Chapter Four

After the first conference concerning Tom ended and his significant others had wandered down the hall, I made my way to our group room with a brief stop at my office, where I found the message slips had grown in number. Perhaps Amy and I could work through lunch break to return some of the calls, since much of the afternoon would be taken up with my lecture and, of course, the Great Mouse Crisis.

Upon entering our group room, I could sense something was disturbing our little band of six resident gamblers. We had decided that today Steve would start the group by reading his short autobiography but clearly something else was on their minds.

“We might be having a visitor to the group today, if you fellows don't mind,” I began. “His name is Tom and he's interested in getting help for a gambling problem. He may be offered the chance to enter the program, but he thinks he can do it by himself. If he met some of you and sat in on one of our group sessions, he might lose some of his fear of being in the hospital. I told him to come by in about 15 minutes. Does anybody object?”

No objections. The gamblers were always eager to have newcomers.

“Good. I have one other announcement before Steve starts. There's to be a special inpatient government meeting for all staff and patients at 3 p.m. in the dayroom. Everybody be there.”

At that moment Tom, early and eager to be in control of his life, stuck his head in the door and didn’t wait to be invited to speak. “Hey,” he said, “I saw my whole family in the parking lot, Dr. Taber. All they’d say was that they were here learning how to help me in the right way. With their help I know I can make it without taking time off to be in the hospital.”

“They're a great family, Tom,” I replied. “Right now we have Steve scheduled for his autobiography, so we'll have to talk about your family later. Grab a chair and relax and just listen for now.”

“Yo, Doc,” said Steve. “We got a problem to discuss before I get going.” Steve was a big, bearded man in overhauls, a steel worker from the local mills who couldn't stay away from the illegal dice games that went on day and night on roof tops, in bars, and in locker rooms throughout Cleveland.

“Bill, you tell 'em,” urged Steve. Bill, a stockbroker from New York City, was president of the inpatient government. The alcoholics usually elected one of the gamblers as president because they were themselves often shy while the gamblers gave the impression of confidence. Besides, the gamblers were usually flattered, and they loved being the center of attention.

“We're all worried about old Benjie,” Bill started. “His mouse turned up missing this morning and he's all upset.”

Old Benjie, not a member of my therapy group, was an alcoholic who had been in and out of treatment for years. We all knew he probably didn't have another drunk left in him. His liver was nearly gone and his brain wasn't far behind. Yet he was a friendly, talkative old man who listened well and was always optimistic. He was on the waiting list for our nursing home care unit, and we hoped to get him transferred there before his time on the Alcohol Treatment Program ran out. Benjie was one of those burned-out alcoholics who never drink in the hospital, so if he never took passes he’d be fine. He was totally unable to live on his own in the community, and his medical problems were now severe enough to earn him a long-term placement in nursing home care.

“What mouse it that, Bill?” I asked, fearing the answer I knew was coming.

“We hate to rat (snicker, snicker) on Benjie, but he's been keeping a pet mouse in his locker. He loves that damn thing. It lives in a big jar with holes in the lid, and he takes food to it from the mess hall.”

“You fellows didn't by any chance share some pizza with Benjie and his mouse last night, did you?” I asked.

“Jesus, Doc, how did you know that?” muttered Steve.

“I have my spies. Hey, guys, we have a bigger problem here than you think.”

“Right,” said Bill. “If Benjie doesn't find his mouse he might go out and get drunk, and that would kill him. There’d be no chance of his ever getting into nursing home care. But if they find out he has a mouse they'll kick him out and he'll get drunk anyway. We gotta find that mouse.”

Tom the newcomer spoke up, “Is this what your group therapy is all about, Doctor Taber? Some friggin’ mouse?”

“Hold on, Tom,” I said. “How the fellows handle this is important. It could be a learning experience for all of us.

“Benjie's very forgetful sometimes, you know. Do you suppose he might have forgotten to put his mousie to bed after the pizza party last night?”

“Jeez,” said Bill. “He said he’d hang around and clean up the kitchen, so we all left to watch TV.”

“I have sad news, guys,” I said. “Our housekeeper and Benjie’s mouse had a run-in this morning. Unfortunately, only the housekeeper survived. Mouse is history.”

