popular gambling activities, can maintain stable gambling behaviors despite incredible odds against winning (Lopes, 1987).

Medicalization of Pathological Gambling

Understanding of the adverse consequences of excessive gambling has undergone profound change. For most of history, individuals who experienced adverse consequences from gambling were viewed as gamblers with problems; today, we consider them to have psychological problems. This change is analogous to the change in the understanding of alcoholics and alcoholism, and it has been reflected in, or stimulated by, the evolving clinical classification and description of pathological gambling in the various editions, between 1980 and 1994, of the Diagnostic and Statistical Manual of Mental Disorders (called DSM) published by the American Psychiatric Association. Changes over time in the DSM reflect a desire to be more scientific in determining appropriate criteria for pathological gambling by accounting for its similarities to other addictions, especially substance dependence (American Psychiatric Association, 1980, 1987, 1994; Lesieur, 1988; Rosenthal, 1989; Lesieur and Rosenthal, 1991). Today pathological gambling is understood to be a disorder characterized by a continuous or periodic loss of control over gambling, a preoccupation with gambling and with obtaining money with which to gamble, irrational thinking, and a continuation of the behavior despite adverse consequences.

The official medicalization of excessive gambling is marked by its inclusion in the DSM (American Psychiatric Association, 1980, 1987, 1994). It is not surprising, however, that some scholars (e.g., Szasz, 1970, 1987, 1991) have objected to medicalizing certain socially or culturally offensive behaviors in general, and gambling intemperance in particular (Rosecrance, 1985).1 Never-


For a discussion of nonmedical models for understanding excessive gambling, see the section on other theories and conceptualizations of pathological gambling later in this chapter.

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