Gambling With Addiction

From the WebMD Archives

May, 16, 2001 -- The backroom poker game and the racetrack traditionally may have been an all-male bastion, but Karen H., of Los Angeles, can tell you that gambling addiction is an equal opportunity employer.

Karen began her dance with Lady Luck at the age of 8. "I classified myself as the best card shuffler in the second grade," she tells WebMD. "We'd flip baseball cards against the garage, and whoever got closest won all the cards."

By the time she was a teenager, she was playing real cards with the boys and delighting the adults at her parents' poker parties. But the thrill of beating the odds -- like the euphoria of alcohol or drugs -- would take its toll, as her gambling became an addiction and a way of life.

As an adult and a mother, she would have to keep some aspects of her gambling life -- like nighttime forays to the card clubs of nearby Gardenia, Calif. -- a secret. "Everyone knew when I went to Vegas or when I bet on the sports games," she says. "But no one knew about my trips to Gardenia. I kept that in the closet. I thought, it was okay for a man to gamble, but I was a mom with two kids."

Today, Karen considers herself a recovering gambling addict. And though aspects of her story are unique, she is definitely not alone: Experts say there has been an explosion in the number of women seeking treatment for gambling addictions.

Estimates of the percentage of people with gambling addictions range from 1% to 4%, and one-third of all gamblers are believed to be women. Yet much of the existing research on gambling is derived from studies of men, experts say.

Now, new research looking at gender differences in pathological gambling is yielding some eyebrow-raising findings. In a comparison of 48 females and 53 males entering an outpatient treatment program for pathological gambling, researchers found that women tended to start gambling later than men but that their disorder progressed faster.

"What we found is that women tend to progress two to four times faster than men between the onset of gambling regularly until they sought their first gambling-specific treatment," says researcher Hermano Tavares, MD, PhD.

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"Many of these women are not the regular image of a gambler. They are mostly recent gamblers, often retired mothers that went to gamble a little, got distracted, and came out with a huge headache. They are bewildered and can't believe what has happened to their lives."

Tavares suggests two possible interpretations for the more rapid progression: Either women are more vulnerable to addiction than men, or they more likely to seek treatment earlier. But he says he is skeptical of the latter explanation, saying that there are a host of social and cultural reasons why women are likely not to seek treatment. "It's still an open question, but we think there is something related to a gender-specific vulnerability," he says.

Tavares, who is with the Addiction Center at the University of Calgary in Alberta, presented his research at the recent annual meeting of the American Psychiatric Association held in New Orleans.

Interestingly, Tavares and colleagues also found that women generally have access to a narrower range of gambling outlets but that the games they do participate in tend to be the most addictive. Those outlets include the old and the new: bingo and video lottery terminals.

The latter are video simulations of games such as poker, often found in casinos but also in many bars and lounges. Their addictive appeal, Tavares says, lies in the fact that they offer rapid, nearly immediate, gratification. "Video lottery terminals are the most common gambling devices," he says. "It's a really fast game. You place a coin in the slot, push a button, and have a result almost immediately."

Gambling addiction expert Nancy Petry, PhD, tells WebMD that the findings of a later age of onset and more rapid progression to seeking treatment roughly mirror what she and other researchers looking at gender differences among gamblers have found. But she believes the faster progression to treatment likely reflects a greater willingness among women to seek treatment, rather than any heightened vulnerability to addiction.

Nevertheless, one thing is unequivocally clear: The number of women gamblers in treatment has exploded.

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"What is striking is that 10 or fifteen years ago 95% of the people in treatment for gambling were men," Petry tells WebMD. "Now it's 60% men and 40% women. Programs all over the United States and Canada are seeing this, and compulsive gambling hotlines are reporting massive increases in women callers."

Petry is an associate professor of psychiatry at the University of Connecticut Health Center and principal investigator at the Gambling Treatment and Research Center in Farmington, Conn.

Petry says that by far, the biggest factor in the increase is in the expanding legalization of gambling. Forty-eight states -- all but Hawaii and Utah -- have legalized gambling, and 27 states have casinos.

The study by Tavares suggests that women may seek out gambling, and later become addicted, for reasons that are different from men's -- a finding that Petry says is also well known, though difficult to quantify. The prevailing wisdom is that men gamble for the high-energy rush that comes from "action gambling" like betting at the racetrack or dice games. Women are believed to be more prone to "escape gambling" in the form of slot machines or video lottery terminals.

While Tavares found that women gamblers tended to be single, Petry says she has found just the opposite, and she says some women gamblers report being in unhappy marriages. Her center is also conducting a study at six sites in the U.S. and Canada to test the hypothesis that women gamblers may be more likely to have a history of physical or sexual abuse.

So when does a fun fling at the casino slot machine become a problem that requires attention?

Petry says there are red flags the gambler can notice herself, even before anyone else does. "When people start feeling guilty about how much they are gambling or start covering up how much they are spending, that's an early warning sign," she tells WebMD.

Participation in Gamblers Anonymous, or GA, modeled on the 12 steps of Alcoholics Anonymous, is widely encouraged at all centers for treatment of gambling disorders. But Petry cautions that the female bingo player or slot machine junkie can sometimes find herself alienated at GA meetings heavily populated by men who have lost thousands at the casino and the racetrack.

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"A lot of women would find themselves a fish out of water," she says. But she urges women who think they are getting in trouble not to be deterred, and adds that GA meetings are becoming more open to women as the numbers seeking treatment increase.

For Karen, the bottom dropped out in 1979 after an all-night binge at the card club in Gardenia. "I called Gamblers Anonymous, mostly to get my husband off my back," she recalls. "They told me to try coming to meetings for 90 days, and after that I could have my misery back."

Today, Karen says she hasn't placed a bet in 21 years and five months. "It was like magic," she says of the meetings. "But you can't help someone who doesn't want help. Up until that point, I didn't want help."

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