“Oh, shit,” was the collective response. Even Tom seemed to be getting caught up in the drama. Now, suddenly, the group had a mission, a cause to fight for. Gamblers are in love with the chase, any chase. Personal problems all forgotten, they jumped into the action of saving Benjie from himself.

“What makes Benjie's problem your problem?” asked Amy.

“Have a heart, lady,” Steve said. “This is life or death for Benjie. We can't let him find out his mouse is trashed. It might kill him.”

“I don't want to know any more about Benjie and his illegal mouse,” I said. “The 3 p.m. meeting is about keeping things clean so we don't attract mice or bugs. The housekeeper, I'm sure, is planning a dramatic, blow-by-blow account of his victory. So far, nobody on staff but Amy and I know anything about a pet mouse. I can manage to miss the meeting and probably arrange for Benjie to be called over to the nursing care unit at 3 p.m. to get a tour of the place. What I can't do is replace the mouse. Once he gets transferred to nursing home care they might even allow him to keep a little pet. Some of the guys over there have canaries or hamsters. Maybe you can figure out what to tell Benjie, but sooner or later he's going to have to learn the truth. Besides, let's keep in mind that Benjie treated his mouse a lot better than he ever treated his wife or children.”

The group went on to hear Steve's autobiography. We discussed it for a while and then broke for lunch. I noticed that Tom rushed out without a word. I had hoped he might want to share a few impressions of the group with me, but he was down the hall and on an elevator before we could make eye contact.

Amy and I didn't work on the message slips over the noon hour because the Chief of Psychology had left a message asking us to meet with him at lunch to talk about internship rotations. And then I had to hurry back to the unit to be ready for my patient lecture at 1 p.m.

As I entered the day, room I noticed that Tom's sister and brother were seated to one side of the room. I gave them a big smile and launched into my gambling lecture. The 30 or 40 patients in the room hunkered down for the duration. Some seemed a bit sleepy, not unexpected since they’d just had lunch. But the gamblers were alert. They loved any recognition of their personal disorder since most of the lectures they heard from other staff were about alcoholism and drugs. What follows here are some of the points of information I usually tired to cover in these lectures on gambling.

First, I reviewed some of the guidelines we used in diagnosing pathological gambling: Preoccupation with gambling, a need to increase the size of bets to get the same level of excitement, legal and financial problems, chasing lost money, and so forth.

Question from the floor: “Yo, Dr. Taber. I'm just an alcoholic. Why to I have to listen about gambling?”

“Because, friend, if you do stop drinking when you leave here, the battle isn't over. I've seen quite a few recovering alcoholics who thought they had life under control come back with gambling or drug problems.”

I went on to mention that gambling has been causing problems for just about as long as alcohol, and that there is a very real danger we will fail to learn from history, or from the experiences of others. I offered a brief example of an amazing lady who will always live in my memory because of her consistent ability to select, for romantic purposes, just those men who were either alcoholics or gamblers. Worse, she picked them out while they were young, while the alcohol or the gambling was still under control.

Some wags would say she drove them to it, but I think she has an incredible sensitivity to certain personality characteristics that precede and predict a tendency to addiction. She detected these characteristics early in the game, and she found them attractive and exciting. “A moth to the flame,” as the old saying goes.

Like so many wives of alcoholics and gamblers, she was the daughter of a man who was both. So she knew the image well, having had a gambler-alcoholic as her first and primary male authority figure. When last we met she was on her fifth husband, and was still unable to understand why they had all been compulsive gamblers and/or alcoholics. I don't like to blame the victim, and certainly she had been victimized by her own unconscious mind if not by her sad collection of husbands. But, I finally told her that her taste in men was, to say the least, abysmal.

She was an incurable romantic and found this opinion hard to accept. I told her that since her own selection had been so unfortunate in the past, if she insisted on getting involved with men in the future, the only way out of her problem was to find and marry that man among men whom she found least exciting psychologically.

“Find some boring, plodding, unexciting, hard-working, average guy,” I told her.

“You mean someone like you?” she blurted out.

