Conclusions

More and better research on the etiology of pathological gambling is needed. As the name of the illness suggests, pathological gambling merely describes a clinical picture. Because the available literature on pathological and problem gambling lacks sophisticated studies enabling this level of discrimination, the committee was not able to say whether the risk factors identified had their impact on initiating gambling or on progression to problem gambling or pathological gambling. Moreover, because risk factors for problem and pathological gambling have usually been dichotomized—that is, respondents either have or have not been exposed to a particular risk factor, and because the sample sizes are small—they are limited in their ability to inform public policy.

Although the past studies have limitations, they have provided the field with a foundation and guidepost for further development. It is now evident that the onset of gambling usually begins in the preteen or adolescent years (Custer, 1982; Griffiths, 1990b; Livingston, 1974) with such activities as baseball card flipping, pitching pennies, and shooting marbles. By adolescence there is poker and sports betting, as well as lottery, racetrack, and casino gambling. Although adolescents can gamble and not become problem or pathological gamblers, certain risk factors, including family member and peer influences, are important for this group. Preliminary evidence suggests that the earlier people begin gambling, the more likely they are to experience problems from gambling. This finding seems developmentally plausible and is consistent with the age of onset and severity for other public health problems, such as substance abuse. It is not clear whether an earlier start at gambling alone represents a risk factor for later pathological gambling, or whether other factors that might drive a person to gamble earlier are also related to developing gambling problems. Little detail is available about natural history of pathological gambling, how long it typically lasts, what causes recovery and relapse. Longitudinal studies would be valuable in answering these questions.

On the basis of the available evidence, we can conclude that men are more likely than women to become pathological and problem gamblers. We do not know yet if gender differences af-



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