When the Stakes Turn Toxic

When the Stakes Turn Toxic

Anyone who’s bought a lottery ticket or played bingo has gambled. Gambling is any game of chance in which money changes hands. It’s common in most cultures around the world. Many people enjoy gambling as recreation without causing harm to themselves or others. Yet some people can’t control their impulse to gamble, even when it takes a terrible toll on their lives.         

For these gamblers and their families, researchers have been making progress in several areas. Scientists are learning why people have problems with gambling: how common it is, what goes on inside the gambler’s brain, which is at risk and what kinds of treatment can help.

Problem gambling is defined by some researchers as gambling that causes harm to the gambler or someone else, in spite of a desire to stop. Between 2% and 4% of Americans struggle with this condition. Problem gambling can progress to a recognized psychiatric diagnosis called pathological gambling.

Pathological gambling may affect from 0.4% to 2% of Americans. “Pathological gambling comes with a constellation of problems that contribute to chaos,” says Dr. Donald Black of the University of Iowa. “It’s associated with worse physical health, excessive smoking, excessive drinking, not exercising, not seeing primary care doctors and worse dental care. It also fuels depression, family dysfunction, crime, bankruptcy and suicide.”

Together, pathological and problem gambling may affect up to 5% of Americans. That number may rise, though. Laws in many states are creating more options for legal gambling, and internet gambling is becoming more common.

Still, gambling is often done in family settings, condoned or encouraged by parents. And the younger you start, the more likely you are to get into trouble later on. From 3% to 8% of adolescents have a problem with gambling.

Dr. John Welte of the University of Buffalo has found that, across the lifespan, gambling problems are even more common than alcohol dependence. They are also much more common in males, in young people, and in people who live in relatively poor neighborhoods. “That’s not true of the prevalence of alcoholism,” says Welte. “Alcoholism is much more democratic. So think about motives for gambling. People are hoping that winning will improve their lot. That makes them more vulnerable to developing a gambling problem.”

In a study of mostly African-American inner-city youth, Dr. Silvia Martins of Johns Hopkins University has found that about 15% have some form of problem gambling. Most at-risk were adolescents and young adults who began showing symptoms of depression at age 12. They were highly impulsive, although not hyperactive or aggressive. As the African-American boys developed into their teens and early adulthood, gambling appeared to be a separate risk factor for early fatherhood and criminal arrest.

“We are following up with these inner-city kids every single year as they enter adulthood,” says Martins.

But why is gambling irresistible to some folks and not others? Using advanced imaging techniques, Dr. Alexander Neumeister of Mount Sinai School of Medicine looked at the brains of people with gambling problems and alcohol problems. He measured the number of special receptors involved in regulating impulse control and other factors.          

“A key feature of addiction is impaired impulse control,” says Neumeister. “Abnormal function of the forebrain leads to reduced tolerance to waiting.” The resulting impatience may cause people to act without considering the consequences. “Our imaging clearly points toward the importance of impaired forebrain function in addiction.”

Pinpointing areas in the brain’s reward center, Neumeister’s team found that people with alcohol addiction and gambling problems show different functioning of these special receptors compared to healthy people. The differences were related to the severity of addiction. Other researchers are trying to develop drugs that could treat the affected areas.

Talk therapy can also help. Dr. Nancy Petry at the University of Connecticut Health Center works with pathological gamblers and people seeking treatment for drug use disorders. Gambling problems arise in about 10% to 20% of substance abusers. Petry compared the use of different types of talk therapy, including very brief interventions and cognitive-behavioral therapy CBT. CBT teaches people how to think differently about problems and then act on that knowledge.

“We found very brief interventions and CBT were effective in reducing gambling and gambling-related problems,” Petry says. “There was a significant improvement relative to usual care or standard forms of treatment like Gamblers Anonymous [a 12-step program].”

Anybody can have a gambling problem, and no one should feel ashamed or be afraid to seek treatment. “Pathological gambling is a medical disorder, not a sin or a vice,” says Dr. Carlos Blanco of Columbia University and the New York State Psychiatric Institute. “There is no stereotype. The main predictor of outcome is really motivation.”

