US Researches of The Problem and Pathological Gambling

In its 1997 meta-analysis of the literature on a problem and pathological gambling prevalence, the Harvard Medical School Division on Addictions, using “past year” measures, estimated at that time that there were 7.5 million American adult problem and pathological gamblers (5.3 million problem and 2.2 million pathological). The study also estimated there were 7.9 million American adolescent problem and pathological gamblers (5.7 million problem and 2.2 million pathological). 1

The “past year” estimates of American adults who gamble is 125 million. Based on the data available to the Commission, we estimate that about 117.5 million American adult gamblers do not evidence negative consequences (125 million minus the 7.5 million estimate of adults who are either problem or pathological gamblers). Because a comparable estimate of American adolescent gamblers has not been determined, there is no reliable way to calculate the number of adolescents who gamble without negative consequences.

There are several terms used to describe pathological gamblers. Clinically, the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies pathological gambling as an impulse control disorder and describes 10 criteria to guide diagnoses, ranging from “repeated unsuccessful efforts to control, cut back, or stop gambling” to committing “illegal acts such as forgery, fraud, theft or embezzlement to finance gambling.”

These 10 criteria represent three dimensions: damage or disruption, loss of control, and dependence.

The National Research Council Review on Pathological Gambling states the American Psychiatric Association uses the terms “abuse” or “dependence,” not addiction. The lay public uses terms like “addiction” or “compulsive” interchangeably with the more scientifically accurate term “dependence.”

All seem to agree that pathological gamblers “engage in destructive behaviors: they commit crimes, they run up large debts, they damage relationships with family and friends, and they kill themselves. With the increased availability of gambling and new gambling technologies, pathological gambling has the potential to become even more widespread.” 2

Most seem to agree that “problem gambling” includes those problem gamblers associated with a wide range of adverse consequences from their gambling, but fall below the threshold of at least five of the ten APA DSM-IV criteria used to define pathological gambling.

The Commission determined its first priority in studying problem and pathological gambling was to bolster existing research with updated data on gambling behavior of the general population, which would include the prevalence of problem and pathological gambling. In addition, measurements of the economic and social impacts on communities from legalized gambling were compiled. As part of its contract with the Commission, the National Opinion Research Center (NORC) at the University of Chicago conducted a national survey of gambling behavior in the U. S. population, including a set of questions focused on problem gambling. In that survey, NORC interviewed 2,417 adults by telephone (the “telephone survey”) and 534 adolescents by telephone (the “adolescent telephone survey”). In addition, 530 adults in gambling facilities (the “patron survey”) were interviewed to increase the sample size of potential problem and pathological gamblers. 3 Also, 100 communities across the country were selected for a detailed examination of the impact of gambling on a variety of indices, including financial health, crime, and social problems. NORC conducted case studies in 10 of these communities in which they interviewed 7 or 8 community leaders regarding their perceptions.

1 Dr. Howard Shaffer, “Estimating the Prevalence of Disordered Gambling Behavior in the United States and Canada: A Meta-Analysis,” (1997), p. 51. 2 National Research Council, “Pathological Gambling: A Critical Review,” (April 1, 1999), p. Exec-2.