Chapter Five

A Trip to Beautiful Lake Tahoe

I hadn't thought of Reno, Nevada, as being all that exotic, but I was looking forward to my first visit, even if it was primarily a working trip to a conference on gambling and commercial gaming. The meetings would be at South Lake Tahoe, some 40 miles west of Reno. As I recall, the year was 1980.

“Lucky Taber,” one of my psychologist friends had said the day before. “Wish I could go to all those exotic resorts where you gambling types hold your meetings. Don't lose your shirt, and don't forget to come back.” Getting away for a week should be a good break in the routine, but in spite of all my travels, I had never taken a real vacation with my family. I was always off alone at professional meetings, assignments in court, or helping to give workshops. People who don't do this sort of thing think it’s exciting. I consider it work.

Most of us around the country who specialized in working with problem gamblers would be there; it would be a chance to learn from each other, network together, and find out what was going on in the gaming industry. Experiencing first hand a casino gambling environment in the American West was high on my agenda.

I had been to the casinos in Atlantic City; a few opulent pleasure palaces surrounded by dismal, poverty-stricken ghettos. Since the New Jersey state government has taken the mob's place in systematically skimming the cream of the gambling take, very little money trickles back to my old hometown; I spent the first six years of my life in Atlantic City. By 1978, it was a depressing, squalid mockery of the once proud resort town where I spent my early childhood in the 1930s.

“Have a good time, Honey,” my wife said as we kissed goodbye.

Good time? The trip would be fun in ways most people would not appreciate. I would be working 12-hour days trying to learn everything, and loving it, and no one was ready to believe it was really work. Love what you do and do what you love. I’m not complaining.

At the terminal I got on the shuttle bus. “Where are you off to today, sir?” asked the driver.

“Reno,” I said, realizing too late I should have said Columbus or Chicago.

“Hey, lucky guy! The wife and I love Vegas. I wish you all the luck in the world. Have a blast.” He proceeded to tell me about his most recent Las Vegas trip during which, he claimed, he had won enough to pay his expenses for the trip —if only his wife hadn't gone crazy at the slots.

I really didn't want to hear this, but since so many people seemed to want me to have a good time I resolved to be a bit of a tourist and see some of the scenery.

When I sat down in my seat on the airplane, I had every intention of going over the draft of my paper, to review the highlights that I would have to cram into my twelve minutes at the microphone. But it was still only 7:30 a.m. I was just waking up.

From my aisle seat I could see a mother and her two daughters seated across from me, dressed as if for church. Suddenly the older daughter, about 14, lively and smiling, with chestnut hair and a hint of makeup, reminded me of someone.

It came back suddenly: Janie! I'd met Janie and her parents in my small private practice, where I sometimes saw people with gambling problems who did not qualify for treatment at the Veterans Administration. I got many calls from non-veteran gamblers because, at that time, I was the only professional between western New York State and Chicago with a reputation for working with gambling problems. Gamblers Anonymous was the only other resource available. Some of the toughest cases came to by way of GA referrals. Reluctantly I would agree to see certain cases, and then only on a short-term basis. Janie had been one of my after-hours cases.

As we lifted off through the gray morning clouds into the bright sunlight, I felt again the sadness of Janie's case.

Kids are not supposed to gamble, at least not to the point of financial ruin. Tradition says that kids can play marbles, and boys are expected to flip baseball cards, and maybe bet a quarter or two on a school game. But, little girls? No problems with gambling among upper class white girls, right?

That sounded like an easy bet, until Janie turned up.

Early research suggested that gambling affected more Jews and Catholics than Protestants. Other data suggested that it affected more Italians than Scandinavians. Not too long ago one seldom saw teenage or black problem gamblers, and we had no idea how many female gamblers there might be. In time, however, all my stereotypes of gamblers were systematically shot down as serious problems started cropping up in one group after another.

On the surface, gamblers are a diverse lot, but the common elements always emerge: intense fascination with gambling, loss of control, ever-bigger bets, family problems, chronic money problems. In every case, there is some amount of denial, along with rationalization, and even delusional thinking. And always there is the unspoken pain, desperation, and disability. Many of these signs can be invisible for a very long time to the untrained eye.

Janie was not complaining, however. At least not about gambling. She was just 15 when her baffled parents brought her to my office. The child was a thin, attractive girl who obviously resented her parents' efforts at control; she did not see herself as having psychological problems; she let me know right away she was not prepared to share her thoughts and feelings. Actually, she seemed to be laughing her way through each counseling session, laughing through her clear brown eyes and with her sly, evasive comments. She preferred to be silent, looking pale, nervous, and anxious when she was not in control of things. Janie seemed to be close to no one, happy to be that way and not at all motivated to change.

She was willing to talk about coins. Her eyes lit up when I asked some technical questions, and I allowed her to control our early sessions in hopes of gaining her trust. Unfortunately, she stopped coming for our sessions, but I was able to see the mother from time to time, and she kept my informed of Janie’s behaviors.

Janie had a genius-like ability to make money buying and selling rare coins. It had started with a nickel collection her father gave her as a Christmas present when she was eight, a collection passed down from her grandmother, who had once managed a pavilion of entertainment machines in an old amusement park.

At first, Janie was happy just to expand the nickel collection; she could get interesting old nickels that were worth 10 to 20 times face value. Her hobby was educational, cheap, and fun.

Janie quickly discovered she could get the best of any coin trading she did with other young collectors at school. She was a quick learner and easily memorized price tables for different types and years of coins. Most of the collectors her age were boys who discounted her ability because she was a girl. She quickly learned to use her innocence to exploit the egotism and greed of these boys. She soon knew every coin in her friends' collections, knew what each was looking for, and learned to be a shrewd buyer at local auctions.

Janie persuaded younger neighborhood boys who collected money on newspaper routes to allow her to sort through their change each week. Then she learned that she could earn a side profit by lending them small amounts of money at interest, against their future collections. A loan shark at twelve!

She would sell coins to her friends on credit if they wanted an item badly enough, and again she calculated interest payments into the terms of the sale.

For quite a while, everything Janie earned went into buying new coins for the collection. She bought quality items from coin shops and advanced collectors. The collection expanded from nickels to general American coinage and then to certain coins of other nationalities.

Not yet in high school, Janie began publishing her own little coin newsletter and selling it to a growing circle of local collectors. Her personal collection, gathered at relatively low cost through hard work and clever dealing, was soon worth thousands of dollars, and she was renting a large strongbox at the bank to protect her hoard.

She kept the old cigar box at home, however, and most of her original nickels were still there. The box had an honored place on her dresser.

Janie became a trusted investment vehicle for friends who were hungry to profit from her numismatic genius. A number of her young friends, and quite a few adults, impressed with the dramatic growth in the value of Janie's collection, offered to buy shares in the collection. Or perhaps it was Janie herself who came up with the idea of selling shares. She had become a clever salesperson as well as a shrewd buyer. She began to take in more cash by selling shares, and she set up books to keep detailed records. The income, at first, went to buy more coins as she plowed value back into the expanding enterprise. Many fine gold pieces entered her strongbox at the bank. Everything was in place for an outstanding career as a leading coin expert and dealer.

There lurked in Janie's character, unfortunately, some disturbing qualities, both valuable and dangerous. She was charming and perceptive, but distant. She could travel along beside you, but never really be with you. The more she achieved, the more her success fed ambition. She earned outstanding grades with no real effort. Janie was very, very sure of herself.

Early in high school, however, she began to feel the pressures of her growing business. Most of us are well into our 20s or 30s before we experience the responsibilities of a career, but Janie hadn't yet had her first date. She was beginning to resent the expectation for ever-increasing success that her fans and investors were placing on her; and she was finding that her college preparation courses now required real effort. Then, as happens in even the most successful business, Janie made a few commitments and trades resulting in losses. No market, including that for rare coins, only goes straight up.

This was a shock to her ego. And so, when an older friend invited Janie to skip school for a visit a local racetrack, she decided she had earned a vacation and quickly agreed. She was amazed at the enormous psychological relief she got from the cheering, excited crowd. It was at this point that she thought she had discovered a new way to make money.

