Compulsive Gambling: Beyond Reason

Mental health professionals became concerned about problem gambling in the early 1970s.

From small beginnings at a Veterans Hospital in Ohio, this concern has grown into a national movement.

Psychiatrists, in particular, have worked closely with Gamblers Anonymous in the development of treatment programs.

It is quite clear that problem gambling has become 'medicalized', that is, has come to be seen as a 'disease', despite the fact that this way of viewing problem gambling has its critics.

Consequently, physicians (mainly psychiatrists) and psychologists have developed a monopoly over the definition of the nature of the appropriate treatment for it.

Among psychiatrists, psychologists, and a wide array of counselors working in the same area of mental health and drug addiction, compulsive gambling has come to be seen as an addiction.

The very use of the term compulsive conveys the idea of a loss of control over one's behavior and an uncontrollable urge to gamble regardless of the psychological, interpersonal, and financial consequences.

One of the leading authorities on the topic, psychiatrist Robert Custer, defined compulsive gambling as 'an addictive illness in which the subject is driven by an overwhelming uncontrollable impulse to gamble. The impulse progresses in intensity and urgency, consuming more and more of the individual's time, energy, and emotional and material resources. Ultimately, it invades, undermines, and often destroys everything that is meaningful in his life.'

Thus, although no 'substance' is involved, the definition parallels that of drug (including alcohol) addiction.

Still, there is an unsettled debate about the nature of compulsive gambling as an addiction. It is not a physiological addiction like of that to alcohol or other drugs, since no external substance is taken into the body.

Yet, it is appropriate to describe compulsive gamblers as psychologically addicted to, or at least dependent on, gambling.

And,, it is always this question, though--- what is compulsive gambling?

The American Psychiatric Association considers pathological gambling to be an impulse control disorder in which there is a chronic and progressive failure to resist impulses to gamble.

Although the APA uses the term pathological, the terms compulsive and pathological are often used interchangeably when discussing gambling disorders.

Professionals who treat compulsive gamblers tend to use the term pathological, since pathological gambling is an 'impulse control disorder', and not a 'compulsion'.

The term problem gambler is used in two different ways. First, it is used to refer to people who develop family, work, or financial problems as a result of their gambling but do not exhibit all of the characteristics of pathological gamblers.

In other words, they have less-serious problems than pathological gamblers have. Also, it is sued in a more inclusive way to capture both pathological/compulsive gambling at one extreme and any problematic involvement with gambling at the other end of the continuum.

The distinction is similar to those that we find in the area of alcoholism.