Gambling and Disordered Gambling: Column by Howard J. Shaffer, Ph.D., C.A.S.

The World Series is over, and soon it will be time for the Super Bowl. No single event is more associated with betting than the Super Bowl. In addition to office pools, many American businesses promote their products using this remarkable sporting event – in fact, the Super Bowl has become a premier advertising event. Gambling on sports and other activities can be an entertaining and exciting experience. However, most people are just becoming aware that gambling also can produce a wide array of adverse consequences. The study of gambling-related disorders is growing rapidly. Gambling studies have attracted scientists of every stripe. For the first time in history, the National Academy of Sciences issued a report on pathological gambling. A report to Congress from the National Gambling Impact Study Commission and a review of this work by the General Accounting Office also brought important attention to the potentially troubling consequences of disordered gambling [1-3].

Gambling activities have been understood from a variety of perspectives, including moral, mathematical, economic, social, psychological, cultural and, more recently, biological. Some people tout excessive gambling as a compulsive disorder. Others view it as an addiction. The American Psychiatric Association views intemperate gambling as an impulse disorder [4]. Far too many people still see at as a moral weakness. Considerable research will be necessary to distinguish the psychiatric elements of gambling disorders from other compulsive behaviors, such as pathological shopping. Recently, author and psychotherapist Adrienne Baker noted that when Richard Rosenthal described pathological gambling, he could have been writing about "addictive shopping." Rosenthal noted that gambling "'…serves multiple defensive functions. There is an illusion of power and control as a way of defending against depression and loss… It may be utilized as a method of self-cure in the struggle to maintain a precarious sense of identity'" [Rosenthal, 1997, p. 209, cited in 5, p. 23]. Both Baker and Rosenthal are correct. This description depicts pathological gamblers and shoppers. Are these disorders the same or distinct? More research will be needed to answer this question.

What we do know about gambling is growing very rapidly. For example, my colleagues and I have been studying the prevalence of gambling disorders in the United States and Canada [6, 7]. Taken from our recent work, past year rates (and 95 percent confidence intervals) for adults from the general population are summarized in the table on the following page [7].

In the table above, Level 3 gambling represents the most serious form of gambling disorder, technically considered as pathological by the American Psychiatric Association. Level 2 represents the prevalence of gambling that produces symptoms, but not a sufficient cluster or intensity of symptoms to warrant a diagnosis of pathological gambling. Level 1 gambling represents the prevalence of gambling without any adverse symptom. As you can see from the table, among adults from the general population, the rate of serious and sub-pathological gambling is almost 4 percent. The prevalence of gambling-related problems among young people significantly exceeds the rate of gambling problems among their adult counterparts. Epidemiological research shows that the rate of disordered gambling among adolescents and college students is two to three times higher than that for adults. Minority youth experience even higher rates of disordered gambling. Psychiatric patients, substance abusers and criminals have a lifetime prevalence rate of level 2 and 3 gambling disorders that is about 30 percent.

Gambling and excessive gambling have been around for a very long time. Fleming [8] provides an accessible and fascinating history of gambling. He reminds us that early gambling involved flipping coins. The earliest dice were called astragals or knucklebones (made from the anklebones of sheep). Games of chance and dice playing were most popular among the Roman ruling class, but not limited to them.

Pathological gambling reflects a "pure" addiction, untainted by psychoactive substances. For example, among pathological gamblers who stop, 30 percent to 50 percent report experiencing withdrawal symptoms. These symptoms are similar to those experienced by people in withdrawal from narcotic or stimulant drugs. Starting to gamble again can make these symptoms of withdrawal go away. Gambling is more similar to drug addiction than you might imagine.

Both behavior patterns having a history that extends many thousands of years; clinicians have noticed that both drug addiction and excessive gambling similarly can destroy the fabric of families. The presence of these addictive behaviors breeds an atmosphere of uncertainty, anxiety, distrust, and hopelessness. Disordered gamblers and people with drug addiction usually fail to recognize the extent to which their behavior is the cause of their day-to-day problems. In fact, they often escape into gambling or drugs as a response to personal distress.

Regardless of the myriad reasons for gambling, there are a variety of ways of stopping gambling.

In my next column, I will examine how to screen for gambling disorders; later, I will consider the available treatments and self-help options.

Suggested Readings

1. National Gambling Impact Study Commission, National Gambling Impact Study Commission Report. 1999, National Gambling Impact Study Commission: Washington, D.C.

2. National Research Council, Pathological gambling: a critical review. 1999, Washington D.C.: National Academy Press.

3. General Accounting Office, Impact of gambling: economic effects more measurable than social effects. 2000, United States General Accounting Office: Washington, D.C. p. 67.

4. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders-Text Revision. Fourth ed. 2000, Washington, D.C.: American Psychiatric Association.

5. Baker, A., ed. Serious shopping. first ed. 2000, Free Association Books: London. 254.

6. Shaffer, H.J., M.N. Hall, and J. Vander Bilt, Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis. American Journal of Public Health, 1999. 89: p. 1369-1376.

7. Shaffer, H.J. and M.N. Hall, Updating and refining meta-analytic prevalence estimates of disordered gambling behavior in the United States and Canada. Canadian Journal of Public Health, 2001. 92(3): p. 168-172.

8. Fleming, A.M., Something for nothing: a history of gambling. 1978, New York: Delacorte Press.