Pathological Gambling

A Critical Review

Committee on the Social and Economic Impact of Pathological Gambling

Committee on Law and Justice

Commission on Behavioral and Social Sciences and Education

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.



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--> Pathological Gambling A Critical Review Committee on the Social and Economic Impact of Pathological Gambling Committee on Law and Justice Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C.

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by the National Gambling Impact Study Commission. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Pathological gambling : a critical review / Committee on the Social and Economic Impact of Pathological Gambling [and] Committee on Law and Justice, Commission on Behavioral and Social Sciences and Education, National Research Council. p. cm. Includes bibliographical references and index. ISBN 0-309-06571-2 (hardcover) 1. Compulsive gambling—United States. I. National Research Council (U.S.). Committee on the Social and Economic Impact of Pathological Gambling. II. National Research Council (U.S.). Committee on Law and Justice. RC569.5.G35 P38 1999 616.85′841—dc21 99-06598 Additional copies of this report are available from the National Academy Press, 2101 Constitution Avenue, N.W., Lock Box 285, Washington, D.C. 20005. (800) 624-6242 or (202) 334-313 (in the Washington Metropolitan Area). This report is also available online at http://www.nap.edu Printed in the United States of America Copyright 1999 by the National Academy of Sciences. All rights reserved.

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--> Committee on the Social and Economic Impact of Pathological Gambling CHARLES F. WELLFORD (Chair), Center for Applied Policy Studies and Department of Criminology and Criminal Justice, University of Maryland COLIN CAMERER, Division on Humanities and Social Sciences, California Institute of Technology LINDA B. COTTLER, Department of Psychiatry, Washington University School of Medicine SARA KIESLER, Department of Social and Decision Sciences, and Human Computer Interaction Institute, Carnegie Mellon University MARK W. LIPSEY, Department of Psychology and Human Development, Vanderbilt University EILEEN M. LUNA, American Indian Studies Programs, University of Arizona BARBARA ANN MELLERS, Department of Psychology, Ohio State University CLINTON V. OSTER, JR., School of Public and Environmental Affairs, Indiana University DAVID RADOS, Owen Graduate School of Management, Vanderbilt University RICHARD J. ROSENTHAL, Department of Psychiatry, University of California, Los Angeles HOWARD J. SHAFFER, Division on Addictions and Department of Psychiatry, Harvard Medical School JEROME H. SKOLNICK, Faculty of Law, New York University School of Law KEN WINTERS, Department of Psychiatry, University of Minnesota SAMUEL C. McQUADE III, Study Director MELISSA BAMBA, Research Associate GLENDA TYSON, Project Assistant

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--> Committee on Law and Justice CHARLES F. WELLFORD (Chair), Center for Applied Policy Studies and Department of Criminology and Criminal Justice, University of Maryland RUTH DAVIS, The Pymatuning Group, Inc., Virginia DARNELL HAWKINS, Department of African American Studies, University of Illinois at Chicago PHILIP HEYMANN, Center for Criminal Justice, Harvard Law School CANDACE KRUTTSCHNITT, Department of Sociology, University of Minnesota MARK LIPSEY, Department of Psychology and Human Development, Vanderbilt University COLIN LOFTIN, School of Criminal Justice, State University of New York at Albany JOHN MONAHAN, School of Law, University of Virginia DANIEL NAGIN, H. John Heinz III School of Public Policy and Management, Carnegie Mellon University JOAN PETERSILIA, School of Social Ecology, University of California, Irvine PETER REUTER, School of Public Affairs, University of Maryland WESLEY SKOGAN, Center for Urban Affairs, Northwestern University CATHY SPATZ WIDOM, Departments of Criminal Justice and Psychology, State University of New York at Albany KATE STITH, School of Law, Yale University MICHAEL TONRY, School of Law, University of Minnesota CAROL PETRIE, Study Director MELISSA BAMBA, Research Associate KAREN AUTREY, Senior Project Assistant