My audience, at this point, had a loud guffaw at my expense.

I knew that she was not trying to insult me; she had separated me from candidates for romance not because she thought I was repulsive, but because I simply didn't have certain body language or response styles common to the addiction-prone individual. She hastened to explain that she thought of me as normal, sensitive, responsible, and caring. She realized that she considered herself unworthy of any normal man, but she also realized that she found normal men romantically unexciting. If it were not for my professional interest in gambling problems, that  lady and I would have had nothing to say to each other.

In attempting to allay her embarrassment, I assured her that I was the dullest of plodders and had none of the courage it takes to be impulsive and reckless. Also, I had to admit to myself that I was uncomfortable with this lady's extravagant style of dress, her heavy perfume, her flashy jewelry, and her overdone makeup. Not my type at all.

Unfortunately, she would find it difficult to learn from experience. She would probably go on liking exciting men who made her miserable because she did not understand the emotional needs that prevented her from making good decisions when it comes to men. Gamblers and gambling are exciting, and she chose excitement over security every time—just like a gambler.

“Hey, guys,” I said. “Can you tell an alcoholic when you first meet him even if he hasn't had anything to drink?”

The response was generally affirmative. Most were sure they could pick up telltale signs of alcohol abuse from appearance, speech, and clothing. “Alcoholics are just different,” they said.

“So are gamblers,” agreed the gamblers in the room.

Question from the floor: “Dr. Taber. A lot of us don't really like the women who attach themselves to us addicts, but, hey, everybody needs love.”

“So you settle for someone you don't really love rather than give up your addiction and become a different kind of person?”

There was considerable nodding of heads around the room. It worries me when uncritical marriage counselors start patching up relationships primarily based on addiction-attraction, since, upon the development of a sober or clean lifestyle, the original basis for the marriage may now be gone. Both partners must grow up together, and often that just doesn't happen.

I went on to discuss the effects of problem gambling on family, friends, and society. Gambling problems, although they seem new in our time, are age-old, and part of the human condition. I sketched out a picture of the families of mankind gathered about some astral conference table, a group called together to discuss and resolve certain general, timeless, and abstract problems posed by gambling and gamblers. What, if anything, shall we do with, to, for, or about the gamblers of history? What, in the long run, shall we do about gambling, this persistent, sometimes pernicious and vexing addition to the human caravan? And what, after all, is the real problem?

I pointed out that our feelings about gambling in general are as strong and as baffling as the love-hate confusion shown toward a gambler by his family. As Americans, we have no clear-cut national policy toward gambling. We have no widely approved treatment method for problem gambling. Even our churches have no consistent policy or philosophy toward gambling and gamblers. Neither the criminal justice system, the business community, nor the medical establishment—none of our great human institutions—has a clear and consistent policy, view, or concept of gambling.

Gambling makes the same secret and personal promise to every problem gambler it attracts. No player can believe that this compelling and seductive mistress could be so unfaithful, that she could make the same sexy commitments to so many strangers. Rage, disappointment, and depression follow the realization that behind the irresistible face and beautiful smile lies the deadly, grim reality; gambling systematically drains all of one’s resources, energy, and compassion. No other devastation is quite like it.

The progressive pattern of behavior in the problem gambler is always the same. First the blame is placed on some intangible force, such as luck, fate, or chance. Or the player will blame himself for not having enough money, time, or experience to beat the odds. Next the disappointed gambler lashes out to blame friends, family, circumstance, or job. Only after prolonged loss and pain does it occur that gambling itself may be to blame, and then many a reformed gambler crusades endlessly against legal gambling, casinos, or bookmakers. In becoming a prohibitionist, the gambler may further neglect personal growth and development.

But gambling itself is only game-playing. It has no mind or will of its own apart from the life the gambler gives to it. There is no evil inherent in a simple game; it's how the player uses the game that makes the difference between recreation and compulsion. In the end, the gambler is left alone with self-recrimination and with the frighteningly difficult tasks involved in becoming a better person.

