Supply and Demand: Who Offers Gambling? Who Gambles? - Demand—the Gamblers

Gambling is a leisure activity—people gamble because they enjoy it. Gambling proponents say there is no difference between spending money at a theme park and spending it at a casino. The money is exchanged for a good time in either case. Gambling has a powerful allure in addition to fun, though, and that is the dream of wealth, a very strong motivator. Some gambling options, like the lottery, offer the chance to risk a small investment for an enormous payoff. This potential is too appealing to pass up for many people.

Adults

In December 2003 the Gallup Organization conducted a nationwide poll to determine gambling participation rates. The results showed that 66% of adults asked had gambled during the previous twelve months. As shown in Figure 2.1 lottery play was the most popular gambling activity. Nearly half of those asked (49%) had engaged in it, while 30% had visited a casino. Other forms of gambling were far less common.

According to the Gallup report, three-quarters of the men reported gambling, while only 57% of women did. There were also considerable differences between urban and rural dwellers. While 69% of people living in urban areas had gambled, only 57% of those in rural areas had done so. There were also differences among education levels. People with a postgraduate education were less likely to have gambled than those with less education. However, the participation rate for people with higher incomes (greater than $50,000 per year) was higher than it was for people making less than that. Only 58% of those

FIGURE 2.1

making less than $30,000 per year reported gambling during the previous twelve months, compared to greater than 70% of those making in excess of $50,000 per year.

Gambling participation rates also varied depending on how often the poll respondents attended church. Those who attended church weekly reported far less gambling activity than those who seldom or never attended church. Midwesterners were more active gamblers than those living in other regions of the country. A slightly larger percentage of nonwhite people than white people reported gambling during the previous year. Age differences were minor as poll participants aged fifty to sixty-four were slightly more active in gambling than those of other ages. Republicans reported gambling slightly less than did Democrats or Independents. Moderates reported gambling slightly more than either conservatives or liberals.

Table 2.4 compares gambling participation rates from 2003 with those reported in Gallup polls conducted between 1989 and 1992. The percentage of people who had visited a casino within the previous year increased by 10% from 20% participation in 1989 to 30% in 2003. Video poker was the only other gambling activity to show an increase in participation, from 11% in 1992 to 14% in 2003. All other gambling activities showed decreased levels of participation. In total, Gallup reported that 70% of those asked during the 1989 poll had gambled in some fashion during the previous twelve months.

TABLE 2.4

Percentage of Americans participating in various forms of gambling, December 2003
	1989 Apr 4-9 %	2003 Dec 11-14 %	Change (in percentage points)
†Feb 15–18, 1990
‡Nov 20–22, 1992
SOURCE: Jeffrey M. Jones, "Percentage of Americans Participating in Various Forms of Gambling," in Gambling a Common Activity for Americans, The Gallup Organization, March 24, 2004, http://www.gallup.com/content/default.aspx?ci=11098 (accessed September 28, 2004). Copyright © 2004 by The Gallup Organization. Reproduced by permission of The Gallup Organization.
Visited casino	20	30	+10
Played video poker	11‡	14	+3
Bet on horse race	9†	4	−5
Bought state lottery ticket	54	49	−5
Bet on boxing match	8	2	−6
Participated in office pool	22‡	15	−7
Played bingo for money	13	5	−8
Bet on college sports	14	6	−8
Bet on pro sports	22	10	−12

A national survey, "Gambling Participation in the U.S.—Results from a National Survey," conducted by university researchers in 2002 and reported by the Journal of Gambling Studies found that 82% of poll participants had gambled during the previous year.

According to the July/August 2002 issue of Harvard Magazine, 81% of adults and 85% of college students in the United States have gambled at some point in their lifetimes. The statistics were based on data from the American Gaming Association (AGA) and analysis of previous gambling studies. The AGA reported, in 2004 State of the States: The AGA Survey of Casino Entertainment, that lottery games were by far the most popular in 2003, followed by casino gambling, and sports betting pools.