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--> Acknowledgments The following persons, many who prepared papers or presentations for the committee, are acknowledged and thanked for sharing their expertise on pathological gambling, and for giving of their time to participate in and support the public workshops hosted by the National Research Council: Curtis L. Barrett, University of Louisville Alex Blaszczynski, The Liverpool Hospital, Sydney, Australia Carl Braunlich, Purdue University David Comings, City of Hope Medical Center, Duarte, California Sue Cox, Texas Council on Problem and Compulsive Gambling, Richardson Renee Cunningham-Williams, Washington University School of Medicine Jeff Derevensky, McGill University, Montreal, Canada Carlo C. DiClemente, University of Maryland, Baltimore County William Eadington, University of Nevada Richard Evans, University of Houston Don Feeney, Minnesota State Lottery, Roseville Joanna Franklin, National Council on Problem Gambling, Washington, DC Peter Goyer, Cleveland Medical Center, Ohio

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--> Mark Griffiths, The Nottingham Trent University, Nottingham, Australia Rina Gupta, McGill University, Montreal, Canada Matthew A. Hall, Harvard Medical School Erik Hollander, Mt. Sinai School of Medicine, New York Durand F. Jacobs, American Board of Professional Psychology, California Norm Kruedelbach, Veterans Administration Medical Center, Ohio Robert Ladouceur, Université Laval, Quebec, Canada Henry Lesieur, Institute for Problem Gambling, Middletown, Connecticut Scott Lukas, McClean Hospital, Cambridge, Massachusetts Janet Mann, American Academy of Health Care Providers in the Addictive Disorders, Cambridge, Massachusetts Richard McCleary, University of California at Irvine Lia Nower, Washington University Judy Patterson, American Gaming Association, Washington, DC Marcus D. Patterson, American Academy of Health Care Providers in the Addictive Disorders, Cambridge, Massachusetts William Rhodes, Abt Associates Inc., Cambridge, Massachusetts I. Nelson Rose, Whittier Law School Lori Rugle, Trimeridian Inc., Carmel, Indiana William Semple, Cleveland Medical Center, Ohio Randy Stinchfield, University of Minnesota Medical School Bradley Stoner, Washington University Rodger Svendson, Minnesota Institute of Public Health, Anoka Jack Thar, Indiana Gaming Commission, Indianapolis Tony Toneatto, Addiction Research Foundation, Calgary, Canada Joni Vander Bilt, Harvard Medical School Rachel Volberg, Gemini Research, Northhampton, Massachusetts Lynn Wallisch, Texas Commission on Alcohol and Drug Abuse, Austin Robert Wildman, Dickson, O'Bryan, Dugan and Associates, Nevada Harold Wynne, Wynne Resources, Edmonton, Alberta, Canada Kurt Zorn, Indiana University

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--> This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: John Bailar, Irving B. Harris Graduate School of Public Policy Studies, University of Chicago; Robert Boruch, Graduate School of Education and Wharton School, University of Pennsylvania; Philip J. Cook, Sanford Institute of Public Policy, Duke University; Stephen Cornell, Udall Center for Studies in Public Policy, University of Arizona; John Dombrink, Department of Criminology, Law, and Society, University of California, Irvine; Reid Hastie, Center for Research on Judgment and Policy and Department of Psychology, University of Colorado; John Kihlstrom, Department of Psychology, University of California, Berkeley; Robert S. Lawrence, School of Medicine and School of Hygiene and Public Health, Johns Hopkins University; Scott O. Lilienfeld, Department of Psychology, Emory University; John Monahan, Professor of Law, Psychology, and Legal Medicine, University of Virginia School of Law; Eric J. Nestler, Professor of Psychiatry and Neurobiology, Yale University School of Medicine; Henry W. Riecken, Professor of Behavioral Sciences, University of Pennsylvania School of Medicine (emeritus); and Lee N. Robins, Department of Psychiatry, Washington University of School of Medicine. Although the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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--> The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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--> Contents     Executive Summary   1 1   Introduction   7 2   Gambling Concepts and Nomenclature   15 3   Pathological and Problem Gamblers in the United States   63 4   Research on the Origins of Pathological and Problem Gambling   107 5   Social and Economic Effects   156 6   Treatment of Pathological Gamblers   192 7   Organization and Technology of Gambling   237     Appendixes         A Gamblers Anonymous Twenty Questions   271     B Diagnostic and Statistical Manual of Mental Disorders Criteria for Pathological Gambling   273     C Legal-Age Gambling Opportunities and Restrictions   283     D Summary of Treatment Literature   313     E Gamblers Anonymous Meetings by State   317     F Biographical Sketches   319     Index   326

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