It may still be difficult for some people to accept that an activity such as gambling, which is not a drug, can be addictive. But the idea that addiction is confined to drug addiction rests on an outdated concept of what addiction is. The old idea that the main symptoms of addiction are drug tolerance (higher and higher doses of the drug are necessary in order to get the same effect) and withdrawal effects (such as delirium tremens or 'cold turkey' symptoms) went out when cocaine took over from heroin as the drug causing most concern in the 1980s. Gambling fits perfectly into the more up-to-date concept of addiction. Like other potentially addictive activities, gambling is no ordinary commodity; it is dangerous and can lead to the establishment of a new and abnormally powerful motivational state which is difficult to break. Gambling operates according to conditioning principles, with emotional and social rewards playing a role as well as financial ones. The sights, sounds and other stimuli associated with gambling take on some of the same rewarding properties and thereby act as incentives in themselves, deepening the habit. Cognitive biases and automatic mental processes further help explain why addictive behaviour is so difficult to break. The result is an approach-avoidance conflict whereby the habit becomes more compulsive and the gambler more defensive and increasingly confused and desperate. The personal testimonies of addicted gamblers and their family members have long been witness to the power of the gambling habit. It has taken a long time for the experts and their theories to catch up but they have finally done so!
The theory in more detail
Gambling is no ordinary commodity
Understanding that gambling is addictive is central to the debate about how society should deal with gambling. Rather than being any ordinary commodity like stationery or underwear, it is instead a dangerous one because it has the potential to create an addictive attachment which is harmful and difficult to break. This is not to say that all gambling is an addiction. Just as many people who drink alcoholic beverages are not addicted to alcohol consumption, so too is it the case that many people who engage in gambling are not addicted to it. Nor are all forms of gambling equally addictive: buying tickets for the National Lottery is not as dangerous as playing roulette in a casino or on a fixed odds betting machine in a betting shop. What is true, however, is that all types of gambling carry to some degree the potential for addiction. In this article I want to explain what addiction is and how gambling fits in.
It can lead to the establishment of a powerful and difficult to break state of attachment
We now understand addiction, not as a neurochemical condition which can only be brought about by repeated consumption of mind altering drugs (although gambling is also associated with certain kinds of brain activity, as we shall see later), but rather as a state of heightened attachment – behavioural, cognitive and emotional – to an activity which can be repeated over and over again at very frequent intervals. Taking drugs of various kinds are important examples of such activities and so is gambling. One way of thinking of addiction is as a powerful habit. The disadvantage of that way of thinking of it lies in the fact that most people do not appreciate how strong habits can be, dismissing mere 'habit' as insufficient to the task of describing something as debilitating as addiction. William James, often described as the father of psychology, had no such difficulty understanding the power and importance of habit, believing that acquiring positive habits and avoiding developing negative ones was at the heart of healthy human development. A more technical expression for trying to capture the essence of what addiction is might be 'incentive motivational state'. That term embraces the important aspect that a person's motivation has been skewed towards, or captured by, a particular object or class of objects which have acquired abnormally heightened incentive value for that person.
Gambling operates according to conditioning principles which encourage the development of such an abnormal motivational state
In order to comprehend how it is that gambling can take such a hold of a person's motivation it is necessary to appreciate how powerful conditioning can be, starting with the kind of 'reward conditioning' studied by the famous B F Skinner. Because money can be exchanged for so many things of value, and is therefore such a powerful 'generalised reinforcer' of behaviour, gambling for money and winning has great capacity for shaping future behaviour. There are several features of gambling, particularly of certain forms of gambling, that increase its conditioning potential. One is the immediacy of receiving winnings: there is a 'gradient of reinforcement' whereby immediate consequences are much more effective in shaping behaviour than are delayed consequences. Another factor is what is referred to as the 'schedule of reinforcement'. Gambling machines pay out on a 'random reinforcement' schedule which is particularly habit forming – the more a person plays the greater the chances of having a win, but the financial reward is highly unpredictable: there is no way of knowing when it will come, and, contrary to the common 'gambler’s fallacy', the chances of winning on the next play do not increase the greater the run of losses. A further factor is the size of the anticipated win: people are specially motivated by the prospect of large wins even when the odds against such wins are extremely high. Arranging payouts in such a way that smaller wins or 'near wins' are much more frequent (but still unpredictable) helps maintain motivation. The National Lottery draw is just one obvious example. Yet another factor responsible for the capturing of motivation which lies behind the development of an addictive gambling habit is the mix of skill and chance. There is an element of skill or knowledge in certain forms of gambling such as horserace betting or poker, although it is easy to exaggerate the skill element and easy to minimise the role of sheer chance. Anything which encourages the 'illusion of control', such as hold or nudge buttons on gambling machines or choice of betting odds and strategies, increases the potential for habit development.
Emotional and social rewards play a role as well as financial ones
The emotional element is important as it is for all addictions. People who have developed gambling habits frequently talk of the 'buzz' it gives them, how it makes 'the adrenaline flow'. Research has repeatedly found substantial increases in bodily indicators of arousal, such as increases in heart rate, during gambling. But, like alcohol, gambling is a versatile mood modifier. As well as acting as a stimulant it can also serve as a way of coping, temporarily, with stress, worries or depression. Some people have spoken of their gambling as 'an anaesthetic' or 'hypnotic', enabling them to feel for a while 'like a different person'.
To the financial and emotional rewards of gambling which contribute to habit development can be added social rewards such as displaying to others one's knowledge, skill, control, willingness to take risks or composure in the face of loss, or simply the pleasure of joining in with what family or friends are doing or socialising with other players.
The stimuli associated with gambling take on some of the same rewarding properties and thereby act as incentives in themselves, deepening the habit
The mix of rewards – financial, emotional or social – varies from one form of gambling to another and from person to person. But whatever the mix, an account of habit development must also include a role for classical conditioning, sometimes termed 'incentive conditioning', first studied by Ivan Pavlov. The act of gambling is always surrounded by stimuli of various kinds which, as habit develops, become conditioned by association, taking on some of the same rewarding properties and thereby acting as incentives in themselves. Gambling settings are full of stimulating light and colour effects, sounds and other devices for drawing attention to winning, spinning reels and race commentaries. As one young British man with an addiction to gambling machines said, 'Although winning money was the first thing that attracted me to playing fruit machines, this was gradually converted to lights, sounds and excitement'. The main character in Dostoevsky's autobiographical novel The Gambler described how when approaching the gambling hall, 'as soon as I begin to hear the clinking of money being poured out, I almost go into convulsions'. Because these otherwise neutral cues become reinforcing in themselves, they play a vital role in maintaining behaviour such as betting despite the fact that much of the time the instrumental act of placing a bet results in financial loss rather than gain.
Cognitive biases and automatic mental processes help explain why addictive behaviour is difficult to break
That kind of conditioning and learning applies equally to many animal species, not just humans, but the human capacity to dwell mentally on our behaviour adds greatly to the predisposition to addiction. For one thing, we develop 'positive expectancies' about engaging in preferred activities. People with gambling problems have been shown to hold significantly more positive expectations that gambling will, for them, be 'exciting' and will make them feel 'important', 'expert', and 'in control', and even that it will solve their financial problems. Such expectations are often laid down early. People with gambling problems frequently say that their earliest experiences of gambling were in the company of family members who helped create a positive image of gambling as something that was normal, exciting, or an easy way of making money. Part of the reason why addictive habits are hard to break is because they are supported by a whole set of such expectations and beliefs. This is particularly relevant in the case of gambling which lends itself to a number of cognitive biases or false beliefs held particularly by people with gambling problems. A number of these, such as the 'gambler's fallacy', are based on a misunderstanding of chance and randomness; others involve the 'illusion of control'. Some of this biased thinking occurs at a conscious level but much of it is automatic and unconscious. Many studies show that a person who has developed an addiction has become a 'biased information processor' when it comes to the objects of his or her addiction and cues associated with it, which now have the capacity to grab attention, occupy thoughts and control memory in a way that maintains the habit. There are a number of features of such automatic mental processes that help explain why addictive behaviour is difficult to break: automatised actions speed up and become more fixed and less variable with practice; they become more easily triggered by a relevant stimulus; they initiate a whole chain reaction or automatic sequence of behaviour without time for thought; and because they require little thought they are mentally without effort. As one cognitive scientist has put it, these processes are, 'autonomous and without intention, difficult to control, effortless and involving little conscious awareness’. Most of the automatic cognitive-behavioural habits which we develop in that way are adaptive for us. One way of thinking of addiction is as a kind of capture or distortion of what is otherwise a normal and functional set of processes.
