Dean, an English lawyer turned psychologist, is the founder and proprietor of the website PsyBlog, which he’s maintained steadily since 2004. This is his first book, and one suspects it won’t be his last. He effects a direct, bloggerly style, mercifully unclouded by the stultified prose plaguing many psychology authors whose backgrounds are different from Dean’s (i.e., career academics). Nevertheless, the book is carefully — even densely — footnoted with a trove of research studies, general readership psychology books, and online resources.

Professional psychologists likely won’t find a great deal of new material in Making Habits, Breaking Habits, and neither will voracious lay readers who’ve digested the likes of Dan Ariely, Daniel Kahneman, Timothy Wilson, James Pennebaker, Martin Seligman, and others of their ilk. Yet Dean’s book remains worth a look for these readers, if only to sift through the bibliography’s many nuggets and to read Dean’s thoughtful chapter on treating online habits.

Dean divides his book into three main sections: “The Anatomy of a Habit,” “Everyday Habits,” and “Habit Change.” He explains what habits are, how they show up in daily life, and how the average individual can set about changing, forming, or ceasing various personal habits ranging from the benign to the existential.

Habits in the popular imagination are most closely associated with either virtuous or vicious activities. On the vicious side, we think of deleterious behaviors like excessive alcohol consumption, cigarette smoking, and doughnut eating. On the virtuous end of the ledger we find beneficial routines like regular exercise, charitable donations, and daily meditation. Yet habits are inherently neither good nor bad, explains Dean. They are merely behaviors repeated with great frequency and regularity and most often performed with little to no conscious intention.

Whether good, bad, or indifferent, habits are an incredibly powerful and pervasive psychological phenomenon.

“In the war of habit versus intention,” Dean writes, “the fight is massively fixed.” Citing a large meta study by Wendy Wood and J.A. Oulette, Dean illustrates that regularly performed habits — from ordering coffee to checking email — involve little or no conscious intention. “It was only when [habitual] behaviors were performed once or twice a year — like getting a flu shot — that intentions took over from autopilot.”

Which is not to say that habits do not follow intentions, Dean tells us.

“Much of the time even our strong habits follow our intentions. We are mostly doing what we intend to do, even though it’s happening automatically,” he writes. “When washing our face each day, picking up an espresso on the way to work, or cleaning our glasses, it’s because at some point in the past we consciously decided (or someone decided for us) that these things were worthwhile activities, so we kept repeating them until they were automatic.”

If habits are automatic executions of intentions consciously set in the past, this means we can all end up performing behaviors that are misaligned with our long-term goals. For example, your expensive pre-work espresso stop may have made sense when your spouse was still earning an income, but does the habit serve you now that you’re a one-income household with a third mouth to feed? We know we should economize in this situation, and yet most of us will likely remain as profligately caffeinated as ever.

“What does this mean for our attempts to control ourselves and our chances of making changes?” Dean asks. He organizes the last two thirds of his book around answering this question. (Spoiler alert: consider re-routing your commute away from Starbucks rather than relying on a shaky mixture of willpower and good intentions for baby’s tuition fund.)   

In the book’s second section, Dean begins by elucidating how habits exert their omnipresent influence in daily life—from routine social interactions, to work, to travel, eating, and shopping. He then shifts to the darker side of habits, examining personal habit pathology as reflected specifically in obsessive-compulsive disorder and depression. Later, Dean zooms out to examine habit pathologies at the societal level relating to plane-crash prevention, seatbelt usage, and environmental protection.

Dean wraps up the second section with a strong survey of online habits, incorporating the latest psychological studies into an analysis of web multi-tasking, email, and Twitter. Synthesizing a wide range of research, Dean examines online behavior through the lens of Skinnerian pleasure reinforcement and through Csíkszentmihályi’s famous concept of “flow.”

Are you one of those people who just doesn’t understand Twitter? Perhaps the concept of variable interval reinforcement can shed some light:

As with email, on Twitter, an interesting tweet could arrive at any moment, but you don’t know when. You could get a batch of interesting tweets one after the other or nothing for a few hours. Because the intervals vary, users get used to the frustration of not getting anything interesting for a while—but they keep checking anyway.

