Gambling is risking something of value (money, possessions, time) on an event whose outcome depends on chance or skill. It has existed in every culture since prerecorded history and is incorporated into many local customs and rites of passage. Problem gambling can affect people of any age, race, religion, class or education level. It can occur in small towns or big cities, and it can be a serious problem for any family.
The prevalence of gambling disorders has been growing rapidly for several reasons. A growing emphasis on the role of money in society is likely one. The economic turmoil of the 1930s caused Americans to place a higher value on wealth and financial stability, and businesses began to focus on “the bottom line” of profits. In addition, technical advances in computing and communications have accelerated the pace at which business can be conducted, creating new opportunities to gamble.
Many individuals develop a gambling disorder because of stress or emotional problems. For example, the loss of a job or the death of a loved one may precipitate a gambling addiction. The compulsion to gamble can also be a way to relieve boredom or loneliness. Many people with gambling disorders begin to seek casino gambling as an escape from everyday problems and stresses, but the activity can quickly become out of control, leading to big losses. This can be followed by attempts to recoup those losses, and the cycle continues.
It is important for primary care physicians to consider the role of pathological gambling in their patients’ lives. It is also important for them to know that pathological gambling can be classified as an addictive behavior, just like substance abuse.
Understanding how to evaluate a patient’s risk for gambling behavior is crucial for primary care providers because pathological gambling is a common and serious mental health problem. This article reviews the rationale for viewing pathological gambling as an addictive behavior, describes evidence of the relationship between gambling behaviors and health, discusses screening strategies for pathological gambling, and outlines treatments for this condition.
A growing number of primary care doctors are evaluating their patients for addictive disorders, including pathological gambling. However, many primary care practitioners do not have the resources to screen all of their patients for gambling disorders. The following guidelines provide an easy-to-use tool that can be used to identify potential problem gambling in a patient and determine whether they meet criteria for this disorder. This tool was developed by Sean Sullivan, MD, Suck Won Kim, MPH, and Loreen Rugle, MD, Yale University School of Medicine. It was funded in part by a grant from the Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Program and the Donaghue Women’s Investigator Program. Additional funding was provided by NIDA and the National Center for Responsible Gaming. The authors would like to thank Drs. Sean Sullivan, Suck Won Kim, and Loreen Rugle for their personal communications. This research was reviewed and approved by the Yale University Clinical Investigations Review Committee.