SENIOR CITIZENS. Gallup's December 2003 poll showed that 61% of people aged sixty-five and older reported gambling during the previous year. According to the July/August 2002 issue of Harvard Magazine, the percentage of people aged sixty-five and up who have ever gambled increased from 35% in 1975 to 80% in 1999.

In September 2002 the Wall Street Journal examined the increasing incidence of gambling problems among older Americans in an article titled "Gambling's Growth." Senior citizens comprise an increasing portion of telephone calls made to problem gambling groups. The California Council on Problem Gambling reports that older adults made up 15% of the callers to their helpline during 2001, up from 12% for the period June 1998 through December 2000. A similar increase occurred in New Jersey, where seniors accounted for 15% of calls in 2001, up from 9% in 2000. The percentages were even higher in Arizona (23%) and Connecticut (32%).

Counselors believe that older adults are experiencing more gambling problems because they increasingly have more disposable income and free time, they live longer and healthier lives, and they have many more gambling options than in years past.

Seniors are very attracted to casino gambling because casinos are warm and friendly places that make them feel safe and welcome. A clinical psychologist in Nebraska reports that one local casino offers a mail-order prescription service with deeply discounted prices, a program extremely appealing to seniors. Casinos also correspond with their patrons, sending them birthday cards and friendly postcards. These little gestures are especially pleasing to older people, who may feel left out of modern society.

Researchers report that women comprise an increasingly larger percentage of the seniors who seek help with gambling problems. This is particularly worrisome because women tend to live longer than men and therefore have a longer period in which to get into financial trouble. In general, seniors with gambling problems tend to reach a financial breaking point faster than younger adults and have fewer options for recouping their money. For example, some are unable to work. The seniors most vulnerable to gambling problems are those who feel isolated, bored, and lonely, particularly the ones suffering from depression or anxiety disorders.

Teenagers and College Students

The minimum legal age for placing a bet at most U.S. gambling activities ranges from eighteen to twenty-one, depending on the state and the activity. The vast majority of states prohibit the sale of lottery tickets to people under eighteen years of age. However, giving lottery tickets as gifts to minors is not generally prohibited. A handful of states limit lottery ticket sales to those twenty-one or older. Pari-mutuel wagering in most states is limited to those aged eighteen and up. One exception is Illinois, which allows seventeen-year-olds to wager at horse races. All commercial casinos have a minimum gambling age of twenty-one as set by state law. Tribal casinos are allowed to set their own minimum gambling age as long as it is at least eighteen. The minimum age to participate in charitable gambling activities, such as bingo games, is eighteen in most states. However, a few states allow people as young as sixteen to wager in charity gambling events.

The January 23, 2002, issue of The WAGER (The Weekly Addiction Gambling Education Report of the Harvard Medical School), includes "If You Do Not Gamble, Check This Box," a study on gambling perception and behavior. Researchers asked 449 college students whether they gambled or not, then asked about their participation in various gambling activities. The results are shown in Figure 2.2.

Surprisingly, nearly 150 of the self-characterized nongamblers had purchased scratch tickets at least once.

FIGURE 2.2

Scratch tickets are instant-game tickets offered by most state lotteries. Seventy-four students who considered themselves nongamblers had bought traditional lottery tickets. Smaller numbers had participated in other activities that researchers considered gambling, like casino games and sports betting.

The researchers were puzzled by the responses of the self-proclaimed nongamblers. They concluded that the definition of gambling among young people might be different from that of adults. This is particularly troubling to psychologists and counselors who work with young people because it implies that a young person could have a gambling problem and not even realize it because the person does not consider the activity to be gambling.

The minimum gambling age is twenty-one in Nevada. In 2001 Gemini Research, Ltd., of Northampton, Massachusetts, performed a research study on adolescent gambling for the Nevada Department of Human Resources and published its results in Gambling and Problem Gambling among Adolescents in Nevada (March 22, 2002). The report reviews previous studies about adolescent gambling conducted in the United States during the 1980s and 1990s.

