• Gambling episodes occur more frequently but still may be widely spaced apart.
• Person experiences gambling episodes as positive and fun events.
• Person starts to view gambling as an important behavior in their lives.
• An increased acceptance of gambling. Rationalizations for increased gambling are used (e.g., it helps me to relax, I deserve some fun after working hard).
• There may be a period without negative economic consequences. For some people, there is a large win that is long remembered.
• The person may adopt an identity as a gambler. They accept gambling as part of their personal image and share stories of winning with others.
• If the person is winning or breaking even, there may be a feeling that they are talented as a gambler or have a special gift for the type of action they engage in.
• There are few or no negative consequences to the gambling. Spouses and family members may encourage the behavior during this time.
• This phase may last for many years or can be quite brief to non-existent for others (especially for slot machine players).

• Gambling episodes occur more frequently, and may be regular and habitual.
• Chasing losses begins; wager size increases.
• Gambling becomes a primary behavior and replaces other hobbies and interests. Occupation and family may suffer from neglect.
• Increased anxiety and depression resulting from financial pressures. Loans are often sought from banks or credit cards, then from family and friends.
• Symptoms of pathological gambling begin to appear.
• Juggling of finances ("creative financing") to pay for gambling may occur.
• Minimization and hiding of the gambling behavior starts.
• First bailout may occur.
• Initial effort to cut back or quit gambling may follow a particularly bad loss.
• A lack of recognition that gambling is causing problems may be evidenced.
• Problem severity may be minimized by the person trying to "handle it myself."

• Increased depression, shame and guilt.
• The chase leads to being "jammed up," where the options for obtaining cash are depleted. May sell possessions, float checks, engage in illegal acts, do things that they never would have considered before the addiction started.
• Debt related anxiety often increases further.
• Physical health and sleep patterns may be affected.
• Isolation from family and friends may increase.

• 20% of pathological gamblers will attempt suicide, almost all pathological gamblers seriously consider suicide.
• 60% will commit a criminal offense. 20% will appear before the judicial system.
• Although a person in this phase essentially gives up, they may still seek or return to treatment.

Adapted from material written by R. Custer, M.D., R. Rosenthal, M.D., L. Rugle, Ph.D. and S. Wexler.