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"At that point I ought to have gone away, but a strange sensation rose up in me, a sort of defiance of fate, a desire to challenge it, to put out my tongue at it. I laid down the largest stake allowed--four thousand gulden--and lost it. Then, getting hot, I pulled out all I had left, staked it on the same number, and lost again, after which I walked away from the table as though I were stunned. I could not even grasp what had happened to me."
~ Fyodor Dostoevsky, The Gambler
As a health writer and a reporter, I'm accustomed to the "spin" phenomenon. It may be two competing drug companies, each touting an expensive product as the last word in type 2 diabetes treatment, or a fast-food chain trying to prove that hamburgers are healthier than bananas. Such claims are the nature of marketing.
So I was not surprised when two conflicting press releases arrived at my office on the same day, each attempting in its own way to impart the significance of a study of the prevalence of gambling disorders during roughly the last 20 years. The interpretation offered by Harvard Medical School (HMS), where the study originated, was that problem gambling appeared to have increased significantly, perhaps by as much as 50 percent.
The American Gaming Association, on the other hand, read the tea leaves slightly differently. The Washington lobbying group's release hailed the study as evidence that "only about 1 percent of the adult population has serious pathological problems incident to gambling."
I suppose, at first glance, this could be comforting news to all Americans. Anyone who's ever bought a raffle ticket for a trip to Aruba would be relieved to discover that the chance of becoming a problem gambler is only about one in a hundred. At the track, most people would call those odds a "sure thing."
But I think it's a sucker's bet. The study still determined that 1.4 percent--or about 2.2 million adult Americans--suffered from severe gambling problems in 1996. And ignored in the Gaming Association's press release are an estimated additional 2.2 million adolescent Americans suffering from similar problems.
As Howard Shaffer, Ph.D., associate professor of psychology and director of the HMS division on addictions, notes, gambling isn't just a financial problem. It is also a public-health problem, and one of the country's most widespread and poorly understood. (The HMS study also estimates that approximately 81 percent of adult Americans have gambled at some point in their lives.) The more we understand about health, says Shaffer, the more we see that lifestyles, including problem gambling, influence our overall health.
The United States is in the midst of a legal gambling boom that began in 1964, when New Hampshire established the first modern state lottery. From 1974 to 1996, the amount bet legally in this country each year increased from $17.3 billion to $586.5 billion, and per capita wagering on lotteries alone rose from $20 to $150. Billions of scratch tickets later, gambling has become so accepted that abstention is almost considered an oddity.
However, the gambling explosion hasn't brought us any closer to finding out what happens when people gamble uncontrollably. The American Psychiatric Association (APA) lists the possible symptoms of gambling disorder as preoccupation with gambling; steadily increasing the size of bets; intolerance of losing and immediate efforts to recoup losses; gambling in response to disappointment in other areas of life; neglect of family; losing one's job or marriage as a result of gambling; and engaging in illegal acts or injudicious borrowing or selling to finance betting. According to the APA, any five or more of these symptoms qualify one as a "pathological gambler." But that's still a somewhat murky definition.
"In most physical and mental disorders, we have what's known as a 'gold standard,'" says Shaffer, "a set of signs and symptoms that more or less put the diagnosis beyond dispute. We don't have anything like that in problem gambling, and it complicates every dimension of our work in this area: treatment, research, prevention, education...everything." (The data don't clearly indicate which population groups are most affected by problem gambling, but Shaffer says studies have shown that gambling has an inherent psychological interest for people of lesser means, because it holds out hope for making a significant change in their lives.)
Although we're not exactly sure what defines problem gambling in individuals, its impact on the nervous system is undeniable. In many ways, problem gambling is like any other addiction. It appears to act as a stimulant, one to which frequent risk-takers can become inured. Research shows that problem gamblers exhibit patterns of brain activity familiar to experts on drug and alcohol addiction.
"Early research has shown a depletion of dopamine in the nervous systems of problem gamblers," Shaffer says. "I think further research will show that the same receptor sites that are stimulated by psychoactive stimulants are stimulated by gambling, at least in problem gamblers."
Like users of stimulants, such as cocaine addicts, problem gamblers frequently experience blackouts--periods of gambling of which they have no recollection. Sufferers display a withdrawal-type depression when they're unable to wager. Once they buy a lottery ticket, the withdrawal symptoms abate or disappear.
"I'm not a 'sky is falling' kind of guy," says Shaffer. "But gambling is a public-health concern from my point of view, and we should train health workers to understand and recognize it."
One area where recognition is most important is the college campus. Many studies, including Shaffer's, have shown that adolescents are at increased risk of problem gambling, probably because they are more likely to take risks of all kinds. Students may gamble for a variety of reasons, including diminished parental oversight, a possible link between college drinking and gambling, or the emphasis on sports and betting that exists on campus.
We need to find out more about adolescent gambling: it may tell a lot about the natural history of problem gambling. Is problem gambling a "phase" most adolescents outgrow? Or is this a crucial period during which a seed is planted, later to erupt as severe problem gambling? Does an increase in adolescent problem gambling now mean even more adult problem gamblers in 10 years? No one knows.
When he first appeared at addiction meetings to talk about problem gambling, Shaffer recalls, many colleagues refused to take him seriously. But now researchers concede that an improved understanding of gambling could open a window on alcholism, drug addiction, and all types of addictive behavior. "Gambling," Shaffer points out, "is a 'pure' addiction, because there's no drug involved. That should make it that much easier to understand the neurological dynamics of addiction and addictive behavior."
Our nation has clearly embraced gambling. Now we need to acknowledge that there are many people who will not be able to control their gambling. A first step may come from the National Gambling Impact Study Commission, which will report to President Clinton, Congress, and state governors on the economic and social effects of gambling in June 1999.
Mohandas Gandhi said, "No doubt war against gambling is not so simple as war against plague or earthquake distress. In the latter there is more or less cooperation from the sufferers. In the former the sufferers invite and hug their sufferings." For our part, we haven't even declared war on problem gambling yet, and until we do, the problem is going to be that much more difficult to solve.