The percentage of adolescents who gambled during the previous twelve-month period ranged from 20% to 86% in studies performed between 1984 and 1988, with a median percentage of 45%. A much higher median percentage (66%) is indicated by studies conducted between 1989 and 1999. These studies, conducted between March and May 2001, showed a range of 52% to 71%. These data indicate that adolescent gambling increased significantly as gambling opportunities have expanded in the United States.

For Gemini's 2001 study, a sample group of 1,004 teenagers aged thirteen to seventeen living in the state were interviewed about their gambling habits. Results were compared to studies performed during the late 1990s in four other states: New York, Georgia, Texas, and Washington. As shown in Table 2.5 Georgia had the highest percentage of nongamblers (38.1%), while New York had the highest percentage of weekly gamblers (15.5%). Demographic data from the study indicate that the adolescent gambler is most likely to be a white male aged fifteen who receives an allowance and lives in a household including two adults.

Previous research, also cited in the Gemini study, has shown that the most popular gambling activities for North American adolescents are:

TABLE 2.5

Gambling participation among adolescents in New York, Georgia, Texas, Washington, and Nevada, 1995–2001
	New York %	Georgia %	Texas %	Washington %	Nevada %
SOURCE: Rachel A. Volberg, "Table 23: Gambling Participation among Adolescents in Five States," in Gambling and Problem Gambling among Adolescents in Nevada, Nevada Department of Human Resources, March 22, 2002
	1997	1995	1995	1999	2001
	(1103)	(1007)	(3079)	(1000)	(1004)
Non-gamblers	14.0	38.1	19.4	22.4	33.5
Infrequent	10.7	9.8	15.7	12.5	17.8
Past year	59.8	39.9	54.9	57.4	41.8
Weekly	15.5	12.2	10.0	7.7	6.9

• Cards, dice, and board games played with family and friends
• Games of personal skill played with friends
• Sporting events
• Bingo

Nevada Adult Residents

In 2000 and 2001 Gemini Research performed a study of gambling in Nevada for the Nevada Department of Human Resources and published its results in Gambling and Problem Gambling in Nevada (March 22, 2002). Telephone interviews were conducted with 2,217 adult residents of the state. Many results are compared to those obtained from previous nationwide studies, particularly the 1998 study conducted by the National Opinion Research Center (NORC) for the National Gambling Impact Study Commission (NGISC).

The survey found that Nevada residents are much more likely to have engaged in casino and machine gambling during the previous twelve-month period than the average American. Nevadans are less likely to engage in many other types of gambling, including unlicensed (illegal) forms of gambling. Forty percent of Nevadan respondents gamble regularly, either monthly (21%) or weekly (19%). Fewer than one-third of the respondents (29%) had gambled in the past year but not regularly, while 14% had never gambled. The remaining 17% had gambled at least once in their lifetimes but had not gambled in the previous year.

The most common reasons given for gambling are as follows:

• Entertainment or fun (72%)
• Win money (67%)
• Socialize (37%)
• Excitement or challenge (35%)

Men were somewhat more likely than women to gamble for the excitement or challenge. Blacks were much less likely than all other ethnic groups to choose entertainment or socializing as a reason for gambling—winning money was the most important reason given.

The reasons given by nongamblers for not gambling also differed along ethnic lines. Approximately 70% of white and black nongamblers did not gamble for financial reasons. Only 44% of Hispanic nongamblers listed financial reasons. Moral reasons for not gambling were also named by one-third to one-half of the nongamblers.

Problem Gamblers

Problem gambling is a broad term that covers all gambling behaviors that are harmful to people in some way—financially, emotionally, socially, and/or legally. The harmful effects of problem gambling include the following:

• Financial difficulties, such as unpaid bills, loss of employment, large debts, and even bankruptcy
• Emotional problems, such as depression, anxiety, addictions, and suicidal tendencies
• Social problems, as evidenced by strained or broken relationships with one's spouse, family, friends, and coworkers
• Legal problems related to neglect of children or commission of criminal acts to obtain money

In the Gallup Organization's December 2003 poll regarding gambling activities the pollsters found that 6% of those asked said gambling had been a source of problems for their families. (See Table 2.6.) This value is up slightly from the percentages reported in 1989, 1992, and 1996, but down slightly from the percentage reported in 1999. The 2003 survey showed a marked difference in answers by age. Only 4% of those aged fifty and up said gambling had been a problem for their family, compared with 12% of adults aged eighteen to twenty-nine years. In comparison, a July 2003 Gallup poll found that 31% of all adults reported that alcohol had been a source of problems for their families.

In general, scientists characterize gambling behavior by the level of harm that it causes. People who experience no harmful effects are called nonproblem gamblers, or social, casual, or recreational gamblers. People who gamble regularly and may be prone to a gambling problem are called at-risk gamblers. Those who experience minor to moderate harm from their gambling behavior are called problem gamblers. Those who suffer severe harm from their gambling behavior are called pathological gamblers.

Scientists use a screening process to determine which category fits a particular gambler. One of the most common is the South Oaks Gambling Screen (SOGS), a sixteen-item

TABLE 2.6

Poll results regarding family problems related to gambling, selected years, 1989–2003
HAS GAMBLING EVER BEEN A SOURCE OF PROBLEMS WITHIN YOUR FAMILY?
	Yes %	No %	No opinion %
*Less than 0.5%
SOURCE: Jeffrey M. Jones, "Has gambling ever been a source for problems within your family?" in Gambling a Common Activity for Americans, The Gallup Organization, March 24, 2004, http://www.gallup.com/content/default.aspx?ci=11098 (accessed August 14, 2004). Copyright © 2004 by The Gallup Organization. Reproduced by permission of The Gallup Organization.
2003 Dec 11–14	6	94	*
1999 Apr 30–May 23	9	91	*
1996 Jun 27–30	5	95	*
1992 Nov 20–2	5	94	1
1989 Apr 4–9	4	96	*

questionnaire developed in the 1980s by Dr. Henry Lesieur and Dr. Sheila Blume. A detailed description of SOGS and its development was first given in the article "SOGS: A New Instrument for the Identification of Pathological Gamblers," published in the American Journal of Psychiatry in September 1987. The authors used information from 1,616 subjects to develop the SOGS screen, including patients with substance abuse and pathological gambling problems, members of Gamblers Anonymous, university students, and hospital employees.

One version of the SOGS questionnaire is shown in Table 2.7. The scoring system is shown in Table 2.8. Of course, since the SOGS screen is a questionnaire filled out by potential problem gamblers themselves, the score depends entirely on the truthfulness of the person answering the questions.

Gamblers Anonymous (GA) is a self-help organization for gamblers that was begun in 1957. GA uses the term "compulsive gambling" to describe the illness that problem gamblers experience. On its Web site (www.gamblersanonymous.org), the organization lists the following general characteristics of compulsive gamblers:

• An "inability and unwillingness to accept reality"
• A belief that they have a "system" that will eventually pay off
• A lot of time spent daydreaming about what they will do when they finally make a big win
• Feelings of emotional insecurity when they are not gambling
• Immaturity and a desire to escape from responsibility
• Wanting all the good things in life without expending much effort for them
• Desire to be a "big shot" in the eyes of other people

TABLE 2.7

GA has a list of twenty questions that it suggests gamblers answer to determine if they have a compulsive gambling problem. The questions are presented in Table 2.9. GA indicates that compulsive gamblers are likely to answer yes to at least seven of these questions.

PATHOLOGICAL GAMBLERS. Pathological gamblers are the most seriously troubled problem gamblers. In general, pathological gambling is a disorder characterized by irrational thinking in which people continuously (or periodically) lose control over their gambling behavior. Pathological gamblers become preoccupied with gambling, constantly thinking about their next bet or how to raise more money with which they can gamble. This behavior continues even if the gambler suffers adverse consequences, such as financial difficulties or strained relationships with family and friends. The consequences of pathological gambling can be quite severe, both to gamblers and to those around them.