The result is an approach-avoidance conflict whereby the habit becomes more compulsive and the gambler more defensive and increasingly confused and desperate
The foregoing summarises the basic processes responsible for the development of a strong appetitive habit. But there is more to a full-blown state of addiction than that. This is because of the state of motivational conflict brought about by such a habit. Powerful appetitive habits such as a gambling habit create harms such as financial loss and relationship difficulties. The anticipated immediate rewards of engaging in the addictive activity are then pitted against equally strong motives to use time and money for more essential purposes, to behave responsibly in the eyes of family, friends and work colleagues, and to behave in a way consistent with one's own standards and self-image. The result is an approach-avoidance conflict. Another way of thinking of this is to think of the person as having a conflict of interests, in a sense at war with one's self, with now diminished capacity to consistently make choices regarding consumption which are in keeping with other life plans. Faced with opposing motives of such strength, the addicted person becomes an even more biased information processor, a 'harassed decision-maker', trying to hide one's behaviour from others, finding devious and perhaps illegal ways of obtaining money, becoming more defensive about behaviour, increasingly tense, guilty, confused, desperate and even suicidal. Resolutions to curb the behaviour are made and broken, and the behaviour becomes more compulsive. One way in which this is manifest in the case of gambling is in the form of increasingly undisciplined ways of betting, in particular the 'chasing losses' characteristic of problem gambling. Following the experience of heavy losses or the existence of debts, the prospect of winning now carries the additional anticipation of relief in the hope of being able to recoup losses or pay off debts. Instead of stopping after a loss, betting is continued and bets or stakes are increased. Needless to say, this and the other consequences of motivational conflict mostly serve to consolidate rather than reduce the habit and they act to further entrap the unwary player. At the same time the addicted gambler is increasingly likely to experience distress in the form of irritability, agitation, restlessness and depression as well as psychosomatic symptoms such as headaches, insomnia, racing heart and even shakes, associated with experiences of loss, feelings of indecision about continuing gambling and worry and preoccupation about debts and other costs of gambling.
The effects of gambling on the brain are similar to those of drugs of addiction
Work on neuroscience and gambling is a growing area and a number of studies have now shown that the effects of gambling on the brain are similar in important respects to those of drugs such as amphetamine, cocaine, nicotine and alcohol. For example, it has been shown that uncertainty about the receipt of a reward, winning money on a gambling game, and experiencing a 'near miss' during a simulated machine gambling game, all produce effects in the limbic midbrain area (an area of the brain which is 'old' in evolutionary terms) which have been shown to be important for understanding drug habits and which are known to be involved in the control of motivation and emotion. One particular area known as the striatum is particularly important; but the brain is a very complicated organ with multiple connections between different regions, and other areas such as the amygdala and hippocampus may also play important roles in addiction. The higher- or neo-cortex is also involved, particularly the medial prefrontal cortex. One hypothesis is that the transition from voluntary (executive or reflective) action to more automatic, habitual (impulsive or addictive) behaviour is represented in the brain as a transition from prefrontal cortical to striatal control of behaviour.
It is this combination of brain effects, conditioning, cognitive elements and the consequences of conflict that, according to modern theory, accounts for the phenomenon of a difficult to break addiction such as can develop in the case of gambling.
Self-exclusion and pre-commitment, surveys and personal testimonies, illustrate the addiction potential of gambling
We do not have to look far for signs that gambling can create a habit that is difficult to control. It is now expected of gambling establishments in a number of countries that they have in place a procedure for agreeing with a customer a self-exclusion contract. There were approximately 70,000 of these in Britain in 2010-11. Another way of helping people exert control is to allow them to state a spending limit at the outset of play, beyond which play will not be allowed. There has been much discussion, in Australia and elsewhere, about the possibility of making such pre-commitment mandatory. Self-exclusion and pre-commitment are clear indications that with gambling we are not dealing with an ordinary commodity but rather with one that is dangerously addictive. The results of national, state and provincial gambling surveys (now no fewer than 190 such adult surveys have been carried out around the world) and the personal testimonies of individuals who have experienced gambling addiction themselves, including members of Gamblers Anonymous, are further witness to the fact of gambling addiction. One of the earliest personal testimonies, written in 1525 by Jerome Cardano, a Renaissance physician, astrologer, mathematician and writer, was ahead of its time in recognising that gambling could become what he called 'a settled habit' amounting to an illness:
During many years I have played not on and off but, I am ashamed to say, every day. Thereby I have lost my self-esteem, my worldly goods and my time ... Even if gambling is altogether evil, still, on account of the very many large numbers that play, it would seem to be a natural evil. For that reason, it ought to be discussed by medical doctors like one of those incurable diseases ...
The experts have taken a long time to catch up but they are getting there
It was several hundred years before the experts understood this. An important event was the inclusion in 1980 of 'pathological gambling' in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of mental disorders, which is generally considered the most authoritative compendium of psychological problems and their symptoms. Since then there has been some confusion about whether the DSM should include pathological gambling as an impulse control disorder or as an addiction. The fifth revision of DSM, shortly to be published, will include 'gambling disorder' as an addiction. It has taken a long time for medicine to catch up but it has finally done so!