Problem Gambling

Cognition, Prevention and Treatment

F. Gobet, M. Schiller, F. Gobet, M. Schiller

• Publisher: Palgrave Macmillan
• Year: 2014
• Print ISBN: 9781349444861, 9781137272416
• eBook ISBN: 9781137272423
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Problem gambling is a perennial issue frequently reported in the media. This book is a comprehensive and up-to-date resource on problem gambling research. It describes the state of the art of the subject and presents the latest developments such as computer modelling of gambling behaviour and risk profiles of gambling products.

1

Introduction

Marvin R. G. Schiller and Fernand R. Gobet

Gambling is, by any means, a most paradoxical activity. Even though it should be evident that the gambling industry makes its living only on its patrons’ money, persistent gamblers continue playing in the vain hope of beating the odds that are stacked against them. In fact, Wagenaar (1988) noted that it is actually the most habitual gamblers (those who should know best) who are the least likely to stop gambling. Even gambling legislation does not fall short of paradoxes. An example is offered by the Gambling Act 2005¹ of the United Kingdom, enacted for “protecting children and other vulnerable persons from being harmed or exploited by gambling” (section 1 c). Section 46 (1) accordingly specifies that “[a] person commits an offence if he invites, causes or permits a child or young person to gamble”. But right in the next subsection of section 46, nine general exceptions are made, including gambling with certain types of fruit machines (better known as slot machines outside the United Kingdom), participation in lotteries and football pools. Thus, in the United Kingdom there is no general legal age limit on fruit machine playing, an activity that is unanimously considered to be highly addictive by scholars (e.g. Griffiths, 1993; Holtgraves, 2009).

In many parts of the world, including the United Kingdom, a large proportion of the population engages in gambling activities of some form. For example, the British Gambling Prevalence Survey 2010 (Wardle et al., 2011) found that 73% of the population in the United Kingdom aged 16 and over had participated in gambling during the surveyed year. Similar figures are known from Canada, where a national survey carried out in 2002 established overall gambling participation at 76% for residents aged 15 and over (Cox et al., 2005); Australia, where adult participation is reported at 69–86% for different Australian states at different points in time between 1999 and 2009 (Productivity Commission, 2010); and the United States, where 82% of respondents aged 18 and over to a national study claimed to have gambled in the past year (Welte et al., 2002).

A notable proportion of the population has lost the ability to control their gambling, to the point that it causes significant harm to their finances and their well-being, and often also affects their work, friends, family and, eventually, society as a whole (see below).² This condition is generally known under the names of “pathological gambling” and “problem gambling”. The number of gamblers who are affected can only be estimated, mainly by survey studies. Whereas the notion of pathological gambling is based on a catalogue of clinical criteria, problem gambling is often used as a more inclusive notion to include harmful gambling, even if it does not fully meet the clinical criteria. A recent study estimated that there might be as many as 451,000 problem gamblers aged 16 and over in the United Kingdom alone (Wardle et al., 2011).³

This chapter sets the stage for the 11 chapters that follow, which contribute to the study of problem gambling from the perspectives of specific sub-disciplines. It aims to provide the necessary background to those readers who are not familiar with the field so that they can acquaint themselves with the central issues, some of which will be discussed in much greater detail in the individual chapters.

We start with a rough definition and clarification of the notions of pathological and problem gambling. Taking a historical perspective, we then point out that gambling has been around since ancient times, just like the individual and societal problems associated with it. We then address the following questions in some detail: What categories of gambling activities can be distinguished? What is the role of gambling (and disordered gambling) in society? To what extent is gambling regulated by legislation? We then move from these general questions to a more precise characterisation of problem gambling as a medical condition. In this context, we briefly discuss instruments for the clinical diagnosis of problem and pathological gambling, as well as treatment options. A long section (‘The psychology of pathological and problem gambling’) of this introduction is devoted mainly to cognitive psychology, as it has made valuable contributions to explain how gambling-related problems develop and how they are maintained. This discussion is complemented by perspectives from neuroscience, biology and genetics on the risk factors affecting problem gambling. Before concluding the chapter, we focus on two topics that have received increased attention recently: the fact that a considerable proportion of youths (including minors) participate in gambling, to the point that some have become problem gamblers, and the proliferation of Internet gambling.

