ance, withdrawal), and (3) consequences to the person and his or her social functioning or surroundings.

Other Theories and Conceptualizations of Pathological Gambling

The committee was charged to review excessive gambling as "pathological" as determined by the American Psychiatric Association. We were not charged with the task of determining the impact of excessive gambling caused by poor judgment untainted by illness. Although this report focuses on a medical model of gambling problems, readers should note that other models can also illuminate gambling-related excesses. For example, gambling can be understood as one aspect of a much larger problem, namely that a large and increasing number of households have trouble living within their means. For some households, the array of temptations to spend more than they can afford and the pressures to do so from advertising and a culture of conspicuous consumption may overwhelm self-control and skill in managing money. Those who cannot resist the temptation to spend beyond their means tend to be constantly in debt and constantly dealing with the consequences of their improvidence through legal and even illegal means. For some, the problem is credit cards and the Home Shopping Channel. For others, it's gambling or speculating in investments. At-risk people may differ with respect to which type of temptation is most alluring, but the consequences and the social costs to themselves and their friends, family, employers, and creditors are the same regardless. The primary strategy for dealing with the problem of temptation has usually been to limit the availability of stimulants and opportunities. Excessive gamblers may be intemperate because they fail to resist temptation or fail to regulate impulses to act.

Besides the medical model, several other conceptual models and theories have been advanced to explain pathological gambling. These include a general theory of addictions, the reward deficiency syndrome, behavioral-environmental reasons, the biopsychosocial model, and the moral model, among others. Although these models are not directly comparable, according to



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