VIII. Why do People Gamble Too Much?--Pathological and Problem Gambling

To many people, gambling is a simple form of entertainment. But to some others, it becomes an uncontrollable behavior. Many terms are used to describe a person who has a problem with gambling, including pathological gambler, gambling addict, compulsive gambler, or problem gambler. All of these terms are used to describe a person for whom gambling has become more than an innocent diversion.

Some of these terms lack specific meaning. This report will follow the literature and use "problem gambling" to mean an umbrella term to describe a situation where gambling activity 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 is a term with 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 gambling behavior with damaging personal, social and financial effects. Very often, the pathological gambler suffers from legal problems. Because the gambler is losing control it is referred to by mental health practitioners as an impulse disorder. Pathological gambling is a progressive disease, meaning that the symptoms will get worse over time. Mental health professionals see it as a complex disease often seen in conjunction with other disorders including depression and chemical dependency.

Graphic Stories Exist of Those Whose Lives Were Destroyed by Pathological Gambling. The media readily tells the tales of those whose lives were destroyed by their uncontrollable gambling. These are some stories that have been pulled from press clippings:1

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 Missouri.2

Describing the behavior is much simpler than explaining why the problem gambler persists in behavior which is so damaging.3 There are several models that are used to describe the problem gamblers.

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 has written the official medical definition, defines 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."4

The results can be quite devastating. The disorder is incapacitating. The pathological gambler is unable to maintain solvency or provide basic support for themselves or their family. Further, as noted in the American Psychiatric Association description of the condition, "When the individual's borrowing resources are strained, the person may resort to antisocial behavior to obtain money."5 That is a vague medical term for theft, embezzlement, fraud, and other crime. A significant percentage of pathological gamblers have a second addiction to drugs or alcohol.

Pathological Gambling Recognized as a Medical Problem. In 1980, the American Psychological Association included pathological gambling in their Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). By including pathological gambling, it gave official medical recognition as a disease. Pathological gambling is also identified as a disease by the World Health Organization.

Since 1980, the definition of pathological gambling has undergone some major changes. At first, the emphasis was on the damage and disruption caused by the disease. The motive was of little importance. Subsequent versions have changed this description and revised the diagnostic criteria for pathological gambling, emphasizing the addictive nature of the disease. It mentions issues concerning tolerance and withdrawal, suggesting a physiological basis for the disorder. In the case of the pathological gambler, tolerance refers to their increasing need for gambling and usually gambling with greater risks to get the same emotional effect. As with chemical dependency, withdrawal refers to the pain and discomfort associated with not practicing the behavior.

According to the latest version of the manual, DSM-IV, a person who exhibits at least five of the following behaviors may be a pathological gambler:6

Researchers consider pathological gambling an invisible problem with symptoms that are hard to distinguish from non-pathological gambling.7 This contrasts with drug or alcohol addiction where there are obvious symptoms of intoxication. Further, individual cases will vary greatly.8

Who is Most at Risk For Becoming a Pathological Gambler? Research has shown that there are factors that increase the risk of being a pathological gambler. Surveys of pathological gamblers show a greater proportion of:9

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 end up in treatment.10

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 Indicate That There is a One to Five Percent Incidence of Problem Gambling in the Adult Population.11 Specifically, the studies usually show the following results:

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.12

One of the most comprehensive research projects on compulsive gambling prevalence was conducted by Rachel A. Volberg with funding by the National Institute of Mental Health.13 In this study, randomly selected individuals in five states were interviewed by telephone, using a survey instrument that detects pathological gamblers. California was one of the five states surveyed. There have been surveys of other states.

