By Bobbe McGinley, MA, MBA, LISAC, NCGC II, CADAC
Virtually every major culture that exists in recorded history exhibited some manifestation of gambling. Whether it was ancient card games in China or dice-based gambling in the Roman Empire, gambling has been around for a long time. In many ancient cultures gambling was seen as a reasonable method of bloodless conflict resolution. A legend exists that around the year 1000 A.D. the King of Norway and King of Sweden peacefully settled a territorial dispute based on a few rolls of dice.
Fast forward to today, as the theme this year for the National Council on Compulsive Gambling in Washington, D.C. is “Problem Gambling: Have the Conversation,” and that is my intention here.
For many people gambling is a simple form of entertainment, to others — it becomes an uncontrollable behavior. It can start so innocently. You had a little bet on the big game and lost, or overspent a little on the horses. So, you tell yourself, “So what, I won’t do it next time.” But the fact is, for some what starts out as a harmless dabble, quickly grows into an obsession.
Many terms are used to describe a person with a problem from pathological gambler, gambling addict, compulsive gambler, to problem gambler. All these words can describe anyone when gambling becomes more than an innocent diversion.
‘Problem gambling’ will be used in this article as an umbrella term to describe a situation where gambling disrupts one’s life, but the extent of the disruption is not defined. Problem gambling includes pathological gambling, which is a more severe condition and has a specific medical meaning.
Pathological gambling is recognized as a medical disorder by the American Psychiatric Association and has elements of addiction similar to alcohol and drug addiction. It describes a gambler who loses control over this behavior with damaging personal, social and financial effects. Very often, the pathological gambler suffers from legal problems. Because they are losing control it has been referred to by mental health practitioners as an impulse disorder. Pathological gambling is a progressive disease, meaning the symptoms will get worse over time. Mental health professionals see it as a complex disease often in conjunction with other disorders including depression and chemical dependency.
Mick, Sarah and Ian know what it’s like to lose control. They all reached the point when gambling ruined their lives. They know what it’s like to lose everything, from family and friends, to money, possessions, dignity and self-esteem. Ian says an addiction to gambling is like an allergy. “For people who may be allergic to bees, they won’t go sitting near a beehive, I’m allergic to gambling.”
Graphic stories exist of lives destroyed by pathological gambling, and the media readily tells the tales. Examples like these:
Tragic examples such as these receive an enormous amount of publicity and are often used by anti-gambling groups to fight the spread of legalized gambling. Industry observers credit attention from these stories as blocking laws that would have relaxed betting limit regulations in some states.
Describing the behavior is simpler than explaining why the gambler persists in such damaging behavior. There are several models used to describe the problem gambler. Mental health professionals prefer the term “pathological gambling” because it stresses the disease aspect of the issue. Pathological gambling is a progressive and chronic disorder that is clearly distinguished from social gambling.
Psychiatrist Richard J. Rosenthal, who wrote the official medical definition, defined it as: “a progressive disorder characterized by a continuous or periodic loss of control over gambling; a preoccupation with gambling and with obtaining money with which to gamble; irrational thinking; and a continuation of the behavior despite adverse consequences.”
The results can be quite devastating. The disorder is incapacitating.
Most pathological gamblers are unable to maintain solvency or provide basic support for themselves or family. When their borrowing resources are strained, they may resort to antisocial behavior to obtain money — theft, embezzlement, fraud and other crimes. In Omaha, a Catholic nun was accused of taking more than $250,000 from the Archdiocese and gambling it away. She was sentenced to 20 years in prison. A significant percentage of pathological gamblers also have a second addiction to drugs or alcohol.
In recent years the definition of pathological gambling has undergone major changes. At first, the emphasis was on the damage and disruption caused by the disease and the motive was of little importance. Subsequent versions have changed this description and revised the criteria for pathological gambling, emphasizing the addictive nature of the disease. It mentions tolerance and withdrawal, suggesting a physiological basis for the disorder. In the case of the pathological gambler, tolerance refers to the increasing need for gambling and usually gambling with greater risks to the same emotional effect. Those who have chemical dependency, withdrawal refers to the pain and discomfort associated with not practicing the behavior.
