The Overlooked Addiction: Problem Gambling

By Linda Stansberry 04/30/14

Gambling addiction leaves no track marks, no smell on the breath or outward signs of dysfunction. It's seen as a socially acceptable vice, but the damage it can do is staggering.


A stocky man in a suit opens the heavy, wood-paneled door for you and says some perfunctory words of welcome. You step from the sunshine into a windowless room, a cacophony of sound. It takes a minute to adjust to the tinkling, boinging sounds of slot machines. The room is large, upholstered with thick carpet, well-lit but not bright. Faintly, above the sound of the machines, you can hear the large industrial fans meant to suck away the fug of tobacco smoke. The casino is on an Indian reservation, technically a sovereign nation, and smoking is allowed here. Next to each slot machine you'll find an ashtray. Girls in tight skirts come by occasionally to empty the ashtrays and take orders for watered down drinks. There are no clocks. Merriment is taking place in small clusters: at the blackjack table, in the lounge or the occasional group of friends sharing a machine. For the most part, though, the slot machines are manned by solitary, smoking gamblers, usually older men and women, pushing buttons and watching the numbers fluctuate, slack-jawed but intent. When you raise your head from the lights and sounds of the machines and look around, the room feels small and close and grimy. In a corner, close to the bathroom, just above a fake potted plant, is a small metal plaque screwed to the wall. PROBLEM GAMBLING? it says. CALL 1-800-GAMBLER.

Something strange happens in the brain of a problem gambler when they sit down in front of a slot machine or a card table. The primal mechanisms that control breathing, heart rate and neural pathways respond. The sight of tiny cartoon fruit settling into a line or a dealer shuffling a deck of cards triggers a rush of dopamine. Gambling addicts usually fall into two subsets: action-seeking or escape-seeking gamblers. Action-seekers (often men) are the card table gamblers, chasers of a stimulant-type high that comes from high stakes, macho posturing and the luck of the draw. Escape-seekers (often women) are the slot pullers, machine gamblers who are tugged by the promise of one big win into hours and hours of the zoning out in front of blinking lights and diminishing returns.

Process addictions such as gambling, sex, or overeating rely not on a set substance to obtain a high but the ability of compulsive behaviors to change brain chemistry. Like most process addictions, gambling is poorly understood and widely undertreated. It's hard to even settle on a name for it. Traditional twelve-steppers, members of Gamblers Anonymous, are likely to call it gambling addiction. Addiction professionals are more likely to group sufferers into one of two categories. Pathological gamblers—one to two percent of the US population—are seen to have a diagnosable mental disorder. Problem gamblers—two to three percent of the US population—make up the balance of those suffering consequences from their gambling without meriting a pathological diagnosis. Whatever the term, demand for treatment often far exceeds the help available.

“The best thing I've found to help me was to put my name on a list so they won't let me in,” says Gina S.*, a problem gambler from Northern California. She's referring to the “voluntary exclusion” system, where gamblers request to become legally banned from casinos. If Gina S. returns to her local casino, she can be arrested for trespassing. Any winnings she accrues at this time will be invalidated.

But the damage is already done. Once a financially comfortable retiree, Gina has fallen behind on her mortgage payments and lost the trust of her daughter, from whom she borrowed money. She planned on paying it back. They always plan on paying it back. This is what non-gamblers often don't understand about problem or pathological gamblers, that they keep playing because they're always certain that if they play long enough they can break even. An initial win early in the gambler's career might set up the internal mythos of possibility, much like an alcoholic's perfect “first drunk,” but this feat is usually followed by successive losses. The system, as they say, is rigged. As a problem gambler transitions into pathology, they follow a pattern of diminishing returns familiar to many addicts. The money and the initial high never return, but the elusive hope of regaining the power and allure of that first win, as well as all of the money “taken” from them, leads them further and further into dysfunction.

David*, 32, has been gambling since he turned eighteen.

“I remember taking the money I made mowing lawns and taking it to the casino and losing it all,” he says. He estimates his total losses over a decade of gambling to be close to $100,000.

“I could have bought a house,” he says, shaking his head. He said that the most he has won at one time was $1,600, which he immediately lost.

Despite many challenges, including a history of mental health problems, David initially balanced his compulsive gambling with a successful life. At twenty-four he owned his own business, a small liquor store in a college town. The store ended up financing his sprees to the local casino, where he spent entire nights at the slot machines.

“I would take $800 out of the till, spend it, drive back to the store and take another $800 out. I'd lose that so I'd come back and take out $400, then $200. I knew I had to have some profit or the bookkeeper would ask me about it, that's why I took out less.”

David eventually lost the store. He moved back in with his parents and pawned off his electronics to return to the casino. He says occasionally he would ask people at the casino for money.

“They don't like it when they do that,” he says. Security would usually ask him to leave.