Prevalence over Lifetime

       
 

Total

Problem Only

Pathological

California, 1990

4.1

2.9

1.2

Average of 13 States

3.9

2.5

1.3

 

Current Gambling Problems

       
 

Total

Problem Only

Pathological

Average of 6 States

2

1.3

.7

Controversy Exists Over the Accuracy of the Surveys. The survey instrument used is the South Oaks Gambling Screen (SOGS). This survey instrument is a twenty-item scale that was derived from the diagnostic criteria for pathological gamblers published in DSM-III.14 Critics of the SOGS say that the instrument is too broad and vague, and it overstates the persuasiveness of the problem.15 They point out that one incident of an argument with a spouse and some remorse over losses from exceeding gambling limits can lead to a positive result on the screen. The potential for false positives may be increased because gambling may be more likely to lead to occasional problem elements by normal individuals.16 In other words, there may be some low or occasional incidence of distress that cannot truly be considered problem or pathological, but does result in a positive score according to the test.

Another criticism is that the screen doesn't accurately detect problem gambling in the young. The screen was developed from response and behavioral patterns of adult pathological gamblers. There is also a concern that it based on the criteria in the DSM-III, not the DSM-IV. Those that use the screen retort that it is accurate for many different groups.17 The screen is in the process of being updated to the new DSM-IV definitions.

Some critics argue, however, that the screen doesn't detect enough problem gamblers. Some observers are concerned that researchers can't realistically conduct phone surveys of problem gamblers. They point out that problem gamblers are at the clubs or afraid to answer the phone because the gamblers don't want to talk to somebody they owe money.18 Another point of interest is that there is a large rate, 27 percent in the California study, of people who refuse to answer a telephone survey. That is similar to other telephone surveys regarding sensitive questions.19

Controversy Exists Regarding Whether Prevalence Studies Suggest a Link Between Pathological Gambling and Legal Gaming. Results of the Volberg study suggest that problem gambling is a greater problem in those states where legal wagering has been available for some time.20 This conclusion is arrived at by comparing rates in different states. Drawing conclusions from comparisons of one state over time or a cross-sectional study of multiple states is difficult. Such comparisons are based only on the prevalence rates and not by looking at population differences that could explain the different rates.

Another way that prevalence studies attempt to shed light on the same question is by conducting the studies over time. In South Dakota, prevalence studies show that despite the legalization of casinos, the prevalence did not change in a statistically significant way over time. A study in Iowa came to quite different conclusions. It showed a dramatic increase from 1.7 percent in 1989 to 5.4 percent in 1995.

Mental health professionals who treat pathological gamblers tend to believe that legalization leads to increased compulsive gambling.21 The DSM specifically notes that the onset of pathological gambling can result from greater exposure to gambling.22

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 was predisposed to have a drinking problem, but never came into contact with alcohol, she or he would not become an alcoholic. The pathology of their predisposing factors may still cause some damage to them and others. They might also be some other kind of addict, but they would not be an 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 that legalization leads to greater acceptance of gambling and greater exposure for the average person.23

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.24 They refer to these as the "crack cocaine of gambling," because of the low cost per wager and their rapid play.25 This connection is disputed. Those disagreeing point to survey results from South Dakota. The amount of video lottery sales in the state increased, but prevalence of gambling problems remained unchanged.26

Regardless of any possible links, legal gambling probably cannot be blamed for all pathological gambling. Research in Texas before the lottery began operating showed that a small percentage of Texas had gambling problems.27 Conversely in Louisiana, a recent study showed a very high rate of gambling problems and that problem gamblers tended to spend more than those in other states.28 Louisiana has a great deal of accessible legal gambling.

If gambling were prohibited, would problem gambling stop? Probably not. According to Jean Falzon, 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."29

Social Costs in California Could Easily be $5 Billion. The following table shows how the cost estimates are derived, and shows social costs that range from $1 billion to $10 billion. These are derived from cost estimates from other states and prevalence studies both from California and other states. It is not known with accuracy either the social costs or the actual number of problem gamblers. Hence, the table presents a range. The social costs per pathological gambler are in the low range as other studies have shown costs as high as $50,000 to $80,000 per gambler.

