Gambling
When your gambling gets out of control, it can be extremely destructive and devastating both to you and those you associate with. Because a gambling addiction develops over time, you, your friends and family members may not notice that your behavior is compulsive or getting out of hand. However, just because you are gambling and like gambling a lot, does not mean that you are addicted to it. But there are ways to determine whether certain behaviors and activities related to your gambling suggest that you are enjoying a recreational activity or if your gambling has become a compulsive habit with potentially serious consequences. As an addiction psychologist and certified addiction counselor in Pennsylvania which surprisingly recently bested New Jersey in combined gambling revenue, many clients and patients come to us to find help sorting through the interrelated mental health issues that may fuel gambling behavior in order to determine whether they have a mild gambling problem, a major compulsive and pathological gambling disorder or just an expensive hobby that is all in good fun.
It’s rare but possible to develop a gambling addiction after your very first gambling experience. When problems do develop, they usually progress over time. Many people participate in social gambling for years with no problems. More frequent gambling or life stress can contribute to social gambling becoming serious problem gambling. Most casual gamblers can stop gambling when they have to because of losses; they can set a loss limit and easily follow it. People with a compulsive gambling problem feel strong urges to keep gambling to recoup their lost money. When gamblers are betting to chase losses things can tailspin out of control and gamblers can lose touch with reality and the disease can manifest in severe and exacting consequences. Over time, this issue can become more and more destructive. For many compulsive gamblers, gambling is about the thrill, not about the money. Many begin to take bigger risks and place larger bets to keep getting more of a thrill: This can take a financial toll. When a gambler is trying to recoup losses that is when lives can be destroyed. Many folks with whom I work recount that their bottom was when this shift happened and they realized that they were gambling in the hope that they could get back their losses. For them, this is when desperation set it whether they knew and understood what they were doing, how desperate they were or not, the elevator was descending down to the bottom and further to bottoms below those bottoms.
A gambling addiction, unlike many other drug or alcohol addictions, often has no obvious physical signs or symptoms that accompany this condition, and is referred to as a “hidden illness.” Many people with problematic gambling habits deny that they have a problem. They minimize the problem or refuse to admit that their gambling is out of control. They often gamble in secrecy; not allowing friends and family to know about their behavior. They may lie, keep secrets, sneak around, or completely withdraw socially. They do this to make it difficult for anyone to interfere with or confront them about their detrimental behavior. In the additive gambling treatment field we have an expression, “we are as sick as our secrets,” e.g., extra credit cards, hidden cash, unaccounted for time, lies about income etc.. An important part of recovery from a gambling disorder is to expose these secrets over time to the right supportive people at the right times. While a spouse or partner may want to know every single nitty gritty detail from one’s gambling addiction you have to decide when and where is the right time to talk about what happened so that the shame and guilt are not so overwhelming that they overtake you. A therapist is a great start and then meeting other recovering gambling addicts can be the perfect place to feel understood, supported and guided into long term recovery.
Just like substance abuse is characterized by uncontrollable urges to consume a particular substance, which causes negative consequences to the addicted person and those around the person; a gambling addiction is characterized broadly by tendencies to gamble in ways that cause damage to the person who is gambling and those associated with that person. The urge to gamble can be especially overwhelming during episodes of stress or depression. A person may use gambling as an unhealthy way to cope. As the problem develops and becomes stronger a gambler becomes overly-focused on gambling (gambling-seeking) and getting money to gamble.
Certain things may put you at greater risk for becoming addicted to gambling or having a harder time stopping. These include other behavior or mood disorders such as substance abuse (alcohol abuse is common), mood (often depression) or personality disorders or attention deficit/hyperactivity disorder (ADHD); age (younger and middle-aged); sex (men) (women usually start later in life and tend to have depression, anxiety or bi and can become addicted quicker, although these differences are disappearing; family influence (having a parent with a gambling problem increases your chances); certain medications such as those which treat Parkinson’s disease and restless leg syndrome (RLS), called dopamine agonists, have a rare side effect that results in compulsive behaviors, including gambling; certain personality characteristics like being highly competitive, a workaholic, restless or easily bored. These risk factors being so closely tied to mental and physical health are why meeting with an addiction psychologist or addiction certified psychiatrist is a good place to start the consultation and and treatment process.
The National Council on Problem Gambling, referring to a Harvard study, estimates that 2 million (or 1%) of U.S. adults meet the criteria for compulsive gambling in a given year. Another 4-6 million (or 2-3%) do not meet the full diagnostic criteria for compulsive gambling, but meet at least one of them and are experiencing problems due to their gambling behavior.
According to the DSM-5 (American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author), a diagnosis of gambling disorder is made when someone meets at least four of the following nine criteria in a 12-month period:
- Tolerance – Needing larger wagers to experience the same “rush” (similar to the “rush” felt by drug users).
- Withdrawal – Restlessness or irritability when attempting to reduce or cease gambling.
- Loss of Control – Repeated unsuccessful attempts cut down or stop on his/her own.
- Preoccupation – Frequent thoughts about gambling experiences; whether past, future, or fantasy.
- Escape – Gambling to improve mood or escape problems.
