Chapter Seven

Not all us gamblers is crazy, right?

(Note: although based on experience, the events, people and places in this chapter are factious. Never discuss outside of a Gamblers Anonymous meeting anything that takes place in a meeting. The rule: What’s said in a meeting stays in the meeting.)

Mickey is a tall, well-dressed gentleman, and an old-timer in the local Gamblers Anonymous. He organized the GA meeting about to take place, and exudes a wonderful sense of fairness, patience, and tolerance.

MICKEY: Hello, folks. My name is Mickey. I'm a compulsive gambler, and I haven't found it necessary to place a bet in over four years.” (Applause)

This is an open meeting of the Trentworth Gamblers Anonymous and Gam-Anon combined groups, and we have a guest speaker this evening. His handout pages were distributed at all our local meetings over the past few weeks, but if you don't have a copy, please come up and get one now.

I'll be your chairman this evening. We've all agreed to get right to our speaker as soon as we finish with the usual opening readings from our Combo Book.

(Various members take part in reading the material aloud. When they finish, Mickey speaks again.)

With us tonight is Julian Taber, the clinical psychologist who manages the Gambling Treatment Program over at the VA Hospital. Most of you know Dr. Taber. His topic tonight deals with problem gamblers who sometimes are mistaken for compulsive gamblers. Dr.Taber.

(Taber fits poorly into a suit a bit too small, and is notorious for mumbling and rambling like an absent-minded professor. His manner is kindly, and behind a mustache and glasses resides a generally benign, although sometimes blunt, personality.)

TABER: Thank you all for coming out this evening. Let's be informal; if you have a question or quick comment just raise your hand.

First, I want to mention some problems aside from gambling that concern me. We've had many individual discussions, and some of you folks told me to lay it on the line and let the chips fall where they may.

Let's consider discipline first. This meeting started a half-hour late. During other meetings, I’ve seen people walk around getting coffee and chatting while others are speaking. Meetings often last into the early hours of the morning. There seems to be an unwritten rule against cutting any speaker off, no matter how long he or she talks.

Just last week I gave a grand rounds discussion on pathological gambling at a major medical center in New England. I faced a wall of white coats whose occupants wanted all the facts in a short, organized format, and I felt challenged to tell everything I knew about the subject in 50 minutes. The only interruptions were occasional beepers going off. Questions were brief, direct, and insightful. Therefore, I'm used to professional meetings and classes that start on time and end on time, meetings during which orderly conduct is the norm. This is the way the world gets its work done. That's the world in which I live, and I don't need to defend it. It works.

In the real world, important business goes on with discipline. Without self-discipline there’s no accomplishment, no true recovery.

By comparison, Alcoholics Anonymous meetings seem more organized and disciplined than GA meetings, and that has always impressed me.

Next, let's talk about personality problems besides gambling that seem to get neglected.

AL: Taber, you fraud! You must be some kind of damn quack! You come in here and criticize the program that saved my life! What the hell do you know about Gamblers Anonymous?

(This man, standing up in the back row, is palpable with livid anger. Fists clenched, he stares wildly off to the side as he delivers his condemnation. His long, dark curls shake in reflection of his rage. An unbuttoned overcoat is draped about his shoulders, and his feet are firmly planted in unbuckled galoshes that make clicks and squeaks when he moves about.)

TABER: It must have been something I said. I don't know for sure what's upset you so, but I've been called worse. Since you're a lot bigger than I am, go ahead and get it off your chest. What's got you so angry?

AL: Damn it, Doc, not all us gamblers is crazy, right? You make it sound like we're just a bunch of immature lunatics. But, we sure as hell know a gambler when we see one come into the room. The problem is gambling, pure and simple, and it's smart-ass guys like you that give people the idea they don't have to deal first and foremost with the gambling.

TABER: The therapist in me wants to abandon logical arguments and try to help you come to a better understanding of your anger, an anger that seems out of place in a meeting like this, where people are supposed to be able to express opinions openly.

But my head tells me to get on with the proposition that GA's Twenty Questions, which do a fine job diagnosing a gambling problem, were never designed to measure other personality characteristics, which almost certainly interfere with recovery from gambling. Speaking of personality characteristics, or as you call them, defects of character…”

(Chairman Mickey doesn't seem to want to touch this subject at all, but fortunately to Taber’s rescue rides another senior member. Joe is a huge, friendly salesman type, with lots of self-assurance and a good sense of people.)

JOE: Al, the doc here is just trying to tell us that people have lots of problems aside from gambling. We all know that some really strange people show up at our meetings. We all know cases in which the gambling was just a front for alcoholism, schizophrenia, real criminal acts, or God knows what. As a matter of fact, Al, although you haven't gambled in over five years, you sure as hell have a problem with anger. What do you say we give the doc a chance to explain himself before we take such furious offense?

AL: I'm going get a smoke! (He stalks outside into the cold evening, galoshes clicking off into the distance.)

TABER: I wonder if the need for tobacco is part of Al's discomfort … or just an excuse to leave the room? Well, anyway, let's hope he comes back. I'll try to keep it short and interesting and encourage any participation related to the topic.

By the way, thanks, Joe. Getting my points across is less important, really, than building good relations with Gamblers Anonymous and Gam-Anon, since both provide so much support for our work. No doubt, I come on too strongly at times.