(If you’re reading this article online — perhaps at the office — do you truly understand how you arrived at this page? You might do well to order Making Habits, Breaking Habits before you get back to what you were doing when your Twitter feed announced a new book review on Psych Central.)

The book’s final section moves through a survey of practical techniques for forming beneficial new habits and for breaking undesired old ones. The latter activity turns out to be a difficult proposition indeed. With considerably less grace than old soldiers, “old habits really do die hard,” writes Dean. “Even after habits have apparently faded away through lack of repetition, they still lie in wait to be reactivated.”

The reason cigarette smoking is so addictive, Dean says, is that it combines two cast-iron habits: daily contextual behaviors (like coffee drinking) plus the biological imperative for regular nicotine infusion. That’s the bad news. The good news is that “the best way to break a bad habit is to pair it with a new one.” For example, you pair your biological nicotine craving with the new behavior of chewing gum instead of lighting a Marlboro.

Dean concludes with a guide to practical habit formation and de-formation techniques relating to health, creativity, and happiness. He examines smoking, exercise, art, and work. As in the rest of the book, Dean’s academic overview of habit changing techniques and mechanisms is solid and substantial, though I wish he had provided more personal or third-person examples. While Making Habits, Breaking Habits is more scientifically grounded and less prone to overly tidy conclusions than Charles Duhigg’s 2012 bestseller The Power of Habit, Dean’s book lacks the compelling narrative force that the journalist Duhigg so effectively imposes on the material.

In addition to craving more specific and involved anecdotes, I found myself wishing Dean had sharpened and expanded upon his practical advice, which at times became repetitive. The book likewise could have benefitted from the addition of some interactive, “workbook”-like material. An attractive feature of recent heavyweight works like Kahneman’s Thinking Fast and Slow and Seligman’s Flourish lies in the frequent opportunities afforded the reader to test and measure herself with a variety of simple but highly informative psychological diagnostic tools.

Ironically, these weaknesses derive from one of Dean’s major strengths: namely, modesty. Dean neither evangelizes for a favored theory nor beats the drum for his own proprietary “habit cure.” Commendably, he merely sets the table for a reader to make his own decisions and implement his own modification regime. For my part, I took away a newfound enthusiasm for some long-forgotten CBT techniques and a resolution to avoid sugar and Twitter in the new year. Unfortunately, in so doing, I fell into the classic pitfall of over-general intentions that Dean warns about near the end of his chapter on healthy habits:

The true aim of personal change is to turn our minds away from miracle cures and quick fixes, and adopt a long-term strategy. Habit change isn’t a sprint; it’s a marathon. The right mindset is to wake up tomorrow almost exactly the same person, except for one small change—a small change that you can replicate every day until you don’t notice it anymore, at which point it’s time to plan another small change….

Fair enough. When I feel like desert at night, I’ll brush my teeth instead. My nasty Twitter habit will just have to linger on until I’m svelte and cavity-free.

Making Habits, Breaking Habits: Why We Do Things, Why We Don’t, and How to Make Any Change Stick
Da Capo Lifelong Books, January, 2013
Hardcover, 272 pages
$26

Enabling is “removing the natural consequences to the addict of his or her behavior.” Professionals warn against enabling because evidence has shown that an addict experiencing the damaging consequences of his addiction on his life has the most powerful incentive to change. Often this is when the addict “hits bottom” – a term commonly referred to in Alcoholics Anonymous.

Codependents often feel compelled to solve other people’s problems. If they’re involved with addicts, particularly drug addicts, they usually end up taking on the irresponsible addict’s responsibilities.

Their behavior starts as a well-intentioned desire to help, but in later stages of addiction, they act out of desperation. The family dynamics become skewed, so that the sober partner increasingly over-functions and the addict increasingly under-functions.

This builds resentment on both sides, along with the addict’s expectation that the over-functioning partner will continue to make things right when the addict doesn’t meet his or her responsibilities.

The Al-Anon program suggests that you don’t do for the alcoholic what he or she is capable of doing. Yet, codependents feel guilty not helping someone, even when the person caused the situation and is capable of finding a solution. It’s even harder for codependents to say no to requests for help. The pressure to enable can be intense, particularly coming from suffering or angry addicts, who generally use manipulation to get their needs met.