This stark choice is clear if you live in a gambling town like Las Vegas, where gambling is everywhere. Here you must learn to ignore gambling, or limit it severely. The locals use the term Nevada Syndrome to refer to the newcomer to that state, many of whom lose a paycheck or two in the casinos before they either put gambling away like the childish toy it is, or go down to ruin as a pathological gambling. It all happens very fast in a gambling town.

The wife or husband of a compulsive gambler will often show the same stages as the gambler. First she sides with her beloved, and joins him in blaming the unfairness of chance, or the odds. Then she may agree that more money, a different city, or some other job would help solve the gambling problem. She gets loans from her parents or takes a part-time job, thinking that more money will help. Finally, she accuses the gambler of causing all her problems; life would be beautiful if only she could get away from him. Or, she may go on a crusade to eliminate gambling by calling the bookie, going to the track to beg them not to admit her husband, or by trying to cut off his credit.

In the end the spouse-victim must stop and ask why she was attracted to such a person in the first place, and why she chooses to go on living with him. Just as the gambler must admit that he is powerless over gambling, she must admit that she is powerless to change or control him. She can go on blaming everything but herself, or she can start the very difficult process of changing her own ideas, values, and behaviors.

Men, too, often find themselves attracted to risk-taking women. It works both ways, and the husband of a problem gambler goes through the same process.

As a people and as a culture, we face the same problem and the same inevitable conclusion: Gambling isn't going to go away and we can't bury it, forget it, prohibit it, or control the desire of people to do it. All we can do is look at our response to risk and try to understand what it is about our personalities that makes us vulnerable, either to games of chance or to those who love to gamble.

The earliest records of gambling are over 5,000 years old. Among the oldest relics of the Egyptians, Jews, and Chinese were found games of chance, crude dice, and pictographs of gambling events. The Bible speaks repeatedly of casting lots to prove ownership of land and goods. And let's not forget the vivid image of gambling among the Roman soldiers who cast lots for Christ's garments at His feet, even as He died. Wall paintings in Rome and Pompeii show men and women engaged in various sorts of gaming. While the Moslems and other followers of strict religions spoke out against gambling, calling it a sin, early sanctions against gambling in ancient Greece and Rome gave way to frantic gambling in public and in private.

The emperors Augustus and Claudius were said to be obsessed with gambling. Richard the Lionhearted as well as many of those he led on a crusade to the Holy Land loved to gamble; in fact, gambling among both lords and common men eventually had to be regulated.

Soldiers and sailors have always whiled away the long hours of harsh military life by gambling among themselves. The English troops under Wellington, and the officers under George Washington, gambled. Our first president promoted public lotteries to accomplish projects such as road building; he was himself an avid gambler at horses and cards. George IV, King of England at the time England lost the American Colonies, was, by every account, a pathological gambler.

“How many of you guys gambled for the first time when you were in military service?” I asked my audience of veterans. Two-thirds of the hands went up.

“And how many of you lost a whole month's pay at least once in service?” About half the hands went up.

“Shit, I never had any money in service 'cause I always lost it at dice,” grumbled one of the alcoholics from the back of the room.

The famous Faneuil Hall in Boston was paid for in part by public lottery in 1762, but long before that, in 1612, the Virginia Company was raising money to support its American colony through a public lottery. Both sides in the American Revolution were financed in part by public lotteries, and from 1790 to 1810 the U.S. federal government tried to raise money to build our Capitol in Washington, D.C., with a national lottery.

The most famous American riverboat gambler seems to have been one George Deval, who wrote Forty Years a Gambler on the Mississippi. He was a clever cheat whose flashy and conspicuous style appeared to suggest wisdom and easy success. Among history's dedicated and perhaps pathological gamblers we must include Edgar Alan Poe (the opium lover), Wild Bill Hickock, Billy the Kid, Feodor Dostoevski, Leopold II of Belgium, Sarah Bernhardt, and a host of others, including a number of Roman Popes, modern movie stars, sports heroes, military leaders, and even members of Congress.

Obviously, all these people are not just eccentric, weak personalities. Dedicated gamblers often are the best and brightest among whatever group they represent. They’re almost always men and women of high potential, unusual drive, and considerable charm. Could it be that our genes favor those who take risks over those who hunker down in the cave in fear of the chase?

