According the website 800gambler.org

, 60 to 70 percent of those who gamble can do so in a "normal" way, using it for fun and entertainment without going over the line. Another 15 to 20 percent of those who bet are "problem gamblers," wagering more than they can afford, sometimes borrowing heavily and causing problems in their lives. And a small percentage of these are compulsive or "pathological" gamblers (the latter is the correct psychological term) who are in the grip of a true mental illness.

"Pathological gambling falls into a family of impulse control disorders, similar to kleptomania," says Dr. Eric Geffner, a psychologist and nationally certified problem gambling counselor based in Los Angeles. "It's like not having brakes on a car-the car may be an outstanding car with a very good engine-that's why you get people who are very intelligent who have this disorder and are very successful. It might appeal to them as a way to stimulate their brain, maybe they're bored or can't unwind, and they need the mental stimulation of juggling scores from baseball teams or poker-it's like figuring out puzzles."

"It's not a moral disorder or a religious spiritual disorder," emphasizes Dr. Geffner. "It's a mental disorder that has neurological substrates to it. Although it's often looked upon as weakness by both the gambler and the people that are hurt by the addiction, in many cases there is something going on neurologically."

"It's a hidden addiction," says Al Gesregan, a compulsive gambling counselor in Bound Brook, New Jersey. "People don't come home smelling of alcohol or their pupils dilated as with drug addiction-they can hide it for years and years. Normally they don't get into treatment until they've lost practically everything."

But what about wealthy individuals who can afford to lose hundreds of thousands of dollars to casino gambling? Do they have a problem? "The issue of people who are extraordinarily affluent makes it more difficult to tease out," notes Dr. Geffner, who wished to clarify that he was not speaking about Bill Bennett, of whom he has no firsthand knowledge. "If an athlete is losing a million a year but makes $10 million, is it a problem? In such a case, it's important to look at whether there is impairment in their life, lack of attachment to children. Is it distracting them in an unhealthy way, is this in place of being more intimate with their family?" (For a diagnostic checklist of symptoms of pathological gambling, see Dr. Geffner's website.)


How difficult is it to treat a gambler who doesn't see himself as having a gambling problem? "That's pretty normal with any addiction," says Gesregan. "The gambling is still creating more pleasure than the consequences are creating pain. They're saying `I'm choosing to gamble' - and that's what's called denial. It's my job to try to show them where that gambling will end up." He adds: "Someone in the public eye will definitely try to keep it hidden even longer because inside it's tearing him up, the guilt and fear of being found out, thinking that he is a hypocrite. What's going on inside of him is twice as bad as someone on the street."

Modes of Treatment

Dr. Geffner says his approach to treating compulsive gambling includes five components:

  • cognitive focus, which looks at distorted beliefs and near-delusional thinking (countering thoughts such as "I'm OK, I'm not hurting anyone, I win a lot") as well as permissive lies ("I'm going to gamble x dollars for x hours").
  • behavioral focus: Do they have access to cash and ATM cards? "Cash is the drug for a gambler, so you have to cut off the supply by turning it over to the spouse," he notes. "But you don't want to infantilize them."
  • social focus: How is intimacy with the spouse and the family being affected?.
  • psychological focus: What is the meaning of the gambling to the gambler? The spiritual component of recovery is highly beneficial, says Dr. Geffner, who strongly encourages patients to join Gamblers Anonymous, a 12-step program which leads to a relationship with their higher power.
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