just once and the whole process starts again," he said. "We often see these people back two or three times before it's finally over."
5. Mar 2001 at 0:00 | Lucia Nicholsonová