Casino gambling flourished for several centuries in many cities of the world and became legal again in Nevada in 1932. Gambling has long been an entertainment mainstay on our western frontier. In fact, gambling in Nevada prisons was legal for quite some time, because it was thought to give the restless prisoners something to do with their energies.

Gambling became legal in England—again—about 1960, having been generally suppressed by law since the late 1800s. The United States’ experience, although shorter than England's, is characterized by a similar waxing and waning of gambling passion. In the U.S., state lotteries began to become legal—again—starting in 1963, when New Hampshire initiated a lottery to finance education. Like alcohol abuse, gambling was epidemic in England and the United States during the 19th century, and excesses in both pastimes led to desperate laws like the U.S. Volstead Act in 1919, which prohibited all alcohol manufacture and sale.  

With prohibition the crime rate soared, while drinking of what was often more toxic alcohol continued almost unabated. So it has been with gambling. Attempts to outlaw it only force it underground. Faced with prohibition, those who would gamble seek it out through illegal channels. Others, who cannot find illegal gambling outlets, merely substitute other addictions. Prohibition, rationing, regulation, and the hundred other strategies to combat gambling all miss the point, and serve only to make the problem worse.

The point is, only a minority of certain vulnerable individuals develops problems with gambling or other addictions. The task is to understand this, and, hopefully, immunize these vulnerable individuals so that they can abstain from what is, for most of us, only a pleasurable pastime.

This seductive gaming, this harlot among pastimes, again and again draws passing generations to its breast, only to be rejected in disgust and fear as the relationship inevitably sours. Laws are passed to encourage gambling only to be replaced by laws forbidding and regulating it. The families of mankind have tried again and again to understand the nature and attraction of gambling, but each conference seems to end in bickering and a conflict of emotions. No single policy or practice stays comfortable for long.

Politicians see gambling as a voluntary taxation scheme. Gamblers see it as a way to quick riches. Educators may see it as a way to teach competition. The religious may see it as a way of divining God's will or, more recently, as a way to support the church itself.

Here, then, is the heart of the dilemma: We allow our needs and dreams to control our vision, so that we see in gambling unrealistic solutions and benefits. What we fail to see are the costs and dangers that turn out to be enormous. If there is ever a solution, it must lie in changing our needs and dreams and expectations. We must outgrow gambling. Only then will it wither away and die from disinterest. Our only hope is increasing maturity.

Once again, in the late 20th Century and into the 21st, the popularity of gambling is on the upswing because we see it as a solution rather than as a mere plaything. Can a trivial game be the foundation of important social benefit? Is it something upon which we can build our culture? Clearly, state-operated gambling is regressive taxation that takes mostly from the most vulnerable. Will we live to see a War on Gambling like the failed War on Drugs?

If, by some magic, all the addictive drugs in the world suddenly vanished, we would still be us. Rather than change the ways in which we think and feel, we would still try to reach out for something to fix our eternal yearning for excitement, some way to fix the pain created by our own unrealistic desires.

In the life of a compulsive gambler, and in the history of gambling, we see this love-hate conflict played out again and again. In trying to control the gamblers in our lives we resolve to stop helping him or her, and then we break the resolve and hope that one more bailout, another act of kindness, will stop the gambling. With that behavior we are much like the gambler who is constantly resolving to stop, moderate, or control the gambling.

Gambling is only one of many different addictions that show similar historical patterns. When coffee was first introduced into Europe a few hundred years ago, controversy surrounded it. The defenders of the bean found that it gave a pleasant edge to social events. It had a good taste, blended well with food, seemed to cheer one up, perhaps stimulated thinking, and provided a social ceremony in the coffeehouses that soon flourished in every city. Connoisseurs noticed how well it blended in with sugar, alcohol, fine tobacco, good food and—yes—gambling.

Coffee's critics alleged that it damaged family life by keeping men away from home through the lure of the coffeehouse. Coffee was said to be a poison that sapped the will and destroyed normal rest. It frenzied the mind, so to speak. Health authorities still debate the merits of coffee drinking, and not a few people seem to become psychologically dependent on the lift coffee provides. Individual consumption can run to 20 or 30 cups per day, although medical authorities say that two cups of coffee per day is a medically safe dose. Coffee, by the way, is especially beloved by alcoholics.

