A More Careful Look at Gambling Behavior and Addiction

Playing Backgammon

Source: public domain

After my book on the history, mathematics, and psychology of the gambler’s illusion appeared, I was continually asked questions like these:

What makes a person a gambler?

It’s difficult to know. There is no one-size-fits-all.

You must have some thoughts on the matter.

Sure. If we believe Skinnerian and Pavlovian views, we come up with cognitive causes surrounding financial awards and emotional excitement. If we take the Freudian view, we come away thinking that pathological gambling parallels a subconscious desire to self-castrate. I’m not going there because I don’t believe that demonic impulses connect to the ego’s struggles with real-world autoerotic desires. A more nuanced view is that addictive or irrational gambling is just a test to control Fortune.

It could be that it all comes down to lusting for risk. But also, it could be that there is an uncanny desire, as Bergler said, to control destiny.

Almost all theories and certainly all the early psychoanalytic views are based on subliminal grounds. They are interesting from an academic point of view and sometimes clinically successful. That’s okay for accepting a theory but without some support from resoundingly rigorous scientific evidence, I cannot support one theory over another of hundreds vying for acceptance. Would you consider, to take a wild example, Han’s Von Hattinberg’s theory that gambling obsessions connect to toddler years of toilet training when unrestricted bowel elimination (which Von Hattenberg believed to be an autoerotic pleasure) is suddenly checked under protocols? Von Hattenberg was a German neurologist and psychoanalyst working in the early twentieth century who espoused that that sort of pleasure comes from an obsessive desire to gamble that emerges in adulthood as the unconscious will to have an unrestricted flow of cash. Do I believe in Von Hattenberg’s theory? Of course not. But not because I think it is bogus. Instead, it is because I see no scientific research pointing to evidence.

Gambling addiction has been followed for centuries. Are you claiming that there is still no scientific evidence pointing to a cause?

No. The history of psychoanalytical studies shows a great deal of imagination. At times people believed almost everything Freud said about Oedipal features to autoerotic desires and about what Bergler said about gambling being an insatiable desire to command the future through some sort of illusion of omnipotence. There were theories connecting inherited instincts, masturbation drive, and masochism. But almost nobody believes them anymore.

Were they not tested scientifically?

Yes, they were. However, those early theories were tested on very small sample sizes—and biased samples. Those tests were done in an age when statistics were ridden with faulty knowledge. At that time—the early half of the twentieth century—there was no discrepancy between the terms pathological gambler and problem gambler. Before 1994, the DSM (the Diagnostic and Statistical Manual of Mental Disorders) had not distinguished between definitions. Mark Griffiths’s post here informs us of that distinction. But even with that distinction, all those early theories have been faultily tested. They remain inconclusive. The problem, as I see it, is that there was little attention paid to environmental factors.

Can you say more about small sample sizes and biased samples to give an understanding of why you believe that testing was inconclusive?

Bergler’s case is close to the examples of every case. He had 200 patients, 80 with acute problems. Of those, 60 continued treatment and, allegedly, 45 were completely cured, meaning “they stopped gambling, recognized their inner conflicts, and ended patterns of self-destructive behavior.”

Wow! But that convinces me that he cured almost two-thirds of his 60 problem gambling patients who continued treatment using purely psychoanalytic techniques!

Ahh, but behaviorists argue that the high numbers of cures could have been circumstantial, that perhaps mere clinical attention alone resolved gambling problems. Other analysts claim that many patients with multiple neuroses were convinced that gambling was a problem only after a lengthy analysis. There were no follow-ups, so we don’t know if the cures were temporary or permanent.

So, then, what does make a person a gambler? Do you have any confidence in any theory that brings us forward in knowing how to treat problem gamblers or pathological gamblers?

We have recent PET scans that suggest—mind you, just suggest—that pathological gamblers, alcoholics, and drug addicts have similar patterns of neural activity when exposed to their individual addictions. The sight of drinks seduces alcoholics; lottery drawings, casinos, and Internet gambling sites influence pathological gamblers. We definitely know that the ventral tegmental area (VTA) in the brain associated with pleasure, a center of reward experiences, as well as the emotions connected to those experiences show increased release of dopamine, a chemical messenger that plays a major role in reward, fear, pleasure, laughter and addiction.

But the latest research is not so simple as to be limited to dopamine activity in the VTA. In the end, it all comes down to unrelated psychiatric complexities involving long-term tendencies, habits, and environmental conditions as well as active libido energy.

With so many unknowns, how can there be treatment?

Neuroscientists are beginning to focus on the effects of neurotransmitter imbalance. Now there are drugs that may inhibit the transmission of dopamine during cycles of detrimental addictive behaviors. The trick is to separate destructive behaviors from biologically necessary ones without purging prudent delightful pleasures in life.