On the notion of pathological gambling

In its tenth edition, the International Statistical Classification of Diseases and Related Health Problems (ICD; World Health Organisation, 1992) defines pathological gambling as a habit and impulse disorder: “The disorder consists of frequent, repeated episodes of gambling that dominate the patient’s life to the detriment of social, occupational, material, and family values and commitments” (p. 211). The current version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-V (American Psychiatric Association, 2013) sees pathological gambling as an addictive disorder akin to substance-related disorders, with which it shares behavioural symptoms; as it is otherwise not related to the use of substances, it is described as a “behavioural addiction” (p. 481). While the disorder was indeed called “pathological gambling” in the fourth edition of DSM and classified as an impulse-control disorder, in DSM-V it is listed as “gambling disorder” and defined as follows: “The essential feature of gambling disorder is persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and/or vocational pursuits (Criterion A)” (p. 586). Excessive gambling with harmful consequences has also been known under the names of compulsive gambling, disordered gambling, addictive gambling or ludomania. A related term is excessive gambling, which is often used in French-speaking countries (i.e. jeu excessif ) synonymously with problem gambling. While the term “compulsive gambling” seems to be used frequently among rehabilitation and service providers such as Gamblers Anonymous (GA) (Oei & Gordon, 2008), the ICD (World Health Organisation, 1992) mentions that its use is less appropriate than the use of “pathological gambling”, since technically, the behaviour is not considered compulsive, and the disorder is not related to obsessive-compulsive disorder.

The preference of one of the above notions over another often reveals a particular viewpoint on the disorder – for example, whether gambling is considered an impulse control disorder or an addiction – but sometimes these notions are used to distinguish between degrees of severity. For example, Sassen et al. (2011) note that surveys using the diagnostic criteria stipulated by DSM-IV (as discussed later in this chapter) commonly consider a score of five out of ten DSM-IV criteria as pathological gambling, and a score of three or four as problem gambling.

Thus, the term pathological gambling may vary slightly in meaning from context to context. Readers should be aware of this when studying the literature on gambling behaviour. In this book, many chapters (Chapters 2, 3, 4, 6, 7 and 9) use the term problem gambling in an inclusive sense to refer to all levels of gambling-related harm as such. In Chapter 8, the terms pathological gambling and problem gambling are used to delineate two different perspectives on the problem, which put forward a medicalised discourse and a socio-cultural discourse, respectively. In work on assessment and treatment, generally problem and pathological gambling are used to delineate two degrees of severity according to clinical criteria, and this is also the case for Chapters 10 and 11 in this book.

A brief history of gambling and problem gambling

The history of gambling reaches far back in civilisation. Gambling activities and problematic forms of gambling are deeply rooted in human culture. In the following, we present an overview mainly based on Price (1972), Reith (1999) and Castellani (2000).

Early forms of gambling include cockfights and dice games. It is thought that cockfighting dates back to 2000 BC in the Indus Valley and was the original reason for domesticating chicken. Evidence of the use of dice is provided in the form of astragali, sheep knuckle bones that were used in games of chance. Cubical dice (as they are used today) are thought to have evolved around 1000 BC in the Euphrates river valley. Dice were initially part of rituals for the casting of lots or foretelling the future, and the separation between secular and (religious) ritual games did not exist. The Vedas, the oldest layer of Sanskrit literature, mention gambling on chariot races for cattle and dice games. The Rig Veda also includes some evidence for problems associated with gambling in the form of a poem, where a gambler unable to resist dicing and lots bemoans the ruinous situation caused to himself and his family (Price, 1972, p. 165).

Gambling was common in Egypt and the ancient Roman Empire. The Romans were considered avid gamblers, and some of their emperors – Augustus, Claudius, Nero – were described playing “to excess”, “like an imbecile” and “like a madman” (Steinmetz, 1870, pp. 64–65, as cited in Reith, 1999).

Problems associated with gambling were considered a moral issue and therefore addressed by religious and secular laws. Dicing was again and again considered immoral by leaders of society (including religious leaders such as Buddha and Mohammed, philosophers and Roman rulers) and subject to outspoken condemnation from the early Christian Church. This view is echoed in popular literature such as “Carmina Burana”, where dicing is portrayed as causing crime, unrest and poverty (Romeo Pérez, 2008).

According to Reith (1999), during the Middle Ages dice games played an important role in the everyday lives of people belonging to all classes of society. The Indian Mahabharata (one of the two major Sanskrit epics of ancient India) suggests that it was not uncommon to stake one’s entire wealth in one single game. Tacitus is credited with describing the “ancient German practice of ‘vicious dicing’ ” (Reith, 1999, p. 47) – in contrast to the wealthy, who staked land and gold, the poor, who had often nothing to lose, staked their liberty, such that they were sold as slaves if they lost.