Never mind that it is illegal for an unaccompanied minor to enter a racetrack and gamble; it happens all the time. It was Janie's first truancy from school and, as luck would have it, she came home a $500 winner. She did not tell her parents. She had started out at the track with bets of a size that might scare an old-timer, but she was used to dealing in large amounts of money and had quite naturally figured out many of the important things handicappers look at in picking horses. What she did not realize was that, in the end, the odds at the track make it impossible for anyone to be a consistent winner, day in and day out. Excitement allowed her to forget the omnipotent power of the ubiquitous track percentage, known as the handle,’ the sizable slice taken out of the gross amount bet on each race.

Tracks take 14 to 18 percent of every dollar bet, to pay expenses and make a profit, and that inevitably grinds away at the gambler's poke, race after race.

When you buy something in a store and pay a state sales tax, they add that percentage on top of your total so you know exactly how much tax you pay. At the track, however, the tax is hidden and not shown separately. When you bet $100 you are really only betting $84 or so.

On top of that, there are other expenses: admission, transportation, tout sheets that handicappers need, even lunch. True, you might make some money on an occasional win, but could you convince anyone that this is some kind of business? It's actually very expensive entertainment!

What a deal, Janie thought. All this fun, and it's an easy way to get some really big money. She was hooked on the excitement of track gambling from the first day. It became the ideal escape from the demanding reality of the precocious pressure-cooker her life was becoming.

In trading coins, she had used her skill to earn legitimate profits, by taking the responsibilities and normal risks that go with owning something of value. Thanks to her experience, the chances of turning a profit with coins were very much greater than the chances of taking a loss. In betting horses—although in her mind it was just another business—she was throwing her abilities up against the house cut. She took ownership of nothing but a ticket that was nothing more than the right to collect on a particular bet. In technical terms, a single bet is a wasting asset, one that has a very short duration before losing its value.

Most deadly of all, Janie failed to understand that she was now doing something to fill emotional needs rather than to satisfy rational business plans. Caught up in the excitement, she was not in touch with her feelings. Janie was still very much a child. Her driving intellect, sense of personal involvement, and need for social approval blinded her to moods and emotional needs. Success had taken her childhood from her.

Within sixteen months, Janie—after a few more early wins at the track—had lost all her savings. She began selling her coin collection bit by bit, feeling that the reversals were only temporary. It wasn't easy to hide these activities from the family; she had to spread her sales out over a wide area and many buyers. But the biggest dilemma was created because she had gone on selling more shares in a rapidly vanishing coin collection, and lied to everyone by keeping false records that showed a collection growing in size and value.

Then one day Janie learned that one of her investors had suffered serious medical expenses. The elderly lady had to ask Janie to redeem some shares. Almost at the same time, another friend had to leave town when her family moved, and Janie was supposedly holding $1,500 in gold coins for her friend and her parents.

However, there were no coins! The money had gone to the ponies.

Janie's house of cards collapsed completely in the next few weeks as her stunned parents found themselves faced with over $20,000 in immediate liabilities.

Janie was still a minor child, so the parents, accepting personal responsibility for their child's actions, used their savings. They took out a second mortgage on the house so that they could bail out their daughter.

Janie's parents followed the advice of an attorney who had never heard of pathological gambling. Like everybody else, the lawyer saw the situation as a financial rather than psychological problem. The possibility that this young woman might have a serious psychological problem apparently occurred to no one. Or if it did, society's rules against hurting people's feelings prevented anyone from discussing the real issue. Janie would not accept the idea of personal weakness herself; she immediately got busy trying to solve the problem in her own way. As was now her habit, she shared her plans with no one.

Convinced that they had bought a solution to the problem, the parents began to relax. They looked forward to a resumption of Janie's superior performance and were sure she had learned her lesson. Above all, they wanted her to feel loved.

“Even the best of us make mistakes, and no child ever grew up without getting into some kind of trouble,” they said. This was the message they gave the creditors as they soothed the anger with their own money. Dad began to work overtime, and Mom took a job to help pay for their short-term, expensive solution.

Only a few weeks after things had calmed down they got a call from one of Janie's former investors, who asked why Janie was again soliciting investments in a new and foolproof plan to buy small gold bars. Confronting their daughter, they learned that she was still going to the track and now had new debts of several thousand dollars. They learned, incidentally, that she had given a $350 purebred cat to a girlfriend, and that she was paying huge cab fares for herself and her friends. Getting to the track by bus was just too slow. Such acts seemed totally out of keeping with Janie's past behavior.

This time they ignored Janie's renewed promises to stop the lying and gambling. They made an appointment with a psychologist, and that's when I met her.

Janie's attitude was one of angry frustration. She just knew this was all a mistake, the result of unusually bad luck, and of her parents' failure to understand her. (Whenever a gambler gets angry and tells you that you don't understand him or her, you can usually be sure that you do.)

As is so common with addicted gamblers, Janie saw others as having the problem. The parents had withdrawn their confidence, she felt, and in a curious twist of reality, she thought that their lack of confidence contributed to her bad luck. She saw them as betraying and humiliating her. They didn't love her, she thought. She certainly didn't want to go to a shrink or attend Gamblers Anonymous meetings with all those burned out dice-heads, as she called them. All she wanted was to be trusted again.

What could the parents do? What were the options? What approach could the counselor take in treating a reluctant patient who was still in love with the cause of her problems? Very little, as it turns out.

At the first counseling session, a confusion of ideas rushed from the parents' mouths. Should Janie go to a private school, or to juvenile detention to teach her a real lesson? Or perhaps she needed to go to a mental hospital? Could medication or shock therapy help?

Over several sessions, I did some psychological tests, knowing that Janie was not taking them too seriously. No power on earth can force a person to benefit from psychotherapy; there is no magic in testing or counseling. Those who are happy the way they are don't tend to change much.

Once we had covered her knowledge of coin collecting, we came to a dead end. After several more sessions, in which Janie offered little more than evasion and angry silence, I had to give up and tell the parents that Janie was not ready for traditional psychotherapy. Her mind was still set on gambling her way back to the top. I did my best to explain a tough love philosophy, but at that time there were no tough love support groups available.

Tough love is a complex and sometimes heart-rending approach to behavior management that would require the parents to revise their entire child-raising philosophy with no guarantee of success. I ended the sessions with an open invitation to Janie to return when and if she wanted to work on her problems. To the parents I gave all the reading materials I could find on effective parenting, along with some referrals to social workers familiar with juvenile corrections. Again, I urged her to keep trying Gambles Anonymous. However, the parents themselves still did not attend Gam-Anon.

Janie had accomplished so much before things went sour. She was a brilliant girl. She was frustrating to her confused parents.

As Janie's behavior shows, however, pathological gambling can sneak up on us, wearing the guise of excellence. In many ways, it is a disease of strength rather than weakness. More often than not, the things we worry about most when we see them in young people are actually harmless and self-limiting fads, while the real problems creep up unnoticed. When we look back at the things Janie was doing, we get no warning of what was to come until it was much too late to prevent the disorder from developing; in fact, we are lulled into a false security by her apparent excellence. Had the people around Janie looked beyond the superficial material success and seen the preoccupation, greed, and frantic quality of her actions, then perhaps an early psychological evaluation might have seemed natural and proper.

I saw Janie’s parents from time to time, and got reports through secondary sources.

In her junior year of high school, Janie took to stealing. She stole from stores, friends, her school, and the family. The racetracks kept taking her money. She had endless excuses to get away on weekends or get to the trotters in the evening for a few races. She was arrested, finally, and taken to juvenile detention pending evaluation as a minor. Things looked very bleak. Eventually the judge sentenced Janie to two years in the custody of the Youth Authority. Janie would attend a special school and remain locked up until she had completed a minimum sentence, at which time the judge would review her progress.

In the eyes of the law, she was a juvenile offender, not someone with a mental disorder.

Eventually I presented Janie's case at a hospital staff conference. Other professionals in the room, after hearing the case, thought Janie surely had an antisocial personality disorder. Such a diagnosis would, at that time, make a diagnosis of pathological gambling impossible. I had weighed all of my evidence—my tests, observations and life history data—and had concluded that Janie did not fit the criteria for antisocial personality disorder, but there is always difference of opinion when differential diagnosis is the topic.