Anyway, we all see the world though the lens of our personal experiences. That's an advantage and a problem at the same time.

People who go to medical school learn to be objective. They learn to put personal experience aside and review all the possibilities dispassionately, so those are the people I trust to diagnose medical problems.

I'm not a physician. A fellow like me who gets a Ph.D. in psychology has to study all mental illnesses, not just one or two. Naturally, then, psychiatrists, psychologists, social workers, and mental health counselors look at a full range of possibilities in considering a diagnosis. Their personal problems and prejudices should not influence their professional judgment.

At least that’s the theory, and it's a good one.

Every one of you here is an expert on gambling problems. The Gamblers Anonymous Twenty Questions, in my opinion, do an excellent job of diagnosing a gambling problem, but that’s all they do. Over time I've hurt more than a few feelings in Gamblers Anonymous by pointing out the limitations of GA's diagnostic ability, and its tendency to see newcomers through only one pair of glasses. I have never seen a pathological gambler with only that one problem; and yet, quite properly, that's the primary problem at which GA looks. Unfortunately, ignoring other serious physical and mental health problems can permit them to undermine even the best efforts to eliminate gambling.

JOE: You may be a bit off base here, Dr. Taber. Our Twelve Steps stress that they encompass the mental, physical, emotional, and spiritual elements of recovery. A lot of good things happen in every aspect of life when we stop gambling and get rid of that stress. We know we're not doctors or ministers or lawyers, but we're not stupid, either. Recovery lets us take responsibility for all these other problems.

TABER: I grant you that, and your point is well stated. Members of self-help groups demonstrate all levels of flexibility on these issues, and I like it best when you expand your views to include all life problems, and encourage people to seek out the other help they may need.

But I've also seen GA assign newcomers the label of compulsive gambler when I knew that these fledglings really didn't fit the diagnostic criteria for that disorder. As a matter of fact, after hearing their stories at open GA meetings, it occurred to me that a few of the old timers with long periods of abstinence might never have been pathological gamblers themselves. They’re obviously not deliberate frauds, and I’d never think of trying to expose them, since they’ve helped so many other people over their years in GA. Neither Gamblers Anonymous nor your friendly psychologist here are infallible. Any problem gambler, pathological or not, can find help in GA.

BIG BOB: Doctor T, what about that guy Art? We brought him over to see you at the hospital a few weeks ago and we haven't seen him since. We really couldn't figure that guy. What was his problem?

TABER: It looks like our man Art is another false positive. That’s the term used to describe someone first diagnosed as a pathological gambler who turns out to be something else. In Art's case, in my opinion, we were dealing with an alcoholic who was simply too proud to admit to his drinking problem. He did his share of gambling, but that wasn't the real problem. He knew he needed help, but he wanted to be seen as a gambler, not as an alcoholic. Clearly, pride and ego are issues for him to work on; I hope he makes it in Alcoholics Anonymous. I can talk about him here because you know him, but let’s not gossip outside of this room.

I discussed the situation with Art's wife and called Art into the office to go over his psychological tests. Our physician's reports, his wife's statements about his drinking, and his answers to questions, both mine and on the tests, all suggested a long history of alcohol dependence. He was certainly a problem gambler and lost far more money than he could afford, but he gambled only when he drank. Alcohol was clearly his drug of choice, and his highest priority.

Art reminds us that gambling problems exist at all levels of severity. What experts call a pathological gambler is an extreme case. If you spend all your time in a hospital dealing with one extreme case after another, you begin to think that the world of gambling is divided neatly into pathological gamblers on the one hand, and all the rest of us who are either non-gamblers or social gamblers on the other. This is tunnel vision. Still, I find myself sometimes thinking like my friend Al: A gambler is a gambler is a gambler, and there are no shades of gray in between.

(As if on cue, the clanking of galoshes is heard coming down the hall toward our musty church basement meeting room.)

TABER: Members of Gamblers Anonymous share the same problem because they, too, work almost exclusively with full-blown pathological gamblers. For this reason, perhaps, some GA members tend to divide the world into pathological and social gamblers, ignoring the fact that there are many points along a spectrum that runs from social through excessive and problem to pathological gambling.

People trained in medicine are also used to looking at two clearly different states: health and illness. Yet physicians know as well as anyone that most problems appear in all degrees of severity. It seems unfair, then, to drag a simple problem gambler into a GA room, or force him into a hospital program for pathological gamblers, and there accuse him of being a sick, compulsive gambler. If he or she protests, we beat them over the head with accusations of denial.

JOE: I have to disagree somewhat at this point. Those of us who’ve been in Gamblers Anonymous for a while do know the difference; we know that no two gambling problems are ever exactly alike. Some of us come in sooner in our gambling careers than others. The Twenty Questions give us a range of scores, and that helps us see the extent of the problem. What matters is whether or not the person thinks there’s a problem, and whether or not that person believes GA can help. Believe it or not, we do advise some people that GA may not be for them when we see that gambling is minor compared to something else in their lives.

TABER: Somebody once said that good therapists are born, not made in universities. So. I'll grant you that there are some Gamblers Anonymous members who do have great sensitivity and judgment when it comes to understanding the extent and nature of human problems. In return, perhaps you’ll concede that being in GA does not automatically confer wisdom upon you.

