Broadcast week starting: April 16, 2003 (Original broadcast July 17, 2002)
In this hour, we explore Gambling. Why can some people walk away from the casino, and others just can't quit? Guests include Dr. Eric Hollander, Professor of Psychiatry and Director of the Compulsive, Impulsive, and Anxiety Disorders Program at Mount Sinai School of Medicine in New York City; Keith Whyte, Executive Director of the National Council on Problem Gambling; sociologist Dr. Gerda Reith, author of The Age of Chance: Gambling in Western Culture; and Joanna Franklin, chief trainer for the Institute for Problem Gambling.
Host Dr. Fred Goodwin begins with an essay in which he says pathological gambling, that is, gambling addiction, raises fundamental questions about human behavior and what drives it. Where is the line between free choice and actions that are determined by brain changes associated with an illness? He concludes that gambling addiction represents one end of a continuous spectrum with normal gambling at the other end and problem gambling in the middle. In that sense, it's much like alcohol - which suggests that for gambling addiction, the answer is not prohibition, but prevention and treatment for those at risk.
Next, we hear from recovering compulsive gambler Lee P. Lee describes his descent into pathological gambling, beginning at age 12, when he placed his first bet on a horse.
To find out more information about Gamblers Anonymous, please visit http://www.gamblersanonymous.org/.
Then, Dr. Goodwin is joined by Dr. Eric Hollander, Professor of Psychiatry and Director of the Compulsive, Impulsive, and Anxiety Disorders Program at Mount Sinai School of Medicine in New York City, and Keith Whyte, Executive Director of the National Council on Problem Gambling.
Dr. Hollander begins by explaining that pathological gamblers fail to assess risks and odds accurately, and they have functional impairments that keep them from putting the breaks on their impulses. As a result, many end up heavily in debt or bankrupt, divorced, or in trouble with loan sharks. About 1-2% of the general population are pathological gamblers; another 2-3% are problem gamblers.
Mr. Whyte adds that, to some extent, all gamblers have difficulty assessing odds correctly. His organization defines problem gambling more broadly as any gambling that causes harm to yourself, family, or vocation.
Dr. Hollander continues to say that most pathological gamblers are impulsive -- they are risk-takers, and they underestimate harm. There is also a high correlation between gambling and other impulsive behaviors, such as problem use of drugs and alcohol. However, over time, pathological gamblers build up a tolerance to the arousal of gambling, and they become dysphoric. At this point, the gambling becomes compulsive -- they do it to relieve the dysphoria.
As Mr. Whyte says, there are different subtypes of gamblers. Action gamblers, who tend to be men, play games that require some skill, such as cards games like poker or blackjack, horse or dog racing, or sports betting. They are often seeking a "high" from gambling. Escape gamblers, who tend to be women, play games of pure chance, such as slot machines, video poker, lottery, or bingo. They often enter into a dissociative or trance-like state when they gamble; rather than seeking a high, they are generally trying to escape depression or other physical or emotional pain .
Recent trials show that medications used to treat other compulsive disorders seem to be effective in helping pathological gamblers. These selective serotonin reuptake inhibitors (SSRIs), such as fluvoxamine, appear to reduce the gamblers' obsessional thoughts and urges. However, many pathological gamblers (particularly men) also suffer from bipolar illness. If this is the case, they must be treated with a mood stabilizer; SSRIs might actually worsen their condition.
To contact Dr. Hollander, please write to: Dr. Eric Hollander, Professor, Mount Sinai School of Medicine, Department of Psychiatry, One Gustave L. Levy Place, New York , NY 10029 . Or visit http://www.mssm.edu/.
To contact Mr. Whyte, please write to: Mr. Keith Whyte, Executive Director, The National Council on Problem Gambling, Inc., 208 G Street, NE Washington, D.C. 20002 . Or visit http://www.ncpgambling.org/.
The National Council on Problem Gambling Nationwide Helpline is 1-800-522-4700.
After a short break, The Infinite Mind's Marit Haahr interviews Dr. Gerda Reith, Professor of Sociology at the University of Glasgow, Scotland and author of The Age of Chance: Gambling in Western Culture.
Dr. Reith discusses the "neglected majority" of gamblers -- those who are not problem or pathological gamblers, but rather turn to games of chance for fun, pleasure and recreation.
For most people, she says, gambling is not about winning money. After all, people tend not to stop when they're winning (or when they're losing, for that matter). She says people enjoy gambling as an experience, in itself -- people like the excitement and they take pleasure in imagining themselves as talented players and fantasizing about what they might do if they should win.
Dr. Reith says gambling is as old as humankind. She traces it back as early as 6000 BC, when our ancestors would engage in divination and fortune-telling rituals that involved casting sticks or bones into the air; even then, some would bet on the possible outcomes.
To contact Dr. Reith, please write to: Dr. Gerda Reith, Department of Sociology and Anthropology, Adam Smith Building, University of Glasgow, Glasgow; UK G12 8RT. Or visit http://www.gla.ac.uk/.
Then, Dr. Goodwin interviews Joanna Franklin, chief trainer for The Institute for Problem Gambling and President of the Maryland Council on Compulsive Gambling, Inc.
Ms. Franklin answers listeners' calls about how to recognize the signs of a gambling problem in a friend or loved one. People without a gambling problem are generally able to stick to their limits (whether time or money). If you see someone going past his or her limit -- gambling for five hours instead of two, or spending $100 instead of $20 -- there may be something wrong.
She encourages the family members of problem gamblers to seek help through Gam-Anon or another support program. To learn more about Gam-Anon, please visit http://www.gam-anon.org/
Ms. Franklin also discusses how recent research shows that men and women may respond better to different types of treatment. Action gamblers -- who tend to be men -- often respond well to the kind of treatment exemplified by Gamblers Anonymous -- the surrender approach. The gambler acknowledges his helplessness and surrenders to accept a different lifestyle. Because many female gamblers are abuse victims, this approach can be ineffective or even harmful. These women -- and escape gamblers, in general -- often respond better to an empowerment approach. The gambler accepts that she has power and is capable of making her own decisions; she need never be a victim again.
To contact Ms. Franklin, please write to: Ms. Joanna Franklin, President, Maryland Council on Compulsive Gambling, Inc, 503 Maryland Ave. Catonsville, MD 21228. Or visit: http://www.gamblingproblem.net/ or www.ncpgambling.org/maryland.html.
Finally, commentator John Hockenberry explains why he has never been bitten by the gambling bug: "I'd just as soon put quarters into a toaster. Who knows, it might blow up. That could be interesting."
- Marit Haahr