- Chasing – Trying to win back gambling losses with more gambling.
- Lying – Hiding the extent of the behavior by lying to friends, family, or a therapist.
- Risked a Significant Relationship – Gambling despite damaging or losing an important relationship, job, or other significant opportunity.
- Bailout – Turning to friends, family, or a third party for financial assistance resulting from gambling activities.
One caveat: A manic episode does not do a better job of explaining the gambling behavior. This just means that oftentimes manic behavior which is part of a bipolar or manic depressive disorder is another illness and needs to be ferreted out because one can be gambling as part of a manic episode and not really be a compulsive gambler so that if the manic episode is treated then gambling will be less likely. Again, be sure to consult someone with adequate training in mental health diagnoses to help you determine the ways in which mental health plays a role in your gambling.
Do I Have a Gambling Problem?
As with drug and alcohol abuse, it is often an indication that you have a problem if you are wondering whether you have a problem. If you are questioning whether you have a problem there is a good chance that you might have a gambling problem. Here are some things to consider: If you are losing time from your everyday activities because you are gambling or thinking about gambling; spend more time gambling than you intended to; are gambling to escape worries or stave off boredom or loneliness; or spent money you needed to pay your bills, rent, food, or other expenses; you most likely do have a gambling problem. Are your friends and family expressing concern about you? They might be recognizing the ways in which your gambling is affecting you and them before you are aware of the situation yourself. The sooner you seek help and treatment, the less damage to your finances, relationships, and work you will have to repair. Would you like to stop? The first steps to getting well are to accept that you have a progressive illness and to want to get well. It is so much easier to change when we want to at least just a little bit and so much harder to change when we have to.
Gamblers Anonymous (www.gamblersanonymous.org) has 20 yes/no questions known as “20 Questions: Are you a compulsive gambler?” You can answer them and get results, talk to someone immediately, or learn where there are nearby meetings.
Quitting for a while or taking a break is a good indication that you have control over your gambling. It’s possible for some compulsive gamblers to go into remission where they gamble less or not at all. Without professional treatment though, they will usually relapse. I often have patients who attempt to prove to themselves and others that they have control by taking a break only to return with a vengeance long after they have convinced themselves comfortably that they don’t have a problem.
With Atlantic City casinos constantly in the news now one wonders whether gambling disorder itself may be falling on hard times. Atlantic city used to be the second-largest gambling location until a few years ago. It now trails behind Nevada and Pennsylvania. The city started 2014 with 12 casinos but may have 8 by now and its revenue in 2013 was nearly half of what it was in 2006. But part of this trend is explained by more gambling halls opening in the northeastern United States; Pennsylvania surpassed New Jersey’s total casino revenue in November 2011 and in combined gambling revenue for 2012 and 2013. More casinos seem to be opening up in our backyards, in our home town and yours. A Pennsylvania legislature recently concluded that Philadelphia can accommodate still more additional casinos.
Like other addictions gambling disorder seems to wax and wane or come and go just as different drugs of choice become more in vogue depending on the zeitgeist. Many of our clients seeking help for addiction like to think of their compulsive behavior as the whack a mole game people play at a carnival. You can whack the mole here but it’s connected to something else and it will pop up again. It might pop up as a different gambling game, drug use, alcohol use, shopping or food addiction but no matter how hard you whack it there is a risk that it will pop up again. So whether it pops up in Atlantic City New Jersey or Philadelphia Pennsylvania gambling is here to stay and so too is addiction. We must learn to live with these tendencies and become curious about how they work and what purpose they serve for us as individuals, our cultures and society. This is how we can know when we are suffering and learn how to help ourselves and those about whom we care and love.
Gambling Screens
The South Oaks Gambling Screen (SOGS)
The South Oaks Gambling Screen (SOGS) was developed by Henry Lesieur, Ph.D., and Sheila Blume, M.D., to evaluate pathological gambling addiction.
Gambling Screens – Adolescents
The South Oaks Gambling Screen – Revised for Adolescents (SOGS-RA)
A gambling assessment for adolescents authored by Randy D. Stinchfield, Ph.D.and Ken Winters, Ph.D. Includes scoring instructions.
Personal Accounts
My Son’s Gamble (Lucy Ferriss, The New York Times Magazine, 6/24/09)
The author relates how her son dropped out of college to devote more time to online and professional face-to-face poker playing and her process in coming to terms with his decision.
Expressions of Addiction (Howard J. Shaffer, Ph.D., C.A.S., 2006)
Photographic exhibit with stories of each person featured. Shaffer is a professor and clinician as well as a photographer. After clicking on individual pictures, click on “next expression” underneath the picture, and you will be able to read their full story and see additional pictures.
Other Articles
Internet Gambling Stays Low Among Youth Ages 14 to 22 But Access to Gambling Sites Continues; Sports Gambling Makes Resurgence (Annenberg Public Policy Center, 11/26/08)
Results of a National Annenberg Survey of Youth.
Betting on a Cure (Mary Carmichael, Newsweek, 6/25/08)
Research on drugs that could block gambling addiction.
