Playing the name game in the development of gambling problems
There has never been a shortage of adjectives to describe the small sub-sample of the population who develop gambling problems and come to the attention of psychologists, psychiatrists, and/or self-help agencies. Over the last 70 years, problem gambling has been described as ‘neurotic’, ‘compulsive’, ‘addictive’, ‘dependent’, impulsive’ and/or ‘pathological’ in a wide variety of scholarly outlets.
At present, the most commonly used terms by practitioners and treatment agencies are arguably ‘pathological’ and ‘compulsive’. The term ‘compulsive’ arose largely from Sigmund Freud’s 1928 description of the Russian novelist Dostoyevsky based on his semi-autobiographical book, The Gambler. Some gamblers clearly display compulsive behaviour and is currently the preferred terminology of Gamblers Anonymous. However, if compulsions are defined as being the behavioural component of the obsessional state in which the individual finds the abnormal behaviour alien and attempts to resist it, then clearly some gamblers cannot be described as compulsive as there is no element of resistance (i.e., they actually enjoy gambling), and their behaviour is not alien to them. In addition, some gamblers may be oblivious to the fact that they have a problem at all.
Influenced by the American Psychiatric Association’s Diagnostic and Statistical Manual, there seems to be an increased preference amongst professionals for the term ‘pathological gambling’ to describe individuals with severe gambling problems. Arguably, this owes much to the pioneering work of the psychiatrist Dr Emmanuel Moran who in the late 1960s and early 1970s argued in a series of seminal papers that the phrase ‘pathological gambling’ is descriptive as opposed to terms like ‘compulsive’ or ‘addictive’ which might suggest specific and homogenous etiologies. Estimates for the numbers of people who have a gambling problem are therefore a direct function of the particular criteria used in defining the problem in the first place. Others in the gambling studies field have agreed that the pathological gambling problem of impulse control is dissimilar to other obsessive and compulsive disorders.
Moran also pointed out in his many papers that it was highly unlikely that problem gamblers were a homogenous group of individuals, and that therefore ‘compulsive gambling’ to describe this diverse group was an unsatisfactory term. Professor Mark Dickerson (formerly of the University of Western Sydney before his retirement) also rejected the ‘compulsive’ typology. He said the label was merely functional, and the term ‘compulsive gambling’ acted as a legitimate way for individuals to seek the help of psychologists and psychiatrists. He also argued that the compulsive gamblers may just be a subset of regular gamblers except that they seek treatment for their behaviour.
The problem is therefore how to differentiate between those who gamble a lot but do not seek help, and those gamblers who end up seeking help at agencies such as Gamblers Anonymous. What difference is there? Is it cognitive? Is it genetic and/or physiological? Is it behavioural? All of the above? Due to the heterogeneous nature of gambling, there is probably no parsimonious answer but it would be useful for research and practitioner communities to choose an appropriate name that clearly distinguishes between those who need help with their gambling problem from those who do not.
Clearly there is more than one type of problem gambler as evidenced by the early classification of different problem gamblers by Moran (i.e., subcultural, psychopathic, neurotic, symptomatic and impulsive) through to the more recent ‘pathways’ model of Professor Alex Blaszczynski and Dr Lia Nower who assert there are three fundamentally different types of problem gambler (behaviourally conditioned, emotionally vulnerable, and antisocial impulsivist). I will return to these typologies in a subsequent blog. The real point I would make is that these typologies have good face validity but it is unlikely that all these types of problem gambler are pathological gamblers – particularly if pathological gambling implies the gambling abnormality comes from within the individual. Can problematic gambling that is due to a situational disposition (e.g., subcultural gambling where people gamble excessively because others do) really be defined as pathological?
What is needed is a unambiguous term that not only differentiates gamblers who seek treatment from those who do not, but that also incorporates the different sub-types of problem gambler. Terms such as ‘habitual’, ‘high frequency’, ‘heavy’ and ‘persistent’ would accurately describe the most regular gamblers but would not include the small minority who gamble only in short binges. Perhaps the most useful terms (and to some extent the most obvious) are those such as ‘excessive’ and/or ‘problematic’. However, both ‘excessive’ and ‘problematic’ are to some extent personal and subjective judgments where the gamblers (or those around them) perceive an imbalance of negative outcomes over the positive outcomes resulting in what is felt to be problematic behaviour. Evidently, these debates are not unique to gambling and can be found across the whole addiction studies field. However, whether the gambling studies field will ever reach consensus remains to be seen.
Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Blaszczynski, A. & Nower, L. (2002). A pathways model of pathological gambling. Addiction, 97, 487-500.
Dickerson, M.G. (1989). Gambling: A dependence without a drug. International Review of Psychiatry, 1, 157-172.
Griffiths, M.D. (2006). An overview of pathological gambling. In T. Plante (Ed.), Mental Disorders of the New Millennium. Vol. I: Behavioral Issues. pp. 73-98. New York: Greenwood.
Moran, E. (1970). Varieties of pathological gambling. British Journal of Psychiatry, 116, 593–597.
Posted on January 25, 2012, in Addiction, Compulsion, Gambling, Gambling addiction, Problem gamblng, Psychology and tagged Compulsive gambling, Gambling addiction, Impulsive gambling, Problem gambling. Bookmark the permalink. 1 Comment.