In other words, what counts most is a strong drive or desire to take action. Blanco offers gamblers motivational interviewing, which helps them explore their mixed feelings about trying to quit gambling. This primes them to be ready and willing to begin CBT. Using both therapies together can be very effective.

If you have concerns about your gambling, ask for help. Your health provider can work with you to find the treatment that’s best for you.

Card Game Rules

Any specific card game imposes restrictions on the number of players. The most significant dividing lines run between one-player games and two-player games, and between two-player games and multi-player games. Card games for one player are known as solitaire or patience card games.  Generally speaking, they are in many ways special and atypical, although some of them have given rise to two- or multi-player games such as Spite and Malice.

In card games for two players, usually not all cards are distributed to the players, as they would otherwise have perfect information about the game state. Two-player games have always been immensely popular and include some of the most significant card games such as piquet, bezique, sixty-six, klaberjass, gin rummy and cribbage. Many multi-player games started as two-player games that were adapted to a greater number of players. For such adaptations a number of non-obvious choices must be made beginning with the choice of a game orientation.

One way of extending a two-player game to more players is by building two teams of equal size. A common case is four players in two fixed partnerships, sitting crosswise as in whist and contract bridge. Partners sit opposite to each other and cannot see each other's hands. If communication between the partners is allowed at all, then it is usually restricted to a specific list of permitted signs and signals. 17th century French partnership games such as triomphe were special in that partners sat next to each other and were allowed to communicate freely so long as they did not exchange cards or played out of order.

Another way of extending a two-player game to more players is as a cut-throat game, in which all players fight on their own, and win or lose alone. Most cut-throat card games are round games, i.e. they can be played by any number of players starting from two or three, so long as there are enough cards for all.

For some of the most interesting games such as ombre, tarot and skat card game, the associations between players change from hand to hand. Ultimately players all play on their own, but for each hand, some game mechanism divides the players into two teams. Most typically these are solo games, i.e. games in which one player becomes the soloist and has to achieve some objective against the others, who form a team and win or lose all their points jointly. But in games for more than three players, there may also be a mechanism that selects two players who then have to play against the others.

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Gambling Disorders

The beliefs of a society about a health condition can have a huge impact on the people who suffer from the disorder. Public opinion can influence public health policy, public and private harm minimization efforts, research funds and treatment support. At the individual level, negative public views of a disease and the stigma it creates can strongly discourage individuals from admitting that he or she has the problem and seeking treatment for the condition. There is little data available on public opinion of gambling disorders; however, a new study published in the Journal of Gambling Studies fills this void with a systematic examination of public opinion on gambling disorders.

Researchers conducted telephone surveys with 8,467 adults in the Toronto area and questioned people about their opinions of how to best understand gambling disorders. Researchers asked if gambling disorders should be treated as a disease or illness, a wrongdoing, a habit, not disease or an addiction similar to drug addiction. Researchers also inquired if people with gambling disorders can get well on their own or must seek treatment to improve and polled adults on whether people with gambling disorders can reduce their gambling to that of a social gambler or if they need to quit altogether. The survey also gathered information on the gambling behavior and demographics of the respondents.

The researchers found that most people viewed gambling disorders as an addiction similar to drug addiction, with one-third seeing gambling as a habit and 17 percent viewing gambling as a form of wrongdoing. Responses to whether gamblers needed treatment to recover showed a split jury, and three out of four thought that abstinence from gambling activities must happen for recovery. Examining the demographics, the researchers found that being female, married, younger and without gambling problems paralleled believing that treatment and abstinence were necessary. In addition, people who viewed gambling problems as a disease or addiction also believed that treatment and abstinence for recovery are necessary.

The researchers noted that public perceptions reported in their study mimic the results of a 2003 study that examined the views of the public on alcohol use, with 71 percent of respondents saying that abstinence must occur for recovery. This popularly held belief is also the view of much of the scientific community as reflected by the upcoming changes the American Psychiatric Association is making.

Finally, researchers concluded that people with gambling disorders were less likely to think that treatment and abstinence were necessary for recovery. This may be because many people who meet the clinical guidelines for a gambling disorder do not think they have a problem and even those who believe they do have a problem are unlikely to seek treatment.