Center for Current Research: The Compulsive Gambling File
Compiles abstracts on different subjects (in this case, gambling) from the National Library of Medicine which patients can use to either find the whole article or bring to their doctor on a type of treatment or prevention that they’re interested in. Their doctor may have access to the full-text article.
Consults Blog: Seeking Help for Gambling Addiction (The New York Times, 11/01/10)
Dr. Timothy Fong, co-director of the gambling studies program and an associate professor of psychiatry at the University of California, Los Angeles, responds to questions about gambling addiction including treatment options.
Hit Me Again! The Gambling Brain (Begley, Sharon, Newsweek, 05/11/10)
This article focuses on a study at the University of Cambridge which tested the brain’s reaction when playing a slot machine. The study found that not only wins activated the brain’s reward system, but so did near-misses. Since the surge in dopamine is similar with a win and a near-miss, the study suggests an explanation for how near-misses are a powerful tool used to keep people gambling.
Website Blockers and Self-Exclusion
ProblemPoker
A filtering service that blocks all wagering websites.
Optenet PC
Gambling website filter.
Pennsylvania Gaming Control Board: Compulsive and Problem Gambling: Self-exclusion Program
The self-exclusion program is a voluntary program that allows a person to be banned from all licensed gaming facilities in Pennsylvania and from collecting any winnings, recovering any losses, or receiving any gifts, services, or anything else of value from these facilities for 1 to 5 years. Self-exclusion for other states and casinos must be done individually by contacting the states and/or casinos you wish to be banned from. There is no uniform or national program.
New Jersey Casino Control Commission: Problem Gambling: Self-exclusion
Self-exclusion from all Atlantic City casinos. Can be for 1 year, 5 yrs, or lifetime.
Delaware Video Lottery Facilities: Self-exclusion
Self-exclusion from all Delaware Video Lottery Facilities. Can be for 1 year, 5 years, or lifetime.
Resources
Gamblers Anonymous
Self-help organization for compulsive gamblers. Phone: 213-386-8789
Gambler’s Anonymous is a 12-step, community based support group for those with gambling addictions and they offer a comprehensive online quiz for anyone questioning whether or not their gambling habit has become problematic.
Their quiz can be accessed by following this link: http://GamblersAnonymous.org/gna.html
Gam-Anon
Self-help organization for spouses, family and close friends of compulsive gamblers. Phone: 718-352-1671
National Council on Problem Gambling
National advocacy, research, treatment, and resource clearinghouse. They have state affiliates and offer a 24-hour helpline in each state where there are affiliates as well as a national number: 800-522-4700. For Pennsylvania: 800-848-1880.
Council on Compulsive Gambling of Pennsylvania
Pennsylvania affiliate of the National Council on Problem Gambling. Aims to educate and disseminate information and help with referrals. Also provides speakers, workshops, seminars, and information to business, industry and labor groups, schools and colleges, healthcare and treatment facilities, and community and religious organizations.
Pennsylvania Department of Health, Bureau of Drug and Alcohol
Has a 24-hour hotline: 877-565-2112 which refers gamblers to local Gamblers Anonymous meetings and one-on-one counseling, if available in their area. Has links to self-exclusion from Pennsylvania gaming facilities, treatment providers, and information.
Gambling Behaviour Self-Study Workbook (Responsible Gambling Council, Addictions Foundation of Manitoba, n.d.)
Designed to help you look at your gambling behavior, decide if it is a problem for you, manage finances, identify patterns and triggers, and develop new behaviors and make permanent changes to replace gambling.
Massachusetts Council on Compulsive Gambling: Prevention Resource Library
Extensive catalog of literature that can be ordered in various media (pamphlets, posters, CD-ROMs, and more).
National Center for Responsible Gaming
National organization exclusively devoted to funding research that helps increase understanding of pathological and youth gambling and find effective methods of treatment for compulsive gambling. Although most of the NCRG’s materials have a scientific, technical focus, some of the publications, including these monographs, may be useful to the layperson as well as the clinician.
UCLA Gambling Studies Program
The UCLA Gambling Studies Program (UGSP) is devoted to understanding pathological gambling, its causes, natural history, cultural factors, and the obstacles to successful treatment. The mission of the program is to translate research findings into cost-effective, evidence-based methods of prevention, education, and treatment.
Intervention
Mayo Clinic: Intervention: help a loved one overcome addiction (Mayo Clinic Staff, Aug. 27, 2009)
Yeah, yeah, I know there is that show on A&E, but I want more information on how to do one of my own. This tells you exactly how to do it, including when you can I do it yourself, and when you need a professional, and how to find one.
Videos
Gambling Addiction
In this video from Britain’s National Health Service a young man named Jake describes his struggles with gambling addiction and experts explain how a gambling problem is just as serious as a drug or alcohol problem.
NIH On the Inside: Gambling Addiction
This video aimed at teenagers from the National Institutes of Health discusses gambling addiction and why teenagers are more likely to take risks.
Audio
How Gamblers Lose Track of Time
Radio interview with Dr Jeremy Frank on NPR/WHYY by Maiken Scott on how gamblers can lose track of time and the devastating consequnces that can ensue following several incidents at the Parx Casino where parents left children in cars unattended while the parent gambled for hours.