Gambling As An Addiction Human

beings have indulged in games of chance since before recorded history. Archeological sites in both the Old World and the New World yield gambling bones, dice, and counters. The Old and New Testaments mention the casting of lots to determine the distribution of property, presumably as an expression of God's will. In addition, the classical literature of both Eastern and Western cultures includes many accounts of gambling, often with dramatic consequences. Lotteries have been popular in Asia and Europe for centuries. The first European government-sponsored lottery was established by Queen Elizabeth I in sixteenth-century England. The thirteen American colonies and the early American universities—including Harvard, Yale, Princeton, and Columbia—were all supported in part by lotteries.

Gamblers play the slot machines at the Casino Sandia, a gaming facility at the Sandia Pueblo north of Albuquerque, New Mexico, January 10, 1997. (© Miguel Gandert/CORBIS)

Most societies have recognized the popularity of gambling and its potential for generating social good and personal harm. Therefore, governments have sought ways to regulate gambling. Some governments have prohibited all gambling, while others have established laws limiting the availability of gambling to particular locations, establishing a minimum age, specifying types of games allowed, and regulating the gaming industry to prevent fraud and raise revenues. In the United States, government attitudes toward legalizing gambling have changed radically over time. By the mid-twentieth century, some state governments increasingly looked to state lotteries as a fertile source of revenues. In addition, casino and riverboat gambling, sports betting, card rooms, and bingo games were variously legalized, taxed, and regulated. By 1994, some form of gambling was legal in all states but Hawaii and Utah, and several American Indian nations were operating gambling establishments on tribal land. In 1997, an estimated 639 billion dollars was wagered annually in the United States, generating a profit of more than 41 billion dollars—with the vast majority of the total legally bet. Illegal gambling has its own special set of subcultures—with rules, limits, and penalties for its devotees.

With the increases in gambling have come mounting concerns about gambling-related personal and social harm. In 1997, the President and

Congress appointed a National Gambling Impact Study Commission to analyze both the positive and negative impacts of gambling in the United States, and to recommend policy initiatives. The Commission made its report in 1999, estimating a five billion dollar cost to American society. Among its many recommendations were freezing or reducing so-called convenience gambling (video gambling machines in retail outlets or taverns), and banning gambling on the Internet. In regard to problem gambling, the report called for more treatment, better health insurance coverage and, state funding for treatment, more and better efforts at prevention, and an increased investment in research.

For most people gambling is a pleasurable, if not very profitable, occasional recreation. For a significant minority, however, gambling has the potential to become a compulsive behavior and a ruinous destructive problem. Compulsive gambling has also been known for centuries. The classic Hindu epic, The Mahabharata, tells the story of a wise and just king whose single flaw, the inability to control his gambling, leads him to gamble away his wealth and kingdom in a dice game. Still unable to stop, he gambles his brothers, his wife, and himself into slavery. This critical game of chance sets off a train of events that mark the beginning of division and strife in human society.

Famous people among the ranks of compulsive gamblers include sports figures, entertainers, and artists. Fyodor Dostoyevsky, who wrote his novella, The Gambler, to restore his finances, was a self-described compulsive gambler. Sigmund Freud's 1928 essay about Dostoyevsky was one of the first attempts to understand compulsive gambling as a psychopathologicalprocess. This conceptualization and its further development guided the treatment of compulsive gamblers with psychoanalytic therapies.

Until 1980, the term compulsive gambling was used to describe the syndrome of apparent loss of control in gambling. At that time, the American Psychiatric Association published the third edition of its Diagnostic and Statistical Manual (DSM-III). For the first time, the DSM-III established standard criteria to diagnose this disorder, which was renamed pathological gambling. The term was coined to avoid confusion with other diagnoses in which the word ''compulsive'' appeared, such as obsessive-compulsive disorder and obsessive-compulsive personality disorder; these disorders were thought to be unrelated to compulsive gambling. Pathological gambling was grouped under the heading Impulse Control Disorders Not Elsewhere Classified, along with such diagnoses as kleptomania (shoplifting) and pyromania (arson). In 1987, the American Psychiatric Association's Diagnostic and Statistical Manual was again revised (to be abbreviated DSM-III-R). In this revision, the term pathological gambling and its classification as an impulse-control disorder were retained, but the diagnostic criteria were significantly altered in response to new knowledge about the disorder. Likewise, the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) has additional changes reflecting additional research.

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