We professionals have to be cautious about false positives in diagnosing pathological gambling in people who might actually be either excessive social gamblers or more advanced problem gamblers. We have to look beyond the gambling to understand the total person.

AL: Doesn't a problem gambler always turn into a pathological gambler if he keeps on gambling?

TABER: Good question, but research has not given us the answer. We’d have to do long-term studies over the lives of many individuals to know that for sure. There has never been a, long-term study of any group of individuals in which they traced the development of gambling behavior over time. Even for alcoholism, an addiction recognized as a problem for a much longer time, there are only a few long-term studies.

There’s credible information that the eventual development of addictive behaviors can be forecast with some success when predictions are based on certain personality features, family indicators, and behavior patterns, but no one can say for sure which addiction will be chosen over another.

AL: Yeah, but I always tell anyone with any kind of gambling problem to lay off for life.

TABER: I can't argue with that, Al, but it is true that some people can and do moderate their drinking, gambling, or whatever as they begin to mature and solve other problems in their lives. Certainly, there is no valid reason why anyone has to gamble in order to have a good life. Why not just quit altogether and get on with life?

JOE: These people you're talking about simply have not progressed to a point where they’ve lost the power of choice. That's according to Bill Wilson, and I think that's the real difference we're all talking about.

BIG BOB: I think all Al wants to say is that once you’re a pathological compulsive gambler there’s no going back to moderate social gambling. That's clearly spelled out in our Combo Book.

TABER: Given our present state of knowledge, and given the treatment goal of a complete lifestyle change, I agree with all this.

Obviously, in view of the risks involved, we should always advise any problem gambler—the gambler with some control left over the decision to gamble—to abstain completely for life. I do know of cases in which problems with gambling did develop into uncontrolled, pathological gambling. This is particularly true when some other addiction such as alcohol or drug abuse is finally given up, and the patient seeks to fill the void with gambling. But I also know of many cases in which problem gamblers just burn out on gambling, and walk away from it.

AL: Doc, every time I try to quit smoking, like a lot of the other people in the room, I get that old urge to go out and gamble again. Damn, it makes me angry!

TABER: Al, there are excellent programs to help people quit smoking. Don't try to do it alone. You needed GA to quit gambling, so why not also get expert help to quit smoking? When we're finished here tonight I'd be glad to give you the names of some people to call. We do have stop smoking classes at the hospital.

You know, it's common for young adults to get heavily involved with addictive behaviors and then, either gradually or abruptly, terminate their indulgence. This is true for gambling, illegal drugs, smoking, promiscuity, alcohol, and all our many forms of pleasure seeking. To react to any gambling problem with the dire warning that worse is yet to come is a reflex reaction that may say more about the speaker's limited view of the world than about human nature.

What I notice in Gamblers Anonymous is that each person seems to think that every newcomer will have to use the same method to quit gambling they themselves used. The fellow who made it in GA says GA is all you need, but the fellow who had professional treatment claims you can't do it without professional help. People who benefit from marriage counseling seem to think everyone should have that.

What worked for you ought to work for everybody, right? Wrong. Let's have a little tolerance. You may have gone to 30 meetings in 30 days to get the message, and that calls for great personal effort. Someone else may have tried that but found something else that worked better for them. And then you find a lady who decided to quit the first time she saw her husband crying as he looked over the checkbook, or you may find a man who gave it up when his child confronted him about broken promises on Christmas morning.

As a matter of fact, I really don't think GA is primarily about quitting gambling. I think it's really about personal growth, and staying honest, but that's another topic.

Back to the question of the difference between problem gambling verses pathological gambling. The hallmark of an addiction to gambling is loss of the ability to decide when to gamble, when to stop, and how much to lose. This loss of control, this surrender to an overwhelming urge to gamble, is what we mean by pathological gambling. It's an injustice to conclude that just because an individual has gambling problems, or gambles more than they can afford to risk, he or she is or will become a pathological gambler. People do, in fact, have multiple problems, and gambling often can be a symptom of these other problems.

MICKEY: So define social gambling if you will, Doc.

TABER: Social or normal gambling may be harder to define than pathological gambling, since professionals are drawn more to serious problems than to the study of normal, ordinary behavior. We take normal for granted, but normal behavior is just as complex and just as deserving of interest as pathological behavior. As a matter of fact, how are we to teach normal behavior to our abnormal patients if we can't even tell them what normal is? So, for a moment, let me try to look into the mind of the normal, social gambler.

AL: Gawd, I hate that word abnormal. When I was trying to get off gambling years ago I got locked up on a psycho ward; they thought I was a nut case and they called me a schizo. Had me taking all kinds of damn pills. I felt like hell all the time, and finally I just walked out and went on gambling.

TABER: I'm truly sorry that happened to you, Al. It happened to many gamblers, alcoholics, and drug people in years past. Modern alcoholism treatment really only began in hospitals in the 1960s, and even then drugs like Valium and Librium were used as substitutes. And that only created a different addiction.

Back to social gambling.

