By definition, gambling is the process of placing something of value (usually money) at risk in the hopes of gaining something of greater value (Potenza et al., 2001). It is a human behavior that has persisted for millennia; some of humanity's earliest historical accounts document gambling as a practice of ancient civilizations (France, 1902; Potenza and Charney, 2001).
Over the past several decades, there has been a rapid proliferation of legalized gambling across the United States, creating a markedly different environment from only a generation ago (National Gambling Impact Study Commission [NGISC], 1999). State-run lotteries were reintroduced in 1964, and legal changes, such as those encompassed in the Indian Gaming Regulatory Act of 1988, have resulted in gambling becoming a big business, grossing an estimated $50 billion annually. As compared with 25 years ago, today more people report having gambled at some point in their lives: 86% of the general adult population in 1998 as compared with 68% in 1975 (NGISC, 1999, as cited in Potenza et al., 2001). With the introduction and expansion of newer types of gambling (e.g., Internet and video gambling) the landscape is likely to change further.
Although most people have gambled, only a relatively small proportion develops problems with gambling (Potenza et al., 2001). Results from a meta-analysis of studies performed over the past several decades in North America yielded past year and lifetime prevalence rate estimates for pathological gambling of 1.14% and 1.60%, respectively (Shaffer et al., 1999). An additional 2.80% and 3.85% were estimated to have experienced problem gambling over the past-year or lifetime, respectively. The study data also suggest that the rates of problem gambling and pathological gambling have risen in conjunction with the increased availability of legalized gambling.
The annual cost to society attributable to problem and pathological gambling in the United States has been estimated at $5 billion annually (NGISC, 1999). However, this figure is likely an underestimate of the true expense due to costs that are difficult to eliminate and thus often go unaccounted. For example, when the cost related to the elevated rates of divorce as a result of problem gambling were calculated, only the resulting legal fees were used to represent the costs incurred and the often devastating effects on family members were not taken into consideration (NGISC, 1999).
Together, these data suggest that pathological gambling is as or is more common than several other major psychiatric disorders (e.g., schizophrenia or bipolar disorder) and represents a significant cost to society. As such, there exists a need for increased efforts in prevention, treatment and research in order to advance current clinical practice.
France C (1902), The gambling impulse. Am J Psychology 13:364-407.
NGISC (1999), National Gambling Impact Study Commission: Final Report. Available at: www.ngisc.gov/reports/fullrpt.html. Accessed Aug. 21, 2001.
Potenza MN, Charney DS (2001), Pathological gambling: a current perspective. Semin Clin Neuropsychiatry 6(3):153-154.
Potenza MN, Kosten TR, Rounsaville BJ (2001), Pathological gambling. JAMA 286(2):141-144.
Shaffer HJ, Hall MN, Vander Bilt J (1999), Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis. Am J Public Health 89(9):1369-1376.
Wexler BE, Gottschalk CH, Fulbright RK et al. (2001), Functional magnetic resonance imaging of cocaine craving. Am J Psychiatry 158(1):86-95.