American Medical Association Family Medical Guide - American Medical Association [477]
Pathological Gambling
Legal gambling has become one of the fastest-growing industries in the United States and is more widely accepted than ever before. The proliferation of casinos and state lotteries has generated a steady rise in problem gambling nationwide. Pathological gambling—irresponsible, uncontrolled betting—sometimes is referred to as a gambling addiction but, although it shares some symptoms with alcoholism and substance abuse (see previous article), doctors categorize it as a disorder of impulse control.
Estimates of the number of pathological gamblers in the United States range from 3 million to 10 million. Up to 8 percent of adolescents may be affected. Most problem gamblers are men, but about one third are women. The problem usually begins in adolescence in males and somewhat later in females. Gambling problems affect people in all segments of society but are more prevalent among the poor and the uneducated, perhaps because they see no other way of achieving the affluence they are exposed to around them and in media images.
Problem gambling seems to result from a combination of genetic and environmental factors. Some psychiatrists believe that compulsive gambling is learned behavior that is reinforced by intermittent, random winning, a form of reinforcement known as operant conditioning. This type of conditioning is very difficult to overcome, even when the reward (winning) is removed by losing.
Compulsive gamblers often have other, concurrent mental disorders, including depression (see page 709), panic disorder (see page 719), and substance abuse. Up to 20 percent have attempted suicide. About half of all people who gamble heavily also have an alcohol problem.
Symptoms
The most common characteristics of pathological gambling are:
• A preoccupation with gambling that includes reliving past gambling activities, planning the next bet, or finding ways to obtain money for gambling
• Needing larger bets and more frequent betting to maintain interest, and not being able to quit while ahead
• Lying to family members and friends to conceal problem gambling
• Repeated failed attempts at stopping
• Intolerance of losing, leading to attempts to win back losses
• Restlessness, irritability, and physical symptoms when gambling is unavailable
• Selling personal property or committing illegal acts to finance gambling
Men who have a gambling problem share some personality traits. They are usually highly competitive, energetic, easily bored, easily angered, and seek the approval of others. They also have problems delaying gratification, tend to bend the rules, and rebel against authority. Some pathological gamblers say that they feel secure only when they are gambling, and many construct a dream world in which they fantasize about providing themselves and their friends and family with a luxurious lifestyle as an escape from the difficulties of real life. Women, on the other hand, tend to gamble to escape feelings of depression.
Financial, marital, employment, and legal problems are common among people who gamble heavily. During the periods between gambling sprees, pathological gamblers often experience nervousness, irritability, insomnia, frustration, and indecision, symptoms resembling those of withdrawal from alcohol or drugs.
Diagnosis
Your doctor will ask you about your gambling behavior. If he or she identifies at least four of the characteristics described above, your gambling is likely to be a problem.
Treatment
The recommended treatment for most pathological gamblers is similar to that of alcohol and drug addiction—group therapy in a structured rehabilitation