I think tolerant amusement best describes the view of most social gamblers when they enter a casino; they’re likely to check the menu board outside the buffet or ask what show is on before they scout out the table games. Real pathological gamblers just don't do this. Social normies also enjoy watching others go through the pangs of losing a few dollars, and they can easily congratulate their friends who win something. Their own curiosity about how a particular game works gets them to play a few dollars here and there, while a slightly more serious and experienced social gambler will often enjoy playing a game he or she knows well. Conservative strategy at the blackjack table can make $20 last for quite a while, but it gets harder and harder to find a table with a one or two dollar minimum bet.

A normal, self-assured dabbler—the social gambler if you will —feels comfortable just being a tourist, a gawker, or a kibitzer. Sufficient ego-strength enables him to assume appropriate humility and to ask innocent questions about odds, or about how to play a certain game. And of course, dealers are always happy to teach a new player. Contrary to some stories, dealers in any respectable casino will never try to cheat the new player, and will not mock a lack of knowledge or skill. A good dealer enjoys breaking in a new player. The dealer will treat you fairly and courteously because she needs your business, and knows that the laws of probability will make a profit for her employer. She doesn't have to cheat you. Cheating would be counter-productive if it were discovered. Casinos want a certain percentage of noticeable wins for all to see. It's good for business.

Interest in gaming, however, can escalate well beyond the dabbler-beginner level without becoming either a problem or a disease.

Lots of social or controlled gamblers have fantasies about winning big, and many experience real thrills when they play. Some are tempted to gamble more than they planned to risk, and some go overboard from time to time. Often they feel that they have discovered or developed winning systems. There may be some degree of mental preoccupation with gambling during non-gambling activities, such as work, and some of their ideas about gambling may be false and irrational. To the untrained eye, these latter types may appear to be compulsive gamblers. Generally they are not, or at least not yet.

The anticipation of gambling, for a controlled gambler, is a bit like the anticipation one might have for a weekend of skiing, skin-diving, or travel. The better you are at any of these, the more you look forward to doing them. Normally, one can set aside such daydreams without resentment in order to take care of other business. I know a number of fellow psychologists, physicians, and professional people who look forward all week to their habitual Saturday night poker game. Other friends plan regular evenings of bingo or trips to gambling resorts. These episodes mean a lot to some people, and they commonly relieve stress without causing new problems. These people successfully use gambling as a change of pace, and simple entertainment.

TOM: You used the term ego-strength. Can you define that for us? I always thought that gamblers had plenty of ego.

TABER: By ego, most people mean inflated pride, or arrogance. In psychology, however, ego means self or selfhood. Some people have a very weak sense of who or what they are; they may be inconsistent, suggestible, and sometimes apprehensive about going it alone. They have low ego-strength. In psychology, ego means the glue that holds a personality together. People with well-developed ego-strength know who they are and what they want. They aren't afraid to go off by themselves when they need to. So pride and arrogance are not helpful, but a strong internal, conscious ego is. We dislike the one and admire the other.

Let me get back to the social gambler.

There are folks out there who gamble on horses, stocks, and poker almost daily, yet they are able to avoid crossing over into problem gambling by limiting the size or frequency of their betting by using mental discipline and restraint. As with food, most of us would like to eat more deserts than we should if we want to stay fit; we have to be restrained eaters, using control. Compulsive overeaters simply can't do that.

Somehow, some gamblers manage to prevent gambling from becoming a source of pain and damage. Their jobs, social activities, and family life do not suffer.

Ironically, since it's often the dream of the pathological gambler to learn to gamble normally, such a gambler might mistake my discussion of social gambling as an invitation to try to become a moderate gambler. In fact, they’ve probably already tried many times to limit or control gambling without success and find it much easier to abstain altogether. In truth, if you tell an active pathological gambler to abstain for life, he or she will often resent the fact that others may be able to gamble socially.

So much for the fun-seeking, relaxed attitude of the social gambler. How does the social or problem gambler differ from the pathological gambler?

Different personalities coming into the same gambling environment experience very different worlds. For example, a person with a poorly developed sense of self, or with chronic doubt about self-worth, reacts to the casino floor—or to the racetrack, pool hall or betting office—in critically different ways from the outset.

Someone likely to experience problems usually does not want to appear innocent or naive, and conceals his ignorance. Or he spends hours studying books on gambling and then goes swaggering onto the gambling floor pretending to be some kind of expert. His ego is on the line from the very start of his gambling career, and he’s not about to take hints or advice from any dealer. He finds it hard to congratulate a winner, because seeing someone else win hits him as a personal loss. He prefers to gamble where he’s not known, and where he’ll escape observation by others, who might criticize or gossip about his behavior. Everyone else on the floor is a competitor, an enemy. Instead of taking a win as a mere stroke of luck, he views it as a personal victory, as some kind of individual validation. Everything is wrapped around a fragile ego. A win makes him feel very, very good, not just amused. A loss is an extremely personal insult, while repeated losses produce a black and angry mood, along with feelings of personal worthlessness, a sense of failure, and growing anger. With victory, he is warm as toast, then in defeat suddenly cold as ice: Opposite mood swings come on a moment's notice, on a single roll of the dice.