In 1975 the first nationwide prevalence study on gambling in the United States was conducted by the University of Michigan Survey Research Center for the Commission on the Review of the National Policy Toward Gambling. Responses were obtained from 1,736 adults. As there was no scientific basis for determining whether or not someone was a problem gambler at that time, researchers used a questionnaire based on GA's twenty questions. Results indicated that 0.77% of Americans were "probable compulsive gamblers" and another 2.33% were "potential compulsive gamblers." The percentages for Nevada residents were approximately three times higher than for the national sample.

The American Psychiatric Association (APA) first officially recognized pathological gambling as a mental

TABLE 2.8

health disorder in 1980 and listed it in their publication Diagnostic and Statistical Manual of Mental Disorders (DSM). The latest edition of the manual, published in 2000, is known as DSM-IV-TR. Table 2.10 shows the diagnostic criteria used by the APA in DSM-IV to define pathological gambling. The SOGS questionnaire was designed to correlate with the DSM criteria for pathological gambling.

In July 1984 Dr. Henry Lesieur and Dr. Robert L. Custer published "Pathological Gambling: Roots, Phases, and Treatment" in the Annals of the American Academy of Political and Social Science. The researchers reported that pathological gamblers have tendencies to be hyperactive and to be able to tolerate high levels of stress.

In 1996 the National Center for Responsible Gaming provided a grant to researchers at the Harvard Medical School to perform another large-scale study of the prevalence of problem gambling. The results were published in

TABLE 2.9

Twenty questions that may help indicate that an individual is a compulsive gambler
Gamblers Anonymous offers the following questions to anyone who may have a gambling problem. These questions are provided to help the individual decide if he or she is a compulsive gambler and wants to stop gambling.
SOURCE: "Twenty Questions," in Gamblers Anonymous, Gamblers Anonymous, 2002, http://www.gamblersanonymous.org/20questions.html (accessed August 28, 2004)
1.	Did you ever lose time from work or school due to gambling?
2.	Has gambling ever made your home life unhappy?
3.	Did gambling affect your reputation?
4.	Have you ever felt remorse after gambling?
5.	Did you ever gamble to get money with which to pay debts or otherwise solve financial difficulties?
6.	Did gambling cause a decrease in your ambition or efficiency?
7.	After losing did you feel you must return as soon as possible and win back your losses?
8.	After a win did you have a strong urge to return and win more?
9.	Did you often gamble until your last dollar was gone?
10.	Did you ever borrow to finance your gambling?
11.	Have you ever sold anything to finance gambling?
12.	Were you reluctant to use "gambling money" for normal expenditures?
13.	Did gambling make you careless of the welfare of yourself or your family?
14.	Did you ever gamble longer than you had planned?
15.	Have you ever gambled to escape worry or trouble?
16.	Have you ever committed, or considered committing, an illegal act to finance gambling?
17.	Did gambling cause you to have difficulty in sleeping?
18.	Do arguments, disappointments or frustrations create within you an urge to gamble?
19.	Did you ever have an urge to celebrate any good fortune by a few hours of gambling?
20.	Have you ever considered self destruction or suicide as a result of your gambling?
Most compulsive gamblers will answer yes to at least seven of these questions.

Estimating the Prevalence of Disordered Gambling in the U.S. and Canada: A Meta-Analysis (1997). A meta-analysis is an analysis of previously collected data. The researchers examined hundreds of scientific studies on gambling in the United States and Canada. They developed a new ranking system to define levels of problem gambling:

• Level 0—Nongamblers
• Level 1—Social gamblers with no gambling problems
• Level 2—Problem gamblers
• Level 3—Pathological gamblers

The lifetime prevalence rate of Level 3 (pathological) gambling in the adult North American population was calculated to be 1.6%.

