What Happens in Vegas Can Actually Be a Big Problem

The term ‘behavioral addiction’ will replace ‘compulsive gambling’ when the new DSM-5 is released this spring.
In May 2013, psychiatrists will start referring to gambling addiction instead as a behavioral addiction, the first disorder in that newly created category of the DSM-5. (Getty Images/Jeffrey Coolidge)
Mar 1, 2013· 3 MIN READ
Shari Roan is an award-winning health writer based in Southern California.

She was wealthy, successful, intelligent, and influential. In other words, she had a lot to lose.

That's why the recent news that former San Diego mayor Maureen O'Connor had a huge gambling problem has residents of her hometown, as well as millions of Americans, wondering how someone could spin so completely out of control. In the end, O'Connor had won and lost more than $1 billion.

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Psychiatrists think they know the answer: Compulsive or pathological gambling, they say, is similar to a drug addiction—just without a drug. They will soon have a new term to describe such a disorder: "behavioral addiction."

In May psychiatrists will start referring to gambling addiction instead as a behavioral addiction, the first disorder in that newly created category of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the textbook for psychiatry that's widely used by doctors, courts, and insurance companies. The latest edition of the DSM—DSM-5—will be published in May.

The change isn't just for show. "It's a meaningful move," Dr. Marc N. Potenza, an expert in pathological gambling, told TakePart. "I'm hopeful that more people will recognize the importance of identifying people with gambling problems," he explains, adding that by moving it into the category of addictions, Dr. Potenza hopes that mental health pros who treat addiction will focus on it more.

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O'Connor's behavior certainly looked like an addict in trouble. She was a high roller in San Diego society who had inherited the fortune of her late husband, Jack-in-the-Box fast-food chain restaurant founder Robert Peterson. After retiring as mayor, she began to play video poker games and was courted by casinos in Las Vegas and California. Her life finally collapsed when it was discovered that she had raided a charitable foundation of more than $2 million to keep gambling. Now bankrupt, O'Connor has made a deal with San Diego prosecutors to repay the stolen funds and undergo treatment for her gambling addiction. "It was like electronic heroin," she told CBS News' Bill Whitaker. "You know, the more you did, the more you needed and the more it wasn't satisfied.

'Gambling was like electronic heroin,' says one addict who won and lost more than $1 billion.

The reclassification of pathological gambling as an addiction may convince more people of the severity of the problem and the need for treatment, says Potenza, director of the Center of Excellence in Gambling Research at Yale University, in New Haven, Connecticut. "I think there are both similarities and differences between pathological gambling and substance-use disorders," he says. "There are similarities and differences across substance-use disorders as well. Nicotine dependence is not the same as cocaine dependence or alcohol dependence."

Pathological gambling has long been recognized as a disorder with many similarities to substance-use disorders. Gambling addicts take risks despite knowing the dangers of their behaviors. They can't resist the impulse or temptation to gamble, and the pattern of behavior repeats itself over and over. People crave the activity and feel miserable without it. Engaging in gambling produces an emotional high, but addicted gamblers then need to do more and more, with higher stakes, to reach that emotional high.

Brain scans show that excessive gambling and drug addiction activate the same parts of the brain.

Problem gambling also mirrors drug addictions in other ways, experts note. Brain scans show that the same parts of the brain are activated by the behavior, such as serotonergic and dopaminergic systems of the brain involved in pleasure-seeking, reward, and the loss of inhibitions.

Moreover, treatment for gambling disorders is similar to drug addictions, including the usefulness of 12-step programs and medications. "I would hope that we would develop better treatments for people with gambling problems," Potenza says. "That includes medications. There is no medication that has an FDA-approved indication for pathological gambling."

Previously, gambling addiction was considered an "impulsive-compulsive" type of behavior or an "impulse control" problem. The move to the new "behavioral addictions" category may impact how people approach treatment, Potenza says. "Some people may find the term 'addiction' stigmatizing. Other people may not," he says. “In speaking with people who participate in 12-step programs, my experience is they may not find the term 'addiction' to be problematic. Part of the recovery process, in 12-step programs, is to state they are powerless over the behavior and accept the addiction and make different decisions."

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Gambling addiction will be the only disorder listed in the category of behavioral disorders when DSM-5 is published in May. Other types of behaviors have been discussed for inclusion in the category of behavioral addictions. Perhaps the best-known is "Internet addiction," in which users spend so much time on online activities or playing video games that they ignore their other responsibilities and roles. Compulsive shopping and compulsive tanning have also been mentioned as possible behavioral addictions. More research will be needed to support describing these disorders as behavioral addictions, Potenza says.

"There was less research that had been conducted to date to warrant this sort of change," he says of those disorders. "Before people make major changes, they want to make sure there are data to support the major changes. There have been data accumulated over the past ten to 20 years on pathological gambling that were taken into consideration."

Do you think compulsive or excessive gambling is an addiction? Do you think the term “behavioral addiction” will help compulsive gamblers get better treatment?