Instead of seeing gambling as a recreational pastime, the problem-prone gambler may take up a kind of personal crusade, in which entertainment is forgotten in favor of an invigorating, symbolic combat between himself, the hero gambler, and them, the tricky, sinister villains who own the game. In other words, instead of seeing himself as receiving a recreational service for a price, the problem-prone gambler personalizes and polarizes gambling. He distorts reality. Basically, he or she is using gambling to satisfy, at some unconscious level, personal and unrecognized needs. Loss of control and disastrous financial losses are the inevitable results.

AL: You got that part right, Doc. When I was at the track I used to think that the damn ponies recognized me and schemed against me. A gambler has no friends at the track, or at any other game. God, it's a lonely life. But the fear creates an excitement, an adrenaline rush that your normie bettors wouldn't appreciate.

TABER: That utter loneliness is often what brings some gamblers in to get help. It's a heavy emotional load to carry alone.

But many problem gamblers are eventually able to moderate their gambling and put gambling into a proper perspective. Others simply learn to avoid it altogether. Still others, I don't know how many, graduate to pathological gambling. So, Al, I think you are right, in a way. Gamblers Anonymous is great at knowing when a person has a problem with gambling, and anybody—problem or pathological gambler—can learn an enormous amount from a Twelve Step Program like GA. In fact, although I've been fortunate not to have problems with drugs, gambling, or alcohol, I feel personally enriched by my own exposure to your program.

AL: Doc, did you ever go to an Overeaters Anonymous meeting?

(There is a long silence. Finally…)

TABER: Al, go for a smoke, will you? No, just kidding. Al, I believe anonymity is very important, if you know what I mean.

AL: “Hey, Doc, what's good for us might help you …”

MICKEY: You made your point, Al. The Doc is our guest, so let him get on with it.

TABER: Now, to summarize: Anyone can temporarily lose control and escalate their gambling foolishly. This is especially true if the person has been drinking, is too tired, or gets overexcited or angry. For most people, behaving irrationally automatically triggers certain built-in controls learned through training and experience, and these tend to moderate their behavior. These folks can admit their mistakes and perhaps leave gambling behind altogether. They seem to have innate brakes to apply when danger is too close.

I believe it’s probably impossible to understand pathological gambling fully, or recover from it, without understanding this normal behavior of self-control. Whatever works in normal life is what recovering gamblers must first imitate, and then learn, if they’re to have any meaningful recovery. That's the main reason we’re talking about social and problem gambling here, today. I don't want or expect pathological gamblers in recovery to moderate their gambling; they need to stop completely. What I want is to see them develop the self-control techniques so-called normal people use in everyday life, outside of gambling.

The normal or social gambler understands that gambling is only a diversion, and is willing to pay a reasonable and affordable price to play the game. Such a gambler is especially careful to tell himself that any large win at gambling is merely luck; he takes particular care to remind himself that a win is not likely to repeat itself often enough to make a living at gambling. The social gambler, in fact, is very likely to stop gambling after a win, and perhaps spend the winnings on non-gambling entertainment.

When losing, the social gambler can be satisfied with having had an enjoyable evening, and suffers no ego damage. If she loses more than she had planned she may be vexed with herself, but she does not externalize the blame onto those who sold the gambling services, nor does she harbor any ideas about having to return to gambling to win back her losses. It is through such normal, healthy thinking that the social gambler stops well before any damaging pain or disability develops in life.

But, to repeat, the pathological gambler has lost the ability to decide when to gamble, when to stop, or how much to lose.

So much for that topic. Any other questions?

AL: Doc, sometimes you seem preoccupied with the stock market and all this technical crap about how bookies and futures contracts work, and you keep trying to explain it to us. Who the hell cares about all that stuff, anyway? Gambling is gambling, that's all we have to know. We're just wasting time with all that technical stuff.

TABER: I love this guy. He may be the most honest person in the room. He gets to the point, and I can appreciate that, if you're still alive when he gets finished with you!

Al, there are two sides to problem gambling. The first is the dream world of the gambler, and you recovering gamblers understand that very well; it's what you've given up, or what you're trying to get away from. The other side of gambling is the mechanical aspect of how gambling is managed. And that is no dream world. The basic business of gambling is like any other business. People running the games may have dreams, but they manage the profession through hard work, skill, experience, patience, and constant learning. I believe that the more you understand how reality works, the more transparent your unrealistic dreams become. As you discover reality, it will help you overcome the tendency to fantasize. Recovery must involve learning more about how the world really works. To do this, we start with formal instruction about how the world of gambling actually works, in the real world.

Managing risk is an honorable business. Taking foolish risks is not. If you don't have the patience, desire, drive, and willingness to study how normal, successful people make their money, then you either must learn how to learn, or you go back to gambling. I really believe that if a pathological gambler worked for a week in a casino, or sold tickets at the track, if he got a look at his game through the other window and saw other gamblers, as he himself is seen by others, he would be a long way down the road toward recovery.

JOE: Another question, Doc. Aren’t there people who really do make a living gambling? I mean, professional gamblers?

TABER: Most regular gamblers, and almost all pathological gamblers, believe that there are bettors out there somewhere who earn a good living at gambling. However unrealistic that ambition may be, especially for pathological gamblers, that hope is necessary to counteract the effects of losing day after day. Fantasy tells them that ordinary, dull work will no longer be necessary once they find the system, the money, or the emotional control to beat the odds. They think they’re on the way to becoming true professional gamblers, and they regard their losses as only tuition in the school of hard knocks.

