by Kelly Field, Public Relations

Like most addictions, it begins innocently enough. A few poker games with the buddies. A vacation in Vegas.

But for compulsive gamblers like Jim and Mary, betting has become far more than a social diversion. It has become an all-consuming obsession.

First recognized in 1980 (American Psychiatric Association Diagnostic and Statistical Manual-III), compulsive gambling is a disorder of impulse control, characterized by a preoccupation with and need to engage in betting. Like drug and alcohol abusers, compulsive gamblers become dependent upon their addiction, and experience restlessness and irritability upon withdrawal from it.

“Like the rush felt by intravenous drug abusers, a win is instantaneously reinforcing to gamblers,” writes John Cusack, M.D., clinical director at the Center for Drug and Alcohol Programs at MUSC’s Institute of Psychiatry in “Insights about pathological gamblers. “....they often claim that betting is more exciting than alcohol, drugs, or sexual orgasm.”

Consider the case of Jim, a hypothetical compulsive gambler. For him, the addiction began with the weekly Saturday sojourn to the race tracks. He would drink a few beers, bet a few bucks, maybe win a moderate jackpot. As his wins accumulated, however, his betting extended to lotteries and casinos. He began to feel invulnerable and would brag about his “gift” to his friends. Calling himself a professional, he devised elaborate strategies to “beat the odds.” When the inevitable losses came, he considered them flukes, attributed them to “bad luck” and redoubled his efforts. His wagers increased exponentially, and soon he fell into horrible debt.

Like many competitive gamblers, Jim suffers from what psychologists call a self-serving attribution bias. Success is in his mind a matter of skill, and loss is a matter of luck. He feels exempt from the laws of the mathematical universe, and wagers increasingly large amounts in his conviction that he will ultimately prevail; His delusion is only reinforced by the occasional “grand” (big win).

“Gambling is a desire to control fate, and pathological gamblers forget that dice have no memory,” writes Cusack. “They gamble without defined goals, lose control, and do not know when enough is enough. Their hope is to change reality to fit fantasy.”

While researchers have yet to identify an addictive personality disorder that may predispose gamblers to excess, studies have found correlations between Diagnostic and Statistical Manual-III cluster B dimensions and gambling behavior. Specifically, people with narcissistic (egotistical, elitist, exhibitionist, exploitative, extroverted) and antisocial (sensation-seeking, delinquent, remorseless) tendencies were overrepresented among compulsive gamblers. These two groups differ from each other in that antisocial gamblers are typically rootless criminals, while narcissistic gamblers are often family persons with communal roots.

Cusack believes that the bells, whistles, and lights of slot and video poker machines may serve as secondary reinforcers for this latter group, whose sense of self-esteem is dependent upon winning.

“Studies have shown that the money is not the primary thing,” he said of the motivation to gamble. “It’s the high of their own adrenaline and the jingle jangle of the bells and lights.”

But while men, who make up roughly two-thirds of all compulsive gamblers, often seek omnipotence through betting, women like Mary, another typical recovering addict, are more likely to seek escape. Her goal is anonymity, and she prefers games of chance such as slot machines over games of skill such as cards.

“Women....are less preoccupied with action and excitement and tend toward slower-paced solitary gambling that offers jackpots....The progression from social to pathological gambling is typically swift and emotionally devastating in (this group).”

Characterized as a hidden disorder, on par with sexual addictions, compulsive shopping and thrill seeking, compulsive gambling is an elusive disorder. Seemingly innocuous at first, it can avoid detection for some time before being recognized by family and friends. As Cusack points out, however, it is ultimately just as debilitating than other, more conspicuous addictions.

“People think it’s harmless at first,” he said in an interview, adding in his article “In their downhill slide gamblers do not notice themselves crossing the boundaries separating social, problem, and pathological gambling. Personal insight into the destructive effects of uncontrolled gambling on social and occupational relationships often comes only after many bridges have been burned.”

Fortunately for gamblers like Jim and Mary, however, there is a treatment, and it’s generally quite successful. As with alcoholism and substance abuse, the therapeutic program is complete abstinence. Psychologists encourage patients to return to the honest life many abandoned during their disease, and offer them advice in restoring damaged relationships.

And because of the frequent co-occurrence of compulsive gambling with other psychiatric disorders (major depression, bipolar disorder, dysthymic disorder, etc.) and alcoholism (50 percent), psychologists will often treat the two disorders simultaneously. Support from groups such as “Gamblers Anonymous,” a 12-step, spirituality-based program resembling Alcoholics Anonymous, can be particularly helpful to recovering addicts. The program can help facilitate recovery by offering strategies for survival and by providing fellowship to fill the void left by gambling.

With time, Cusack says, compulsive gamblers often learn to focus on losses instead of wins. This represents a pivotal moment in the recovery process.

“You know they’re getting better when they start talking about losses instead of wins, when they stop focusing on the big fish, and start focusing on the lost lures.”

Psychologists use criteria to identify addiction

Do you think you or someone you know might have a gambling addiction? Here are the diagnostic criteria psychologists use to identify pathological gamblers. Presence of four or more criteria may indicate maladaptive behavior. Of course, an official diagnosis can only be made by a professional. Contact the Center for Drug and Alcohol Programs for a consultation: 792-5200. Or call (213) 386-8789 to locate the Gamblers Anonymous nearest you.

• Frequent preoccupation with gambling or with obtaining money to gamble.
• Frequent gambling of larger amounts of money or over longer periods of time than intended.
• Need to increase size or frequency of bets to achieve desired excitement.
• Restlessness or irritability if unable to gamble.
• Repeated loss of money through gambling and returning another day to win back losses (i.e. chasing).
• Repeated efforts to reduce or stop gambling.
• Frequent gambling when expected to meet social or occupational obligations.
• Sacrifice of some important social, occupational, or recreational activity in order to gamble.
• Continuation of gambling despite inability to pay mounting debts or despite other significant social, occupational, or legal problems that are exacerbated by gambling.