An illustrative source for gambling in the Middle Ages is offered by the writings commissioned by Alfonso X, the King of Castile, Leon and Galicia. In the 1283 book Libro de los Juegos (The Book of Games), a variety of games are explained, including betting games and Todas Tablas, the precursor of modern backgammon (Musser Golladay, 2003). Through pictures, the book conveys the context and atmosphere of gaming at the time, including one scene showing a fight where knives are pulled. The need to regulate gambling is expressed in Alfonso X’s El Ordenamiento de las Tafurerias y el Ajedrez (The Law of Gambling Houses and Chess), which is imposed on gambling houses (tafurerias). As noted by Romeo Pérez (2008), illustrations include gamblers portrayed naked, since clothes were commonly included as a collateral for a bet. The picture of the gambler losing the last item of garment has shaped the public perception for centuries.

As noted by Reith (1999), the main motive for regulations and bans on gambling in the Middle Ages was a concern about the disorderly effects of gambling practices on the productivity of a society and the steadiness of its army. For example, Richard I enforced an edict regulating the gambling activity of the Christian Crusader army, which prohibited soldiers below the rank of knight from playing dice for money and imposed limits for knights and clergymen. In Europe, lotteries were introduced in the 15th century by governments to fund public projects (e.g. support of the British colonies in America) and merchants to dispose of their wares. However, it was found that lotteries “undermined the honest virtues of hard work” (p. 56) and were considered to be “radically vicious” (p. 56). This resulted in the proscription of private lotteries by an Act of 1721 in Britain, and finally the discontinuance of the British lottery in 1826. Reith describes an explosion of opportunities for gambling in the 17th century, including speculation (dealing with stocks and shares, enabled by capitalism and a thriving banking system), betting (predominantly by aristocrats) and commercial forms of gambling (clubs, and illegal taverns and lotteries). According to Reith, the rational societies of the Enlightenment were concerned that for poor families gambling would be especially ruinous, such that they would not be able to pay their taxes and become a burden to the state. This resulted in a “flurry of legislation”, which led to the advent of “gambling hells”, concealed gambling venues attracting the criminal underworld.

The 19th century brought a “commercialisation” (Reith, 1999) of gambling activities; the casino in its modern form emerged (e.g. in France and in Germany), the forerunners of slot machines were invented in the United States and horse-betting became widespread in Britain. Again, legislation against popular betting in Britain was introduced via the Street Betting Acts of 1853, 1874 and 1892, leading to underground betting activity. As argued by Reith, commercialisation enabled a dramatic increase in participation, and the flow of small wagers from an increasing customer base guaranteed a steady profit. Reith also notes that participation, not winning per se, was increasingly becoming important for players, and gambling became a commodity.

Scientific interest in gamblers awoke in the early 20th century. In a handbook on psychiatry, the German psychiatrist Emil Kraepelin described a condition called “gambling mania” (Spielwut in the original), as noted by Black and Moyer (1998). The Austrian psychoanalyst Sigmund Freud published an article in 1945 on the Russian writer Fyodor Dostoyevsky, whose excessive gambling is reflected in his novel The Gambler (1867/2011). In 1943, Edmund Bergler published “The gambler: A misunderstood neurotic” in the journal Criminal Psychopathology.

As noted by Castellani (2000), Bergler’s 1957 book The Psychology of Gambling marks an important shift in perspective – from perceiving problem gambling as a matter of “sin and vice”, that is, predominantly a moral problem, towards studying it as a medical and psychiatric disorder. Bergler’s book addressed gambling in the United States, where at that time, in fact, gambling was illegal in most places. Therefore, still, the “discourse of law and religion prevailed” (Castellani, 2000, p. 28). Gamblers were considered criminals in the first place and therefore at fault for departing from the path of law and order.

Castellani describes the beginnings of Gamblers Anonymous in the United States, patterned after Alcoholics Anonymous. Their programme viewed problem gambling as an illness of a progressive nature and thereby adopted a perspective referred to as the medical model of problem gambling (cf. Castellani, 2000). In collaboration with GA, Dr Custer, a psychiatrist, opened the first in-patient treatment facility for compul...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• List of Figures and Tables
• Preface and Acknowledgements
• Notes on Contributors
• 1. Introduction
• Part I: Psychology of Problem Gambling
• Part II: Gambling and Society
• Part III: Treatment of Problem Gambling
• Part IV: A Problem Gambler’s Perspective
• Index