In one last and fatal kindness by the judge,  he released Janie to her parents for a short visit home once he had set a date for her to begin confinement. On the morning she was to report to the juvenile authorities she came downstairs holding a familiar wooden box. It was grandmother's nickel collection. Why, of all the valuable things that had passed through her hands, did she save this special collection? It would be nice to think that sentiment for her grandmother and respect for her father's gift led her to regard this collection as something very special. A real con artist, on the other hand, would have seen it as the hook. Janie knew that her father had consented to her imprisonment. There were things he could have done, lawyers who could have changed things, if only Dad had really wanted her to stay out of the Youth Authority.

“Here, Dad. Keep this for me. I love you,” said Janie. She managed just one tear in her eye at just the right moment as she gazed up at her astonished father. Then she was out the door and into the big white County Youth Authority car.

The next morning Janie's mother found her husband sitting in his car. The garage door was shut and the engine had been running for some time. Next to him on the front seat was a box full of old nickels.

I awoke from my reverie as the plane’s intercom announced, “Ladies and gentlemen, the captain has begun our final descent into the Chicago area.”

I left the plane and entered the terminal where I discovered the flight to Reno was delayed. To pass the time, I bought a Wall Street Journal but found it difficult to concentrate as smoke drifted past my chair in the waiting area. Smoking had not yet been banned from most public places in those days.

I had given up puffing cigarettes and my beloved cigars in 1970. After several years, tobacco smoke became an irritant to me. The Surgeon General declared cigarette smoking hazardous to health back about 1964. Sadly, as tobacco addiction is slowly and painfully driven from our culture, others addictions seem to take its place. Enter gambling, the new hero. It doesn't cause cancer and it doesn't smell. Fun and games for everyone, without guilt or pain!

A tall porter came past, smiling and nodding to everyone as he emptied trash and cleaned up ashtrays—a cheerful, happy man doing a job few would envy. I smiled in return.

Years before I had visited the first casino to open in Atlantic City. I stood with a roll of nickels, pretending to play a slot machine while studying my fellow players, all of whom were intensely focused on their own machines. During two hours on the floor of Resorts International, only one person ever made eye contact with me, and she even offered a cheery smile. That was a black woman whose job was to patrol the slot area picking up empty glasses and sweeping around the machines. She was the only person in that place who seemed to be alive. Suddenly, in that casino, I realized I was in the midst of hundreds of people who existed in a temporarily altered state of consciousness. I was actually seeing firsthand people intoxicated with gambling!

Ignoring my Journal, my thoughts drifted back to a patient named Willie. Janie's gambling career was like a meteor streak in the night sky compared to the long, slow agony that engrossed Willie, 48, a janitor and odd job handyman who came in for treatment when his alcoholism and physical ailments drove him into our hospital's medical unit. He was a large, tough black man with a striking nap of white hair. When I shook his hand, it felt like tree bark, hardened by a lifetime of hard labor. Subtle signs of alcohol deterioration were apparent in his lined face, pockmarked nose, and the slightly yellowed whites of his eyes.

A friendly nurse on the medical unit, who knew about the gambling treatment program, helped arrange a transfer to my program for Willie; he, in turn, was happy to stay on in the hospital because life in his ghetto was something he did not mind escaping for a while.

Willie's nurse had asked him a very shrewd question. She asked about his pattern of drinking and gambling. The drinking typically followed major gambling losses, and once the drinking began, Willie seemed powerless to stop it. He would get himself admitted to a short-term alcohol detoxification program or get arrested, and then he would get sober until the next gambling episode. Gambling always came first, then the drinking. Clearly, Willie was both an alcoholic and a pathological gambler, as well as a heavy smoker. What should we treat him for, and in what order?

The nurse knew I would try to address all of Willie's problems, not just the ones my professional assignment to the gambling program encouraged me to work on.

It was hard to tell when the gambling problem first started. Willie was severely abused as a child by his stepfather, an alcoholic sharecropper. His mother was the strong family anchor; her devotion to religion and to her nine children was as beautiful as the stepfather's dedication to drinking was ugly. Willie ran away for good when he was 12 and learned to drink and gamble on the road, but he always earned a living. Over the years, he had been a truck driver, coal miner, army sergeant, and finally a cleanup man in an apartment complex. The gambling and drinking had been under control for most of his life, or perhaps it was just the vigor of youth that tolerated his lifestyle.

Willie married and had three children somewhere along the path, but he had never supported his family. He always wanted to do that and always felt sure that someday things would be better. Someday the gas bill would be paid, and there would be a house of their own with plenty of food on the table. As the ghetto poor have always done, Willie yearned after the good life he saw on television and in the movies. The lottery became his dream ticket to this faraway world. Why not? He had never really known anyone who had succeeded through work, and he lacked a lot of the basic social skills and attitudes many take for granted.

As Willie grew older, his drinking, poor diet, and hard labor at temporary jobs in all kinds of weather lowered his resistance. Eventually, instead of just spending a few dollars on lottery tickets, Willie spent every cent he could earn.

Willie's dreams were fed by a trickle of small wins, $10 or $20 every month or so. Like most lottery players, if he bet a number such as 5-12-17-22-31, and 5-12-17-21-32 came up, he felt as if he had won something big, although in reality a near miss was as good as a mile. Once he was actually a $500 winner, and in celebration, he brought some gifts for his children to the apartment of his estranged wife. They argued, the wife smashed the gifts, and Willie went out and got drunk. He lost the rest of the money in a dice game in a vacant garage.

Willie was the first gambler, but certainly not the last, to tell me about the swami racket. Racket is my word, not Willie's; he still firmly believes that certain special people have the gift of foretelling winning numbers. Again, if the swami says bet 618 and 628 comes up, it only proves that the swami can predict two out of three numbers, and that eventually cash will rain from heaven if you are faithful and follow the system. Such near misses had convinced Willie that a good swami had incredible power and could look into the future with nearly 20/20 vision.

In his slow, slightly confused way, Willie told our therapy group how certain men and women move around from city to city, staying for just a weekend in a motel near the poor area of town. The coming of the swami is announced around the neighborhood by a confederate, who sells you a private audience with the swami for whatever price he can get— $5, $10, or $20—depending on the buyer's faith and history of success with fortune tellers. These victims are buying the number.

When they meet the swami in a motel room, they are treated to a bit of mumbo jumbo and often a disdainful lecture about being too greedy and not paying enough attention to spiritual matters. The swami may berate the victim, saying he or she is too dumb to handle all the money to be won. Other swamis try to be mystic, enigmatic, and distant. Some female swamis play the stern grandmother role and dispense advice as if they had suddenly adopted the victim as a long-lost grandchild. In addition to the number, they sell the feeling of being loved by an important person. In the end, the victim is told by the swami to play a certain number or set of numbers on such and such a day, as determined by stars, dreams, crystal balls, or even chicken livers. The day of the play, not surprisingly, is always at least a day or two after the swami has moved on to a new town.

During his month-long stay with us on the gambling treatment unit, Willie was a good patient. But he felt very uncomfortable in group therapy where other group members—all of them white — included a stockbroker, a wheat farmer, a southern poker machine player, and a gay artist from California. Willie’s lack of education and his rambling speech—a mix of ghetto slang imposed on an old southern drawl—separated him from what should have been a close fraternity, but one that was, unfortunately, already showing signs of racial discrimination.

Rather than examine his own psychological problems and plan for a different kind of life, Willie talked a lot about his various systems of lottery play: dream books, numbers taken from dollar bills, and, of course, his revered swamis. Our stockbroker finally turned to Willie in anger one day and demanded, “If that swami is so damn good at picking numbers, why doesn't he give up swamiing and play the numbers himself?”

I controlled my laughter as well as I could, remembering that the stockbroker himself had just told us the day before that he always read the opinions of certain Wall Street advisors before investing in wildly speculative, and generally losing, investments. We all have our swamis in life, I suppose.

Willie took up the challenge. The answer, to him, was obvious. The swami was a spiritual person on a spiritual mission, bringing hope to the poor. Such a person could have no interest in material things like stocks and bonds.

