Jerry, 16 years old and new to treatment, leaned forward restlessly and said, “I started by betting on sports games. I’m into football, see, but soon I was betting on all of the sports, basketball, baseball, soccer and even tennis ... you name it. I did pretty well at first. I was making good money, and I said to myself, ‘this is pretty neat.’ I couldn’t wait to get the sports page every day so I could work on the point spread. I guess it all started there.

Soon I had a bookie, they’re not hard to find, and then I discovered Internet gambling. Sports betting and scratch tickets pale in comparison to that, it’s instant. I’d be up all night betting and then have problems getting to school. But who needed school? I had all this money I could win without an education. Education was for suckers. Then I started losing, I mean really losing. I couldn’t make a good bet, and if I did win, I’d put it right back in. I tried to stop but I kept going back. It was as if the computer owned me. I was at it all day and all night sometimes, trying to make up the losses.

I had to steal from my parents to pay back my credit card bills and then I used their credit card numbers, punched them in just like they were my own. Well that did it. I had to steal their credit card bills from the mail so they wouldn’t know what I was doing, but I knew if I didn’t win soon they would know. When the credit card companies started calling the house, I was done. I couldn’t always get to the phone first even if I tried. When the truth came out, the family was thousands of dollars in debt. That night I tried to kill myself. I couldn’t stand hurting my parents like that. That’s when I ended up here.

The story is familiar isn’t it? An innocent game, a lark of adolescence, turns bad and then lethal. Addiction professionals know how this game goes with drugs and alcohol, but gambling seems different, a pure behavior — no drug.

But from recent research in the neurobiology of addiction, we now know that all addiction works through the mesolimbic dopamine system in the brain. This triggers the endogenous opioids that are many times more powerful than morphine. Recent evidence shows that naltrexone blocks the reinforcing properties of alcohol and other substances and it does the same thing for gambling. All addictions have a neurobiological basis; so pathological gambling is a chronic relapsing brain disease, like alcoholism. Pathological gambling has all of the hallmarks of addiction including tolerance and withdrawal (Kim, 1998; Wray and Dickerson, 1981).

Further evidence suggesting neurological dopaminergic involvement comes from a study that found that nearly 50 percent of a group of pathological gamblers carried the DRD2 gene-receptor variant so common in other addictions. The more severe the gambling problem the more likely the individual was to be a carrier for this receptor variant (Comings, Rosenthal et al, 1996).

The business of gambling

This country is in big trouble and we don’t know it. Seventy years ago it was illegal to gamble in America. Gambling was considered immoral by our grandparents. Today you can gamble in all but three states, Hawaii, Utah and Tennessee, and states actually encourage their citizens to gamble. Gambling is big business in America, earning the gaming industry $50.9 billion in net revenue annually.

Gambling is very attractive, particularly to people who need money. The Illinois Lottery did a study to see who gambles, and found people who made less than $10,000 a year gamble six times more often than those who earn over $50,000 a year. People know they might win millions by risking a dollar. A recent program on the Discovery Channel illustrated that gambling is so attractive, that when the powerball is high, 90 percent of eligible adults buy a ticket. There is no other commodity where the percentages are this high and there is no product — just a chance of winning. The real odds of winning a state lottery are approximately 14 million to one; the same odds as being hit by lightning seven times while waiting in the lottery line.

Our parents grew up thinking that gambling was wrong, but our children are growing up with gambling opportunities as accessible as McDonald’s. For the first time in history, gambling is available close to home and now even inside of the home — on the Internet. People can walk to and from work and gamble. Gambling problems are at least as prevalent in teens as they are in adults. Teenagers can gamble away their future in their rooms. Governors go on television and encourage their citizens to bet and tell them how much they can win. Gambling is good they say, it’s fun, no one gets hurt and everybody is doing it. We in the addictions field know that what we hear on television about alcohol and substance abuse kills 24 percent of Americans.

Problem gamblers

Most people who gamble enjoy gambling as a game; it’s exciting and fun. But some citizens are caught up in an addiction as powerful as drug addiction. Here are a few facts collected by the National Council on Problem Gambling:

• Pathological gamblers have a suicide rate 20 times higher than nongamblers.
   
• Women comprise one-third of pathological gamblers.
   
• Forty-six percent of pathological gamblers borrow on, or use up the cash value of their insurance policy. Fifty-two percent surrender their policy.
   
• Forty-two percent of 14 year olds gamble. Forty-nine percent of 15 year olds gamble. Sixty-three percent of 16 year olds gamble. Seventy-one percent of 17 year olds gamble. Seventy-six percent of 18 year olds gamble. Eighty-eight percent of 19 year olds gamble.
   
• Eleven percent of gambler’s wives attempt suicide.
   
• Twenty-five percent of children of pathological gamblers have significant behavioral or adjustment problems.
   
• Sixty-five percent of wives of pathological gamblers give their spouses their personal savings to gamble or pay debts.
   
• Forty-seven percent of pathological gamblers abuse alcohol. Forty-six percent are depressed. Forty-two percent have stomach problems. Thirty-five percent have insomnia. Thirty-five percent feel faint or dizzy. Twenty-nine percent have headaches. These figures are only slightly less for the spouses of gamblers.
   