Estimated Social Costs of Pathological Gaming in California

Percentage and Number of Pathological Gamblers

Cost Per Pathological Gambler

Total Cost

.5

105,000

$8,000

$844 Million

$15,000

$1.6 Billion

1

210,000

$8,000

$1.7 Billion

$15,000

$3.2 Billion

1.5

316,000

$8,000

$2.5 Billion

$15,000

$4.8 Billion

3

633,235

$8,000

$5.0 Billion

$15,000

$9.5 Billion

Source: California Research Bureau

The social costs of pathological gambling are explained in more detail in the economics chapter.

The State of Florida estimated that crime and social costs attributable to casinos would total $2 billion at a minimum. For California, with slightly over twice the population, the total would then exceed $4 billion, a figure in line with the above estimates.

Pathological Gamblers Play a Number of Different Games. Surveys have shown that some play a number of games. A study in a state with casinos showed that the majority of problem gamblers were having problems with non-casino gambling, including the state lottery.30 The study also looked at the reasons that people called a help-line. Among these, a small majority said their problem was related to casino gambling. But, significant numbers said that their problem was lotteries or sports and race betting.

There are Two Main Types of Pathological Gamblers. With so many different types of gambling opportunities, the course of the disease can be broken into two types:

Pathological Gambling and Gamblers Exist Outside of Gaming Establishments. One article points to Donald Trump and Robert Maxwell.31 Both men were gambling that their empires would emerge unscathed from the challenges they faced. Both men gambled incorrectly as subsequent events have shown. They are identified because of the nature and size of the risks they took. Experts in pathological gambling point to some of the more notorious financial market trading scandals as evidence of pathological gambling outside of gaming establishments.32

Resources for Treating Problem Gamblers Have Grown. Historically, problem gambling was regarded as an individual failing rather than as a medical or social problem.33 As such, little treatment was available.

The original treatment for problem gamblers was Gamblers Anonymous. It is also known by the shorthand GA. GA was established in 1957 and until the 1970's, it was the only treatment program in the United States for problem gamblers. The program of Gamblers 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.

Since its Inception, the Number of Gamblers Anonymous Chapters Has Grown Rapidly. In 1960, there were 16 chapters in the U.S. This number grew to 130 in 1970, and by 1988, 600 chapters existed.

The National Council on Compulsive Gambling (now called the National Council on Problem Gambling) was founded in 1972. The first inpatient treatment program for compulsive gambling was established at the Veterans Administration Hospital in Ohio in that same year.

With the inclusion of pathological gambling in the DSM-III in 1980, people started to look at this problem as a disease, and paid more attention to treatment. There were an increasing number of treatment programs for compulsive gambling. Some programs were established by state legislatures in response to concerns voiced by the opponents of legalized gambling. There are also a number of private practitioners whose private practices are focused on compulsive gamblers. Generally, treatment is modeled on the treatment of alcoholism and other drug addictions. That consists of 12-step programs, behavioral modification and counseling, including individual, group, and family therapy, although, a review of the literature shows that a variety of treatment forms have been tried, including electric shock treatment and aversion therapy.

Treatment is complicated by the nature of the disease. Addicts are in denial of their disease, hence 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. The employer can be a valuable tool in requiring an employee 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 that they have a problem.

Another complicating factor is that 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 health insurance it may cover alcohol or drug treatment but only rarely gambling.

Effectiveness Rate of Treatment is Not Accurately Known. Although individual pathological gamblers can be quite successfully treated, little is known about the effectiveness of treatment programs. Self-help programs such as GA don't keep track of their success. One study showed that 8 percent of the members haven't gambled two years after joining the program. It is likely the effectiveness is greater because some members take longer than two years to completely refrain from gambling. When GA is combined with outpatient and/or inpatient treatment, the success rate is thought to be more like 50 percent.34 However, many members leave GA because they don't want to abstain or they have difficulty with the concept of admitting a lack of control and having to decide to turn their life over to a power greater than the individual.

There is a school of researchers that argue that prevention is much more cost-effective, because of the high treatment costs and the uncertain success. Prevention programs include public awareness advertising and programs in the schools to make individuals aware of the disease. Again, despite the questions about the overall success rate, clinicians describe the disease as very treatable for any particular individual who has the appropriate motivation and receives the proper treatment.

