PATHOLOGICAL GAMBLING
by
Dr. Ki-yan MAK

 

What is gambling?

There are many different versions for the definition. Some consider any activity with a possibility of win and lose is gambling, while others consider any `risk-taking’ behaviour is a gamble. Therefore, those who belief in Christianity can be considered `religious gamblers’ for their lives!

According to the Illinois Institute for Addiction Recovery webpage [1] , gambling can be defined as `playing a game of chance for stakes’; and there are different forms of gambling, including

1. pari-mutuels: horse and dog tractks, off-track-beeing parlors, etc.

2. lotteries

3. casinos: slot machines, table games, etc.

4. bookmaking: sports books and horse books, etc.

5. miscellaneous: card rooms, bingo and even the stock market.

 

What is pathological gambling?

On the other hand, the American Psychiatric Association has a clearer definition for those with abnormal or `pathological’ gambling behaviour. It is a type of `impulse control disorder’, and the DSM-IV diagnostic criteria [2] are `persistent and recurrent maladaptive gambling behaviour’ as indicated by five or more of the following:

1. is preoccupied with gambling

2. needs to gamble with increasing amounts of money in order to achieve the desired excitement

3. has repeated unsuccessful efforts to control, cut back, or stop gambling

4. is restless or irritable when attempting to cut down or stop gambling

5. gambles a way of escaping from problems or of relieving a depressed mood

6. after losing money gambling, often returns another day to get even

7. lies to family members, therapist, or others to conceal the extent of involvement with gambling

8. has committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling

9. has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling

10. relies on others to provide money to relieve a desperate financial situation caused by gambling.

 

Development of pathological gambling

According to Dr. Robert L. Custer¹, there are three phases, viz.:

1. the winning phase: initially, the gambler experiences a big win or a series of wins that gives him an unrealistic optimism of continued winning, resulting in excitement in gambling and increasing amount of the bets.

2. the losing phase: unfortunately, the gambler starts to lose, and he begins bragginf about the wins, starts gambling alone, ruminates about gambling and borrows money legally or illegally. He/she starts lying to family and friends and becomes more irritable, restless or withdrawn. Homelife becomes more unhappy, and the gambler begins to “chase” after the losses.

3. the desperation phase: there is a marked increase in gambling time, accompanied with remorse, blaming others and alienating family and friends. Finally, the gambler may engage in illegal acts to finance the gambling or to pay off the debts. He/she may experience hopelessness, suicidal thoughts (and attempts), arrests, divorce, alcohol (and other drug abuse), or an emotional breakdown.

 

Epidemiology

It is estimated that about 3% of the American adult population will experience a serious problem with gambling¹. In Hong Kong, a community survey in the New Territories conducted by the Chinese University of Hong Kong gave a 3.11% for the local population (Table 1) with features of pathological gambling [3] . However, this may be an under-estimate of problematic gambling, as the Chinese has a philosophy that `you will be poor all your life if you do not gamble’, and it is an honorable act to `borrow money’ provided you can pay back the debt.

 

Table 1: Life-time prevalence (%) of pathological gambling

Sex	Age Range
	18 – 24	25 - 44	45 - 64	Total
Male	3.84	3.03	1.99	2.95
Female	0	0.21	0	0.16

　

According to clinical experience, there are certain groups of persons more easy to be addicted to gambling:

1. Adolescents – Dr. Herny Lesieur and others found out that this age group is three times more likely than adults to become problem gamblers¹. This feeling is also evidenced by the development of special counseling services for the adolescents. A retrospective study in Alberta and other studies in Quebec found that the teenagers start gambling on average at age 10, and such behaviour is associated with delinquency and crime, poor school performance and work function, and disrupted social relationships. However, the primary of many teenagers gambler is not for money, but a route to escape from reality and their problems seem to disappear when gambling.
2. sex differences – on the surface, men are more at risk for pathological gambling. However, with the advent and legalisation of internet betting, women (especially house-wives) become quite easily hooked on it.

 

Legalisation of gambling

Many countries have legalized gambling, including sports betting. But in the USA, the Congress passed the Amateur and Professional Sports Protection Act which kept sports betting illegal in most states. But in Nevada, sports booking is legal. According to studies by Sullivan [4] (1993) and Doocey [5] (1996), illegal betting cannot be stopped by legalization. It appears as the amount of legal betting increases, that for illegal betting increases even greater. Christianseen/Cummings Assocates, Inc. estimated that the legal gorss wagening (for sports booking) in Las Vegas increased from US$0.4 billion in 1982 to US$2.6 billions in 1995, that for illegal beeting jumped from US$8 billions to US$88 billions during the same period [6] .

 

The Christian Mandate

Though the Bible does not have any specific statement against gambling, the tenth Commandment `thou shalt not covet against thy neighbour’s …’ does attack the underlying motive of many gamblers – greediness.

On the other hand, the Bible speaks a lot about the proper and improper attitudes towards money and material goods. These Christian principles are useful for those who use their savings and earnings for gambling activities.

Since problem gambling is associated with a lot of social evils and can result in family disruption and personal disasters in the long run, the Bible does contain a lot of teachings about holistic health and family unity.

　

Management of pathological gambling

Assessment

There are a number of instruments to assess whether a person is a problem gambler. According to the National Council on Problem Gambling, Inc. [7] , another positive answer to the following ten questions should alert to the need for professional assistance.

1. Have you often gambled longer than you had planned?

2. Have you often gambled until your last dollar was gone?

3. Have thoughts of gambling have caused you to lose sleep?

4. Have you used your income or savings to gamble while letting bills go?

5. Have you made repeated, unsuccessful attempts to stop gambling?

6. Have you broke the law or considered breaking the law to finance your gambling?

7. Have your borrowed money to finance your gambling?

8. Have you felt depressed or suicidal because of your gambling losses?

9. Have you been remorseful after gambling?

10. Have you gambled to get money to meet your financial obligations?

 

Prevention

It is really difficult to stop gambling altogether, but measures can be taken to discourage such behaviour. Besides legal banning, preventive advice on `responsible gambling’ can be publicized. The requirements for such, according to the Responsible Gambling Council in Ontario, Canada, [8] are as follows:

1. gamble for entertainment, not as a way to make money

2. balance gambling with other leisure activities

3. only use discretionary income, not money for everyday expenses

4. set a budget and stick to it

5. don’t borrow money to gamble

6. set a time limit for gambling

7. take frequent breaks during gambling, and

8. be aware that risk increases at times of loss or depression.

Though the above guidelines are simple, it is quite difficult to follow strictly, and only a small percentage of the population has such qualities.

Such prevention education should be targeted particularly at the at-risk groups, especially the children and adolescents. Therefore, support and cooperation from the schools are of great importance.

 

Treatment

For those with pathological gambling, or those with social problems associated with gambling, professional advice and treatment is indicated. Pathological gambling is a form of `Impulse-control disorder’ and specific psychiatric treatment is needed.

Counselling and specific psychotherapy are sometimes needed, and marital and family therapy can complement individual care.

 

Conclusion

Gambling is really a risky business, and many people are vulnerable to develop problem gambling. Though an adult person has choose his own life-style, he or she should be responsible for his/her behaviour and the consequences on other people (especially the family members) and on society. Children and adolescents are at particular risk of gambling, and they should be educated on the psychosocial risks of gambling. Studies so far did not support the notion that `legalisation of gambling can curd illegal betting’, and the short-term gain in revenue by legalisation of sports booking may not be sufficient to pay off the long-term social costs. Indeed, politicians who advocate such legalisation areactually gambling themselves, by putting the whole society and the future generation at stake.