Pathologic Gambling

For most people, gambling is a social activity done with family or friends for recreation, and lasts for a limited time. An acceptable amount of money that can be lost is predetermined and that amount is adhered to. For these individuals gambling is a recreational event . However, recent studies show that about 2.5 million Americans are pathological gamblers and another 3 million Americans are problem gamblers. Broadening the diagnostic criteria 15 million Americans adults are at risk for problem gambling. Legalized gambling is available through multiple forms from soft gambling (lotteries and bingo) to resort casinos, urban/suburban casinos, race tracks, the stock market, sports betting, and the newest form of ultra-convenient gambling (interactive television, mobile phone, or internet gambling). Illegal gambling is harder to pin down. A few decades ago, Nevada was the only state where you could legally gamble. Now only two states, Utah and Hawaii, are without some form of legalized gambling. The lifetime prevalence rate for pathological and problem gambling is estimated as 1.2 percent and 1.5 percent, respectively.

What is Pathologic Gambling?

Pathological gambling (ludomania) relates to a relentless urge to gamble despite harmful negative consequences or a desire to stop the gambling behavior. Pathologic gambling is also referred to as "compulsive gambling" or a "gambling addiction". These diagnostic terms are used to describe gambling behaviors which causes significant disruption in an individual's psychological, physical, social, financial, or vocational functioning. Pathological gambling is a progressive addiction characterized by an increased preoccupation with gambling, a need to bet more money more frequently, restlessness or irritability when attempting to stop gambling, "chasing" losses, and a significant loss of control of gambling activities despite negative consequents.

Gambling Facts to Ponder

  • About 86% of Americans have gambled during their lives.
  • 60% of Americans gamble in a given year.
  • The amount of money wagered annually in the United States is estimated to be about $500 billion.
  • Casino gambling (often referred to as "gaming") had gross revenues of $84.65 billion in 2005.
  • The American Psychiatric Association says between 1% and 3% of the U.S. population is addicted to gambling, depending on location and demographics.
  • Youth have even higher addiction rates, between 4 an 8%.
  • Pathological and problem gamblers in the United States cost society approximately $5 billion per year, and an additional $40 billion, in lifetime costs related to productivity reductions, social services, bankruptcy, and health care. Each compulsive gambler costs the economy between $14,006 and $22,077 per year.
  • About 80% of pathologic gamblers seriously consider suicide, and 20 to 30% actually attempt or succeed in killing themselves.
  • Nevada has been the highest in the nation for suicides for 10 of the last 12 years
  • Gambling addiction rates double within 50 miles of a casino
  • Rates of past-year job loss are twice as high in individuals with a pathologic gambling disorder
  • Rates of having filed for bankruptcy are four times as high individuals with a pathologic gambling disorder

Pathologic Gambling as a Mental Illness

The American Psychiatric Association (APA) classifies compulsive gambling as an impulse control disorder. Other impulse control disorders include pyromania and kleptomania. Compulsive gamblers simply cannot control the impulse to gamble, even when they know that their gambling is hurting themselves and their loved ones. Pathologic gamblers will keep gambling whether they're up/down, broke/flush, happy/depressed. Forensic studies have also confirmed that pathologic gambling is a brain disease similar to other types of addictions such as alcohol or substance dependency. The part of the brain that is most affected in compulsive gambling is the nucleus accumbens which is related to the pleasure center. Dopamine plays a role in developing any addiction. Brain cells release dopamine as part of the reward system through which you learn to seek pleasurable stimuli, such as food and sex. Imbalances in two other brain chemicals, serotonin and norepinephrine (adrenaline), are additional biologic factors in compulsive gambling.

Additionally, individuals with a pathological gambling disorder have a high rate of co-morbidity rate for additional mental health disorders (depression, bipolar disorder, anxiety, personality disorders, and other impulse control disorders) and substance abuse. In fact, a major depressive disorder is likely to occur in ¾ of all pathologic gamblers.