Willie was terminally in love with a dream. He knew that the dream would never come true, and that the swami was a crook; he even laughed about it sometimes. But he chose to believe. It was the quest for the dream—the hunt, if you will—that gave meaning to his life. To abandon the quest would be to abandon his very identity as well as his hope. Nothing made him feel as good as getting his tickets lined up and then waiting out the draw of the lottery.

Willie went to his first Alcoholics Anonymous meetings while in treatment for gambling, and to his credit he accepted AA, and stayed sober. However, at his first AA meeting in the community, just after his discharge from our program, he was handed a raffle ticket as he entered the room. The ticket was a chance to win what AA members call The Big Book, the revered volume titled Alcoholics Anonymous. It was written by Bill Wilson, one of the co-founders of AA, and includes the personal experiences of the first 100 recoveries. At the end of the meeting, the chairman called out the number n Willie’s raffle ticket, and he knew he had found a home in Alcoholics Anonymous.

Willie did not attend Gamblers Anonymous after he left our program, probably because he felt too different from the other members. Some day, I hope, there will be other Willies in GA who, in turn, will help hold other minority group members. But for Willie, there was no message of hope in GA equal to that of the swami. To his credit, we have seen as much personal growth in him as in any other patient. Although he still plays his beloved lottery, and it is still destroying any chance he might have at a more normal life, he does it now without the help of alcohol. He is working, he sees his grown children frequently, and he is devoted to the AA fellowship. Overall, the outcome of treatment was positive.

If I were a perfectionist, I wouldn't last long in the therapy business. Willie will stop gambling someday, one way or the other.

Back in the airport terminal, the boarding announcement snapped me out of my remembrance of Willie. Walking onto the aircraft, I realized that I was a little too preoccupied with gambling. Why was I wool=gathering about past cases instead of enjoying the trip? I didn't want to be fanatic about my gambling work. There is too much else in life to appreciate, even if you happen to have an interesting and rewarding career; psychology is far too compelling and varied to confine one's interest to only one disorder like problem gambling.

As I settled in for the four-hour flight, I did a little self-examination and quickly came up with the answer. The World Health Organization had recently accepted pathological gambling as a formal mental health diagnosis, and the American Psychiatric Association was about to do the same. This was very good news, but I also saw it as a mixed blessing. Up to this point there had been some doubt about the reality of the disorder; the endorsement and recognition by prestigious professional organizations would make our work much easier. The courts would now accept pathological gambling as a real mental disorder that could affect human behavior, and hospital administrators could no longer accuse us of making up imaginary illnesses. Gambling thus could be seen as a recognizable disorder, not simply a bad habit, a willful indulgence, or an antisocial behavior.

The rules for diagnosing or recognizing pathological gambling, however, troubled me a great deal. The disorder was to be diagnosed by its effects on behavior, by its symptoms. A pathological gambler was someone preoccupied by gambling, a person for whom gambling leads to financial problems, family disruption and, quite likely, illegal behavior. For the pathological gambler, bigger and bigger bets are required to produce the same elevated mood. No one knew what really caused pathological gambling, so we could not use causes to diagnosis the disorder as you might in, say, a physical illness caused by a virus or a traumatic blow.

If you pluck a blade of grass, you can learn a great deal about grass by microscopic examination and chemical analysis. However, you would not really understand grass. You would know nothing of its root structure, how it reproduced, the effects on it of water and soil, or how long it took to grow to maturity. You would not really know the causes of grass in the first place. So if you just look at gambling behavior you will neither understand gamblers, nor why some develop problems while others do not. More important, you will not know what is actually needed in terms of treatment. Real treatment is different from symptom control.

Recognition of pathological gambling as a mental disorder was a great victory for which the leaders in the field had wanted for a long time, but now came the responsibility of filling in the details that would give the diagnosis value. Now, many people were hoping that the treatment of pathological gambling in private practice would be reimbursed by health insurance. Up to this point, most gamblers who got private treatment had to be diagnosed as having depression; this impression is not inaccurate, but was only a way of getting around the requirements of the insurance companies.

I decided that was why I was remembering some of my worst cases: I was trying to see pathological gambling in the total context of human life, not just as a set of behaviors or symptoms. Someday we will be better able to explain how the disorder develops, but for the moment I resolved to put the ghosts of cases past out of mind, and relax.

Here was my unread Wall Street Journal, so I started in on the lead article as our plane navigated O'Hare's complex runway system. The article was about stockbrokers who churn their customers' accounts just to get commissions.

When you want to invest in stocks or bonds, you can make all your trading decisions by yourself without the help of a broker, or you can just deposit your life's saving and let a broker make all the buy-and-sell decisions for you. A middle path is to listen to a broker’s expert advice, study the markets, and then make your own selections. Many, many people who invest let the broker make all the decisions, because they cannot or will not take the time to study. They open what is called a managed account, and sign a power-of-attorney to allow the broker to manage their portfolio.

The broker makes his money on commissions, fees charged to the customer for every buy and sell order executed on the floor of the stock exchanges. The more trades, the more the broker and his company make. Although it has been demonstrated that buying and holding good securities over time works best for most of us, the broker makes no money if you just sit on your investments. While patience by the investor is critical in long term investing, a few brokers cannot resist the temptation to churn, to keep on rapidly buying and selling in the accounts entrusted to them. This is unethical and illegal, but some brokers do engage in churning; they are either greedy for commissions or enjoy the fast action of trading themselves.

Soon I was looking out the window at the clouds and thinking about Bill. It would be so simple if rational people stayed rational, and pathological gamblers never had any good qualities. But a man like Bill shows how the best and the brightest among us can earn our trust, and then, at some point, lose sight of his original goals when caught up in the psychology of risk-taking.

Bill marched through a fine private military school, earning good conduct medals, scholastic awards, and scholarships. He graduated as the highest officer in his class. With the military band echoing in his ears, he breezed into an eastern Ivy League college and finished an engineering degree in only three years.

Graduate school beckoned, and more scholarships and teaching fellowships were offered. The military draft threatened to catch up with Bill at this point, however, so rather than wait he volunteered and served two years as an Army officer. He left the service on a hardship discharge when his father became seriously ill. His father died after several months, and Bill's mind once again turned to the idea of graduate training. Perhaps a Masters in business administration would be a path to success. But Bill decided that he wanted some experience in the real world of business, so he accepted an engineering position with a major corporation in New York City.

Bill quickly began his march up the corporate ladder, as if he were still responding to the beat of his old school band.

“Young man in a hurry! An up-and-comer! Bound for greatness!” agreed Bill's supervisors. Over lunch in the corporate dining room, Bill, only in his late 20s, impressed the corporation's executives with his ability to learn and retain complex information. With little obvious effort, he soon developed a comprehensive and detailed knowledge of the company's diverse activities.

The corporate comptroller's office finally managed to borrow Bill from product design to oversee the computerization of the corporation's investment portfolio. Major corporations cannot let millions of dollars in surplus capital sit idle, awaiting some eventual use. Even when cash is earmarked for a particular use, it must meanwhile earn interest in a variety of long-term and short-term investments, some of which may have little to do with the company's primary business. Like individuals, corporations invest surplus cash in stocks, bonds, and other financial paper.

Bill designed and supervised the installation of complex computer programs that not only tracked his corporation's stocks, bonds, and money market contracts, but also offered very efficient screening methods for potential new investments. Bill became fascinated by the financial markets, and saw in their ebb and flow a kind of order and beauty, where others saw only chaos. Gradually Bill learned that he had abilities well beyond those ordinarily found in the investment field. He was delighted when he was consistently accurate about future market trends; he enjoyed the awe and respect he saw in the eyes of co-workers when his forecasts bore fruit. Although outwardly humble, he especially enjoyed the feeling of being a special person in a high-risk field.

Soon Bill had opened a stock trading account under his own name at a local brokerage office, using his own money. And when he bought 20,000 shares of a stock for his company, he would also buy 100 or 500 shares for himself. But this kind of trading, in which a high quality, blue chip stock might increase in value 25 percent over a year or two, soon proved too slow for Bill. He wanted that special feeling of victory more and more often; he could hardly wait until he had some really big money in his own trading account. More money meant more profits, he was sure.

