Gambling: a dependence without a drug

This paper reviews the research literature on excessive and persistent gambling with particular emphasis on the reasons why such behaviour has come to be classified among the addictions. The characteristics of gamblers who seek help from mental health agencies are discussed in relation to the diagnostic criteria for ‘pathological gambling’ given in DSM III-R.⁵ Although there have been few controlled treatment evaluations the range of therapeutic approaches employed in Australia, the U.S.A. and the U.K. are reviewed. A variety of theoretical models have been proposed to explain the psychological and physiological processes that may underlie the progression of this behavior from an infrequent leisure habit to a costly, all-engrossing, addictive-like preoccupation. These models are critically reviewed in the light of existing empirical findings. The evidence that excessive gambling shows features of dependence despite the absence of a psychoactive agent is evaluated. The concluding section of the paper explores the potential theoretical and clinical benefits inherent in classifying this behavioural excess as an addiction.