Diagnostic Criteria for Pathologic Gambling

To meet the American Psychiatric Association's PA's diagnostic criteria for compulsive gambling, a person must show persistent gambling behavior as indicated by at least five of the following criteria. If an individual meets 1-4 criteria they are considered problematic gamblers.

  1. Being preoccupied with gambling (for example, reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
  2. Needing to gamble with increasing amounts of money to achieve desired excitement.
  3. Having repeated unsuccessful efforts to cut back or stop gambling.
  4. Being restless or irritable when attempting to cut down or stop gambling
  5. Gambling as a way to escape problems or to relieve a dysphoric mood (feelings of helplessness, guilt, anxiety, depression).
  6. After losing money gambling, often returning another day to get even ("chasing" one's losses).
  7. Lying to family members, therapists or others to conceal extent of involvement with gambling.
  8. Having committed illegal acts, such as forgery, fraud, theft or embezzlement, to finance gambling.
  9. Having jeopardized or lost an important relationship, job, or educational or career opportunity because of gambling.
  10. Relying on others to provide money to relieve a desperate financial situation caused by gambling.

Becoming a Compulsive Gambler

Compulsive gamblers fall in love with the excitement and action of gambling. Four phases of compulsive gambling have been identified; winning, losing, desperation, and hopelessness. At first, during the winning phase, the gambler is often successful. This success leads to fantasies of further successes; and resultant wealth, power, and prestige. They are certain they know how to beat the system. Their self-esteem becomes centered on being smarter or luckier than the average gambler.

Inevitably the compulsive gambler suffers financial losses which eventually lead to a damaged ego. In an effort to maintain their self-esteem they begin to rationalize losses and may blame others. During the losing phase the pathologic gambler becomes more preoccupied with gambling. He begins to gamble alone, borrow money, skip work, lie to family and friends, and default on debts. This is the point in which pathologic gamblers begin to "chase" their losses; gambling in order to win back money that was lost, "I'll get even tomorrow." This chasing behavior is a defining characteristic of the pathological gambler. Thus, a vicious cycle has begun; chasing leads to more gambling and additional financial losses. The gambler attempts to determine his handicapping abilities to assure that losses will be minimized. If the gambler has run out of money for "the chase", he now begins to tap into savings or to borrow money. The more money that is spent or borrowed is again reflected in a belief that the only way to recoup or pay off debts is to gamble even more. Loans are due, bookies are seeking payment, and the entire situation begins spiraling out of control. Those who have jobs may embezzle from their employer. Others may make fraudulent loan applications or insurance claims. Many will resort to theft for the money. Initially, the pathologic gambler rationalizes these crimes. He will repay it all... it is just a loan... he really isn't a criminal. A cycle of tapping all resources, pawning items, taking out loans, embezzlement, theft, lies, rinse, and repeat ensues.

During the desperation phase pathologic gamblers lose all control over their gambling. Desperate gamblers see heightened gambling activity as the only chance for survival. Although desperate gamblers feel ashamed and guilty after gambling, fundamentally they cannot stop. They frequently resort to illegal activities to finance their addiction. At this point, the consequences of compulsive gambling invariably catch up with them; they get fired, divorced, forced into bankruptcy, or arrested.

In the hopeless phase the pathologic gambler literally hits rock bottom. They lose all hope and belief that anything or anyone can help them. They do not care if they live or die, they consider or attempt suicide. They abuse drugs and alcohol to dull the pain, to escape. Essentially, they give up. They are basically forced into a corner; social isolation, death, incarceration, or treatment.

Additional Risk Factors for Pathologic Gambling

The growth of riverboat and Indian casinos, state and national lotteries, and Internet access to offshore sports/parlor betting has dramatically increased gambling access for all Americans. You do not have to leave the chair you are perched at to make a bet, make a killing, or lose it all.