Bill next began to speculate in puts and calls, the rights or options to sell (put) or buy (call) certain stocks at fixed prices at some time in the future. This allowed faster action, and let him use just a small amount of his own money—the price of the option—to control a much larger potential outcome. This is called leverage. He could buy options for a few hundred dollars that could double or triple in value when the underlying stock moved up only a few points. The risk of loss was limited to the price of the option. Thus, he was able to generate extremely fast action and huge risks in an otherwise slow game.

Bill had now entered an area of speculation into which he could not take his company's accounts. The corporation did not approve of this kind of risky trading on options. And so it came about that his own interests began to diverge from those of his company, whose equipment and programs he now used to research his own projects.

Bill had freedom to do as he liked because so many people had come to trust and admire him. No one noticed when he spent time using his company's computer to analyze and keep track of his own portfolio. The truth was that Bill could now keep track of the company's ho-hum investments efficiently by using only a small part of each workday. Then he could focus more attention on his so-called experiments, which, he said, were research efforts designed to bolster his already glowing performance for the corporation. Nobody was in a position to question him!

Bill didn't have to sneak away to go to the racetrack. He didn't have to fly to the Atlantic City casinos after work. Pushing a few buttons on his computer keyboard linked him to Wall Street and brought him all the furious action he could possibly handle. Now he was spending all afternoon nearly every day tracking the frequently violent price swings of the stock market. Friends only noticed that Bill was on the phone a lot. His trading at the brokerage house picked up as the markets began a new up-trend, or bull market phase.

The corporation's portfolio was doing very well.

After just a year of managing his company's investments, Bill's immediate superiors were only rubber-stamping his recommendations and had turned their attentions to other matters. Bill seemed solid as a rock; they were taking him for granted.

At this time Bill took and passed the security analyst's examination. He had become friends with a number of people in the brokerage business, and so, realizing that he had actually completed the transition from engineer to securities analyst, he was happy to accept a new and promising offer at a major brokerage office. Now he could spend all his time in the fast-paced world he had come to love.

After a short period of supervised training in company policy and methods, Bill was able to recruit several discretionary trading accounts, funds placed for management at his brokerage house by wealthy individuals and companies. He earned commissions by buying and selling stocks and bonds; when he discovered a promising investment, he called his customers with his suggestions. Usually they followed his advice. Bill also got busy on the telephone and canvassed all his friends, asking them to open trading accounts with him. And his friends suggested their friends. Soon he was handling all the action he could for other people, and had complete freedom to trade in his own account with his own money, at reduced cost. In fact, he could day-trade without commissions; that is, as long as he closed out his positions before the close of the markets he could open a trade in the morning and liquidate his position during that same day—at no cost.

Bill liked his expensive European automobile. He liked living in a plush condominium downtown. He was married to an attractive professional woman. There were no plans for children. He had arrived!

Bill's trading increased in complexity and volume, and as long as the market continued to advance he did quite well. His first scare came when he decided that the markets were topping out and getting ready for a major decline. Now he bought heavily in puts—the right to sell stock at a price fixed in advance—which is an action you take if you think that stock prices are about to fall. Unfortunately, he was slightly premature in his prediction. It is relatively easy to predict long-term trends, but options expire within 30 to 90 days after purchase; then they become worthless. Betting on short-term fluctuations is very tricky, even for the best of forecasters.

Instead of falling, prices gave a final, upward surge, as they often do at market turning points, thereby confounding the experts and their systems. Likewise, bear markets often plunge downward just before turning back up because many investors engage in panic selling at the end of a decline. This sometimes drives the market further down, to irrationally low levels. This is because many of the people buying or selling at the very end of a cycle are always the least well informed, the most emotional, and the slowest to get in or out, as the case may be. Even the market professionals themselves seem to underestimate the foolishness and persistence of those who enter or leave at the end of a cycle just at the wrong time.

So Bill was right, but he was right too soon! This timing error cost him $150,000, nearly all his capital. He had to sell his puts against a rising market. As they say, he took a bath.

Bill recouped nicely when the market indeed did finally plunge. Unlike those who buy and hold stocks, a trader seeks to make money in down markets as well as up markets.

Always a treacherous beast, the stock market now entered a prolonged whipsaw phase, a so-called consolidation period. Individual stocks darted up and down on swings of investor sentiment, and cross currents of short-covering (traders buying stock to replace stock previously borrowed and sold to others). For an options trader, such a choppy market presents plenty of chances for rapid action, for both fast gains or losses. But Bill had begun to get sloppy on his research. He no longer had the large computer of his former corporation or the time required to do extensive research. Curiously, he had also lost that even more vital ingredient: patience. He was trading now for the sake of trading, for the elusive euphoria called action. He had crossed the invisible line into irresistible, uncontrolled pathological gambling.

Precisely where Bill's prudent reasoning failed and his emotional needs took over, no one can say for sure. Pathological gambling is a state of mind and cannot be defined by the games we play. This remains my fundamental quarrel with how we define and diagnose pathological gambling. One man's investment is another man's gamble depending on the underlying motivation, upon whether actions are governed by rational thought or by unrecognized and emotionally driven impulses. For the addicted gambler, money becomes trivial in the pursuit of the next emotional high.

As the financial markets fluctuated randomly, Bill now sometimes found himself a big gainer, sometimes a heavy loser. He had learned how to hold larger positions for himself by using an easy but illegal trick; he allowed some of his clients' funds to pass through his own trading accounts on the way in or out of investments. He began to use their money in some of his discretionary accounts—accounts with other people's money, over which he held power-of-attorney—for his own trading. As usual with problem gamblers, there was no criminal intent in this deceit, at least none that Bill himself would label as criminal. What he did, in fact, was illegal, but he fully intended to replace the money he borrowed from the accounts of others. Somehow, this made it seem okay to Bill. He never thought of it as stealing, and I believe he could have passed a polygraph test if asked such questions.

All this had been going on for a long time before Bill was caught. Even then, amazingly, his discovery was pure accident. Although he was usually on top of such technicalities, one of Bill's clients happened to get a huge computer printout in the mail, a record of trading in stock options. Mystified, the client tried to call Bill but was unable to reach him. Fearing that an error had been made, and not wanting to let anyone be hurt by the error, the client insisted on speaking with the manager. This shrewd and experienced individual, instead of confronting Bill, ordered a watch put on all Bill's accounts.

Protecting the company's good image is the first requirement of a manager when he discovers an irregularity, as they are called. Information about dishonest transactions, allowed to get into the press, can cause huge losses as panicky investors demand that their accounts be closed and their money refunded.

The manager acted quickly to end Bill's trading; he suspended Bill while he placed reassuring calls to puzzled clients. The bookkeepers worked overtime to get things in order. Let's not forget, Bill was a good friend who had earned huge commission dollars for the brokerage. His boss gave him a good letter of reference and sent Bill on his way.

Over the next few years, incredibly, this pattern repeated itself in several more brokerage houses: a good start, heavy-volume trading, discovery of shortages and irregularities, and dismissal with favorable reference letters attesting only Bill's good qualities.

Chronic gambling worked its usual damage in Bill's case. His wife, with her own developing career in mind, refused to move when Bill had to leave New York. “Why,” she asked, “leave the Big Apple when we have everything we need here?” Leaving made no sense to her because, of course, Bill lied to her about why he needed to move. However, she had a strong ego and was able to let go of him and avoid going down with him.

Although he dealt daily in huge amounts of money, Bill's lifestyle deteriorated until he was living in rented rooms, eating at fast food joints, and avoiding creditors. He rode the bus to work and covered himself against the cold in the threadbare overcoat bought years before when he was on top. Telling himself how smart it was to move to the Sun Belt, Bill worked his way from Miami to New Orleans to Phoenix. Each job ended with what he called errors and misunderstandings, and with audits followed by now vaguely worded letters of reference. In his own mind, Bill was always certain that he would catch up. All he needed, he thought, was a good market, and he would be riding the crest again.

At no point over many years did anyone Bill knew ever consider the possibility that his behavior might have anything to do with gambling. The last thing anyone in the securities business wants is the image of gambling.