Coffee beans, like problem gamblers and games of chance, are quirks of nature. The coffee tree needs a bean for reproduction, and if humans get a boost out of roasting, drying, and brewing them, it's not the tree's fault. The harm, if there is any, is our own reaction to coffee. We could blame coffee for our insomnia and we could try again to ban its importation. We could take sleeping pills to cure its effects. Or we could just stop drinking the stuff, realizing that a perfectly good life is possible without it. In other words, we could simply change our minds about what seems important.

Generations have tried to deal with coffee through prohibition, rationing, moralizing, education, abstinence, and so forth. But coffee is just a bean and is neither devil nor rogue. The rogue lies within the user.

Alcohol is a better example. So-called beverage, or drinkable, alcohol is a simple chemical, the metabolic by-product of yeast cells, which turn oxygen and sugar into carbon dioxide gas and alcohol.

Efforts to control human abuse of alcohol included vilification of Demon Rum, said to exert an evil power over people. But alcohol is a chemical that does nothing to anybody until it enters a susceptible human nervous system. There it triggers or releases the rogue, a personal feature in some individuals that we seldom see in social drinkers.

Most people are uncomfortable being drunk or half-drunk, but for others it is like coming home or like having a great weight lifted from the shoulders. Thus, some people avoid excess alcohol, while others constantly seek to recreate the buzz it produces. We can pour the drunkard's rum down the drain, but we cannot empty him of the quirks that make him susceptible to the alcohol experience. Only he can do that by immunizing himself psychologically and physically to the need for an altered mood.

In addition to coffee and alcohol, controversial villains also include tobacco, sugar, tea, cocaine, pornography, money itself, and marijuana. Time and again, our attention is focused on controlling a substance rather than on strengthening our personalities so that we become uninterested in, or detached from, these dangerous triggers.

And gambling is merely that, a trigger that in some people evokes uncontrolled, selfish, and even antisocial behavior. It brings out the rogue. Gambling triggers irrational behavior in the gambler, and this evokes the emotional storm of conflicting impulses in family, friends, and business associates. To blame gambling, however, is only to postpone the hard work that must be done in changing needs, values, and personalities.

Three general factors seem to control gambling's appeal: environment, the nature of games themselves, and—most important of all—personality.

Looking first to the environment, we now know that exposure to gambling early in life and the ready availability of gambling activity are common factors in the lives of excessive gamblers. It is especially hard for a young person to avoid joining the gambling crowd when gambling is viewed as glamorous, macho, or smart.

It is also very difficult for a young person to ignore gambling when a parent or other admired adult models and demonstrates gambling. Our competitive society values quick and dramatic victory over difficult odds. This also builds the appeal of gambling. Our children grow up to value what we value.

Other environmental factors include state sponsorship of lotteries, church supported bingo games, high school Las Vegas nights to raise money, and commercial advertising. Films, books, and television highlight the exploits of gamblers. Casinos cater to the big shot image that is so important to gamblers. They do this by using an atmosphere of upper-class elegance, formal dress, gifts of free food and drink, decorations such as larger-than-life nude statues of Roman gods at play, complimentary rooms for high stakes players, and lavish stage shows.  Clocks are banished from casinos in order to create freedom from time pressures. Every effort is made to magnify the clanking of coins in metal bins at the slots, and to encourage the shouts of victory at the gaming tables. Flashing colored lights hypnotize the patrons.

While most tourists realize that all this is only a dream world of fun and fantasy, the casino atmosphere is a heady wine that can quickly dissolve a fragile ego and intoxicate an immature personality.

Secondly, the nature of games themselves, as professional managers of gambling services know, is also associated with the lure of gambling. The racetrack moves at a slow pace as gambling games go, but once the horses are off, the thrills of the action are densely packed together. In horse betting there may be 20 minutes or more between races, but the excitement is fed constantly by the gambler's own ego as he spends the time concentrating on his racing forms and various taut sheets. In this manner, he imagines that he exercises great skill in handicapping the entries.

