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Q: What is problem gambling?
A: Problem gambling refers to any gambling that goes beyond "normal" bounds of gambling for fun, recreation, or entertainment. Pathological gambling is the inability, over an extended period of time, to resist impulses to gamble. It is often characterized by increasing preoccupation with gambling and a general loss of control. Pathological gamblers often "chase" their losses, feel a need to bet more frequently and in larger amounts, and continue to gamble in spite of the serious negative consequences of their behavior.

Q: Are pathological gambling and compulsive gambling the same thing?
A: Yes. Most scientists and mental health professionals prefer the term "pathological gambling" as the condition is not believed to be related to "compulsions" like excessive hand-washing. The term "disordered gambling" has often been used to describe this condition.

Q: Is someone who gambles a lot a pathological gambler?
A: Not necessarily. Many people who gamble frequently are simply people who enjoy gambling as entertainment. Generally these people set aside a predetermined amount of money for gambling, gamble for fun rather than for the "certainty" of winning, recognize that they are likely to lose, and don't bet more than they can afford to lose.

Q: Can you have a gambling problem without being a pathological gambler?
A: Much as it's possible to abuse alcohol without being an alcoholic, it's also possible to have gambling problems without being a pathological gambler -- someone can go out and lose a lot of money at a casino after being denied a promotion, for example. Often this sort of problem resolves itself without professional intervention. Pathology is determined by both severity and frequency of the problem.

Q: Are there phases to pathological gambling?
A: Dr. Robert Custer has identified three phases to pathological gambling.
• The adventurous phase -- marked by an increasing desire for gambling as excitement and often including a big win which the gambler sees as resulting from their personal abilities;
• The losing phase -- in which the gambler bets increasing amounts of money "chasing" the money they've lost;
• The desperation phase -- when gambling becomes a full-time obsession, the gambler increasingly gambles on credit, and takes greater and greater risks.
These phases do not represent an inevitable progression. Most people experiencing a big win do not become pathological gamblers, and some who begin to chase their losses stop before reaching the desperation phase. However, most of those seeking treatment have passed through the adventurous and losing phases and have reached desperation.

Q: How can I tell if someone is a problem gambler?
A:Some warning signs of a gambling problem might include:
• Looking for the "high" that comes from gambling
• Increasing isolation from family and friends
• Declining work performance
• Neglecting basic needs like money for food and rent
• Pressuring others for money as financial problems crop up
• Lying about how money is spent
• Escaping to other excesses (alcohol, drugs, sleep)
• Denying there is a problem
(Reprinted with permission from the Vanguard Compulsive Gambling Treatment Program, Granite Falls, Minnesota.)

In addition, Gamblers Anonymous has assembled a list of 20 questions which can help individuals determine if they might have a gambling problem. These questions should be considered as guidelines, however, and not a substitute for diagnosis by a competent therapist.

So do most gamblers eventually become problem gamblers?
No. For the vast majority of those who choose to gamble, it remains a harmless form of entertainment.

How many pathological gamblers are there?
No one knows for certain. Various methods for measuring the prevalence of gambling problems have been tried, each with their advocates and detractors. There is not agreement on the appropriate instrument to be used, on whether to consider behavior at any point in a person's life as opposed to their current condition, or at what level gambling becomes a problem. A 1998 report from the Harvard Medical School attempted to synthesize all studies done on problem gambling in the United States and Canada. Their best estimate was that 1.6 percent of the adults in both countries had experienced pathological gambling at some point in their life, while 1.1 percent had experienced it in the past 12 months. They further estimated that an additional 3.85 percent of adults had experienced mild to moderate problems with gambling at some point in their lives but had not progressed to the pathological level. More recently, the National Opinion Research Center of the University of Chicago recently completed the first-ever national (U.S.) survey on problem gambling prevalence. Conducted for the National Gambling Impact Study Commission, this survey used a different measurement tool than most of the studies included in the Harvard Medical School synthesis. It found that 0.9 percent of U.S. adults have met the criteria for pathological gambling at some time in their life, while 0.6 percent met the criteria in the past year. The survey also found that an additional 1.2 percent of adults had experienced moderate problems with gambling that did not reach pathological levels at some time in their life; of these, 0.4 percent experienced these problems in the past year.

Q: Who becomes a problem gambler?
A: Problem gamblers can be male, female, young, middle-aged, old, wealthy, poor, white, or people of color. The National Opinion Research Center study described in the last section found that young adults, ethnic minorities, and people with little education were slightly more likely to have serious gambling problems, but the differences were not very large.

Q: Can adolescents become pathological gamblers as well?
A: Yes. The National Opinion Research Center study found that 1.5 percent of 16 and 17 year olds could be considered problem or pathological gamblers, or about half the rate for adults. It is not yet known, however, to what extent adolescent gambling predicts problems in an adult.

Q: Is there a link between problem gambling and chemical dependency?
A: Yes. In several studies approximately 50 percent of problem gamblers were found to also have drug or alcohol problems, while studies of people in treatment for substance abuse have found between 10 and 30 percent also having a gambling problem. People may have both addictions simultaneously, or can switch from one addiction to another.

Q: Is pathological gambling associated with other mental health problems?
A: It appears that in many cases the answer is yes. Various studies have found high rates of alcoholism, depression, anti-social personality disorder, mood disorders, and other conditions in pathological gamblers, leading some researchers to suspect that problem gambling is often a symptom of an underlying condition. NASPL's problem gambling bibliography includes references to several studies done on this issue.