Factors that increase risk for pathologic gambling:

  • Age: There is an increased risk of pathologic gambling with individual who begin to gamble at a young age. Pathologic gambling usually begins in early adolescence in males. Additionally, older adults may be the most vulnerable age group to pathologic gambling considering their dependence on fixed incomes.
  • Gender: Men are more likely than are women to develop a gambling addiction. Pathologic gambling is typically a problem of men between 21 and 55 years of age. Onset for females is between ages 20 and 40 years in females.
  • Location: People who live close to a casino are twice as likely to develop a gambling problem as are those who live farther away.
  • Family influence: 50% of the children of pathological gamblers become pathological gamblers themselves.
  • Substance Abuse: People who are alcohol or substance dependent have pathological gambling rates ranging from 13-33%.
  • Military: Pathological gambling is significantly more prevalent among military veterans than in the US general population and has been associated with combat-related posttraumatic stress disorder. Studies have shown that 20% of veterans have problematic gambling.
  • Medications used to treat Parkinson's disease: Studies have identified a link between the use of dopamine agonists and the onset of compulsive gambling.

Pathologic Gambling and Crime

There is an irrefutable correlation between pathologic gambling and criminal behavior. A study by the U.S. Department of Justice demonstrated that 30% of pathologic gamblers arrested in Las Vegas had committed a robbery within the past year; 13% had assaulted another individual. The motive was simply to obtain money to pay for gambling, or gambling debts. Studies by Gamblers Anonymous members are even more troubling. 67% admitted to committing crimes or civil fraud to finance their gambling or to pay gambling-related debts. 47% admitted to having engaged in some form of insurance fraud, embezzlement or arson. Not surprisingly, pathological gamblers are much more likely to have sold drugs than other arrestees.

Comparing crime rates for murder, rape, robbery, aggravated assault, burglary, and motor vehicle theft reveals Nevada is the most dangerous state to live in the United States. Nevada also rates as the number one state for suicides, divorce, prostitution, women killed by men, and gambling addictions. It rates number three in high school dropouts, poor mental health and alcohol related deaths. Additionally, it rates number four for bankruptcies and deaths from firearms.

Treatment for Pathological Gambling

Like other impulse control or addictive disorder pathological gambling is a treatable disease. Treatment for people with pathological gambling begins with recognizing the problem. Because pathological gambling is often associated with denial, people with the illness often refuse to accept that they are ill or need treatment. Most people with pathological gambling enter treatment under pressure from others. Treatment for problem gambling involves cognitive and behavioral therapy; 12 step-based programs (Gamblers Anonymous), self-help, and peer-support. Psychotropic medications to treat pathologic gambling include: antidepressants (Paxil, Zoloft, Prozac, Celexa, Luvox, Lexapro), opioid antagonists (Nalmefene), and mood stabilizers (Lithium). A combination of treatment modalities is fundamentally optimal.

If You Suspect That Someone You Care About Has a Gambling Problem

  • Remember that gambling is an illness, do not judge them.
  • Confront them with the issue.
  • Be honest about how the gambler's behavior makes you feel.
  • Discuss treatment options.
  • Hold problem gamblers responsible for their actions including the consequences. Do not bail them out financially, emotionally, or legally.
  • Protect yourself emotionally, get counseling or join a support group such as Gam-Anon
  • Do not blame yourself for the gambler's problems.
  • Stop enabling, cut off the gambler's money supply.
  • Protect yourself financially; take over the family finances, review bank and credit card statements, request credit reports from the three main credit bureaus, monitor Internet use to see if the person is gambling online.
  • Assess for suicidal thoughts, if you believe the individual is suicidal call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK.

Betting on a NFL game or on the ponies does not constitute pathologic or problematic gambling. Nor does a trip to Las Vegas or Atlantic City with family, buddies, or peers for general debauchery and a chance to win back your airfare indicate you may have any mental health disorder, including compulsive gambling. However, if you think that you or someone you know may have, or at risk for, a compulsive gambling problem you may want to take (or offer) a self test. If you believe you are at risk, the simplest solution is to avoid places, people and things that will trigger a compulsion to gamble. Always gamble with others, never alone. Set limits on how much time and money you spend on gambling. Utilize self-control methods, links are provided below. Remember that virtually everyone who gambles loses money in the long run. If you bet more than you can afford to lose, you may have a problem. The good news is there are solutions, treatment and hope.