Pathological Gambling a Medical Problem, Not a Bad Habit

Medically Reviewed by Jacqueline Brooks, MBBCH, MRCPsych
From the WebMD Archives

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. Learn more about spotting the signs of a gambling addiction.


"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.


The difference, says Potenza, is just like the people who pull up to Beverage Square in cars so beat up the doors don't open. A pathological gambler has no money to spend on car repairs, let alone a new car, he says. The pathological gambler will use food, rent, and utility money for gambling -- and when that runs out he or she may steal to feed the habit. Like the alcoholic who becomes a "closet drinker," the pathological gambler will lie to family and friends about his or her gambling.


A typical scenario, says McKearney, "is like the woman who won $75 on an instant ticket and said, 'Now I can pay the electric bill.'"


Some groups have a higher risk for pathological gambling than others, says Potenza. Men are two to three times more likely to be problem gamblers than are women, and blacks have a higher risk than whites. A family history of gambling problems is also a risk factor and the poor are more likely to be drawn into problem gambling than are wealthier, better-educated people.


The good news, says Potenza, is that some drugs may lessen the gambling urge. A few small studies suggest that antidepressants such as Prozac and Zoloft may work in some individuals, he says, while others may respond to naltrexone, a drug used in treating addiction to alcohol and heroin.


Potenza says, too, that self-help programs such as Gamblers Anonymous and the family support program called Gam-Anon have also been helpful for some pathological gamblers.