It's sad that pathological gamblers, for whom poor impulse control makes a career as a successful professional gambler quite impossible, hold most strongly to this self-deception.

Sociologists studying the gambling scene estimate that no more than five percent of all racetrack gamblers make money in the end. About the same dismal ratio holds in most forms of stock market speculation. As opposed, of course, to long-term investment.

I’ve questioned those who claim to know certain prosperous professional gamblers, but I’ve yet to be given the name of a single one, and I personally know of no one who has proven to be a regular moneymaker at the trade. Nor is there any published evidence, to my knowledge, proving the existence of consistently winning gamblers—and here comes the tough part—who pay taxes, keep records, and do not need to supplement their income with regular work. Only bookies who do not gamble seem to prevail.

However, there are a few in my experience who—while not proprietors, owners of games, or bookmakers—actually make money, either by cheating or by playing in games where skill is a significant factor, and where no percentage is paid to the house, such as at private clubs. Such gamblers often avoid taxes by not reporting their income to the IRS. So they cannot be called legitimate business people.

These few successes inevitably pay a steep price for their success, most often exacted in psychological distress. The ones I've known about are lonely, alienated, distrustful, depressed, and restless. They tend to be without roots, or to complain of family disunity, and they end up feeling rejected and without meaningful life goals. All this appears to be the result of spending enormous time and energy obtaining an unreliable living at their game of choice, not to mention the pressures and stress. Nor can they take any public satisfaction in their accomplishments, since they must hide their winnings or discount them to the IRS, their families, and especially to the ‘marks’ or suckers they milk for profit.

Al: Doc, you make such a big deal about keeping records and paying taxes. Why the hell should anybody report gambling winnings the IRS? Those bloodsucking bureaucrats get too much as it is.

TABER: Think about it, Al. It's the law. Do you believe in the rule of law?

BIG BOB: Most of us ignored a lot of laws when we were gambling, and some of us still obey only those laws we happen to like.

TABER: Here's a different reason to obey the law you might consider. We need to do it because obedience is good for us. (Smiles and laughter.) Honestly, it's good training in self-discipline and self-control. The law is the law until and unless we use our democratic system to change it. And changing it will take all the effort and patience we have. Compliance, effort, and patience—opposites of instant gratification—are characteristics worth cultivating in the search for peace of mind. Childish defiance doesn't change a thing, and only confirms the foolish idea that one is special, or above the law.

And please, don't obey the law just for the sake of other people; learn to obey it for your own sake too. Paradoxically, through obedience we learn true independence, believe it or not. The law itself should be a higher power for all of us. And I don't want to hear anyone talking about a religious higher power until that person understands there are also plenty of earthly higher powers to be obeyed if we’re all to live together in the real world.

AL: Oh, bullshit! Most laws are stupid! (The clanking of galoshes is heard in the land as Al stalked off for another cigarette.)

TABER: He's thinking, I can tell that now. Speaking of the law, let’s consider the true criminal personality, another false positive.

In spite of the fact that addictive disorders such as pathological gambling and alcoholism are grave mental health problems, many psychiatrists and psychologists with little experience in these areas continue to think of them as moral or character weaknesses. In the traditional view, addiction was symptomatic of some severe yet self-correctable flaw in character. Thus, there remain many professionals who still uncritically view all pathological gamblers solely as psychopathic or  criminal personalities. In their eyes, the gambler needs to exercise more self-control, and be willing, like the rest of us, to deny himself some of the pleasure he craves. This makes sense, perhaps, if you've never seen a low-bottom alcoholic or gambler continue an addiction against his own will, and in spite of his own determination to stop killing himself.

According to this traditional view, over-indulgent people are seen as simply unmotivated, people who deliberately ignore the consequences of their excessive appetites and are unwilling—not unable—to change their ways. And so for many years mental health professionals would not try to treat addictive disorders, unless they could be seen as mere symptoms of deeper psychological problems.

Thankfully, our modern view recognizes a broad range of dangerous pleasure-seeking activities over which people can lose control. Addictions are primarily self-harming, since the user suffers the most damage in terms of social, spiritual, physical, and economic loss. In the pursuit of an addiction, the individual may also harm others because of the overwhelming preoccupation with feeding the appetite, but in a true addiction, this damage is a secondary result of the self-destructive appetite. Harming others is not the primary motive. Once the addictive behavior is arrested, the recovering individual is once again an asset to society.

The traditionalists are not all wrong about the existence of a criminal mentality. There are such individuals, with or without addictions, who are enduring sources of major harm to others. Their behavior can easily, but wrongly, be blamed on the addictions that they often practice so freely. These folks have what is called an Antisocial Personality Disorder.

These people present a high degree of danger to people around them because of personality characteristics unrelated to addictive behavior. Their primary threat to others arises from a failed or distorted personality development, a factor that makes them quite different from those who are just gamblers and alcoholics.

Most pathological and problem gamblers can and do perform quite well in many adult roles. In spite of the harm they may cause others, addicted people feel remorse, shame, fear, guilt, and love; they care for and about the people they are close to. Many are tortured by the desire to change, and willingly make restitution when they can.

