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Bad Bets
February
2001
by Bruce Fellman
In the
hit song "The Gambler," Kenny
Rogers had this advice for listeners: "You got to know when
to hold 'em, know when to fold 'em; Know when to walk away, know
when to run."
Most
gamblers know when to leave the card tables, slot machines, lotteries,
and other legal games of chance on which Americans wagered more
than $50 billion last year. But, says Marc
Potenza '87, '93PhD, '94MD, an assistant professor of psychiatry,
"nationwide, we've seen a dramatic increase in the number of people
with gambling problems in the past several decades."
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"You
got to know when to hold 'em, know when to fold 'em."
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Consider
these odds, says Potenza, director of Yale's Problem Gambling Clinic.
In 1998, 86 percent of the adult population reported gambling at
some time in their lives -- the figure was 68 percent in 1975 --
and experts estimate that up to five percent will experience difficulties.
(One national survey put the cost to society at $5 billion annually.)
While
there have been casinos in Las Vegas since the 1930s, the modern
gambling era began in 1964 when New
Hampshire legalized a state lottery. Since then, three dozen
states have followed suit, and now, from the office Super
Bowl pool to multimillion- dollar Powerball
jackpots, it has become in most locales almost as easy to place
a bet as it is to breathe.
A lottery
helped Connecticut provide funds for Yale in the early 1700s, but
the state got into the gaming business in a big way more recently
with the introduction of off-track
betting, jai-alai, lotteries,
and the opening of two Indian-operated casinos. While all of these
have generated large amounts of revenue, they also had significant
human costs.
"The
Connecticut Council
on Problem Gambling opened a hotline in 1994, and they now receive
over a thousand calls a year," says Potenza. Not much was known
about these individuals, so in 1997, Potenza, then a resident fellow
in psychiatry, began the clinic, a joint effort between Yale and
the Connecticut Mental Health Center, as a way to coordinate research
into the biological causes of problem gambling and effective ways
to treat a condition that, increasingly, is seen as a mental illness
rather than a moral weakness. "Pathological gambling, the most severe
form of this addictive disorder, affects about 1 percent of the
general population of this country; that's about the same percentage
of adults diagnosed with schizophrenia and bipolar conditions,"
says Potenza.
In the
PGC, Yale researchers have worked with powerful imaging techniques
to determine where in the brain the gambling urge takes shape, and
the clinic was chosen as one of only four treatment sites in the
country to test the effects of drugs and behavorial therapies in
helping gamblers kick the habit. Potenza and his colleagues have
also conducted work that reinforces the notion that gambling is
an "addiction without a drug" and investigated, using information
generated by calls to the hotline, the differences between men and
women with gambling problems. (In a paper published last September
in the American
Journal of Psychiatry, the PGC researchers showed that while
men are more likely to get into trouble with "face-to-face," strategic
games like poker or blackjack, women's gambling problems tend to
involve "escape-oriented," nonstrategic forms such as slot machines.)
The psychiatrist
notes that while these investigations show promise, a cure remains elusive. Progress is slow because gambling is a complex and all-too-human
activity. Says Potenza: "It taps into some of the core behaviors
-- the assessment of risks, rewards, and punishments -- we do on
a daily basis."  |
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