Q: Can problem gamblers be helped?
A: Yes. Studies have shown that treatment is effective in a great many cases. A wide range of programs exist, ranging from Gamblers Anonymous to inpatient treatment centers. There is no one program that is right for all people. If a treatment program hasn't worked for a particular individual, a different program may well succeed where others failed. Unfortunately, treatment programs are not equally available in all parts of North America. In the U.S., the National Council on Problem Gambling maintains a hotline (1-800-522-4700) that can help find appropriate and convenient treatment programs. The Canadian Foundation on Compulsive Gambling also maintains a helpline at 1-888-391-1111. Both numbers are available 24 hours a day 7 days a week.

Q: What types of gambling cause the most problem gambling?
A: Most researchers and mental health professionals believe that different types of gambling cannot be said to "cause" problem gambling. Dr. Durand Jacobs, for example, has written: "it appears that the addict's pursuit and over indulgence in alcohol, other drugs, food, gambling, sex, overwork, or whatever, is NOT the addicts "problem". On the contrary, a person's addictive pattern of behavior represents that person's best SOLUTION to the stresses generated by their long-standing underlying problems." Dr. Julian Taber has written: "Blaming alcohol or gambling for an addiction has important negative consequences. ... it allows the patient to focus on treatment and discharge plans that deal with everything except personal change."

That being said, problem gamblers are attracted to different forms of gambling for different reasons. Some are attracted to the sensory stimulation of video games of chance, while others to the perception of skill in cards or sports betting. Still others are drawn to the seemingly easy money of high-risk investments. Many, if not most, pathological gamblers indulge in more than one form of gambling, However, studies of pathological gamblers have found that the most frequently cited games of preference are slot machines, card games, and sports betting. A Minnesota study of 944 gamblers in treatment found that 37 percent listed slot machines as their preferred game and 37 percent listed cards. Lottery games, dice games, and games of skill were each cited by less than 1 percent of those in the study. (Stinchfield and Winters, 1996)

Q: So then what causes problem gambling?
A: This is another area in which research is still in its preliminary stages. Different researchers have suggested a number of character traits. Dr. Richard Rosenthal, for example, has cited three components he believes necessary: an intolerable feeling state, such as helplessness, depression, or guilt, a highly developed capacity for self-deception, and exposure to gambling under circumstances in which it is valued. Other researchers have suggested that physical or hereditary predispositions may play a role; these links have not been proven or disproven.

Q: Is it true that 40 percent of white collar crime is caused by pathological gambling?
A: This frequently quoted figure is attributed to a study by the "American Insurance Institute." However, there is no such study and no such institute. A recent Gaming Law Review article by Dr. Joseph Kelly discusses the origins and persistence of this particular myth.

Q: So is there a relationship between pathological gambling and crime?
A: Undoubtedly yes, though there is little hard information about the extent and nature of the link. Some pathological gamblers turn to crimes such as embezzlement or writing bad checks as their gambling losses mount. One Australian study showed about 36 percent of gamblers in treatment programs had committed crimes that they attributed to their gambling problem (Blaszczynski et al, 1989). However, a recent German study points out that in many cases the criminal behavior preceded the gambling behavior and points out that in at least some cases the factors predisposing one to an addiction may also predispose someone to criminal activity (Meyer, 1997). The link between pathological gambling and substance abuse and between substance abuse and criminal behavior further complicates this relationship.

Articles cited:
Blaszczynski, Alex, Neil McConaghy, and Anna Frankova (1989). Crime, Antisocial Personality and Pathological Gambling. Journal of Gambling Behavior Vol. 5(2), Summer 1989.

Jacobs, Durand F. (1998) An Overarching Theory of Addiction: A New Paradigm for Understanding and Treating Addictive Behaviors. Presented to the National Research Council, September 3, 1998.

Kelly, Joseph M. (1997) The American Insurance Institute, Like THAT Bunny, Keeps Going and Going and Going ..., Gaming Law Review: Volume 1, Number 2, pages 209-212.

Meyer, Gerhard (1997). Pathological Gambling and Criminal Behavior. Presented at the 10th International Conference on Gambling and Risk-Taking, Montreal.

National Opinion Research Center at the University of Chicago (1999). Overview of National Survey and Community Database Research on Gambling Behavior. Presented to the National Gambling Impact Study Commission.

Rosenthal, Richard J. (1993) Some Causes of Pathological Gambling. In Gambling Behavior and Problem Gambling, William R. Eadington and Judy A. Cornelius, eds., pages 143-148. Reno: Institute for the Study of Gambling and Commercial Gaming, University of Nevada, Reno.

Stinchfield, Randy and Ken C. Winters (1996). Treatment Effectiveness of Six State-Supported Compulsive Gambling Treatment Programs in Minnesota. Presented to the Compulsive Gambling Treatment Program, Minnesota Department of Human Services.

Taber, Julian I. (1993) Addictive Behavior: An Informal Clinical View. In Gambling Behavior and Problem Gambling, William R. Eadington and Judy A. Cornelius, eds., pages 273-286. Reno: Institute for the Study of Gambling and Commercial Gaming, University of Nevada, Reno.