Examples of enabling include: giving money to an addict, gambler, or debtor; repairing common property the addict broke; lying to the addict’s employer to cover up absenteeism; fulfilling the addict’s commitments to others; screening phone calls and making excuses for the addict; or bailing him or her out of jail.

How to Stop the Enabling Behavior

Often addicts aren’t aware of their actions when intoxicated. They may have blackouts.

It’s important to leave the evidence intact, so they see how their drug use is affecting their lives. Consequently, you shouldn’t clean up vomit, wash soiled linens, or move a passed-out addict into bed. This might sound cruel, but remember that the addict caused the problem. Because the addict is under the influence of an addiction, accusations, nagging, and blame are not only futile, but unkind. All these inactions should be carried out in a matter-of-fact manner.

Stopping enabling isn’t easy. Nor is it for the faint of heart. Aside from likely pushback and possible retaliation, you may also fear the consequences of doing nothing. For instance, you may fear your husband will lose his job. Yet, losing a job is the greatest incentive to seeking sobriety. You may be afraid the addict may have an auto accident, or worse, die or commit suicide. Knowing a son is in jail is sometimes cold comfort to the mother who worries he may die on the streets. On the other hand, one recovered suicidal alcoholic said he wouldn’t be alive if his wife had rescued him one more time.

You may have to weigh the consequences of experiencing short-term pain vs. long-term misery, which postpones the addict’s reckoning with his or her own behavior. It requires great faith and courage not to enable without knowing the outcome. Although enabling can prolong the addiction, not all addicts recover, even despite counseling and going to many rehabs. This is why the 12 Steps are a spiritual program. They begin with the recognition that you’re powerless over the addict. The desire for sobriety must come from him or her.

To avoid unnecessarily suffering the consequences of an addict’s drug use, it’s vital you begin to reclaim your sense of autonomy and take steps wherever possible not to allow the addict’s drug use to put you in jeopardy. Allowing the addict to drive you or your child while under the influence is life-threatening. On the other hand, taking on the role of designated driver gives the addict free license to use or drink. The spouse might refuse that enabling role by taking a separate car. If the addict is charged with DUI, it might be a wake-up call.

Always have a Plan B to cope with addicts’ unreliability; otherwise, you end up feeling like a victim. Sometimes, Plan B might be going to a 12-Step meeting or just staying home and finishing a novel. The important thing is that it’s a conscious choice, so that you don’t feel manipulated or victimized.

It’s a good idea to follow through with plans, whether it’s keeping counseling appointments or social engagements that the addict refuses to attend at the last minute. This precludes the addict’s attempt to manipulate the family.

Having some recovery under his belt, one husband resolved to remain on vacation with the children when his alcoholic wife suddenly decided she wanted to return home. He later remarked, “It was the first time in years that my mind was free of obsessing about her.”

In another situation, an alcoholic husband picked a fight an hour before guests were arriving for dinner. He threatened to leave unless they were uninvited. When his wife refused, he stormed out and hid in the bushes, while his wife enjoyed herself. Feeling ashamed, he never repeated that ploy.

Enabling has implications for all codependents, because they generally sacrifice themselves to accommodate others’ needs, solve others’ problems, and assume more than their share of responsibility at work and in relationships.

Common examples are a woman looking for a job for her boyfriend, a man paying his girlfriend’s rent, or a parent meeting his child’s responsibilities that the child can do or should be doing. Learning to be assertive and set boundaries are often the first steps in stopping enabling. See my book How to Speak Your Mind – Become Assertive and Set Limits.

Email me if you’d like to hear an interview I gave on enabling.

In the regular world, we desperately want to reach great heights of love and beauty and excitement and achievement, but must face the reality of falling short. We disappoint ourselves. We disappoint other people. Other people don’t behave the way we want them to and often hurt us.

In the regular world, we can try our best to be safe and still have unpredictable and cruel things happen to our loved ones and to ourselves. We have choices, but not control. We have power, but it is limited. We must continually make decisions based on limited information, among options that are all flawed in some way. We then have to live with the consequences of those choices.

Somehow we are able, through using substances like drugs, food, and alcohol, to carve out a world for ourselves in which these regular rules do not seem to apply to us. We gain access to times of feeling totally free, invincible, safe and completely fulfilled. At least for a moment or more, we get exactly and purely what we want, without jumping through any tedious hoops, and don’t have to think about the consequences.

