Most people are social gamblers, who gamble for entertainment and typically don't risk more than they can afford (Custer & Milt, 1985). If they should "chase" their losses to get even, they do so briefly. There is none of the preoccupation, long-term chasing, or progression of the pathological (compulsive) gambler.

In referring to gambling, the terms "pathological" and "compulsive" are often used interchangeably. Compulsive gambling is the layman's term and is used by Gamblers Anonymous. Pathological gambling is preferred by clinicians and was introduced in 1980 when the American Psychiatric Association first recognized pathological gambling as a bona fide mental disorder and included it in its Diagnostic and Statistical Manual (DSM-lll). Compulsive gambling was thought a misnomer (Moran, 1968; Lesieur & Rosenthal, 1991) since, in the language of psychiatry, compulsive behavior is involuntary and "ego-dystonic" (external or foreign to the self). Examples of a compulsion would include repetitive hand washing or the irresistible urge to shout an obscenity. Pathological gambling, at least in its early stages, is typically experienced as pleasurable.

Pathological gambling has been defined as 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 behavior despite adverse consequences (Rosenthal & Lesieur, 1992).

This is essentially the definition of an addiction. Other similarities with alcohol and chemical dependency have been noted (Moran, 1970; Miller, 1980; Levinson, Gernstein & Maloff, 1983). While money is important, male gamblers in particular say they are seeking "action," an aroused, euphoric state comparable to the "high" derived from cocaine or other drugs. Gamblers will go for days without sleep and for extended periods without eating or taking care of bodily needs. Clinicians have described the presence of cravings, the development of tolerance (increasingly larger bets or the taking of greater risks to produce a desired level of excitement) (Lesieur, 1984), and the experience of withdrawal symptoms (Wray & Dickerson, 1981; Meyer, 1989; Rosenthal & Lesieur, 1992). Gamblers report a "rush," characterized by sweaty palms, rapid heart beat, nausea or queasiness.  This can be experienced while gambling, in anticipation of gambling, or in response to any situation or feeling which reminds them of gambling.

There are other kinds of intense physiological reactions. Some pathological gamblers, however, are less interested in the excitement, or action, than they are in escape. They are seeking to numb themselves, and will speak of their quest for "oblivion." This latter group includes many women gamblers (Lesieur & Blume, 1991), as well as many slot and video poker machine players. Many gamblers, both male and female, experience amnesic episodes, trances and dissociative states (Jacobs, 1988; Kuley & Jacobs, 1988; Browne, 1989; Lesieur & Rosenthal, 1994; Brown, 1996; O'Donnell & Rugle, 1996).

For both the action seekers and the escape gamblers, there are distortions in thinking (Henslin, 1967; Gaboury & Ladouceur, 1989; Walker,1992). These include denial, fixed beliefs, superstition and other kinds of magical thinking, and notably omnipotence. This illusion, or delusion, of power and control is born out of desperation (Rosenthal, 1986). The more helpless the gambler's situation, the greater their sense of certainty about a positive outcome.

To be diagnosed as a pathological gambler, an individual must meet at least five of ten diagnostic criteria established by the American Psychiatric Association (1994) (Bradford et al.1996; Lesieur & Rosenthal, 1998). The ten criteria include: loss of control, tolerance, withdrawal, increasing preoccupation, gambling to escape problems and dysphoric feelings, long-term chasing, lying about one's gambling, jeopardizing family, education, job or career, serious financial difficulties requiring a bailout, and illegal activities to finance gambling or pay gambling debts.

Four phases have been described: winning, losing, desperation, and hopelessness (Custer, 1982; Custer & Milt, 1985; Lesieur & Rosenthal, 1991). As the disorder progresses, there is not only an increase in the amounts wagered and the time devoted to gambling, but an increase in depression, shame, and guilt. We know that 20% will attempt suicide (Moran, 1969; Livingston, 1974; Custer & Custer, 1978; McCormick et al. 1984; Lesieur & Blume, 1991; Thompson, Gazel & Rickman,1996), while two out of three will turn to criminal activities to support their gambling (Lesieur, Blume & Zoppa,1986; Brown,1987; Lesieur,1987). There may be an exacerbation of other mental disorders; stress-related physical illnesses are common (Lorenz & Yaffee, 1986).

It is not bad luck, greed or poor money management that makes one a pathological gambler. Some individuals sought help in the early phase of their gambling career, while they were still winning. They were astute enough to become concerned about their intense physical reactions or the effect their preoccupation with gambling was having on the other aspects of their life. One need not lose everything to be a pathological gambler, nor is it necessary to think about gambling every day. Some gamblers are binge gamblers, who do their damage sporadically. Some pathological gamblers only gamble compulsively at one type of gambling. They may not be interested in other types, or may even gamble at them to support their addiction.

More recently, the term problem gambler (Rosenthal, 1989; Lesieur & Rosenthal, 1991) has been introduced to describe those individuals who have gambling problems, but who don't meet the full criteria for a diagnosis of pathological gambling. It is possible that they are merely in an earlier stage of the disorder, or they may never develop the progression and increasing preoccupation which characterizes pathological gambling. This is an area for further study. Unfortunately, there is confusion about the term problem gambling because it is also used in a more inclusive sense to encompass pathological or compulsive gambling at one end of a continuum of problem gambling involvement. In its wider sense, problem gambling may be defined as any pattern of gambling behavior which compromises, disrupts or damages family, personal or vocational pursuits. This would include, but of course not be limited to, pathological gambling.

Courtesy of Richard Rosenthal, MD.

Types of Problem Gamblers

Phases of Problem Gambling