Gambling, Psychiatry & the Catechism

The American Psychiatric Association is getting closer to putting into use the Fifth Edition of the Diagnostic and Statistical Manual. This massive work defines behavioral symptoms of nearly 300 conditions that it deems to be “psychiatric disorders.” Each is coded with a number. For one to obtain services through insurance, there has to be a DSM diagnosis. This book medicalizes psychiatry and is similar to the International Classification of Diseases (ICD), which does the same coding for medical conditions. Now is not the time to debate the wisdom of having a DSM–instead let’s look at the increased attention to gambling behaviors, becoming more prominent, especially with young people who constitute a first generation since gambling became legal in 1978.

Previously “Pathological Gambling” was an outlier in a section of the book where a few impulse control problems were noted. Now it will be in one of the most prominent sections of the book, the one classifying many various forms of substance abuse and dependence. The task force includes these behaviors in its definition of gambling abuse/dependence: the need to bet increasing amounts; gambling to avoid feelings of depression and emptiness; gambling after a big loss in order to “chase” losses; lying, put your own or your family’s financial lives in jeopardy, or borrowing from close friends and relatives.

Catechism aficionados (and I include myself in this group) will be interested to know that the American Psychiatric Association and the Catechism of the Catholic Church both show basic agreement in recognizing gambling as a legitimate pastime for many that can rapidly evolve into a major problem. Catechism 2413 states “Games of chance (card games, etc.) or wagers are not in themselves contrary to justice. They become morally unacceptable when they deprive someone of what is necessary to provide for his needs and those of others. The passion for gambling risks becomes an enslavement.”

In view of concern of the high prevalence of tween-age and teen-age gambling (some researchers say 4-6% of young people have a gambling problem, and 10-15% are at risk), researchers are studying gambling in young people. There are two psychological tests for researchers to measure gambling behavior in young people: the Signs of Gambling Checklist (also used with adults) and the Gambling Timeline Followback, a retrospective journal where college students detail their gambling behaviors over the past six months. Gambling is often linked with drinking, and I am not aware of research findings that link these two problems.

Conceptually gambling falls under risk-taking behaviors, and these can be either very constructive or very destructive, depending on the situation and intended ends. Because of this, one doesn’t speak of a “cure” for pathological gambling, but rather one hopes for ongoing “management.” Where to draw the line between problem gambling and recreational gambling can be extremely difficult. There is a 12-step program for problem gambling, Gambler’s Anonymous.

The giddiness of many over the stock market in the 1990s and of the housing bubble suggest to me that gambling has become too embedded in our culture. What do you think? What is your assessment of this form of recreation? Have you gone on any “free” trips to a casino? Poor people in America frequently become addicted to state-sponsored lotteries–this can be seen by visiting any inner-city bodega or convenience store. I would appreciate your comments and examples (and your thoughts on appropriate gambling as well as how to distinguish between recreational gambling and hurtful gambling). This is topic isn’t talked about enough and therefore it is hard to gauge the devastation that is occurring in our midst.

William Van Ornum