None of this is true for the person with an antisocial personality disorder. This individual is sometimes misdiagnosed as a pathological gambler, but he or she cares very little for the feelings of others. There is often, in fact, a malevolent and vindictive anger toward others.

The antisocial personality is entirely self-centered and self-serving, not because of any one addiction, but because of a lack of basic human values. In the pathological gambler these basic human values, although eroded and pushed aside by an urge to gamble, offer a foundation for recovery. An antisocial personality never had such values, or has them in such small measure as to render them ineffective against the stronger, ego-driven tendencies around which it is organized.

Social harm done by the antisocial individual is not usually associated with addictive behavior. These folk often strike out for no reason other than the pleasure they take in exercising power over others.

In contrast, many pathological gamblers, although they may show what seem to be antisocial attitudes and behaviors, can eventually respond to treatment, once their disorder reaches deeply uncomfortable levels. The antisocial personality, on the other hand, can sometimes look like a good candidate for treatment, but is seldom able to profit from it. The antisocial is among the most frustrating and difficult people to treat in traditional psychotherapy. He usually tends to undermine the treatment of others by taking up time with his own recurrent, self-induced problems and personality conflicts. Instead of trying to change himself, he constantly finds fault with the helper, the treatment program, and the world in general. The basic problems in his life may be made worse by his addictions, but the problems are not caused by the addictions. The antisocial is often violent, impulsive, angry, and manipulative, whether or not he is under the influence of any addictive activity.

LITTLE BILL: Lots of people in this room broke the law to get gambling money, Doc. If they're truly sick, if they’re real pathological gamblers, then what they did isn't a crime. I mean, we're not criminals, right?

TABER: Antisocial personalities very seldom have the patience to stay in GA for long. They come in, cause a lot of trouble, and then split. So no, you’re not an antisocial personality, in spite of any wrong you may have done. On the other hand, our prisons hold many, many addicts who committed crimes to feed their habits. Some studies claim over 50 percent of prisoners are there because of addiction-related problems. Under the law, a crime is a crime. As I understand the principles of Gamblers Anonymous, everyone is accountable for all the harm they cause, financial or otherwise. And it makes no difference whether or not the harm was a result of an addiction.

Mental status sometimes makes a difference in how the courts deal with crime, but innocent by reason of insanity is a very rare outcome in a trial. Psychology and the law are worlds apart, and knowing one doesn't prepare you for the other. One of these days, I want to talk about how we deal with the legal problems of pathological gamblers. It's too complicated to get into tonight.

It’s not uncommon to have a double diagnosis of pathological gambling and some other serious mental illness. More often than not, though, when you have a major mental illness along with gambling, the gambling is more in the nature of problem, as opposed to pathological. The gambling is usually secondary to more disruptive mental problems.

Pathological gambling is a disorder of the vulnerable. When people are depressed, anxious, or in physical pain, they may call on something—gambling, alcohol, food, sex, or drugs—to help them feel better.

Psychiatric problems, including emotional illness as well as mental retardation, make the individual vulnerable to gambling and other addictions as a way of feeling better. However, it is my impression that most people with serious mental illnesses never gamble at all. And when they do, they are no more or less likely to have serious gambling problems than anyone else with other kinds of risk factors, such as poor health, physical disability, poverty, or loss of a loved one. It seems to me, if a person with a major mental illness does begin to gamble, it is far more likely that he or she will become a problem rather than pathological gambler. For the most part, psychiatrically ill people don’t have access to large amounts of money to bet, nor can they find many gambling outlets.

Most problem gamblers with psychiatric disorders, once they have come to terms with their emotional limitations and problems, seem quite able to moderate or even abandon their gambling. Some, of course, do turn out to be pathological gamblers as well, and these must learn to use long-term support such as Gamblers Anonymous.

Of all the psychiatric illnesses that seem to predispose a person toward gambling problems, the so-called disorders of affect are unique. In professional language, the term affect refers to feelings, emotions, and moods. When emotions get out of control, so does life itself, and that can lead to addictive behavior.

Unfortunately, some people seem chronically unable to regulate or moderate their mood swings. This can be due to extreme stress, biological factors, or genetics. Whatever the cause, strong and effective outside interventions are needed if these people are to have a chance. And that alone, without real willingness on the part of the individual, is not likely to succeed, either.

Al: OK. But like I said in the beginning, not all us gamblers is crazy, right?

TABER: Al, you are crazy, but don't change a thing. We love you like you are.

MICKEY: Is it possible, I wonder, to be a pathological gambler and not hurt anyone or commit any crimes? I know guys who live alone, and that's what they do with their lives. Whatever little money they get, they gamble it away. But they don't cause problems for others.

TABER: Right. I remember a wonderful old fellow who drove a taxi, lived mostly on rice, and spent all he earned on the ponies. I would have been miserable living his kind of life, but he was content. He was never miserable psychologically. He was doing exactly what he wanted to do, hurting no one, committing no crimes, living alone and doing his job.

Where was the pain and disability? Where were the illegal behaviors, the family problems, the job disruptions? True, he was preoccupied with gambling; in fact, it was his entire life. The man was also self-absorbed, but he knew exactly what he was doing. He knew he would never get rich gambling. He was content to spend all his money on his entertainment, and that was that. This fellow was clearly eccentric, but he was not crazy. Life was completely under control, and it gave him what he wanted. He had given up any dreams of a home, family, status in the community, even good health, all for the privilege of gambling at the racetracks.

