Gambling involves wagering something of value on an event that is largely a matter of chance in the hope of realizing a profit. It has existed in virtually every society since prerecorded history and is incorporated into many customs and rites of passage. It has a prominent role in the culture of Native Americans, who have a long and distinguished history of gambling.
Although the majority of people who gamble do so for enjoyment, a small group become seriously involved in terms of time invested and money wagered, and continue to engage in gambling behavior despite adverse personal, family, social, and financial consequences. This group has been referred to as problem or pathological gamblers.
The prevailing theory of compulsive gambling is that it involves a deficiency of impulse control. This view is supported by data suggesting that individuals with this disorder have an underactive brain reward system, a tendency to take risks, and an inability to weigh the costs and benefits of their actions (Zuckerman, 1979; Cloninger, 1987).
There is growing recognition of the importance of evaluating patients for gambling behavior in primary care settings. This is reflected by the inclusion of pathological gambling in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and the development of screening tools for problem and pathological gambling.
The most significant challenge in addressing the issue of gambling is to identify when it has crossed the line from recreation into addiction. This is made more difficult because some communities consider it a normal pastime and may not recognize it as a problem. For those who are unable to stop gambling on their own, there are inpatient and residential treatment programs that offer round-the-clock support. There are also a variety of community-based interventions, such as family therapy and credit counseling.