Gaming the System
Redefining compulsive gambling as an addiction is not mere semantics: therapists have already found that pathological gamblers respond much better to medication and therapy typically used for addictions rather than strategies for taming compulsions such as trichotillomania. For reasons that remain unclear, certain antidepressants alleviate the symptoms of some impulse-control disorders; they have never worked as well for pathological gambling, however. Medications used to treat substance addictions have proved much more effective. Opioid antagonists, such as naltrexone, indirectly inhibit brain cells from producing dopamine, thereby reducing cravings.
Dozens of studies confirm that another effective treatment for addiction is cognitive-behavior therapy, which teaches people to resist unwanted thoughts and habits. Gambling addicts may, for example, learn to confront irrational beliefs, namely the notion that a string of losses or a near miss—such as two out of three cherries on a slot machine—signals an imminent win.
Unfortunately, researchers estimate that more than 80 percent of gambling addicts never seek treatment in the first place. And of those who do, up to 75 percent return to the gaming halls, making prevention all the more important. Around the U.S.—particularly in California—casinos are taking gambling addiction seriously. Marc Lefkowitz of the California Council on Problem Gambling regularly trains casino managers and employees to keep an eye out for worrisome trends, such as customers who spend increasing amounts of time and money gambling. He urges casinos to give gamblers the option to voluntarily ban themselves and to prominently display brochures about Gamblers Anonymous and other treatment options near ATM machines and pay phones. A gambling addict may be a huge source of revenue for a casino at first, but many end up owing massive debts they cannot pay.
Shirley, now 60, currently works as a peer counselor in a treatment program for gambling addicts. “I'm not against gambling,” she says. “For most people it's expensive entertainment. But for some people it's a dangerous product. I want people to understand that you really can get addicted. I'd like to see every casino out there take responsibility.”