In 1999 Pathological Gambling: A Critical Review was published by National Academies Press. The book identified and analyzed all available scientific research studies dealing with pathological and problem gambling. The studies were reviewed by dozens of researchers on behalf of the National Research Council, an organization administered by the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The effort was supported by the NGISC. The book estimates that 1.5% of U.S. adults are pathological gamblers at some point in their lives. In any given year, 0.9% of U.S. adults (approximately 1.8 million people) and 1.1 million adolescents aged twelve to eighteen are pathological gamblers. The following general conclusions are drawn:

• Men are more likely than women to be pathological gamblers.
• Pathological gambling often occurs concurrently with other behavioral problems, such as drug and alcohol abuse and mood and personality disorders.
• The earlier in life a person starts to gamble, the more likely he or she is to become a pathological gambler.
• Pathological gamblers are more likely than those without a gambling problem to have pathological gamblers as parents.
• Pathological gamblers who seek treatment generally get better.

The researchers complained that the research literature on pathological gambling available at that time was of limited scientific value. For example, they were unable to determine whether any particular treatment technique was more effective than most others or even if some pathological gamblers are able to recover on their own. They were also unable to determine whether particular groups, such as the elderly and the poor, have disproportionately high rates of pathological gambling. They recommended that the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) monitor pathological gambling as part of their annual surveys on the nation's health status.

Another nationwide study published during 1999 was titled Gambling Impact and Behavior Study: Report to the National Gambling Impact Study Commission. This study was conducted by the NORC at the University of Chicago. The study found the lifetime prevalence rate for pathological adult gamblers to be 0.9%. The past-year prevalence rate was 0.6%.

There have also been statewide studies of the prevalence of problem gambling. The report Gambling and Problem Gambling in Nevada (March 22, 2002) summarized the findings of the most recent studies for various states in Figure 2.3. The prevalence of problem gambling in Nevada in 2000 was 6.4%, the largest of any state. Nevada also had the highest percentage of probable pathological gamblers—3.5%. Despite the widespread availability of casinos in Nevada, the type of gambling with the highest prevalence of problem gamblers is not casino gambling (at 8.7%) but card room gambling (at 33.7%). This is followed by horse/dog racing (18.8%),

TABLE 2.10

Diagnostic criteria for pathological gambling
Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:
SOURCE: Rachel A. Volberg, "Table 1: Diagnostic Criteria for Pathological Gambling," in Gambling and Problem Gambling in Nevada, Nevada Department of Human Resources, March 22, 2002
Preoccupation	Preoccupied with gambling (e.g. preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
Tolerance	Needs to gamble with increasing amounts of money in order to achieve the desired excitement
Withdrawal	Restlessness or irritability when attempting to cut down or stop gambling
Escape	Gambling as a way of escaping from problems or relieving dysphoric mood (e.g. feelings of helplessness, guilt, anxiety or depression)
Chasing losses	After losing money gambling, often return another day in order to get even ("chasing one's losses")
Lying	Lies to family members, therapists or others to conceal the extent of involvement with gambling
Loss of control	Made repeated unsuccessful efforts to control, cut back or stop gambling
Illegal acts	Committed illegal acts, such as forgery, fraud, theft or embezzlement, in order to finance gambling
Risked significant relationship	Jeopardized or lost a significant relationship, job, educational or career opportunity because of gambling
Bailout	Reliance on others to provide money to relieve a desperate financial situation caused by gambling
The gambling behavior is not better accounted for by a Manic Episode.

FIGURE 2.3

private gambling (17.2%), and gambling on machines not located at casinos (12.0%).

Gemini Research, Ltd., examined the prevalence of problem gambling among teenagers in Gambling and Problem Gambling among Adolescents in Nevada. Table 2.11 shows the percentage of nonproblem, at-risk, and problem gamblers identified among adolescent gamblers in five states from 1995 to 2000. Georgia had the highest percentage of problem adolescent gamblers (2.8%). The percentages were determined using SOGS-RA, a version of the SOGS questionnaire specially developed for adolescents.

