Problem gambling is similar in many ways to problem substance use. The two behaviours serve many of the same purposes, including escape (sometimes to the point of dissociation), excitement, pleasure and socialization. Those affected have similar subjective experiences of preoccupation, craving, tolerance and loss of control. There are overlaps in the neurobiology associated with each disorder (Comings et al., 1996), and evidence exists of common genetic factors (Slutske et al., 2000). In addition, substance use and problem gambling both affect a person’s functioning: individuals are subject to depression, low self-esteem, anxiety and chronic stress, as well as family, legal, employment and financial problems. In both cases, the negative consequences tend to lead to more of the behaviour, creating similar cycles of addiction. Both groups tend to become the focus of attention in their families, and to take on childlike, irresponsible roles there. In both cases, models among families and peers influence the person’s behaviour, and the impact on relationships of substance use and problem gambling is alike in many ways. Both sets of families suffer high rates of dysfunction, as well as serious consequences for children (for some effects on children, see Darbyshire, 2001). Most importantly, similar strategies work well with both groups.

Despite these many similarities, problem gambling has some unique features. It is a disorder that relates in large measure to belief systems and cognitive distortions, which are associated with the random schedule of reinforcement mentioned above. An estimated 50 per cent of people with gambling problems have had a big win early in their gambling history (Turner & Liu, 1999). Although gambling includes an effect of adrenaline, perhaps endorphins and other neurotransmitters, and sometimes a subjective experience of withdrawal, the physiological impact is minimal compared with that of substance use.

People with gambling problems are generally healthier and more clear-headed than those with substance use problems. They are more likely to be employed, and on average they are higher functioning. However, their financial problems are usually more severe. No matter how much a person spends on alcohol or other drugs, he or she cannot spend as much as a person can gamble in a single night, or even a single bet. Because the problem is much easier to hide than is substance use, people with gambling problems are often able to build up huge levels of debt. Money trouble is the issue that brings the problem to light in most cases. Although illegal behaviour is common in both disorders, problem gambling is more likely to lead to financial crimes (Meyer & Stadler, 1999). Consequences for families are particularly severe, including the chronic fear and uncertainty that go with devastating financial loss and the hidden nature of the problem.

Although relapse is common in both disorders, only in gambling is it possible to encounter relapse as a winning experience. People with gambling problems can be difficult to keep in treatment when they win. And although individuals are vulnerable to both disorders for many of the same reasons, there are additional precursors for problem gambling. For instance, many people with gambling problems come from families that place a high value on money and material wealth. They may be particularly business-oriented, and perceive gambling as an investment. Interestingly, the persistence and determination that is so effective elsewhere in the lives of such entrepreneurial people tends also to be applied to their gambling, with disastrous results.  

Many stereotypes exist about problem gambling, but there is no “typical problem gambler.” People with gambling problems do have many common experiences. But their backgrounds, needs and personalities vary enormously, and so a single treatment modality will not work for everyone. One useful approach to understanding etiology is Blaszczynski’s pathways model (2000), which identifies three major routes to gambling problems. It divides people with gambling problems into three general types: “normal,” emotionally vulnerable, and those with biologically based impulsivity.

People in the first group, essentially healthy before their problems begin, are described as falling victim to circumstances such as easy access to gambling, poor judgment and misunderstanding of the odds. Such symptoms as preoccupation, anxiety or depression are results, rather than causes, of their gambling. These people are high-functioning and have many resources. They tend to respond quickly to fairly minimal treatment, and are more likely to successfully reduce (rather than stop) their gambling, if this is their choice.

Those in the second group are predisposed to a gambling problem through a history of precursors such as addiction or mental health problems, including trauma, anxiety and depression. They gamble to escape from negative moods. These people are also affected by the same triggers—such as easy access and misunderstanding the odds—as those in the “normal” group. Given their vulnerability, abstinence is generally the most realistic goal for people in this group.

The third group comprises people with a biologically based tendency to impulsive behaviour. For instance, attention-deficit/hyperactivity disorder is one very common precursor to problem gambling; research suggests that as many as 20 per cent of those with gambling problems have ADHD (Specker et al., 1995). Such people are likely to have a number of concurrent problems, such as substance use, poor school or work performance, emotional liability, chronic boredom and inadequate social skills. Gambling provides exciting stimulation and an apparent chance to excel. The same precursors that affect people in the first two groups also apply here. These people are generally poor candidates for the goal of reduced gambling.