According to the (The Diagnostic and Statistical Manual of Mental Disorders) DSM-5, persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, is indicated by someone exhibiting four (or more) of the following in a 12-month period:
Needs to gamble with increasing amounts of money in order to achieve excitement.
Is restless or irritable when attempting to cut down or stop gambling.
Has made repeated unsuccessful efforts to control, cut back, or stop.
Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
Researchers consider pathological gambling an invisible problem with symptoms hard to distinguish from non-pathological gambling. This contrasts with drug or alcohol addiction where there are obvious symptoms of intoxication. Research has also shown there are factors that increase the risk of being a pathological gambler. Pathological gamblers show a greater proportion of:
These findings are from prevalence surveys, NOT from studies of who is in treatment. White middle-aged males are the pathological gamblers most likely to seek help.
Researchers have been less successful in determining what causes problem gambling and what the differences are between problem and normal gamblers. There are many people who have a variety of risk factors but don’t become problem gamblers. Studies show there is one to five percent incidence of problem gambling in the adult population. Studies usually show the following results:
Over their lifetime, about 1 to 5 percent of the population are problem gamblers. This includes individuals currently experiencing problems as those who may have experienced problems in the past.
Subsets of problem gamblers, a group that may be as large as one to three percent of the total population, are pathological gamblers. This figure is the most recent encyclopedia of mental illnesses, but there remains some dispute over the actual level.
These incidence figures are surveys for the adult population as a whole. The rate of compulsive gambling among teens may be higher, reaching seven to eleven percent.
Mental health professionals who treat pathological gamblers tend to believe legalization leads to increased compulsive gambling. The DSM specifically notes that the onset of pathological gambling can result from greater exposure to gambling.
Counselors form this belief based on their experience and the nature of addiction. They tend to hold the view that some people may be predisposed to an addiction. If a person were predisposed to have a drinking problem, but never came into contact with alcohol, they would not become an alcoholic. The pathology of their predisposing factors may still cause some damage to themselves or others. They might also be some other kind of addict, but not alcoholic. In the same way, a person with a predisposition to problem gambling may not see it manifested until access to gambling becomes available. Another element of this is legalization leads to greater acceptance of gambling and greater exposure for the average person.
This behavioral pattern occurs because pathological gambling is a problem of impulse control. The more accessible gambling is, the harder it is to maintain the control. Despite the logic of this line of reasoning, there are no prevalence studies that prove the notion that expanded gambling will lead to increased problem gambling.
Another theory of problem gambling counselors is that electronic games such as slots and video lottery terminals are especially addictive. They refer to these as the “crack cocaine of gambling,” because of the low cost per wager and their rapid play. This connection is disputed. Those disagreeing will point to survey results from South Dakota. The amount of video lottery sales in the state increased, but prevalence of gambling problems remained unchanged.
Regardless of any possible links, legal gambling probably cannot be blamed for all pathological gambling. Research in Texas before the lottery began operating showed a small percentage of Texas had gambling. In Louisiana, a recent study showed a very high rate of gambling problems and problem gamblers tended to spend more than those in other states. Louisiana has a great deal of accessible legal gambling.
If gambling were prohibited, would probably gambling stop?
Probably not. During Prohibition, did drinking alcohol stop?
According to Keith Whyte, executive director of the National Council on Problem Gambling, “Problem gambling is going to exist despite the availability of legalized gambling or the lack thereof. Many problem and compulsive gamblers have problems with sports betting which is predominantly illegal in this country.
With so many different types of gambling opportunities, the course of the disease can be broken into two types:
Historically, problem gambling was regarded as an individual failing rather than as a medical or social problem. As such, little treatment was available. The original treatment for problem gamblers was Gamblers Anonymous. It is also known by GA. GA was established in 1957 and until the 1970’s, it was the only program in the U.S. for problem gamblers. The program of Gambler’s Anonymous is based upon Alcoholics Anonymous. AA is a spiritual program that uses twelve steps as a guide to help program participants recover from alcoholism and its effects. GA uses the same basic twelve steps for treating uncontrolled gambling. The program is supported entirely by member contributions. The only requirement for membership is a desire to stop gambling.