So, is trying to change worth it? Especially when the path of recovery is painful, scary and incredibly frustrating?

Well, it is a tradeoff.

The price we pay for trying to opt out of regular life is that day after day, year after year, we become weaker and weaker — physically, emotionally and mentally. Our lives become smaller and smaller. Inside our brains and bodies, the same pattern is repeated again and again and again. We become bored and numb and stuck. We see life going on around us, but feel a wall of separation between the world of the living and ourselves.

When you choose to try to stop an addictive habit or behavior, you gain access to a regular life. Your power, in this regular life, lies in taking each moment, starting now, as an opportunity to make the best possible choice for yourself, and then another choice and then another choice. Your invincibility lies in your ability to depend on others even when it feels extremely uncomfortable. Your control over shaping your life lies in your willingness to stay the course on the bumpy and often circular path toward fulfillment.

Without the option of escape, your intelligence and creativity grow as you learn to work within the reality of human existence to make your life as amazing as possible. You are forced to find nourishing relationships in order to survive. Your world expands beyond the old patterns, and you have the energy and motivation to explore new experiences. You even have the ability to actually feel them.

Is this trade worth it? That is up to you.

The book is an account of Sojourner’s support group, known as Scheherazade’s Sisters. The reader follows each woman’s journey in fighting her gambling addiction, witnesses the psychological and physiological hardships caused by compulsive gambling, and learns of the biological, economical, and social factors contributing to the behavior. The narration is simple and straightforward, with the goal of educating the public about compulsive gambling for women, and helping the victims overcome their addiction. Sojourner divides the book into twelve chronological chapters, beginning with when a woman gets “hooked” onto gambling, and ending with the long battle facing her in “staying clean.”

The door leading to the nightmare that is compulsive gambling has countless keys, “[b]lackjack, poker, bingo, slot machines, keno, lottery tickets, online gambling sites…,” all of which can trigger the downward spiral to self-destruction. Sojourner “welcome[s you] to [her] world” by casting light on the mechanics behind the nightmare, from both the gambler and the industry’s point of view.

In the user’s guide she has helpfully provided at the beginning of her book, Sojourner summarizes the contents of each chapter and points out specific chapters that may be of interest to different individuals reading the book. Chapter 2, “Crossing the Line,” provides a test of 20 questions taken from Gamblers Anonymous for those who “suspect [they] have a problem, but [are] not sure.”  Chapters 3 to 6 talk in depth about the brain chemistry and psychodynamics behind compulsive gambling, the impact of gender on gambling addiction, and the “industry’s strategies to keep women playing,” respectively. The rest of the chapters center around the recovery process, the relapses addicts fall into, and the family’s role and experiences during that time period. Finally, there are resources and a works cited list included at the end, offering websites and hotlines for those in search of support and a books list for suggested further readings.

Although the book is a continuous narrative of a compulsive gambler’s struggles to break free of her cycle, the key points in terms of factual information can be found in chapters 3 through 6. The third chapter, titled “Dopamine is Queen,” even lists out its main points in easy-to-digest numbered and bulleted lists. Specifically, “dopamine is [a chemical] linked with pleasure,” and is triggered in surges by “unexpected positive reward,” which then causes “genetically dopamine-impaired people…to seek those surges.” Put into context, Sojourner’s list clearly explains how a certain group of people fall prey to the calculated odds of casinos. Chapter 4 explores different theories regarding why gambling becomes an addiction, from the perspective of various figures such as Sigmund Freud and B.F. Skinner. Chapter 5 outlines the difference between genders when it comes to gambling. The games men and women gravitate toward, the “reward” they seek from their bets, and the amount of time it takes for them to “cross the line” all differ because of their gender. Sojourner looks at the female side of the coin in chapter 6 when investigating the methods casinos employ to draw in women, such as visual repetition, interior design, and even carpet manufacturing.

While the research portion of the book lies in the middle, it does not take away from the rest of the chapters, nor does it discourage the reader from flipping the page after hitting the last words of chapter 6. The book has certainly achieved its goal of informing the public of the truth behind compulsive gambling behavior; it tackles the reader’s interest by skillfully blending hard facts with the personal stories of women from various backgrounds, social statuses, and life stages. Even those who are not compulsive gamblers are likely to sympathize with the Scheherazade’s Sisters as they describe their lives.

