within (Oxford English Dictionary, 2nd edition, 1989). The essential feature of an impulse control disorder, as defined by DSM-IV, is ''the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others" (American Psychiatric Association, 1994:609). This implies a loss of control over behavior. There may be a sense of tension prior to committing the act, in which case committing it brings relief. The act is often pleasurable, though it may be followed by guilt and regret.

Existing literature on pathological and problem gambling uses many terms to describe impulsive behaviors from a variety of important perspectives, including "sensation-seeking," "behavioral disinhibition," and "risk-taking" (Lopes, 1987; Monroe, 1970; Zuckerman, 1979, 1983; Zuckerman et al., 1972). There is substantial literature suggesting that the descriptions are correct and contribute to both the origins and the maintenance of gambling involvement and problem gambling (Davis and Brisset, 1995). For example, indicators of behavioral disinhibition—the inability or unwillingness to inhibit behavioral impulses—have been associated with gambling involvement (Ciarrochi et al., 1991; Condas, 1990; Graham and Lowenfeld, 1986; Moravec and Munley, 1983; Templer et al., 1993; Castellani and Rugle, 1995).

In a study of cocaine treatment-seekers (Steinberg et al., 1992), the only measure that differentiated those with gambling problems from those without problems was a measure of disinhibition. In a study comparing a group of pathological gamblers in treatment to controls from the community, Specker and colleagues (1996) found that a significantly higher proportion of pathological gamblers had at least one other impulse control disorder (35 versus 3 percent). Similarly, the findings of increased antisocial behaviors and a history of criminal offenses among pathological gamblers also suggest disinhibitory tendencies (Cunningham-Williams et al., 1998; Blaszczynski and McConaghy, 1989; Busch, 1983; Hickey et al., 1986; Roy et al., 1989). Also, elevated rates of childhood attention-deficit hyperactivity disorder (ADHD) (Carlton et al., 1987; Carlton and Manowitz, 1994) and adult ADHD (Castellani and Rugle, 1995; Rugle, 1998) have been observed among pathological and problem gamblers.

Despite this evidence, this body of research may be mislead-



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement