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Monday, September 17, 2012

A Roll Of The Dice: Pathological Gambling An Impulse Control Disorder


The very simple definition of the word gambling is: "the act or practice of risking the loss of something important by taking a chance or acting recklessly." If you pull apart this definition then you can determine that taking a gamble can be one specific act or be a repeated practice. For example, if you witness a horrific event, you might gamble your own life to save the life of another. In a case like this, if you take the chance you are often called a hero; however, if, on the other hand, you engage in dangerous behavior repeatedly in a cavalier manner, then chances are, sooner or later, you are going to endanger yourself or another. When we discuss pathological gambling, we are usually talking about betting: betting on cards, horses, sports games, slot machines, lotteries to the point of risking everything.

Gambling: A look back in America

There was a time in our recent history that the only place that one could legally and openly engage in gambling was to take a trip to Las Vegas, Nevada. And since Las Vegas is located in the western part of the United States most people might never have found the time or means to make such a trip. Following prohibition and the start of building of the Hoover Dam in 1931, the State of Nevada determined that gambling could be profitable for local businesses and the state legislature legalized gambling in 1931 with the first gambling license issued in 1931 and US Route 95 was extended into south Las Vegas. 

And so it went until 1978 when Atlantic City, New Jersey, in an effort to revitalize the economy, on May 26, 1978, the first legal casino opened in the eastern part of the United States. This followed the citizens of New Jersey approving legal gambling for Atlantic City in 1976.

In 1988 the United States government passed the Indian Gaming Regulatory Act which, according to Wikipedia, "recognized the right of Native American tribes to establish gambling and gaming facilities on their reservations as long as the states in which they are located have some form of legalized gambling." Again this act, like the laws that helped establish legalized gambling in Las Vegas and Atlantic City, was a way of "generating revenue for the tribes, encouraging economic development of these tribes."

Also, government sponsored lotteries actually came on to the scene as early as 1934 in Puerto Rico. It was not until 1964 that the first state run lottery started in New Hampshire. And today up to 48 states and the District of Columbia, Puerto Rico and the Virgin Islands have government sponsored lotteries. Most of these lotteries support public educations systems.

So it can be seen that the legalization of gambling in the United States was born out of a desire to find new ways to help businesses to be profitable, revitalize a stagnant economy, generate revenue for Indian tribes and support public education. 

Don't we all gamble?

There is no doubt that most of us, if we are over 18, have participated in gambling. We might buy a lottery ticket, scratch ticket, participate in a football pool or March Madness pool...we might have a standing poker game with friends; we might enjoy visiting the track when the horses are running in your community. For the most part this type of gambling is just fun entertainment and when the game or event is over and the lottery numbers are called we return to living our daily lives without consequence.

But for many Americans the acts described above are just the tip of the iceberg of an impulse control disorder.

How prevalent is problem gambling and how costly is problem gambling?

Because gambling is regulated by the individual states, getting a national overview of statistics as they relate to gambling addiction can be difficult. According to The National Council on Problem Gambling:
"Our research finds that 2%-3% of the US population will have a gambling problem in any given year. That’s 6 million to 9 million Americans yet only a small fraction seek out services, such as treatment and self-help recovery programs."
This organization also offers 10 questions to determine if you might be suffering from pathological gambling:

1. You have often gambled longer than you had planned.
2. You have often gambled until your last dollar was gone. 
3. Thoughts of gambling have caused you to lose sleep. 
4. You have used your income or savings to gamble while letting bills go unpaid.
5. You have made repeated, unsuccessful attempts to stop gambling. 
6. You have broken the law or considered breaking the law to finance your gambling. 
7. You have borrowed money to finance your gambling. 
8. You have felt depressed or suicidal because of your gambling losses. 
9. You have been remorseful after gambling. 
10. You have gambled to get money to meet your financial obligations.
Additionally, the annual cost to the United States resulting from addicted gamblers ranges from a low of $6.7 billion to a $53.8 billion. This is a wide range, but either number is alarming.  

DSM-5 Proposed Re-Classification

Currently the American Psychiatric Association is preparing for publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013. According to their website:
"The work group has proposed that this diagnosis [gambling disorder] be reclassified from Impulse-Control Disorders Not Elsewhere Classified to Substance-Related Disorders which will be renamed Addiction and Related Disorders."

Gambling addiction treatment...going forward

Gambling addiction, whether it is referred to as an impulse-control disorder or a substance-related disorder or an addiction and related disorder, can destroy your life figuratively and literally. If you feel you have a problem, you should seek treatment. If you sense that your loved one has a problem with gambling, remember that family members can and do enable this behavior. Again, suggest Gamblers Anonymous, treatment or an intervention.  According to Wikipedia, pathological gambling can lead to depression and suicide ideation:

A report by the National Council on Problem Gambling showed approximately one in five pathological gamblers attempts suicide. The Council also said suicide rates among pathological gamblers are higher than any other addictive disorder.

Dr. David Phillips, a sociologist from University of California-San Diego found "visitors to and residents of gaming communities experience significantly elevated suicide levels." According to him, Las Vegas, the largest gaming market in the United States, "displays the highest levels of suicide in the nation, both for residents of Las Vegas and for visitors to that setting." In Atlantic City, the second-largest gaming market, he found "abnormally high suicide levels for visitors and residents appeared only after gambling casinos were opened."

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