Finally, at a point when he was flat broke and depressed, and at the insistence of a friend who understood problem gambling, Bill called for help and came into our program. He was forty-five years old but looked sixty. The most difficult feature of Bill's case, from a therapist's point of view, was Bill's attitude; he just couldn't see that there was anything about himself and his personality that needed changing. He still saw himself as a leader. Although he always blamed circumstances for his downfalls, he still insisted he was in control of his life. He thought of himself as organized, disciplined, and responsible. Prizing these qualities, he could not grasp the idea that a need for gambling euphoria controlled his life. Therefore, he was delighted when the men on our ward elected him president of the ward government. He was not the first stockbroker to occupy that post.

“No matter how low I have fallen,” he said to himself, “I can be proud of my leadership abilities.”

His strengths were killing him!

He devoted all his extra energy to fixing what he thought were defects in our program: the food was cold, the rules for passes to town were too strict, the toilet paper was too stiff, on and on. This preoccupation with his presidential responsibilities, of course, deflected attention from the work he badly needed to do on his own personality. In treatment, we see this kind of smoke screening frequently, and we attempt to help the client see what he is doing. Other pathological gamblers are most astute in detecting such avoidance behavior in their peers, but never good at seeing it in themselves. That is why group therapy, with professionals and in Gamblers Anonymous, is so important; if they are willing to look at important issues, gamblers will get the clearest picture of themselves through the eyes of other gamblers. Unfortunately, however, the other gamblers could not bring themselves to demand Bill's resignation from the ward presidency.

It’s a sad truth that people least want to change those traits that they most need to change if they are to avoid further suffering. Conversely, people will often say they want to develop qualities they already have. Highest on Bill's treatment agenda was to become more efficient. The last thing he wanted to do was give up the brokerage business. He wanted to improve his leadership skills, yet failed to see that it was precisely those skills—the ability to see solutions and to get others to trust him and follow his suggestions—that had so often led to his downfall.

Following orders is also a skill. It requires something called willingness, and it is often vital to survival. Without this critical ingredient, real recovery will not begin.

However, Bill saw no reason to follow directions, to be humble, or to accept ordinary rules for conduct. Like so many pathological gamblers, he needed to learn to listen, not to talk more. He needed to learn to live on less money, not to practice making more. He needed to learn to hear criticism, not to avoid it.

In short, Bill had what I like to call normophobia; he was terrified and repulsed by the idea of being normal, obeying ordinary laws, paying bills on time, and living a simple life. The fact that his addiction had reduced him to a life below any normal standard made no impression. He would rather be dead than normal!

There is little you can teach an unwilling person in a few weeks, and we discharged Bill fearing the worst. However, although he had much to learn, Bill must have heard something during his treatment. Having no job and no place to live, he took the only work he could find, a job offered by a member of Gamblers Anonymous. Bill had no choice but to accept humble, honest work. During one long, cold Cleveland winter, he worked for minimum wage at a construction site, as a guard and handyman. He spent his days pulling nails out of used lumber. He found a lady, and they set up an apartment together. Things got better, and Bill eventually got a job managing accounts receivable for a small corporation. Two years after coming to Cleveland penniless, Bill invited the Gambling Treatment Program staff up to his penthouse apartment for a small party. Curiosity led me to ignore our strict rule against staff-patient social contacts. I considered it a follow-up house call. Besides, not everything to be learned can be learned where you happen to work.

Bill had found a unique way to handle his money. Whenever he had a few hundred dollars extra—he was now well paid and earned bonuses—he simply went out and bought something. He knew that having cash or a large bank balance would always be a temptation to set up a new trading account, so instead he would spend it. His apartment was furnished with the best the stores had including three color television sets and the best recording equipment. Bill drove a fine car, and his lady did not want for jewelry.

Bill no longer attends Gamblers Anonymous meetings and has settled on a substitute compulsion, spending. This, of course, was merely an alternative for a program of personality development. But, at least Bill’s life was a lot better than before.

In therapy we take what we can get and hope that later our customers will risk another step on the long road to maturity.

Fortunately, most securities dealers are responsible, ethical professionals. Only a very small number are crooks and gamblers. Those few, however, do tremendous damage. Gambling in the financial markets is extremely hard to detect because it takes sophistication and knowledge of financial matters, as well as the psychological skill to discern the differences between investing and gambling. Heavy trading is never a sure sign of a problem. In my experience, only a complete mental status examination by a competent therapist with some knowledge of both financial markets and pathological gambling can tell if the client is gambling. In any case, it is far more likely that many more customers than brokers gamble. A good broker, like a good casino owner, doesn't need to gamble. If he's a good salesman, his commissions will make him rich without risking his own money!

Trading in stocks, bonds, options, and contracts was never designed to be gambling. All these instruments were developed for rational, prudent business needs. Stocks are originally sold to decrease risk and uncertainty. They enable a large number of people to share the risks and rewards of corporate ownership, while at the same time reducing investor uncertainty by letting the individual investor diversify and participate in the ownership of several corporations at the same time.

It's an old story: When we decide we really want to take a risk for some prudent reason, we seek to reduce or offset that risk through some form of insurance, counter-purchase, or hedge. Even the yearly fee paid on a strongbox at the bank is a form of insurance against the value of the jewels, coins, or stock certificates held in the box. In contrast, the hallmark of the gambler, who plays for the psychological high involved in risk-taking more than for financial gain, is a lack of concern for such prudent protection. To take out insurance of any kind would simply reduce the risk on which the emotions of the gambler feed. The gambler is not interested in reducing the risk; he wants it. A true investor always tries to reduce risk—a very telling distinction.

This, then, is an important clue in determining that someone is gambling in financial securities rather than investing: The basic regard for value is lost. The gambler's argument that really big money cannot be made by conservative and prudent investing is hollow, and can be challenged by countless personal stories of millionaires and entrepreneurs who gained their wealth through creative yet cautious investments and hard work.

In pure gambling, all efforts to protect capital—to hedge the bet—are discarded. The goals of gambler and investor are actually very different, even if they happen to be using the same trading vehicle. The investor has a financial goal, plenty of time to achieve it, and good ways to protect it. The gambler has an emotional goal, and he or she chases that, not the money. An investor is never free of emotions, but emotional turmoil is neither the master nor the goal.

I learned a great deal from gamblers like Bill who used financial securities the way other gamblers use slot machines or racehorses. How do you tell a gambler from an investor? Beyond the obvious loss of concern for the basic value of commodities, you must look past the particular investment, past the jargon of Wall Street, and past all the technical strategies. You must learn to look into the mind of the individual. When you get past all the outer complexities and look straight into the thinking and feeling of the person, then it is usually easy to tell sobriety from euphoric, irrational intoxication.

Gradually, it became my personal goal to make such a mental inventory more reliable, easier to teach to others, specific enough to use as a treatment vehicle, and powerful enough to predict—not just diagnose—addictive vulnerability.

My attempt to get my mind off gamblers by reading the Wall Street Journal had failed completely. I believe strongly that if something is causing you serious trouble you should leave it, sell it, give it away, burn it, or toss it out. The Journal, lying ignored in my lap for the past thousand miles, was giving me no release from preoccupation with pathological gamblers. I offered the paper to the man in the aisle seat beside me.

He thanked me but refused, saying he had to review some product information on new items in his sales line. Like many salespeople he was a people person and would much rather be talking than reading, so we chatted. In discussing his work his eyes lit up, and he needed very little prompting. He did what he loved and loved what he did, the only kind of salesperson you ever want to hire.

Many sales representatives had passed through our gambling treatment program; gambling almost seems like an occupational disease for them. Most of these patients were energetic extroverts who loved to work on a commission schedule. The big and often unpredictable commissions were like big wins in gambling. Good salespeople were in love with the job of selling, and it didn't seem to matter what they sold. It could be anything from used cars to real estate. Some chase the next sale just as a gambler chases the next bet.

This fellow beside me reminded me of Herb. Herb was generally a relaxed and optimistic fellow, but he could never tolerate an assembly line or office job. The thought of being cooped up in an office or factory, with supervision and rules, put Herb into a panic. As long as he could come and go on his own schedule, and as long as his company overlooked his sometimes padded expense account, Herb was happy. He was a classic example of the successful American traveling salesman.

