For most people, gambling is a social activity done with family or friends for recreational enjoyment, and it is time limited. An acceptable amount of money that can be lost is predetermined, and that amount is adhered to. However, according to the National Council on Problem Gambling, an estimated 2 million Americans, or about 1% of the population, are pathological gamblers. An additional 2-3 percent%, or 4 to 6 million people, would be considered problem gamblers; people whose gambling affects their everyday lives. Broadening the diagnostic criteria 15 million Americans adults are at risk for problem gambling. The lifetime prevalence rate for pathological and problem gambling is estimated at 1.2% and 1.5%, respectively.
Legalized gambling is readily available through multiple forms: 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.
What is a Gambling Addiction?
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
- Over 80% of American adults gamble on a yearly basis.
- U.S. land-based casinos are expected a gross $357 billion from gamblers this year.
- An estimated $95 billion will be gambled, mostly illegally, on NFL and college football this season
- The American Psychiatric Association says between 1% and 3% of the U.S. population is addicted to gambling.
- Youth have even higher addiction rates, between 4 an 8%.
- The likelihood of developing a gambling addiction increases 23X for people affected by alcohol use.
- 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.
- 80% of those with a gambling addiction consider suicide, while 1 in 5 actually attempts it.
Gambling Addiction as a Mental Illness
American Psychiatric Association (APA), through the "The Diagnostic and Statistical Manual of Mental Disorders V", classifies compulsive gambling as an addictive disorder; previously in was considered an impulse control disorder. 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. Pathological gambling is significantly more prevalent among military veterans than in the general population and has been associated with combat-related posttraumatic stress disorder. Studies suggest that 20% of veterans have problematic gambling.
The Process of Gambling Addiction
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 may need to resort to criminal 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 nothing 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.
Gambling Addiction and Crime
There is an irrefutable correlation between pathologic gambling and criminal behavior. On average, an estimated 50% of those affected by gambling problems commit crimes in order to support their addiction. 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.
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 programs. Psychotropic medications to treat pathologic gambling include antiseizure medications (Tegretol, Topamax); mood stabilizers (Eskalith, Lithobid); medications used to address addictions (Naltrexone); and antidepressants (Anafranil, Luvox). 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 and respond appropriately.
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. However, if you think that you or someone you know may have, or at risk for, a gambling problem or addiction take action. 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.
Pamela Kulbarsh
Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.