TREATMENT ORGANIZATIONS. A variety of treatment methods are available to problem gamblers through organizations and private counselors. Major organizations devoted solely to problem gambling include GA, the National Council on Problem Gambling, and the Institute for Problem Gambling.

GA is a self-help organization open to all people who want to stop gambling. Meetings are held throughout the United States at which gamblers can remain anonymous by using their first names only. At the meetings, gamblers talk about their past experiences and the problems in their lives caused by gambling. The group method offers compulsive gamblers moral support and an accepting environment in which they can talk about their problems openly and honestly. Gambling is not treated as a vice but as a progressive illness.

GA contends that compulsive gamblers are sick people who can recover if they follow to the best of their ability the organization's 12-step recovery program. (See Table 2.12.) These steps are similar to those employed by other support groups like Alcoholics Anonymous. Although the steps have a spiritual aspect, GA is not affiliated

TABLE 2.11

Problem gambling among adolescents in New York, Georgia, Texas, Washington, and Nevada, 1995–2001
	New York %	Georgia %	Texas %	Washington %	Nevada %
SOURCE: Rachel A. Volberg, "Table 24: Problem Gambling among Adolescents in Five States," in Gambling and Problem Gambling among Adolescents in Nevada, Nevada Department of Human Resources, March 22, 2002
	(1103)	(1007)	(3079)	(1000)	(1004)
Non-problem	83.6	86.8	88.2	91.6	91.9
At risk	14.0	10.4	9.9	7.5	6.2
Problem	2.4	2.8	2.3	0.9	1.9

with any religious group or institution, and the organization is funded by donations. GA believes that a recovering compulsive gambler cannot gamble at all without succumbing to the gambling compulsion. In other words, GA advocates a "cold turkey" approach to quitting gambling rather than a gradual step-down.

The National Council on Problem Gambling (NCPG) is a nonprofit organization founded in 1972 to increase public awareness about pathological gambling and to encourage development of educational, research, and treatment programs. NCPG was known as the Council on Compulsive Gambling from 1972 to 1976 and as the National Council on Compulsive Gambling from 1976 to 1989.

NCPG sponsors the Journal of Gambling Studies, an academic journal dedicated to scientific research on problem gambling. The NCPG has 34 state affiliate chapters and operates a national 24-hour confidential hotline (1-800-522-4700) that can refer people for further help. The hotline received more than 145,000 calls during 2003.

NCPG also operates the National Certified Gambling Counselor program, a certification program for professional counselors who treat problem gamblers. On its Web site (www.ncpgambling.org), NCPG offers an extensive database of more than two hundred counselors around the United States who have completed its certification program. Other organizations that certify gambling counselors include the American Compulsive Gambling Certification Board and the American Academy of Health Care Providers in the Addictive Disorders.

The Institute for Problem Gambling (IPG) is a notfor-profit organization founded in 1997 that primarily assists government leaders in dealing with problem gamblers. IPG provides the resource of scientific information on the study, prevention, and treatment of problem gambling. It also collects and develops public service announcements, educational videos, and instruction manuals useful to treatment programs.

ASPECTS OF TREATMENT. Effective treatment of a problem gambler requires recognition of the problem by

TABLE 2.12

Gamblers Anonymous 12-step program of recovery
SOURCE: "The Recovery Program," Gamblers Anonymous, Gamblers Anonymous, 2002, http://www.gamblersanonymous.org/recovery.html (accessed August 28, 2004)
1.	We admitted we were powerless over gambling - that our lives had become unmanageable.
2.	Came to believe that a Power greater than ourselves could restore us to a normal way of thinking and living.
3.	Made a decision to turn our will and our lives over to the care of this Power of our own understanding.
4.	Made a searching and fearless moral and financial inventory of ourselves.
5.	Admitted to ourselves and to another human being the exact nature of our wrongs.
6.	Were entirely ready to have these defects of character removed.
7.	Humbly asked God (of our understanding) to remove our shortcomings.
8.	Made a list of all persons we had harmed and became willing to make amends to them all.
9.	Make direct amends to such people wherever possible, except when to do so would injure them or others.
10.	Continued to take personal inventory and when we were wrong, promptly admitted it.
11.	Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12	Having made an effort to practice these principles in all our affairs, we tried to carry this message to other compulsive gamblers.

