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Pathological Gambling a Medical Problem, Not a Bad Habit

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July 18, 2001 -- The workers at Beverage Square in Lakewood, Ohio, have an inside joke: How can you tell the real gamblers from the amateurs? "When the real gamblers pull up in their cars, they have to roll down the window and reach outside to open the car door because nothing works," says store manager Charlie Fansler.

At the store there is no sign advertising lottery ticket sales, but for lottery fans this is the place. Beverage Square sells more lottery tickets than any other place in the greater Cleveland area, says owner James McKearney.

Last week the Ohio Lotto drawing set a state record for a single jackpot: $54 million. But McKearney says even a big jackpot like that doesn't bring out the real gamblers.

"The real, compulsive gamblers aren't interested in the Lotto," says McKearney. "They want instant winner tickets or daily pick-3, pick-4 drawings. It seems like they need the instant gratification."

That, says Marc N. Potenza, MD, PhD, is probably an accurate observation.

For a small number of people, gambling is a sickness that resembles alcoholism or drug addiction, says Potenza, in that the urge to gamble causes biological changes in the brain similar to changes observed in alcoholics and drug addicts.

So a person who is a pathological gambler is more likely to seek immediate gratification on demand, making an instant winner game a sort of drug of choice, says Potenza, who heads the Problem Gambling Clinic at Yale-New Haven (Conn.) Hospital. In last week's Journal of the American Medical Association, Potenza co-authored an article that reviews published studies on pathological gambling.

"This is a public health concern that general practitioners should be pursuing with their patients," says Potenza. Many physicians now ask patients about drinking, drug use, smoking, diet, and sexual practices, he points out, so why shouldn't they also ask about gambling?

Just as there is social drinking, there is social gambling, says Potenza, and about 85% of adults say they have gambled -- be it racetracks, lotteries, casinos, bingo, or a weekly poker game -- within the past year. "But we estimate that about 1-3% of the population are pathological gamblers and another 3% or so are problem gamblers," he says.

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