Once, when I was a guest on a television talk show, a woman in the audience stood up and said, “I save my money and once each year I go to Las Vegas, 2,000 miles away, where I gamble day and night. When my money is gone, I just stay in my room until it's time to come home. Do I have a gambling problem, and should I stop going to Las Vegas?”

I could not offer her advice without a great deal more information, so I simply advised her to vote against any move to legalize casino gambling here in her hometown. She laughed, and I regretted not having given a better answer. Was she some kind of problem gambler, or is hers an acceptable, albeit unusual, pattern for a social gambler?

Chronic problem gamblers seldom come to the attention of treatment specialists, but over the years, I have heard of many and gotten to know quite a few. Many examples come to mind, but May Ann was special.

May Ann was 68, and lived in a poor section of East Cleveland. She had raised her children the best she could while earning a living cleaning homes in an upper-class suburban neighborhood. Now, on a small Social Security income, May Ann's daily habit was to bet on the  so-called policy number. The state lottery cost a dollar, didn't let you gamble on credit, and had to be played at a store five blocks away. But the numbers man for the illegal lottery took any size bet May Ann wanted or could afford to make on any given day. He gave credit up to a week or longer, knowing her Social Security check would arrive. Best of all, since May Ann had a hard time getting around, the numbers man came by her home to get her bets or deliver her occasional wins. He would even bring items from the store when she asked him to. She felt secure knowing that someone would be looking in on her every day.

May Ann also knew that the state kept over half the gross, while the illegal numbers boss gave back 80 percent or more to the players. His overhead was a lot lower, and so it was a better deal all around.

A staff nurse told me about May Ann, who wasn't eligible for treatment in our hospital. I visited her to learn more about her life. We sat and talked for a long time in her small front room, and I got a glimpse of life in a tenement complex. May Ann was a tough old woman with lots of determination and self-reliance. She owned only a few pieces of second-hand furniture and some old pots and pans. Her stove smelled of leaking gas, and the alley outside was full of discarded mattresses and garbage. But she was a bright, talkative, and caring person. Her Social Security income was small because most of the people she had cleaned for had not bothered to report her earnings, or pay their share of her Social Security. But May Ann focused on the brighter side, and complained of nothing.

She admitted she needed new teeth, and she confessed that she deprived herself of healthy food, clothing, and entertainment. There was no television in her small apartment, no newspapers or magazines. She obviously could not afford to live well, but she definitely could have had more material comforts. But the daily number took a large share of her tiny income, even though she never made really large bets. She saved enough out of each monthly check to play 25 cents or more each day of the month. If she had a strong hunch she would bet as much as $2 on a number. She was in control of her gambling. Although her game was illegal, it made a lot more sense to her than playing the state lottery.

Just as clearly, gambling was limiting her life and depriving her of extras such as a television, new false teeth, and glasses. I urged her to have someone look at the gas stove, but she laughed and said a repairman would cost too much. The property owner had told her to forget the smell and just air out her apartment occasionally. She was used to it, she said. She was more interested in telling me her system for picking numbers. She obviously had mistaken my interest in her gambling as the interest of a fellow player.

Where were the classic signs of pathological gambling in May Ann's case? There seemed to be no major pain or disability as a result of her gambling. Her history suggested no gambling-related crime, no suicidal thoughts arising from heavy losses, and no disruption of her social life. And yet I’m still reluctant to view her as merely a social gambler, since such a high percentage of her small income went toward gambling. She gambled daily, and more than she could afford to lose. But my standards are personal. The fact that I believe in them, and that they work for me, gives me no freedom to impose them on others.

Are people like May Ann compulsive gamblers? Are they really problems to anyone but themselves? Does society need to do anything about them? Certainly, she did not need to be hospitalized; her problem was not that severe. She would have felt very much out of place in a Gamblers Anonymous group. Since she didn't think she had any problem, she would not have done well in individual psychotherapy.

An effective and caring social worker could have helped her take better advantage of the community services in her area. I did mention the excellent health care available at the Cleveland Free Clinic, but she laughed at me, saying she would go there when she was ready to die.

There are probably millions of gamblers just like May Ann all over the country. Any night of the week, you can see people flocking to neighborhood bingo games. Where do they get all the money they spend there? Hundreds of busloads of elderly people enter and leave Atlantic City every day of the week. The bus people coming to Nevada from California and other states are called ‘up-and-backers.’ I believe their lives are often diminished in some important ways by gambling. Their individual losses may be small, but I wonder what portion of their income goes to these gambling junkets.

I hear of old people retiring to Las Vegas and playing the slots every day, or those who move to Florida and locate near a horse or dog track. We have no accurate reading on how many retirees manage to control their gambling, and how many lose far more than they can afford. I suspect not too many cross over the line to become full-blown pathological gamblers, but we don't know that. In a way, it would be better if they did, because then their increasing pain and misery might drive them in for help.

AL: God bless you and your work, Doc. Keep coming back.

MICKEY: Everyone, please take the hand of a neighbor and join me in the Serenity Prayer.

(Al grips Taber’s hand in the circle.)

THE GROUP: God, grant me serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. Amen.

Keep coming back.