any situation or feeling that reminds them of gambling (Rosenthal and Lesieur, 1992). Pathological gamblers may go for days without sleep, and for extended periods without eating or taking care of other bodily needs. Clinicians have described the presence of cravings, tolerance—the need to make increasingly larger bets or take greater risks to produce the desired level of excitement (Lesieur, 1994)—and withdrawal symptoms (Wray and Dickerson, 1981; Meyer, 1989; Rosenthal and Lesieur, 1992).

Although there are other kinds of intense physiological reactions, clinicians also report that some pathological gamblers are less interested in the excitement or action and more interested in escape. They are seeking to numb themselves and report a quest for oblivion. This motivation for escape may be understood as a quest to reduce psychological discomfort and as an attempt to attain a more normal state—a self-medication (Khantzian, 1975, 1977). These reactions are reported by many women gamblers (Lesieur and Blume, 1991), as well as many slot and video poker machine players. Many pathological gamblers, both male and female, report experiencing amnesic episodes, trances, and dissociative states (Jacobs, 1988; Kuley and Jacobs, 1988; Lesieur and Rosenthal, 1994; Brown, 1996; O'Donnell and Rugle, 1996).

Pathological gamblers also evidence distortions in their thinking (Gaboury and Ladouceur, 1989; Walker, 1992). These cognitive distortions include denial, fixed beliefs, superstition and other kinds of magical thinking, and notably omnipotence. Pathological gamblers experiencing cognitive distortions deny the reality of their gambling situation, including their odds of winning or losing (e.g., Langer, 1975; Langer and Roth, 1975; Ladouceur and Mayrand, 1984; Coulombe et al., 1992; Ladouceur et al., 1995). They may fixate on particular numbers, days of the week, colors of clothing, or a particular slot machine or may possess other magical objects that for them signify or enhance luck (Toneatto, personal communication to the committee, June 2, 1998). Rosenthal (1986) contends that such feelings of omnipotence are born out of desperation: the more helpless the situation, the greater their sense of certainty that they know what will happen next, and that they will achieve a positive outcome.

Bad luck, greed, or poor money management are not sufficient for someone to be a pathological gambler—although these



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