At the time of our interview, David had not gambled for six months, largely due to his residency at an inpatient program where he is addressing his mental health problems. Close to half of compulsive gamblers have a co-occuring mood disorder, while an even higher percentage struggle with substance abuse. David has been diagnosed with everything from Tourette Syndrome to bipolar disorder. He says that the medications he's on now help somewhat with cravings.

Gambling addiction leaves no track marks, no smell on the breath or outward signs of dysfunction. It's seen as a socially acceptable vice. Casinos often market themselves as family friendly entertainment destinations, offering swipe reward cards that give players points towards in house restaurants or special deals on their birthdays. In rural areas, tribal casinos are often the only nightlife available. Special buses often ferry people to and from the casinos. Lonely senior citizens have been shown to be extremely vulnerable to problem gambling, as casinos and bingo halls offer a chance to be around other people. When playing the slots is just seen as a fun way for grandma to blow off steam, it can be a long time before a problem gambler's losses become known to their family.

The discovery and the damage is often staggering. Problem gamblers refer to the “hypnotic effect” of slot machines, the exhilarating high of the blackjack tables, how they draw the player in to a private world. The common logic is that “you have to play big to win big.” Entire paychecks, college tuitions, life savings, seem like a worthy investment. 

As in more traditional addictions, family members often try to restrict the gambler's access to their fix. Names are taken off checking accounts, mortgages and vehicles. The combinations to safes are changed. But addicts are slippery. There are always credit cards that can be taken out, or friends and family members that can be hit up for loans. In an effort to protect the reputation of a gambler, those that know about their problem often won't reveal it to others. The gambler will go on to exploit this secrecy, asking for loans or sometimes outright stealing, then taking the money to the casino or the track with the intention of scoring big and paying it all back. In this respect, gamblers can often create more accumulated financial wreckage than addicts or alcoholics. 

This addiction has an incredibly high suicide rate: the National Council on Problem Gambling (NCPG) has estimated that one in five problem gamblers attempt to kill themselves. It stands to reason that gamblers would be vulnerable to suicide. Alcohol and heroin will eventually kill you. Gambling won't. Crack and cigarettes can sustain a reason to live: the desire to smoke more crack and cigarettes. When every resource is exhausted, every credit card maxed out, your family estranged and nothing left but a pile of debt, a gambler has no mirage left to chase.

A Catch 22 often faced by problem gamblers is that recovery is expensive. Pretty much every community offers free or low-cost rehabilitation programs for drug users, but treatment for compulsive gambling is almost exclusively offered through private rehab centers. By the time a problem gambler hits rock bottom, it's unlikely that they'll be able to afford treatment. Moreover, the road to recovery back from gambling is often a slow one if a great deal of financial damage has been done. A gambler's credit and reputation are often both bankrupt at the end of their use, and what took years to build and seconds to undo may take subsequent decades to rebuild.

“We're in the entertainment industry, and if you aren't having fun, there are issues that need to be addressed,” said Judy Patterson, senior vice president and executive director of the American Gaming Association in an interview with the magazine “Casino Enterprise Management." The trajectory of the gaming industry's efforts to encourage “responsible gaming” resembles that of the tobacco industry, a proportion of whose revenue goes towards allaying future smokers and helping addicts quit. 

California, which has had legal tribal gambling since 1999, allocates a small percentage of casino revenue towards free treatment for compulsive gamblers and their families. Dr. Eric Geffner, who has worked in the field since 1997, says that he's noticed a sharp uptick in clients seeking help for compulsive gambling since the advent of the casinos, and that while the expansion of treatment options is promising, there is no “magic bullet” for sufferers.

“There's no one treatment for gambling addiction, just as there is no one type of gambler,” he says, adding that he strongly encourages his clients to attend Gambler's Anonymous in addition to counseling. As in David's case, he says that medications can be useful for clients suffering mental health problems that might exacerbate their compulsion.

The gambling industry has a wide reach and an aggressive marketing strategy. David says that when he turns on the radio and hears the familiar trill of the slot machines on a casino's ad spot, his brain starts racing. He's thinking about how he can get to the casino, who will give him the money to spend there. Even with all of the consequences he's experienced as a result of his compulsion, he's still convinced that he can beat the system. 

“The way to make the money back is to milk them,” he says, “If you win five dollars you put it in your pocket and you walk out.”

When asked why he hasn't tried this before, he frowns. 

“I just haven't, I guess. But it's the way to do it. I could make a lot of money if I just did it right the next time.”

*Names have been changed in the interest of anonymity.

Linda Stansberry is a regular contributor to The Fix. She has written about the ayahuasca trail and that parent dilemma for addicts.

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Linda Stansberry is a writer and regular contributor to The Fix. You can check out her blog or follow her on Twitter.