Maintaining Your Health on Mackinac
Expanding Gambling Industry May Cause Problems for Some
By Yvan Silva, M.D.

The phenomenon of casino gambling is expanding in many locations in the United States, in addition to the many forms of legal and illegal gambling that have existed for a long time. There are several campaigns to expand in the latest trend on the growth of Indian tribal gambling - a practice known as offreservation gambling. Revenues for tribal casinos amounted to about $18.5 billion in 2004, according to the National Indian Gaming Association - up from $5.4 billion in 1995. There are currently more than 411 tribes operating casinos that employ an estimated 533,000 people. The trend for expansion continues.

This is rapidly adding to the otherwise extant industry of legalized gambling throughout the United States, increasing the prevalence of gambling and, consequently, the prevalence of problems resulting from inappropriate gambling. Ten years ago, it was estimated that legalized gambling grossed more than $50 billion, more than the entertainment industries - music, theme parks, and motion pictures - combined. The amount of money changing hands, with all the peripheral ramifications, is a socioeconomic parameter that is important to reckon with.

In 1998, surveys showed that 86% of the adult population said they had gambled sometime in their lives, compared to 68% in 1975. Placing bets on lotteries, in casinos, and horse races continues to increase, while Internet gambling, video poker, and other innovations in gambling technologies can become more habituating because of the rapidity of action and the ability of gamblers to bet in isolation.

To most people, gambling is acceptable. Nowadays, many people buy lottery tickets, and thrill to the possibility that they will win. They know the odds, they accept the loss, and yet the excitement of hearing how someone won another big one keeps them buying. Many enjoy going to casinos, with a variety of games available, and often affordable entertainment. Bets on sporting events are an important part of the lives of many people. Their lifestyles remain relatively unimpaired, and gambling can be fun, if not always painless.

Gambling involves the challenge of risking something of value to gain something of greater value. Gambling becomes a problem when it interferes significantly with the gambler's occupation, interpersonal, and financial functioning. The most severe form of gambling, defined as "pathological gambling," was included in the Diagnostic and Statistical Manual of Mental Disorders as far back as 1980. Interestingly, the criteria are remarkably similar to those for drug dependence, including increasing tolerance, withdrawal, and loss of control and relinquishment of important activities.

Gambling can become an addiction, with many symptoms similar to that of drug abuse. They include intense preoccupation with gambling - repetitious discussions of gambling experiences, especially with winning, often exaggerating the amounts; planning the next opportunity to gamble, and expectantly working out ways to get more money for gambling. Tolerance leads to needing more frequent and bigger bets to keep up the level of excitement; lying to family members, friends, and others to conceal the problem, and especially lying to self; inability to stop gambling, in spite of several attempts to stop; trying to win back losses and getting farther behind; restlessness, frustration, and inability to stop, and finally, breaking the law to finance the gambling habit.

The consequences of pathological gambling that ensue include financial problems that increase with magnitude over time, loss of job and job opportunities, problems with marriage, long-term friendships, and relationships, and withdrawal from society. Legal problems arise, with widespread ramifications, including other people, family members, and friends. Pathological gamblers are known to have high suicide rates, and tend to abuse alcohol and other drugs more than other people.

For the pathological gambler, the first step in getting help is to admit that it is a problem. This is often very difficult, as is well known with alcoholism and other forms of drug abuse. Denial can become so entrenched that people around the gambler become frustrated and feel helpless. A consultation with the family doctor may be helpful, with the possibility for psychological counseling. Consultation with a lawyer may also be relevant. It is important to realize that the gambling is a part of a complex picture of psychological and physical problems, and that treatment must be directed to all of these elements.

The significant adverse consequences that accompany gambling problems, for individuals as well as for society, clearly point to the need to identify the spectrum, do research, and develop effective treatments for individuals with gambling problems. Today, almost everyone knows someone who indulges in some form of gambling in its simplest definition - gaining value while risking something of value. Fortunately, for most, it remains a game, take it or leave it. Unfortunately, as the opportunities for legalized gambling continue to increase, more people will fall victim to the pathology of gambling, with its potential for pain and suffering. It is important to learn about it and work positively to help, if we can, and when we can.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.