For Tsutomu Nakamura, taking back control of his life from a gambling addiction meant first hitting rock bottom.

The 50-year-old preached the same mantra to gambling addicts at the recovery facility he founded, only to discover his own experiences had little to do with the gambling troubles others suffered, because the affliction is so often personal and influences people in different ways.

“We’re now focused on providing various forms of support in accordance with individual needs after discovering those needs through interviews with visitors and their families,” said Nakamura, who opened the Yokohama care facility called One Day Port in 2000. “For example, we offer residential and job-hunting support for some and teach others about financial management, as well as spending time in leisure activities outside gambling.”

The debate over what constitutes gambling addiction has been rekindled in recent months amid the government’s plans to build so-called integrated resorts, encompassing casinos and other facilities in a bid to boost tourism and regional economies.

In principle, gambling is prohibited in Japan with the exception of betting on some racing events and lotteries. Horse racing and certain motor sports, as well as authorized lotteries, are touted for contributing to public welfare. Pachinko, meanwhile, is essentially a kind of quasi-legal gambling.

In Nakamura’s case, his gambling habit started with pachinko while he was a teenager, and he later got hooked on betting at racing events. Eventually, he found himself trapped in a world of illegal gambling, widely known to be controlled by the underworld.

A number of people enjoy authorized forms of gambling for recreational purposes and only a relatively small segment of the population develops an addiction, according to a Japanese doctor who has been treating patients with the disorder.

Like alcohol, tobacco or drug abuse, gambling addiction can hit anyone. People should not be considered bad, morally weak or lacking in self control, experts say.

“Anybody can develop a gambling disorder regardless of his or her social and economic background or age,” said Sachio Matsushita, deputy director of the National Hospital Organization Kurihama Medical and Addiction Center. But Matsushita added that there may be characteristic traits among such people, such as tendencies to be more laid-back or having a predilection for thrill-seeking.

Matsushita said one prevalent trait among “pathological gamblers” is an obsession for winning back money they lost in gambling through more gambling, unlike casual gamblers who usually stop when they are losing or set loss limits.

“In the worst case, pathological gambling could drive a person to suicide, as it causes financial problems,” said Matsushita. Others, buried deep in debt, end up turning to crime, he added.

There is no definitive cause for developing gambling dependency, but genetics, environment in upbringing and mental problems have been named in numerous studies as probable points of origin, according to Matsushita.

With an abundance of pachinko parlors dotting the landscape, Japan would appear to be a fertile ground for gambling addiction to take root.

In fact, a survey found that 700,000 Japanese adults were estimated to have suffered from gambling addiction in the past year, and about 3.2 million adults were estimated to have suffered from it at some point in their lives.

The nationwide survey was conducted on behalf of the government by the Kurihama Medical and Addiction Center, which specializes in treating various forms of addiction.

Referring to the survey results, Matsushita said, “The (gambling) environment in Japan can be considered distinctive, considering the high accessibility of pachinko parlors.”

Pachinko and pachinko-slot machines are legally categorized as gaming instead of gambling on the basis of the indirect way players turn their winnings into money. Balls won at parlors can be exchanged for gifts, which in turn can be exchanged for cash at off-site booths.

But the game is widely regarded as a form of gambling among the general public.

As part of its measures against pathological gambling, the government is considering capping online bets for racing events and creating a system to impose entrance restrictions at racing venues, based on requests from concerned individuals or family members. From February, it will place stricter limits that will lower the number of balls and medals pachinko and slot players are able to win.

At the Kurihama Medical and Addiction Center and elsewhere, cognitive behavioral therapy, invented by American Dr. Aaron Beck, is used in treating patients with gambling disorders.

In the treatment, which focuses on solving problems and initiating behavioral changes, patients learn methods of coming up with effective strategies for coping with gambling cravings and avoiding high-risk situations that might trigger compulsive behavior.

The treatment includes instructing patients to explore the positive and negative consequences of quitting gambling, identifying risk factors, and calculating the total amount of money spent on the past gambling, so that individuals can learn to identify and correct problematic behavior.

One Day Port’s Nakamura says managing life, work and leisure is the key to resolving gambling problems. The facility places emphasis on various problems people might have — gambling being just one of them. Whereas casual gambling might be advised for some, others are encouraged to go cold turkey.

Many people who seek support at the facility often suffer from more serious conditions, such as developmental disorders, he said, adding that the underlying disorders often drive them to gamble.

“In many cases, the people who gamble compulsively are diagnosed with other disorders or conditions that need addressing first, such as personality disorders, or borderline intellectual or developmental disorders, among others,” Nakamura said.

Kurihama Medical’s Matsushita suggested other facilities be involved to offer long-term support.

“People who are deeply involved with compulsive gambling tend to have other life issues, such as problems managing their finances, so it is difficult to complete treatment at hospitals alone,” he said.

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