However, She Bets Her Life is not without its flaws. In the “Dopamine is Queen” chapter, diagrams could have saved the reader from having to visualize the brain chemistry and cell parts. When I stumbled upon the well-phrased metaphor explaining the process pages later, I couldn’t help but be confused as to why the cell parts needed mentioning at all when the metaphor was a perfectly functional one that made no mention of the aforementioned parts.

Other parts of the book felt rushed and uncalled for. The unfair treatment of casino employees by their employers was breezed over so quickly in chapter 6 I was forced to step back and reread the summary so to assure myself the book is, indeed, about the women who are gambling. The issue itself is one worthy of controversy, but it digresses from the book’s subject with unexpected abruptness and disrupts the reading midway.

Furthermore, the book focuses heavily on dopamine impairment as an explanation for compulsive gambling, and I was not particularly convinced by the way all the women in the Scheherazade’s Sisters fit the idea. Other possible causes are not given adequate attention, leaving the impression of bias.

Overall, She Bets Her Life does a commendable job of unveiling the life of female compulsive gamblers through its engaging storytelling and clear-cut presentation of facts. The lack of diagrams and occasional deviations from its main topic should not prevent you from picking up this book. The aha moments you’ll find with the Scheherazade’s Sisters alone make the book shelf-worthy. It is, as Sojourner puts it, an invitation to the “slow, patient work of saving our own—and each other’s–lives.”

She Bets Her Life: A True Of Gambling Addiction
Mary Sojourner
Seal Press: April 2010
Paperback, 288 pages
$17.95

1. Do you find yourself haunted by bill collectors?

2. Is the person in question often away from home for long, unexplained periods of time?
3. Do you feel that the person cannot be trusted with money?
4. Does the person promise faithfully to stop gambling; beg, plead for another chance, yet gamble again and again?
5. Does he or she borrow money to gamble with or to pay gambling debts?
6. Have you noticed a personality change in the gambler as his or her gambling progresses?
7. Have you come to the point of hiding money needed for living expenses, knowing that you and the rest of the family may go without food and clothing if you do not?
8. Do you search the gambler’s clothing or go through his wallet or her purse when the opportunity presents itself, or otherwise check on the person’s activities?
9. Does the gambler hide money?
10. Does the gambler sometimes lie compulsively, avoid any discussion of debts, or refuse to face realities of the situation?
11. Does the gambler use guilt induction as a method of shifting responsibility for the gambling upon you?
12. Do you attempt to anticipate the gambler’s moods, or try to control the person’s life?
13. Do you feel that your life together is a nightmare?

The simple and straightforward approach to letting someone know you are concerned is most often helpful. Yet, it can sound easier to do than it really is. Not everyone will be thankful that someone cares enough to share his concern. None of us can control what a person says or does in reaction to what we say. But we can control what we say, how we say it and where and when we talk to a person we are concerned about. While there is no foolproof way to share a concern with another person, the following process has worked well for many people.

Read through these ideas recommended by Gamblers Anonymous and try them out the next time you want to tell a friend that you are concerned about something he is doing.

Do’s and Dont’s for Loved Ones of Gamblers

Do:

• Utilize the support of others with similar problems.

• Explain compulsive gambling to the children.
• Recognize your spouse’s good qualities.
• Remain calm when speaking to your spouse about his behavior and its consequences.
• Let your spouse know that you are seeking help for your own sake because of the gambling’s effect on you.
• Understand the need for Gamblers Anonymous and other treatment for compulsive gambling despite the time away from home it involves.
• Ask for control of family finances.

Don’t:

• Nag, preach or lecture.

• Create the impression that you are somehow a better person than the gambler.
• Make threats or ultimatums unless you intend to carry them out.
• Participate in gambling activities with the gambler.
• Exclude the gambler from family life and activities.
• Expect immediate recovery, or that all issues will be resolved with the cessation of gambling.
• Bail out the gambler.
• Cover up or deny the existence of the problem.

Your Teenager

Researchers have found that teenagers experiment earlier and get hooked into gambling much more quickly today. Many young people start gambling before age 11, earlier than they experiment with alcohol or drugs. Some researchers believe that gambling may even be a gateway to other harmful behaviors.

