Problem vs. Pathological Gambling

In general, a given behavior or activity is a “problem” when it results in significant negative consequences for a person. “Pathology” is a harmful symptom or manifestation of a disease or condition. The National Council on Problem Gambling states that “Problem gambling is gambling behavior which causes major disruptions in any major area of life: psychological, physical, social, or vocational. The term…includes but is not limited to the condition known as ‘Pathological’ or ‘Compulsive’ gambling” (2013). Therefore, pathological gambling is a subset of problem gambling, as all pathological gambling is problem gambling but not vice versa.

In attempting to create a means of quantifying pathological gambling propensity and behavior, Lesieur and Blume (1987) devised the South Oaks Gambling Screen, a 20-item questionnaire to be given to those potentially in need of treatment for that condition. They stated in their report that the APA had, in 1980, included pathological gambling in the category of diseases of impulse control (Lesieur & Blume, 1987). Thus, the distinction between problem and pathological gambling: the former is when the afflicted person retains some degree of ability to stop the harmful behavior, while in the case of the latter, the person has lost the ability to do so, even if he/she desires to.

The treatments for the two conditions should therefore be different. Problem gambling should be treated by counseling, while more radical interventions are necessary for pathological gambling. It is very difficult and probably futile to introduce a program of behavior modification for a person whose behavior is pathological, since the very definition of pathological behavior is that the person exhibiting it has lost the ability to control that behavior. It may be necessary, in treating the pathological gambler, to simply remove his or her ability to gamble (this, of course, may not be a bad idea for the problem gambler as well). Such a move, however, would be to treat the symptom rather than the disease, as it were; a further problem is that it would be extremely difficult, given the ubiquitous availability of gambling in the United States, and with seemingly bypassable gambling regulations, to completely remove a person’s ability to gamble for any substantial length of time. The patient’s financial independence would also need to be curtailed or removed altogether.

A major goal of therapy for the problem gambler should be to stop him/her from sliding further downward into pathological gambling. Some pathological gamblers have seen success with conditioning and CBT treatment types therapies. The distinction between problem and pathological gambling is a matter of degree, however, and the slide from the former to the latter is defined by a diminishing of self-control, meaning that the greater the “problem,” the less likely that behavioral modification will work. A further problem is that such a progression is not inevitable (though it is the largely accurate popular perception that it often is); many people engage in problem behaviors all their lives without those behaviors becoming pathological per se. There is also the question of when gambling (which is an extremely popular recreational activity) becomes problem gambling. That question can’t be answered by defining a problem gambler as one who seeks help, but neither is it easy to quantify just when the negative consequences of gambling activity constitute a problem. For instance, if a person lives near a casino, visits it once a week, and loses an average of $200 each time, does that constitute a “problem,” or is he enjoying himself at a cost which he (rationally, according to conventional economic theory) has chosen to pay?

The therapy given a pathological gambler, in contrast, should proceed under the assumption that the patient’s behavior is grossly harmful and must be modified, even if it takes a major effort to do so. As noted earlier, said therapy must assume that the patient is incapable of independently modifying his behavior. This means that strong and constant intervention, much as in the case of treating other addictive behaviors such as drug and alcohol abuse, will be required.

References

Lesieur, H.R. & Blume, S.B. (1987). The South Oaks Gambling Screen (SOGS): A new instrument for the identification of pathological gamblers. Retrieved from http://walkerd.people.cofc.edu/360/AcademicArticles/LesieurBlume1987.pdf

National Council on Problem Gambling (2013). What is problem gambling? Retrieved from http://www.ncpgambling.org/i4a/pages/index.cfm?pageid=1