The new American Psychiatric Association diagnostic manual, DSM-5, scheduled for publication in May 2013, for the first time specifies that an activity not involving a substance can be addictive - namely compulsive gambling. Of course, Charles O'Brien, who heads DSM-5's Substance-Related Disorders Work Group, had to jump through intellectual and scientific hoops to justify this radical departure (which I indicated was necessary in my books, Love and Addiction, in 1975, and The Meaning of Addiction, in 1985). To wit: "substantive research," O'Brien says, indicates "pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system."
Leaving aside that this gibberish actually means nothing, it seems that O'Brien is envisioning the kind of intense gambling episodes where people - caught in a frenzy - dispense all of their worldly goods to casinos in a desperate, compulsive cycle of losing betting.
This conceptualization - while apparently expanding the somatized, neurochemical model of addiction - is actually subject to the mythical, Platonic notions of drug addiction from which O'Brien and colleagues are unable to escape.
To illustrate just how confusing O'Brien's and DSM-5's conceptual blinders are (the small change being proposed for DSM-5 will lead to decades of argument and misunderstanding), consider from a clinical standpoint the case of Jack, a 60-something whom I know around town.
Jack was always a recreational gambler, beginning in his days as a bachelor. If he reminisces, he describes, in regretful tones, early wins that he had, but which he readily gave back over time.
He married a "sweet woman" (as Jack describes her) who had never gambled, and introduced her to gambling, principally in nearby Atlantic City. Semi-regularly, they traveled there (a 2.5 hour drive from where we live) to gamble, and for other entertainments created by the casinos.
From time to time, the couple decided that they were losing too much money which, along with the other costs of their trips, caused them to stop gambling. Very shortly, however, the casino they frequented would send them a series of complimentary benefits ("comps") for meals, shows, sometimes even small amounts of betting money, and they were induced to return.
Three years ago, Jack's wife won a $40,000 prize on a slot machine. This created a dilemma. They could either accept the money forthwith, or take it back in trade at the casinos, and thus avoid paying taxes on these winnings. The couple decided to take it back in trade. This meant that they were given rooms, meals, admissions to shows, transportation -- including trips to the casino's other outlets in Las Vegas and New Orleans - and, most especially, coupons that they could turn into chips for gambling without realizing the money as income.
Despite winning on one visit to the casino an additional $20,000 slot machine prize, they have not only given back the $60,000 in the last three years, but they've spent a considerable amount of out-of-pocket money (leading to the conclusions that casinos really know how to work their customers, and that gambling consumers are really good business).
Let us take a step back to observe that Jack and his wife - like all such preferred casino customers - are both stably employed. They have children and grandchildren, and maintain a nice home they purchased many years ago. At the same time, as my father used to put it, they don't have a pot to piss in, meaning they have no accumulated cash assets.
Tell me, dear readers, are Jack and his wife addicts? They don't comport with the kind of intense gambling episodes or binges that involve loss-of-control, or withdrawal when they don't gamble, or their incurring any legal, physical, or family problems (aside from standard marital bickering).
As two side issues, we might contemplate what people's ives are like that the best options they can exercise are costly trips to casinos in Atlantic City and Las Vegas, spending their days (and many nights, aside from elaborate meals and shows) indoors gambling, away from family and friends, exercise and hobbies, community involvements and political engagement, etc.
In addition, we might wonder - "Aren't there any laws about casinos actively soliciting people back to gamble when they are trying to get away from it?" Well, there can't be - because the only entities more addicted to gambling than individuals are governments completely wedded to the money that gamblng pours into the states' coffers, especially when other states - in our case Pennsylvania - are only too ready to lure Jack and his wife over the border to spend their money to offset PA's deficit spending.
Oh, so are Jack and Spouse addicts? Should I - or his family -- perform an intervention? Should they then be sent to residential rehab? Tell me, dear readers, what should be done?