The Hidden Addiction

Problem gambling has received a great deal of attention recently. In June 1999 the Congressionally mandated National Gambling Impact Study Commission (NGISC) completed two years of deliberations and issued a report calling, among other things, for greater attention to problem gambling from the states (especially those operating lotteries and licensing and taxing casinos and race tracks). The gambling industry, especially the casino segment, has acknowledged that problem gambling is a by-product of gambling expansion and has begun promoting "responsible gaming." National television network programs dealing with problem gamblers and their families also have increased in frequency. Despite all this, problem gambling remains very much a "hidden addiction," despite the fact that it is every bit as real as an addiction to alcohol or other drugs.

The main concern of this article is identifying some of the reasons why problem gambling is a hidden or unrecognized addiction. But first, it is essential to explain what problem gambling is and just how prevalent it is. In doing so, we find that some of the factors contributing to the hidden nature of this addiction should become apparent.

Unfortunately, the terms "pathological," "compulsive," "disordered," and "problem" gambling are often used interchangeably to describe this addiction. Strictly speaking, pathological/compulsive/disordered gambling refers to gambling that meets at least five of the American Psychiatric Association's ten criteria for pathological gambling. (These criteria are presented in Table 1.) DSM refers to the American Psychiatric Association's Diagnostic and Statistical Manual, and "IV" simply refers to the fourth edition of the Manual.

The term "problem gambling" is often used in two different ways. It is used to refer to gambling in which people develop family, work, or financial problems as a result of their gambling but do not exhibit the extreme characteristics of pathological gambling. It also is used in a more inclusive way to capture both pathological/compulsive/disordered gambling at one extreme and any involvement with gambling that creates problems in people's lives at the other extreme. The distinction is similar to what we find in the area of alcoholism. Not all problem drinkers are alcoholics, but alcoholics certainly have a drinking problem.

What these terminology differences mean is that there is a range or, continuum of difficulties that some people get into with gambling. My own preference is to use the term "problem gambling" in the more inclusive way, and I will do so here except when quoting or referring to writing that uses other terms.

For the overwhelming majority of people who-gamble, it is a harmless recreational and leisure time activity. However, for some, gambling is a totally different experience.

The serious study of problem gambling is a relatively recent phenomenon. Since the early 1970s, research and clinical experience have come together to produce a fairly clear picture of problem gambling that fits an "illness model." Problem gambling has become "medicalized" in the sense that it is seen as a disease which is essentially an addiction. One of the pioneers in the study of problem gambling, psychiatrist Robert Custer, defined it as "an addictive illness in which the subject is driven by an overwhelming, uncontrollable impulse to gamble. The impulse progresses in intensity and urgency, consuming more and more of the individual's time, energy, and emotional and material resources. Ultimately, it invades, undermines, and often destroys everything that is meaningful in his life" (Robert Custer and Harry Milt, When Luck Runs Out: Help for Compulsive Gamblers and Their Families, New York: Facts on File Publications, 1985). Although no substance is involved, this could substitute for a definition of alcohol and other drug addiction. Others have described 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" (Richard J. Rosenthal and Henry R. Lesieur, "Self,Reported Withdrawal Symptoms and Pathological Gambling," American Journal of Addictions 1 [1992]: 150- 154). This, too, is fundamentally a defin, ition of an addiction.

Problem gamblers have an intense preoccupation with gambling. Their lives are focused on gambling, to the exclusion of other interests. They gamble more often and with more money than they intend, and they have great difficulty controlling the amount of money they wager or the amount of time they spend gambling.

Like people addicted to drugs, problem gamblers develop tolerance. They need to increase the amount of money wagered in order to achieve the desired excitement. They escalate from simple to "exotic" wagers, where both the risks and the potential winnings are great.

Problem gamblers also experience withdrawal symptoms when they attempt to cut back or stop their gambling. When they cannot get to a gambling venue, or when they do not have money with which to gamble, problem gamblers may get irritable, nervous, and restless.

Perhaps the most important thing that distinguishes problem gamblers from recreational gamblers is chasing. When they lose, compulsive gamblers chase their losses in an attempt to get even or win back what they have lost. When they lose, most recreational gamblers walk away from their losses without further consequences. Problem gamblers cannot do that. They make every effort to return as soon as they can (that is, as soon as they can get more money) to try to win back what they have lost.

Problem gamblers try to keep their gambling, and especially their losses and debts, a secret as long as possible. They construct elaborate lies to conceal their activities and related problems. A big part of this is lying to family and friends about their gambling activities, their losses, and their debts.

When their financial difficul, ties become severe, problem gamblers may engage in illegal activities to obtain money with which to gamble or to pay off gambling debts. Their debts create a situation where they constantly need money to pay off loans and continue gambling. In studies of 394 members of Gamblers Anonymous in Illinois, Wisconsin, and Connecticut, 57 percent admitted to stealing in various ways to finance their gambling (Henry R. Lesieur, "Testimony for Expert Panel on Pathological Gambling, National Gambling Impact Study Commission, Atlantic City, NJ, January 22, 1998). The total amount of money stolen was $30,065,812 for an average of $76,309. Committing crimes is often a matter of convenience, opportunity, or the ease with which money can be obtained. An employer's funds or a client's account are seen by the problem gambler as an easy solution to his or her problems. The most common crimes committed by problem gamblers are embezzlement, forgery, misappropriation of funds, and tax and insurance fraud. "White collar" crimes predominate, but robbery, burglary, shoplifting, and drug dealing also occur, although less frequently.

A number of other characteristics of problem gambling need to be noted. Problem gamblers have a high incidence of insomnia, intestinal disorders, migraine headaches, and other stress-related disorders. Depression is quite common. About three-quarters of members of Gamblers Anonymous have been diagnosed as suffering from depression by a mental health professional at some time in their lives. Whether they gamble to relieve depression (as the DSM-IV criteria suggest) or whether depression is a result of their gambling (indebtedness, marital conflicts, job loss) is an unresolved issue.

Members of Gamblers Anonymous report an attempted suicide rate about six times as high as that of the general population. One study of 162 members of Gamblers Anonymous found that while 13 percent had attempted suicide, an additional 21 percent had seriously considered it (Michael L. Frank, et al., "Suicidal Behavior Among Members of Gamblers Anonymous," Journal of Gambling Studies, 7, Fall 1991, 249253).

Problem gamblers also exhibit some distinctive personality characteristics. While these are found among many problem gamblers, it must be remembered that not every problem gambler will exhibit all of them or exhibit them in an extreme way. There is considerable "diversity" among compulsive gamblers. Some are "action seekers" drawn to gambling for the excitement it offers. Others are "escape gamblers" who use gambling as an escape from a variety of personal problems.