• Sixty-five percent of pathological gamblers commit crimes to finance gambling: 34 percent/check forgery, 31 percent/civil loan fraud, 30 percent/-
  embezzlement, 20 percent/forgery, 19 percent/tax evasion, 12 percent/tax fraud.
   
• The average amount of debt of a pathological gambler in the United States ranges from $54,662 to $92,000 for males, and $14,979 for females.

Where do children first learn that gambling is safe? To answer that question you have to look into the AVERAGE American home. In the AVERAGE home, the parent spends three minutes a day talking to their child, while the child watches and is influenced by TV four to eight hours daily. Our children see and begin to believe that gambling is fun and safe.

If you believe that teenagers will not gamble because it’s illegal, then why do so many teens abuse drugs and alcohol?
A recent survey in Vermont of 21,297 high-school students found that 53 percent of the students gambled in the last 12 months and 7 percent reported significant gambling problems (Proimos 1999).

According to the American Psychia-tric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, pathological gambling is a persistent and recurrent maladaptive gambling behavior as indicated by five or more of the following criteria:

1. The individual is preoccupied with gambling (i.e., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble.
    
2. The individual needs to gamble with increasing amounts of money in order to achieve the desired excitement.
    
3. The individual has repeated unsuccessful efforts to control, cut back or stop gambling.
    
4. The individual is restless or irritable when attempting to cut down or stop gambling.
    
5. The individual gambles as a way of escaping from problems or of relieving a dysphoric mood (i.e., feelings of helplessness, guilt, anxiety and depression).
    
6. The individual, after losing money gambling, often returns another day to get even (“chasing” one’s losses).
    
7. The individual lies to family members, therapists or others to conceal the extent of involvement with gambling.
    
8. The individual has committed illegal acts such as forgery, fraud, theft or embezzlement to finance gambling.
    
9. The individual has jeopardized or lost a significant relationship, job, education or career opportunity because of gambling.
    
10. The individual relies on others to provide money or relieve a desperate financial situation caused by gambling.

Treatment
Pathological gambling is an addiction that can be treated essentially the same way as other addictions, with certain exceptions. To recover, gamblers like all addicts, need to get honest with themselves and others, go to recovery group meetings and help other people there, and get on a spiritual journey to God.

Gamblers need to understand from the onset of treatment that there is an answer to their financial problems. There is an excellent financial worksheet available from the Gamblers Anonymous general service office that will help you through the financial history, or if the local GA group has a pressure-relief group, they can do it. A financial solution must be presented from the moment a problem gambler comes into treatment. If they don’t do this, they will be out the door. “I know you are worried about the money, but if you stick with the recovery program we will develop a program so you can pay everyone back. You must be responsible for every penny you owe.” Professionals shouldn’t encourage a pathological gambler to go bankrupt, that’s called a bail out and often triggers more gambling because the gambler thinks they have a clean slate and they can start over.

The drug of choice for gamblers is money and the biological chemicals it creates, so they can’t carry money around for a while. Some responsible person has to keep the money and give them the exact amount they need each day. You wouldn’t want an alcoholic walking around with a pocket full of whiskey. After the gambler has developed a stable self-directed program of recovery, they can gradually take control of their finances.

Jerry’s progress

So, what happened to Jerry? First we got the whole story, even though he didn’t want to remember it all. We finally got the last of what he did and what he owes. Gamblers hold out on what they owe, so check carefully. To get the facts, you have to create an environment that is so gentle, safe and loving that the patient can search for and share the truth. Then Jerry learned about the disease of addiction. He learned that it’s genetic and neurobiological, and he is not addicted just because he’s “bad.” He worked through the first five steps of GA, and then he began helping others, showing them the way, and restoring meaning and worth to his life.

Jerry then searched for a connection with his Higher Power. Gamblers have a hard time with this one; too much ego can get in the way. But when you are powerless, things change. Through daily prayer and meditation, Jerry sought conscious contact with God and began to get answers from God, finding new direction to his life, and along with that, new happiness and peace. This was what he was seeking in gambling. Of course he didn’t want to go to recovery group meetings, he was special and all, but he finally agreed and is going once a day and to aftercare once a week. Jerry also takes 50 mg of Naltrexone a day. Many can benefit from the use of Naltrexone, as it cuts the craving and the reinforcing properties of gambling in case they slip.

So, generally, teen gamblers — and all gamblers — need to do three things to stay away from gambling.

1. They need to get honest with themselves and others;
2. attend GA meetings and help others, and
3. get on a spiritual journey.

In regard to treatment outcome, 50 percent of gamblers stay clean with treatment alone, 70 percent if they go through treatment and then regularly attend GA, and 90 percent if they go through treatment, go to GA and attend aftercare. Pretty simple, just like any addiction. Remember, gamblers need a financial payback plan, and they can’t carry money.

Robert R. Perkinson, PhD, is the clinical director of Keystone Treatment Center in Canton, South Dakota. He is a licensed psychologist, certified chemical dependency counselor, level III, a licensed marriage and family therapist, and a nationally certified gambling counselor. He has written five books including Chemical Dependency Counseling: A Practical Guide, Sage Publications, The Chemical Dependence Treatment Planner, John Wiley and Sons, and Treatment for Pathological Gambling: A Step-by-Step Approach. He treats approximately 200 gamblers a year.

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