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The Overlooked Addiction: Problem Gambling

It's seen as a socially acceptable vice, but the damage it can do is staggering.

Photo Credit: Sergey Nivens /


This article  first appeared in The Fix, which features coverage on addiction and recovery, straight up. Also on  Sex, Screenwriting and SobrietyBreaking Free from Sexual AbuseA Reason to Exist

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 metalplaque screwed to the wall. PROBLEM GAMBLING? it says. CALL 1-800-GAMBLER 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.

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