Very Small Minority of Pathological Gamblers Seek Treatment. Although accurate figures are not known, the consensus of researchers is that it is a small minority. The best estimate for the population of Gamblers Anonymous is about 80,000. There are about 1 to 2 million pathological gamblers in the United States. A much smaller number gets professional treatment without going to GA.

One gambler who did seek treatment was Chet Forte, who was better known as the director of "Monday Night Football." He also was producer-director of the 1984 Olympics. Mr. Forte won 11 Emmy awards. But he also gambled away nearly $4 million including his million-dollar home. He was spared from prison only because the judge recognized his cooperation and his efforts in gaining treatment for his gambling addiction. According to press accounts, he paid back his debts, including back taxes, and continued attending Gamblers Anonymous meetings up until his untimely death from a heart attack in May 1996.

Some States Have Directed Significant Resources to the Problem. California is not among their number. Some examples include Texas where the agency that administers alcohol and drug abuse programs also has a gambling responsibility. The agency sponsored a pathological gambling prevalence survey in Texas. Massachusetts funds the Massachusetts Council on Compulsive Gambling with unclaimed lottery winnings. The State of Texas contributes to the Texas Council on Problem and Compulsive Gambling. Other states have sponsored extensive prevalence studies or provided funds directly for treatment and public education. Some states fund their programs through a portion of the lottery proceeds or fees on gaming activities.

The Gaming Industry Has Responded to the Issue of Problem Gambling. Though there is debate over the prevalence of problem gambling, the industry generally accepts that there are problem gamblers. Some gaming companies are participating in programs aimed at educating the public about problem gambling and providing information about the help that is available to those who need it. But participation is far from uniform. One observer has characterized the industry as doing surprisingly little.35

There are different approaches to educating the public about problem gambling. Toll-free help-lines have become popular and one can see posters or stickers with the 1-800 number posted in casinos. Public service announcements on television and radio have also become popular. These announcements are often sponsored by the casino industry or a specific casino company.

While the industry is taking some responsibility and has been an active participant in the education effort, it does not feel its responsibility extends to treatment. The industry view is that pathological gambling should be treated like any other medical condition. Individual members of industry may have donated to charitable organizations that promote the counseling and treatment of problem gamblers.

Could casinos do more? One researcher noted that it is possible that seasoned casino personnel can be quite effective in identifying pathological gamblers. However, once a pathological gambler is identified it is not clear what is the appropriate response. Industry action is complicated by the concern that a gambler may walk down the street to a competing casino or facility.36

There are Regulatory Strategies That Might Reduce Pathological Gambling Problems. The situation is quite different in European countries than in the United States. In Europe, individuals can request to be banned and even family members can request that an individual not be allowed in the casino. Some areas go so far as to prohibit locals from entering casinos.

The British experience with casinos provides an interesting contrast. This discussion is drawn from an article by the noted University of Nevada researcher Dr. William Eadington.37 British casinos are run on a club basis with members and guests as the only allowed patrons. Credit is not granted and alcohol is prohibited. There is not any advertising for the general public. Casinos are required to provide printed material to advise patrons of wise gambling strategies.

Pathological Gamblers Leave High Costs in Their Wake. People seek treatment for compulsive gambling, but not just because of the losses they run up. Pathological gambling is not just a problem of lost money. Compulsive or pathological gamblers seek treatment when other addicts do, when their life is an absolute mess and they can't take it anymore. Mental health professionals point to factors such as widespread borrowing, deception, and crime making the lives of pathological gamblers uncontrollable. Reportedly, a large number of compulsive gamblers are involved in white-collar crime. Not surprisingly given the pathological gambler's need for funds, a significant proportion of those incarcerated may be pathological gamblers.38

These problems don't even begin to detail the impact of their behavior on their family, including children. In other words, pathological gambling is not victimless. Research has shown that children of pathological gamblers had a variety of problems and were much more likely to be abused. In the parlance of the mental health professionals, "Children of pathological gamblers show more signs of serious psycho-social maladjustment."39