Herb was 48 and fat. The weight was a small problem in his mind since his bulk let him think of himself as a big man who needed to drive a very large and expensive car. Herb's bulk was usually covered with a bright sports jacket, his feet with expensive two-toned shoes, and his fingers with several gold and diamond rings. His wristwatch, complex and jewel-studded, seemed as big as a lunch bucket. Herb sold manufacturing equipment and tools over a four-state territory and, as odd and vulgar as he must have seemed to his conservative purchasing agent customers, he was a very effective salesman. He was cheerful, and appealed to the leftover youthfulness buried within his aging, pinstriped customers. The men he contacted looked forward to lunch with Herb as a welcome break in routine. Once business was complete, as it usually was within a few minutes, Herb would entertain them with his latest exploits, all of which seemed to involve either women or horses. Herb was an ardent and lifelong devotee of both.

In spite of appearances, Herb was not a fool. Like many top salesmen, he knew his business and his merchandise. The reason he sold his line so easily was precisely because his customers learned to trust his knowledge of his products and of their needs. Herb often knew what they needed before they did and was frequently an unpaid consultant in solving production problems. He could be trusted to set up an entire assembly routine and to give the lowest possible prices on the equipment needed. He never tried to sell something he knew was unnecessary.

Herb's company, in turn, was happy to grant him freedom of movement. He made his own schedule. They knew that if Herb departed from his scheduled visits, he would stay in touch with his old customers even when his salesman's instincts led him temporarily to some more lucrative opportunity.

His live-in girlfriend, Gail, was one of a series of casual arrangements in his life. Herb always managed to find some extroverted, loving female companion with whom to share a year or two of his life. His paramour at any given time was always, by his preference, a woman in good health, not motivated toward motherhood, and willing to work for a living; Herb was as phobic of close family ties as he was of supervision and office routine. He had a knack for attracting women with emotional needs who were at the same time strong, caring, and financially independent. Something about his disorganized, impulsive, and boyish approach to life cried out for mothering, I suppose. So it was that in more than thirty-five years of adult life, Herb had lived with no fewer than twelve outstanding women: teachers, social workers, and business owners.

A bird-in-hand, of course, never stopped Herb from doing a little hunting out on the road occasionally. Hunt is a carefully chosen word, because I suspect it was the hunt he loved more than the kill.

To each of his women Herb brought a piece of the fantasy … a wild, carefree, and romantic ride on a magic carpet. The ladies, in turn, took pleasure in providing some maturity, control, and stability to Herb's impulsive comings and goings. And, of course, they also provided rent and food money during those frequent weeks when the horses were running against him.

Marriage? Children? Family life?

“Sorry, not ready yet,” said Herb. He always put a noble face on things by admitting to his own immaturity and saying he would never want to put children through the misery of having a traveling salesman for a father. Herb must have been, in fact, one of the world's best responsibility-avoiders. However, he knew himself, and never tried to hide who and what he was.

As Herb approached the age of 50, however, he found himself less and less content with his rambling life. He was beginning to feel empty, and these feelings were increasingly hard to shake off. Gail seemed somehow different from all the rest. At times, he actually spoke about marriage. But she, instead of jumping into a formal commitment, put down some conditions of her own. The first of these conditions was: No more gambling.

Gail, unlike the others, never lent Herb any money, never paid his share of the bills, and even refused to pick him up one day when he ran out of gas coming back from the racetrack. He knew she loved him more deeply and was a better influence on him than any of the rest of his women friends, but he simply had no experience in behaving like a mature adult. Instead, he just kept doing more of what had always worked in the past: He worked harder, made bigger commissions, and gambled more.

Energy, however, began to run out, as it does when we age. There were times when Herb felt drained, and this upset him. Sometimes now, rather than making his sales calls or going gambling, he would just sit in his motel room all day and stare at the soap operas on television.

Over time, he began to eat compulsively. His sleep was poor, but he blamed it on bad motel beds. Worst of all was the empty feeling of indifference and boredom that grew as the months passed. Although he had a good income, a wide circle of loyal customers, and a devoted girl friend, he felt like a failure. This was a first for Herb. He was also beginning to have strange chest pains, which he blamed on his occasional golf games with customers. Just out of shape, he thought. When he hadn't played any golf, he blamed it on indigestion.

Pathological gamblers are expert in what psychologists call denial, the unconscious refusal to accept painful reality.

Gail contacted us for information when she read an article about compulsive gambling in a popular magazine. During several conversations, she gave me most of the preceding information about Herb. She finally persuaded him to come with her to discuss admission to our program.

He had no difficulty admitting that he had a serious gambling problem, but he really didn't seem to understand why that should bother anyone. The problem, as he saw it, was to make Gail happy. If going into the hospital would please her, he would go. But first, he said, he had to get ahead of his job and make sure all those bases were covered so he could take the necessary 30 days away from work. I saw no problem with that, since we had a waiting list anyway.

What did worry me, however, was a complex of vague signs that emerged during our interview. Herb's color was poor, almost ashen. He sighed deeply and often. Clearly, he was depressed, although he voiced a kind of mechanical optimism. He mentioned his chest pains and I suggested an immediate outpatient visit to a physician. But he refused, saying, “The docs here can check that out when I come in.” He belittled the pains, the fatigue, and the depression. So we had to settle for his plan, and hope that we could get things sorted out during his inpatient treatment.

Herb died of a sudden, massive heart attack three days before his scheduled admission.

Herb was another case in which time ran out. Another case about which to ask, again and again, “What more could I have done that might have changed the outcome?” Another case in which to remember the Serenity Prayer.

The physical toll gambling inflicts on the body as well as on the spirit is amazing. Some alcoholics like to think that if they give up drinking they can simply substitute gambling and avoid medical problems. In this misguided effort, they trade liver problems for heart disease.

From a distant reality, I heard a faint but insistent question: “So, do you suppose the VA might be interested in looking at our memory storage line when they up-grade their computers?” My fellow passenger had been holding a conversation with me as I was remembeing Herb.

“Let me have your card,” I answered. Soon we were landing in San Francisco.

I love San Francisco. All I would see was the airport this time, but even the overpriced gift shops seemed special and different. I browsed my way slowly toward the gate for my Reno flight, enjoying the sun streaming in the windows, the shops and restaurants, and the bits and snatches of conversation I picked up from my fellow travelers.

Two ladies walking behind me were talking about bingo. Are we all preoccupied with gambling, I mused, or is it just me, stuck as I am on the problem of defining and diagnosing pathological gambling? Can't two women discuss their favorite pastime without setting off alarm bells in my little head?

Bingo? Bingo! Memory was off and running as I waited to board my next flight.

Most gamblers who join Gamblers Anonymous or come for professional treatment are men. In the early history of Alcoholics Anonymous most members were also men, and only recently have women found membership in AA comfortable. Now, over 40 years after the founding of GA in 1957, we are learning more and more that problem gambling does in fact affect many women.

Female gamblers seem to prefer games of pure chance such as lottery, keno, roulette, and bingo. Men, on the other hand, seem to prefer games in which the illusion of skill is prominent: the stock market, sports betting, poker. Generalizations, of course, are dangerous. For whatever reasons, it is often difficult for women to feel at home in a GA room; perhaps it is the difference in language, experience, or personality. In recent years, however, we have heard of new GA groups for women only, and a few mixed groups in which women outnumber the men.

There are at least three major problems in trying to help the female pathological gambler get treatment. First, like drinking and smoking in earlier days, gambling isn't supposed to be ladylike. Somehow, society is more tolerant of certain so-called bad habits—what I would call disorders or mental illnesses—in men. Women, for example, experience more social pressure to reduce body fat. Generally, they also feel more social pressure than men to hide addictive behavior.

Second, patterns of gambling and patterns of alcohol abuse may differ between men and women. There is some evidence that female alcoholics are better able to avoid getting grossly intoxicated; they may tend to sip more over a longer period and thus stay mellow rather than get obviously drunk. Even when drunk, the female may show less overt anger and violence than the male. And the female gambler sometimes seems more likely to avoid wild binges of gambling in favor of a constant and daily stream of small bets. She is more likely to gamble with friends and to enjoy gambling as a social occasion, although she may reach pathological levels even in a social context.