Like alcoholics, GA members attend meetings and talk of their experiences. GA members believe that they cannot control their gambling and must abstain. They learn to avoid gambling establishments and also learn that gambling won’t solve their problems. For the problem gambler, the fellowship of GA represents a source of comfort, friendship, and social activities rather than turning to gambling.
The National Council on Compulsive Gambling was founded in 1972. The first inpatient treatment program for compulsive gambling was established at the Veterans Administration Hospital in Ohio that same year. There are a number of treatment programs for compulsive gambling and ACT-Counseling & Education was the first in Arizona to provide treatment for gamblers with a contract established by state legislatures in response to concerns voiced by the opponents of legalized gambling.
Treatment consists of 12-step programs, behavioral modification and counseling, including individual, group, and family therapy. Yet, treatment is complicated by the nature of the disease.
Addicts are in denial of their disease and they cannot be relied upon to accurately report their condition. Many GA members were in therapy prior to joining GA, usually for depression, anxiety, and marital conflict, but their gambling problem was not admitted, recognized or discussed. Employers can be a valuable tool in requiring an employee to receive treatment. But because gambling is a disease that involves loss of control over money, any pathological gambler who is handling money is especially reluctant to let their employer know they have a problem.
Another complicating factor is pathological gamblers often don’t have insurance to cover treatment. Many are having financial and employment problems so they don’t have health insurance. If they have insurance it may cover alcohol or drug treatment but only — rarely gambling. If a gambler is not aware of what their state may offer for prevention, education and treatment, they take that much longer before seeking any type of help or treatment for themselves or family members.
Pathological gamblers can be quite successfully treated, if they have a desire to learn to do something different, especially when the treatment is combined with GA.
Unlike alcohol, drug or nicotine addictions, gambling is tolerated, even encouraged by society and the government, who depend on its revenue. “Our society promotes gambling; it just seems like every thing today is a gamble, and it is minimized so easily,” said recovering gambler, Jane. “But it is such a contradiction because an addiction is an addiction is an addiction.”
Jane has been involved in Gamblers Anonymous since she hit a painful financial bottom in 2003. “It’s been the demise of a lot of people. I’ve come across people who have committed suicide or gone to prison,” she said. The devastation is huge. I had a great career, home, wonderful husband and three children. I begged, borrowed and stole to feed my addiction to slot machines. Sure there were times that I won but even when I did, it didn’t stop me from playing the machines more and more. I rarely left a casino with anything in my wallet.
She continues to make progress with her recovery thanks to the support of her therapist and involvement in GA. “The cure, in my life, is GA,” she said. I will always get the occasional trigger, but I also understand I have to make a choice.”
If you or someone you know needs help contact, National Problem Gambling Helpline, 1-800-522-4700, AZ Office of Problem Gambling 1-800-NEXT STEP, (1-800-639-8783) or ACT Counseling & Education, 602-569-4328.
Bobbe McGinley has worked in the field of Chemical Dependency for 27 years, and with Problem and Compulsive Gamblers and their families since being certified by the Arizona Council on Compulsive Gambling, Inc. and is Nationally Certified. She is founder of ACT-Counseling & Education, a licensed out-patient program with three Valley offices. She is contracted with the Department of Gaming, Office of Problem Gambling to provide services for problem gamblers, their families and provides training for professionals. She is a National Speaker and known expert and consultant on Problem Gambling.
In addition, she co-founded PITCH4KIDZ, a non-profit organization providing positive interventions targeting communication and healing for children ages 6-12, of alcoholic and drug addict parents/care givers, and is Executive Director of Recovery in the Pines and Recovery in the Desert, Christian extended care facilities for men and women. For more information visit www.actcounseling.com or call 602-569-4328
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