Asians and Native Americans (as well as the young) have been identified as being particularly sensitive to pathological gambling problems.40 Another study identified the elderly, the poor, minorities, and housewives.41 Asians have been identified because gambling is a more accepted part of their culture and participation tends to be much higher. The young are at risk because of their immaturity, which can lead to excess.42 Those involved in treating pathological gamblers also note large numbers of senior citizens, although this may reflect their high participation rate in gambling.43

Underage Gambling Shows Worrying Trends. Some who are concerned about the issues say that gambling-related problems are overtaking drug addiction as the most prevalent problem among teenagers.44 Surveys among young people show that a very large number gamble. The surveys show that about 80 percent responded that they have gambled by the time they were 15.45 Approximately one-eighth of the nation's compulsive gamblers are teenagers.46

An alternate point of view is that young people engage in a variety of experimental behavior of which gambling is but one example, and can be viewed as relatively normal.47

A survey of teenagers in New Jersey showed that 64 percent of high school students had gambled at the casinos.48 As reports note, there are tragic stories behind the figures:

A recent story that received considerable press attention involved three students at a New Jersey high school who ran a betting ring. They were charged with extortion, kidnapping and terrorists threats. The ring came to the attention of authorities when they kidnapped a 14-year old student who owed $500. The student was dropped off at a housing project. The ring took in $5,000 to $7,000 per week.

Many played games that were illegal for minors to play and a significant number also bet on sports. Problem gambling counselors find this pattern of behavior worrying because it is illegal, hence it may have implications for those caught and convicted. Second, gambling among minors may lead to increased levels of problem gambling when they become adults.49 A significantly larger percentage of pathological gamblers than the population as a whole report starting when they were young. At least some mental health practitioners view problem gambling, like alcoholism, as a family disease.50 That is, there is a definite link between parental problem gamblers and their dysfunctional household and a higher level of addiction in their children, including pathological gambling.

The prevalence studies seem to show a consistently higher rate for youthful gambling than adults.51 One study of college students showed that 87 percent had gambled at some point, 26 percent gambled weekly, and 11 percent said they had gambled more than $100 in one day. In that study, 5.7 percent were pathological gamblers, a higher figure than that found in adult prevalence studies.

There is some question about the actions taken by regulators and the casinos to deal with the problems of underage gambling. Although there are figures on the thousands of underage patrons that were turned away or escorted from a casino, according to one researcher, no casino has even been fined for allowing minors to gamble.52 His article is several years old, however, and there are recent press reports of such fines, but it is not know how widespread they are.

Recent Louisiana Study Showed High Proportion of Young Problem Gamblers. The study released in July of 1996 showed that one in seven state residents between the ages of 18 and 21 are problem gamblers.53 The rate was three times the adult rate. Technically these are not underage gamblers, because 18 is the legal age for most gambling in Louisiana. They are also not yet pathological gamblers.

Legal Treatment of Pathological Gambling Varies. Despite the recognition of pathological gambling as a medical condition, it is specifically excluded from the Americans with Disabilities Act. It is at least theoretically possible that a pathological gambler could claim disability under social security. Such a claim would not likely be for the gambling itself, as it isn't clear how that would make an individual disabled and unable to work. However, the gambling would probably be an indicator of another disorder. Many pathological gamblers also suffer from another mental illness.

California law has protected the pathological gambler by not allowing enforcement of the collection of gambling debts. The reasoning of the Supreme Court in a recent case was that, "...the law should not invite them to play themselves into debt. The judiciary cannot protect pathological gamblers from themselves, but we can refuse to participate in their financial ruin."54

The liability of gaming proprietors is largely unexplored. The courts have been quite ready to hold dispensers of alcoholic beverages liable for damages to third parties from accidents caused by drunk drivers. There have not been any lawsuits yet for third-party damages from pathological gamblers, but the analogy has not been lost on observers.

Test for Gambling Addiction

If you answer yes to any of these questions, you might reconsider your gambling, according to experts on problem gambling.

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