Notice that all of my generalizations use hedges like may be and likely to. Many readers will know of exceptions. You may know, for example, a female who was very violent when drunk. I remember one lady who was among the sharpest sports gamblers I have ever known. Her sports knowledge would have put most men to shame. Impressions of sex differences in gambling are statistical generalizations, not laws of human nature.

A third and final reason that women may not come into treatment as readily as men is that female homemakers are less visible than those who go out to work everyday. Alma was a closet gambler for years; she divided her life among children, church, and bingo until, in the end, the gambling crowded out everything else.

When I met her, Alma was 38, referred through the employee assistance program at the bank where she was a part-time teller. There was no hint of dishonesty, no suspicion of theft; Alma just talked a lot about gambling, so her neighborhood friend, who also happened to be the bank's employee assistance counselor, suggested to Alma that an evaluation could be helpful.

No one would ever think of calling Alma fat. The word was big. Alma was a big woman, well proportioned, and radiant with health. She was a light-skinned African-American whose presence and dramatic voice dominated any situation. Alma apparently controlled her extra weight mechanically, in what must have been a series of well-constructed undergarments, or, as they used to be called, foundation garments. To the world, she always presented a color-coordinated, fashion magazine image. Her necklaces, earrings, and bracelets were always large and flashy, but she never looked cheap. Her makeup was meticulous and heavy, but again, her taste and skill allowed her to accent her strong features without calling attention to her efforts. Somehow, she made it all fit together.

Like many gamblers, Alma seemed bigger than life. She did many things well. Earlier in her marriage, she had been a loving and caring mother to her two boys. Her husband, a production supervisor, truly adored her, although his own mild presence quickly faded into the background as Alma took over every situation.

From the beginning, it was clear that Alma preferred to control the conversation. She loved story telling—mostly stories about her gambling experiences—and she laced her conversation with jokes and laughter. Always she was smiling and optimistic. Alma, on first contact, was overwhelming. Once you got to know her, however, she turned out to be rather demanding, self-centered and perfectionistic.

Alma's gambling centered on bingo, which she played nearly every night of the week. Being something of a community leader in her public school district, she had led a successful effort to raise money for the high school's new band uniforms, a project that involved setting up a Las Vegas Night at the school. This yearly event earned money with an evening of bingo and casino games in the school gymnasium. The parents, and many students as well, came and bought play money with real money so they could enjoy blackjack, wheel-of-fortune, and craps for an evening. When they won they could buy cheap prizes with the surplus play money, but most of the players gambled until their play money was all gone. Often they went back to buy more.

Alma's dedication to the high school band uniforms, unfortunately, was in reality much more a symptom of her problem than a manifestation of her community spirit.

For several years, Alma was a bingo fanatic. She always said it was just a way of having fun and helping charity at the same time. To her, bingo was not gambling. Her husband was also unwilling to think of Alma as a gambler. He did complain, in their first visit, about unusually high bills for gasoline. Alma had five different, heavily used gasoline credit cards. She did not confine her bingo trips to the immediate neighborhood. She had a directory of all the bingo games in a three-state area, and she went where the prizes seemed largest. She thought of herself as the representative of her church to these other charity games, and of course she was always on the lookout for tricks or gimmicks that would make her own church's game bigger, better, and more attractive.

After close questioning and cross checking with her husband, I found Alma was traveling literally thousands of miles each month in pursuit of her hobby, and she was away from home nearly every evening. The bank said she was a good teller—fast, accurate and courteous—but she turned down chances for full-time work and for a potential management position because she wanted time to follow her outside interests. Her preoccupation with bingo was very visible, but she could not see it herself. She knew so many other bingo junkies that she just assumed her interest was normal, not an obsession.

Of course, her half-time salary was not enough to support the gasoline bills, pay admissions to the games, buy $25 to $50 worth of cards each night, and pay for some additional instant bingo books. These books were small pads of tear-out pages; successive pages showed a bingo card with successive number-letter combinations blocked out, as in a real game. I once talked to another lady who was also a bingo addict, and she told me that she had worked in the factory that made these instant books. She packed boxes full of the books, and knew that each box was packed in a certain order. She claimed she knew where in the box the good books were. When she went to the bingo hall herself and looked into the box from which the dealer was getting his books, she knew precisely how low her chances were of getting a good one that would pay a prize. Yet even when she knew there was no chance to win, she still bought some books. She never understood why.

Back to Alma. She had quite a few interesting ways to get cash in a hurry. Sometimes she offered to fill her friends' gas tanks by putting their gas on her credit cards, then having them give her cash in amounts less than the charge. Alma sold discount gas, but this gave her cash in hand. Several times she had helped others by buying them tires and batteries on her credit cards, and charging them reduced rates for cash in return.

Among pathological gamblers, the abuse of credit cards is a common way of getting cash. Lately, however, credit card companies have been arranging for customers to use the cards to get direct personal loans, or cash from stores, an opening most gamblers cannot resist. The fact that interest rates and charges on such instant loans are outrageous by banking standards has little moderating effect.

Alma allowed her husband to believe that she had a generous and charitable disposition, which always made her help her less fortunate friends. “Ginny Mae had to take her baby to the hospital and needed a new battery. I just had to help her. She'll pay me when she gets ahead.”

The husband's salary barely covered Alma's obsession, but what can a man do? A husband is liable for his wife's debts, and besides, he said, “She's the greatest wife a man could ever have.” With genuine fear he stammered, “I could never do anything that would make her hate me.”

Alma had one very interesting quirk; like many other gamblers, she drove the highways like a runaway demon. Her car was equipped with a citizen band radio and a radar detector. This put her in constant radio contact with truck drivers in order to get the latest reports on speed traps. She would drive the 125 miles from Cleveland to Pittsburgh in well under two hours, at breakneck speeds, in all weather. She whiled away this travel time with impulsive and suggestive conversations with truck drivers who, as a group, seem to love to engage any female in teasing conversations. To the best of my knowledge, she never did more than talk. Bingo was the priority.

Alma agreed to come into individual counseling mainly to please her friend, the employee assistance counselor. She attended about 12 weekly sessions, and I held a few joint sessions with her husband, whose cooperation and firm support would have been very helpful. Unfortunately, he could not bring himself to confront his wife.

There was one memorable session with the whole family, which included the two high school age boys who shared their mother's optimistic nature. The problem standing in the path of successful therapy in this case was the absence of any real pain. The boys were protected from the most harmful effects of their mother's addiction. Certainly, they missed having her around to help with homework, but they were getting used to fixing their own meals after school, and naturally enjoyed the freedom from supervision that Mother's trips afforded. Father thought he had far too much to lose by confronting his wife; he was willing to accept the role of her sugar daddy even if it meant putting himself seriously into debt. Alma, of course, was having the time of her life and saw no reason to quit. She did think that perhaps she should cut down a little, but really saw no reason to abstain completely. No one in the family was in sufficient pain to object strongly to their way of life.

As they say in GA, no pain, no gain. It is human nature to want to fix only the things that hurt, so until gambling really begins to cause pain and disability, it is ignored. Alma was doing what she wanted to do, and was getting support for it from her family, her friends, the church, and the high school fund-raising committee. She soon found reasons to drop out of therapy.

When last seen, Alma and her family were planning a spring vacation to Florida. The memory of Alma's last goodbye lingers. With a twinkle in her eyes, she let me know that the largest bingo prize in the world was offered at a game run on an Indian reservation in Florida.

In Alma's case, I had no psychological test results to guide my diagnosis, but there was no doubt that she was a pathological gambler. Perhaps the strongest evidence of this was her complete refusal to curtail her gambling. The only hostility I ever saw in Alma flared up when I suggested regular attendance at GA, or asked her what it would be like for her to try to abstain from gambling altogether. At times, I noticed a deep undercurrent of anger that was usually masked by her extroverted, jolly exterior. Upon learning some of the details of her early life, I began to see how anger might have become a basic theme in her personality.

Again, as I boarded my Reno flight in San Francisco, I swore to stop thinking about pathological gamblers and enjoy the rest of my trip. So, Taber, how is going to Reno a way to forget gambling?