by Jackie Ferris
Wildman (1997) has suggested that the important thing to remember about gambling is that it is “a conscious, deliberate effort to stake valuables, usually but not always currency, on how some event happens to turn out.” (P. 1) There are also “quasi-gambling” activities, such as stock market and real estate investments that can be used as opportunities to gamble, and so must be counted in any survey of gambling activity. How often a person is involved, as well as the sum of money involved, may be used as a rough criterion for whether or not an activity is actually “gambling.” It has also been suggested that unless there is some sort of excitement or thrill involved in the pursuit of an activity, it probably isn’t gambling. Some people, for instance, don’t consider buying lottery tickets, or raffle tickets for charitable purposes, as gambling, and yet there is clearly some anticipation or excitement involved in the purchase of these tickets, whether or not a large amount of money or time is invested in their purchase. A combination of excitement and level of involvement is perhaps the best means to determine what is or isn’t gambling. The limits of what is considered “gambling” behaviour have shaped the definitions of “problem” gambling that are used, and how problem gambling is measured. Wildman (1997) provided a useful summary of the theories that explain why people gamble (Table 1). All of these explanations are used to treat people affected by problem gambling. For those who believe that gambling was an important behaviour in human evolution, as well as for those who look at gambling as a generator of excitement and stimulation, the biological school of thought on problem gambling suggests that there are genetic predispositions toward gambling — problem gambling in particular. Thus, measurable chemical changes occur in someone who either has this predisposition, or who develops problem gambling behaviour. Medical treatment is necessary in these cases.
Table 1. Explanatory Theories for Gambling Behaviour
- Vestiges of a behaviour pattern that had some advantages for evolution of the species (Thomas, 1901; France, 1902).
- A continuation of primitive magical or religious ceremonies (Stocking, 1931).
- A behaviour shaped and perpetuated by intermittent reinforcement and other learning phenomena (Knapp, 1976).
- For profit (Snyder, 1975).
- Gambling as play (Herman, 1976: Kusyszn, 1990; Smith & Abt, 1984)
- A symptom of psychodynamic conflict (Freud, 1928).
- A focus of socialization and a “social lubricant” (Rosecrance, 1988).
- A generator of excitement and stimulation (Boyd, 1976).
A more behavioural approach to gambling and problem gambling believes these behaviours derive from social learning, either as a focus of socialization, or a result of reinforcement. This approach also encompasses the personification of luck, and other superstitious forms of thinking often seen in social and people affected by problem gambling, a manifestation of “primitive magical or religious ceremonies” (seen in table 1). Cognitive behavioural treatment approaches are the logical approach if gambling behaviour is seen as linked to specific environments or subject to specific triggers.
Those who see gambling as a rational behaviour might be more likely to suggest that gamblers a) see that gambling is strictly for fun, or b) feel that they can make a profit at it. Cognitive behavioural approaches to gambling problems are also the most likely means of treatment for those who see gambling as a rational behaviour. Teaching gamblers the odds of their favourite games often changes their belief that gambling can be profitable. However, none of the explanations for gambling behaviour outlined in the table above provide an appropriate rationale as to why some gamblers develop gambling problems. For that, we need to look at a multi-dimensional approach. For instance, Wildman suggests that all of these explanations may be present, to varying degrees, in the same individual.
What is “problem” gambling?
This section will review some of the more common definitions of problem gambling, as well as their pros and cons. Problem gambling has most often been conceptualized and defined in the past as an addiction or medical problem, because this was a familiar framework for both policy makers and clinicians, and because of the surface similarities between gambling problems and alcohol and other drug problems. Rosenthal’s (1992, pp. 22-23) definition is perhaps the best place to start in terms of defining problem gambling, because it is broadly accepted by psychiatrists, many psychologists, and Gamblers Anonymous members, and is also the foundation for the influential Diagnostic and Statistical Manual’s criteria for problem gambling:
A progressive disorder characterized by a continuous or periodic loss of control over gambling; a preoccupation with gambling and with obtaining money with which to gamble; irrational thinking; and a continuation of the behaviour despite adverse consequences.
This definition, like the DSM-IV criteria, is behaviourally based, and sees gambling as a disorder that one either has or doesn’t have. It captures most of the important behaviours that are seen with severe problem gambling, but only indirectly includes the consequences of gambling. Of course, it is because of the consequences that most gamblers end up in treatment. In addition, by calling gambling a “disorder” the definition suggests that those who have gambling problems are in some qualitative way different from those who do not. The literature suggests that this is not true.
What does pathological or compulsive gambling mean?
The terminology used to describe problem gambling varies. The terms “problem,” “pathological” and “compulsive” gambling are all used in the literature, seemingly interchangeably in many cases. Compulsive gambling is most strongly identified with the Gamblers Anonymous approach to problem gambling, and is usually used in this context synonymously with “pathological.” Members of GA would suggest that compulsive gambling is primarily influenced by biological factors, and that it is a disease from which there is no true recovery. Once an individual has been diagnosed as a “compulsive gambler,” he or she is a compulsive gambler for the rest of his or her life, whether or not he or she ever gambles again.
The GA 20 questions, which GA suggests identify compulsive gamblers, incorporate many of the same behavioural indicators of problem gambling that psychologists use. The ga questions focus more on the consequences of the disease, however, than on the disease or the behaviour itself (e.g., felt remorse after gambling, or felt that gambling impacted one’s reputation, Gamblers Anonymous, 1984). Despite conceptualizing compulsive gambling as a disease, ga gives prominence to the serious consequences of the disease, not the symptoms, likely because the consequences may be the only truly visible indicators of the disease.
“Pathological” gambling means that the individual has been diagnosed as having the disorder of pathological gambling, according to the Diagnostic and Statistical Manual’s criteria. That means that if an individual meets five or more of the DSM criteria, he or she can be labelled “pathological.” The South Oaks Gambling Screen (SOGS) is the instrument most often used to screen for pathological levels of gambling, and those with a score of five or more are labelled as “probable pathological gamblers.” Lesieur and Blume (1987) explain the term “probable” is used as an acknowledgment that any screen is a poor substitute for in-depth clinical assessment, and so the SOGS can only identify the likely presence of the disorder.
As Walker and Dickerson (1996) note, “problem” is currently the favoured term for describing the more severe end of the gambling problem continuum. Using the term “problem” gambling avoids the medical and pejorative connotations of “pathological” (Walker & Dickerson, 1996), and suggests a broad range of difficulties with gambling, not merely the most severe. However, this usage is imprecise (Walker & Dickerson, 1996), because it assumes that the “problems” are those created by the gambling behaviour, rather than the problems that may have led to it. It is based on a subjective assessment of “problems,” and individual assessments of problematic levels of gambling will vary. Which problems are deemed relevant depends on the conceptualization and resulting definition of problem gambling used.
Typically, prevalence rates are given for those who are “pathological” according to the SOGS or DSM-IV, and for those who are affected by problem gambling, a group that typically scores slightly lower on these standard measures. The measurement of prevalence is based on the definition of problem gambling used, and there have been a number of efforts recently to redefine problem gambling from the perspective of community harm, as well as personal harms, trends that may dramatically change “prevalence rates” over the next few years.
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