the gambler. Most problem gamblers deny that they even have a gambling problem. Those who enter treatment often do so under pressure from a spouse or family member and are driven by their fear of losing that relationship. The most common treatment method used by professional counselors in group or individual counseling sessions is called cognitive behavior therapy. The cognitive portion of the therapy focuses attention on the person's thoughts, beliefs, and assumptions about gambling. The primary goal is recognizing and changing faulty thinking patterns. Behavior therapy focuses on changing harmful behaviors.

The major components of cognitive behavior therapy for problem gambling include:

• Acknowledgment that gambling is causing problems
• Indication that a change in circumstances is desired
• Examination of decision-making processes related to gambling
• Discussion of gambling misconceptions
• Identification of any behavior triggers
• Development of coping strategies

Most programs favor complete abstinence from gambling as the only sure method to prevent relapses.

One thing that makes the treatment of pathological gambling difficult is the likelihood that it is accompanied by other psychological problems. In 1987 Dr. Henry Lesieur and Dr. Sheila Blume, the developers of SOGS, reported that existing studies at that time showed clear connections between pathological gambling and substance abuse. These researchers also found a much higher rate of pathological gambling among psychiatric hospital patients and prison inmates than among the general population. A 1995 article in Annals of Clinical Psychiatry reported a significantly higher rate of impulse control disorders and attention deficit disorders among pathological gamblers than among a control group. One of the most prevalent impulse control disorders among pathological gamblers was compulsive sexual behavior.

The National Research Council reported to the U.S. Senate in 2001 that "gambling is highly associated with other behavioral disorders, particularly depression, alcoholism, and drug addiction." These other disorders accelerate and intensify gambling-related problems like financial crises, strained relationships with family and friends, problems at work, and criminal activities to repay gambling debts.

THE GAMBLER'S FALLACY. Scientific literature about problem gamblers often mentions the gambler's fallacy. A fallacy is a false or mistaken idea. The gambler's fallacy is the mistaken belief that a string of losses makes it more likely that the next bet will be a winner. For example, the gambler's fallacy says that if a coin is tossed and comes up heads five times, the chances are extremely good that the sixth toss will come up tails. This is not so. The probability of each individual coin toss coming up heads or tails is 50-50. The long-run probability says that over many coin tosses the number of heads and tails will come out even. The proportion of heads to tails will approach 50-50 the more times the coin is tossed, but it may take many thousands of tosses. Ignorance about long-run probability causes many gamblers to make poor betting decisions.

In the March 22, 2002, issue of Science, researchers at the University of Michigan published a study on the role of the brain in processing win and loss information during gambling. Twelve subjects (six men and six women) aged nineteen to thirty performed 768 trials of a gambling game while their brain activity was monitored with an electroencephalogram (EEG).

During each game, two boxes appeared on a computer screen, one marked 5 cents and the other 25 cents. The player had to choose one of the boxes. After a short delay, each box would turn green or red. If the player's chosen box turned green, the player won the amount listed in the box. Choosing a box that turned red resulted in a loss of the amount listed in the box. Sometimes both boxes turned green or both turned red.

The researchers found that the medial frontal cortex of the brain responded whether the choice was a win or a loss, as evidenced by a dip in the EEG tracing. However, the dip was larger after a loss. Researchers suspect that the brain shows greater activity when it realizes that an emotionally painful error has been made. The dip became even more pronounced after subsequent losses, suggesting that each additional loss is more painful. The researchers noticed that after losses, players were more likely to take bigger risks during the next game. The researchers concluded that earlier gains and losses affect risk-taking behavior and brain activity, suggesting that the two are linked. In other words, the brain's automatic response to a loss may be to make a riskier bet the next time.