Compulsive gambling has been called the hidden disease because it is not detectable with a blood or breath test. Compulsive gamblers look no different than their peers, and they develop amazing techniques to hide their addiction.

It is thought by some that arcade video game playing in some adolescents may develop into a behavior that resembles a gambling addiction. Parents should be alert that such behavior may become compulsive and appear like gambling or an addiction.

Many compulsive gamblers go through terrifying experiences before they are ready for help. The compulsive gambler needs to be willing to accept the fact that he has lost control over gambling and have a sincere desire to get well.

Be honest with family members. Tell them the truth because secrets will eventually come out. Enlist the support of family, friends and religious groups. Also, stop gambling; recovery from this illness is impossible if you are actively engaged in gambling.

Treatment Options

Initial treatment necessitates the involvement of people with expertise in the treatment of compulsive gambling. Most counselors in this area will certainly recommend involvement with Gamblers Anonymous.

Your doctor will assess the nature of your gambling problem as well as other potential related psychiatric problems such as depression, anxiety, substance abuse or other addictive disorders, or attention-deficit/hyperactivity disorder, which may affect your efforts at recovery. He may prescribe medications to treat these disorders in addition to addressing your gambling problem.

Treatment in a Clinical Dependency Center

Gambling is part of the addictive illness spectrum and, just as we evaluate and treat alcoholics for their cigarette smoking and eating disorders, we should evaluate them for gambling. Due to the high rates of dual addictions, the following is recommended:

• All patients should be screened for gambling problems.

• Assess risk in substance-dependent patients who are not compulsive gamblers (more in patients with a family history of gambling problems, patients with intense interest in sports and betting lines).
• Treat both disorders simultaneously.
• Educate all patients regarding gambling addiction and switching addiction.
• Do not allow gambling in treatment centers.

Patients treated for opiate dependence with methadone may be at special risk for gambling. Recent survey data has shown that pathological gamblers taking methadone are most likely to use heroin and alcohol are the substances just prior to or while gambling. Marijuana and cocaine were the substances next most likely to be used when gambling. Methadone programs that aim to prevent all illicit drug use have reported gambling associated with relapse.

• increasing the frequency and the amount of money gambled

• spending the majority of free time thinking about gambling
• spending an excessive amount of time gambling at the expense of personal or family time
• being preoccupied with gambling or with obtaining money with which to gamble
• feeling a sense of euphoria, an aroused sense of action or a high from gambling
• continuing to gamble despite negative consequences such as large losses, or work or family problems caused by gambling
• gambling as a means to cope with uncomfortable feelings
• “chasing” or the urgent need to keep gambling, often with larger bets or the taking of greater risks in order to make up for a loss or series of losses
• borrowing money to gamble, taking out secret loans or maximizing credit cards
• bragging about wins but not talking about losses
• frequent mood swings—higher when winning, lower when losing
• gambling for longer periods of time with more money than originally planned
• lying or secretive behavior to cover up extent of gambling

Normal Gambling vs. Pathological or Compulsive Gambling

Gambling is defined as any betting or wagering for self or others, whether for money or not, no matter how slight or insignificant, where the outcome is uncertain or depends upon chance or “skill.” Gambling is classified into four types: social, professional, problem and pathological.

Social gambling typically occurs with friends or coworkers. The gambling lasts for a limited period of time and the losses are predetermined and reasonable. In professional gambling, the risks are limited and discipline is exercised.

Problem gambling is marked by:

• preoccupation
• narrowing of interests
• continued behavior despite adverse consequences
• failed attempts to cut down

Pathological gamblers:

• have distortions of thinking such as denial, superstitions, overconfidence or a sense of power and control

• believe that money is the cause of and the solution to all of their problems
• tend to be highly competitive, energetic, restless and easily bored
• tend to be generous to the point of mania or extravagance
• often are workaholics or binge workers who wait until the last moment before working hard

Is buying lottery tickets or participating in a sports pool considered gambling?

Yes. Gambling is defined as any betting or wagering for self or others, whether for money or not, no matter how slight or insignificant, where the outcome is uncertain or depends upon chance or skill.

Can a compulsive gambler ever gamble normally again?

