creasing and the possible effects of pathological gambling on individuals, families, and communities.

The charge to the Committee on the Social and Economic Impact of Pathological Gambling was to identify and analyze the full range of research studies that bear upon the nature of pathological and problem gambling, highlighting key issues and data sources that can provide hard evidence of their effects.

Pathological gambling differs from the recreational or social gambling of most adults, who view it as a form of entertainment and wager only small amounts. In 1975, the Commission on the Review of the National Policy Toward Gambling estimated that less than 1 percent of the U.S. population were ''probable compulsive" gamblers. Pathological gambling was first included as a mental health diagnosis in 1980 in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the official publication of the American Psychiatric Association, classified in the section on disorders of impulse control. It was described as a chronic and progressive failure to resist impulses to gamble, characterized by undesirable outcomes ranging from borrowing money from family or friends and losing time at work, to being arrested for offenses committed to support gambling. Much of the literature examined by the committee on pathological gambling also reflects the American Psychiatric Association's conceptualization of pathological gambling as a disorder characterized by people's continuous or periodic loss of control over their gambling behavior, a preoccupation with gambling and with obtaining money with which to gamble, irrational thinking, and a continuation of the behavior despite adverse consequences.

The current description of pathological gambling in DSM-IV characterizes pathological gambling in relatively precise operational terms; provides the basis for measures that are reliable, replicable, and sensitive to regional and local variation; distinguishes gambling behavior from other impulse disorders; and suggests the utility of applying specific types of clinical treatments. Moreover, the DSM-IV criteria appear to have worked well for clinicians for the past five years. However, because it is a clinical description with little empirical support beyond treatment populations, there still are problems with its use to define the nature



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