The pathways typology is a good reflection of clinical experience, and suggests that individuals require differential treatment based on their particular etiology.

Problem Development

Eric gambled occasionally with his wife and friends. When he was laid off at work, having time on his hands, he decided to visit a casino. He won the equivalent of a week’s salary playing blackjack, and went home exultant. In the next two weeks he visited the casino four times, on two occasions winning several hundred dollars. He began gambling several times a week. When his wife Anna expressed concern, he began to conceal his trips. Eric continued to have some wins, but his net losses were depleting their savings. When Anna tried to withdraw money from their joint account and found it empty, she confronted Eric. He confessed to gambling “a bit too much,” and promised to cut back and start looking more seriously for work. However, within a week he was back at the casino, betting his entire unemployment cheque. Although eventually he found a new job, the family continued to have to struggle almost entirely on Anna’s salary. Eric’s occasional wins paid some bills, but more and more frequently any wins were simply gambled away, and he would leave the casino with barely enough to get home. Eric visited the casino so frequently that he was often unavailable to his family. Within a year the couple was on the verge of separation.

To an outside observer, Eric’s apparently irrational behaviour might seem baffling. A person with a gambling problem may lose money over and over again, and yet go back repeatedly to lose more. Typically the frequency, the bet size and the duration of gambling episodes increase over time. Negative consequences multiply, and still the person appears to seek a different outcome from the same behaviour.

Blaszczynski would describe Eric as a “pathway two gambler”: he is depressed and escapes from unpleasant realities by gambling, and is also triggered by easy access (lots of free time) and a misunderstanding of the odds. Let’s look at the experience from Eric’s point of view.

Worried about unemployment and his family’s finances, and feeling depressed and inadequate, Eric is delighted by his unexpected success at the casino. The experience is far more pleasant and rewarding than his job hunt, and apparently far more lucrative. When twice more he leaves with more money than he arrived with, Eric feels even more powerful and successful, and his view that gambling is easy money is confirmed.

Blackjack players who use care and a knowledge of the game can minimize their losses, leaving the house with an edge of about three per cent. Eric’s initial wins are not unusual; given the small house edge, outcomes often fluctuate fairly broadly. However, over time even the best players will lose to the house. At the point where Eric might acquire an understanding of these odds, he is already deeply engaged in the belief that he can make money by gambling. The initial wins have been so salient, particularly in combination with his unhappiness and feelings of failure elsewhere, that later losses seem only a temporary aberration on the road to more wins.

Once Eric’s losses reach a certain point, the need to win his money back becomes imperative, and it becomes harder and harder to give up on the large amounts already invested. His belief that he will eventually come out a winner justifies his spending, all the concealment and the expenditure of time. Nonetheless, his self-esteem outside the casino inevitably takes a beating, increasing the contrast between his depressing life and the thrill of winning.

Not all people with gambling problems progress in similar ways. Men tend to begin gambling earlier, in their teens, and generally progress more gradually into serious problems. Women tend to start gambling later, in their thirties or forties, progressing much more quickly to problem levels (probably because on average they have less money to spend). Some gambling problems fluctuate in severity, depending on such factors as the person’s circumstances, income and employment, and the availability of gambling venues.

A wish to win money is not always the focus of gambling, at least initially. While many people with gambling problems seek a “big win,” others are motivated chiefly by the potential for escape in playing for hours on end, or simply by enjoyment of the game. For such people, interest in money centres on having enough to keep playing. But even when money is not the initial motivator, as losses mount people may become increasingly preoccupied with the need to win in order to resolve financial problems.

Turner et al. (2003) examined the characteristics and early gambling experiences of people with and without gambling problems, to determine differences that might act as precursors to the development of problems. They found five basic risk factors:

• a big early win
• susceptibility to boredom
• a poor understanding of randomness
• a tendency to use escape as a way of coping
• a stressful life with a lack of support and direction around the time that gambling began.

Impulsivity and interpersonal anxiety also correlated with problem gambling, and those with gambling problems were more likely to have started when a new opportunity to gamble presented itself. The more of these factors that were present, the more likely a person was to have a gambling problem.

Turner also identified some factors that reduced the risk of problem gambling, including:

• financial security
• supportive friends
• having hopes and dreams for the future
• doing well at work
• using support rather than escape to cope
• knowledge of randomness
• the setting of limits on betting.

These findings fit well with Blaszczynski’s model: they identify situational and cognitive factors, factors relating to pre-existing poor coping, and links to biologically based precursors such as impulsivity.