No. The first bet to a problem gambler is like the first drink to an alcoholic. Sooner or later, she will gamble out of control again. Compulsive gambling, like any other addiction, is marked by numerous failed attempts to engage in behavior in a controlled manner.

Is gambling addictive? How is it related to other addictions?

Yes, gambling can be addictive. Like drinking alcohol, gambling can be a social activity for many, but some people cross the line, never to return again. An estimated five percent of the population are compulsive gamblers. Most experts agree that somewhere between 10 to 15 percent of the people in treatment for substance addictions are also compulsive or pathological gamblers. Also, experts report that anywhere from 47 to 52 percent of the people who are pathological gamblers also have alcohol- and substance-related disorders.

Like alcohol and drug addictions, compulsive gamblers also report a withdrawal syndrome consisting of the following symptoms: restlessness, irritability, insomnia, anorexia, and numerous somatic complaints such as headaches and gastrointestinal upset. In addition, depression symptoms have also been reported upon stopping gambling.

Compulsive gambling is considered a form of addiction. The term addiction is usually reserved to explain a compulsive attraction or pathological attachment to a substance, normally a drug. However, we now recognize that some behaviors can be addicting, such as eating, sex and gambling. All addiction is characterized by loss of control, preoccupation, compulsivity, narrowing of interests, dishonesty, guilt and chronic relapse.

Addictions to behavioral processes are called process addictions. The process of engaging in these behaviors leads to typical addiction symptoms (withdrawal, tolerance, heightened excitement or euphoria).

Process addictions are more common among children of alcoholics or addicts, recovering alcoholics or addicts, or current alcoholics or addicts. Like other addictions, in many cases there are no correlations with high-risk situations or history—it just happens.

When people describe their subjective experience related to gambling or other process addictions, their stories are qualitatively similar to users’ descriptions of their drug addictions. Compulsive gamblers indicate that they seek being in action, referring to the “high” or euphoric state associated with the act of gambling. Gamblers also describe the anticipated high or “rush” prior to being in action.

The description of these aroused states is remarkably similar to that described by cocaine addicts. A study involving 298 cocaine abusers found that a diagnosis of compulsive gambling could be made in 15 percent of the population—19 percent of the males and 5 percent of the females. This is about five to seven times the rate expected in the general population.

Course of Gambling Addiction

The course of the gambling and process addictions is remarkably similar to that of drug addiction or alcoholism. Some divide pathological gambling into four phases: winning, losing, desperation and helplessness.

The early or winning phase is similar to the learning phase of a substance addict where the high is fun and the consequences minimal or nonexistent. As the disease progresses, there is a marked narrowing of interests as the gambler becomes preoccupied with gambling and obtaining money to gamble.

Home life and interpersonal relationships are affected as the gambler lies and covers up losses and is careless about the welfare of his family. Interests narrow to gambling and planning to gamble. There are often “bailouts,” where the family members lend the gambler money to pay off debts. This is akin to enabling behavior seen in families of alcoholics and addicts. Finally, as the gambler becomes alienated from family and friends, helplessness, demoralization, divorce, suicidal thoughts and other catastrophic consequences occur as the gambler hits bottom.

Phases of Compulsive Gambling

Compulsive gamblers go through the following four phases:

Phase 1: Winning phase

• more common in “action seekers” (usually men) than escape gamblers (usually women)
• initially occasional gambling followed by more frequent gambling
• big win
• increasing bet amount
• unreasonable optimism—feeling of omnipotence
• big shot—brags about winning while minimizing losses
• lasts months to years

Phase 2: Losing phase (“the chase”)

• often begins with unpredictable losing streak
• can’t stop gambling (“chasing”)
• borrows money (bailouts)
• covering-up, lying
• home and work life affected
• spouse, even if aware of gambling, usually unaware of extent of debt incurred
• personality changes—irritable, restless and withdrawn

Phase 3: Desperation phase

• often begins with gambling away funds from a bailout that were supposed to pay debts
• options decrease
• illegal or immoral acts (e.g., fraud, embezzlement, writing bad checks)
• reputation affected
• alienation from family and friends
• most common time for seeking help — “hitting bottom”

Phase 4: Helplessness

• suicide thoughts and attempts (15 to 25 percent prevalence rate of suicide)
• major depression
• co-morbid substance abuse
• divorce
• emotional breakdown
• arrests