Attractive casino games are fast-paced and offer the chance to make bets one right after the other. For this reason, and because payoffs are frequent, the slot machine is the most popular revenue producer in casinos. In craps, a bettor can have any number of bets simultaneously, and there is a potential outcome on every roll of the dice!

Many games of cards and dice offer the illusion that skill will overcome the house advantage. The most attractive games allow for active participation to enhance the illusion that skill and personal control, rather than blind luck, are at work. Indeed, skill is often an element, but never the crucial element. Management sees to it that the inevitable house percentage makes all casino games profitable.

Lottery players are attracted by huge payoffs in the millions of dollars; this gives them the chance to feel that the potential payoff could change their lives completely. But in truth, the odds of winning are heavily stacked against them. The dream of winning $5 million at impossibly long odds appears more attractive than the chance of winning a few hundred at much better odds, especially when it costs only pocket change to enter the big game.

The availability of credit is always an incentive because it makes gambling easier. This is why the illegal numbers racket is often more popular than the state lottery. In addition to extending credit, the local numbers man will come to your home to pick up the bet, and he takes even very small bets, whatever you can afford to play. And his game goes off every day, not once a week like the state lottery. While casinos are expert in keeping track of credit records, in order to exploit credit to the limit, bookmakers have profited for decades by giving the convenience of credit to their customers.

Convenience is a major factor in the popularity of a game. This is why off-track betting—betting on horse races in seedy storefront offices right in town—has made racing a major source of revenue for the State of New York without increasing attendance at the tracks. It is not uncommon to see welfare recipients and their children gambling in off-track betting offices, on what was once called the sport of kings.

Not winning every bet is perhaps the most compelling single feature about gambling. Perhaps the quickest way to stop a gambler at her favorite game would be to let her win just a little more than she placed on each bet. She isn't really interested in money anyway. With the special challenge gone, gambling would suddenly become a drudgery of boring work. If you made, let’s say, seventy-five dollars in eight hours just pulling a lever, wouldn’t you want a better job?

Psychologists speak of schedules of reinforcement when they talk about the frequency and size of the payoff. In general, once the gambler has learned how to play a given game, gambling behavior can be maintained easily with only an occasional payoff. It is a paradox that behavior becomes ever more persistent the less frequently it is rewarded. Casinos have become very adept in adjusting schedules of reward to maximize play, while minimizing payout.

Especially fascinating to the player are fast games that allow frequent betting, unpredictable payouts, and the hopes of an occasional very big win. If the game offers the illusion of skill, so much the better.

Various game features also interact in complex ways with the personalities of gamblers. For example, people who are loners or introverts can play slot machines or mark keno tickets without ever talking with anyone. For extroverts who love a crowd there are the dice tables, racetracks, and card games. Electronic poker machines can mesmerize people with chronic pain so that the pain seems to disappear as long as they are gambling. For those with high anxiety who would not otherwise take real risks, alcoholic drinks are served free in casinos. The alcohol quickly reduces anxiety and allows the gambling impulse to run free. Indeed, gambling is one of the most complex of all addictions.

It is personality, however, that is critical in understanding vulnerability to addiction. Certain personality characteristics seem to predispose an individual to gambling problems. Among these are low self-esteem, a strong competitive drive, high energy levels, poor impulse control, inability to step back and see the big picture, and a variety of mental disorders. Many compulsive gamblers abuse alcohol or other drugs, many are hyperactive, and most have significant problems accepting authority.

However unrealistic it may be, gamblers often have a sense of being very special people. This sense of personal specialness includes a feeling of having a special destiny, special skill, and special insight. The natural laws that govern ordinary people—thinks the gambling-prone individual—simply do not apply to his situation. Compulsive gamblers tend to admire such myths as Santa Claus, and they believe in silver linings, pots of gold at the ends of rainbows, and the luck of the Irish. They can be witty, charming, devoted, and generous. But, caught in the hopeless frenzy of endless and insatiable addiction, they become alienated, cruel, abusive, and capable of any crime to get money for gambling.

Since it is often hard to see gambling as only a small part in the big picture of life, it is especially hard to give it up when the gambler is emotionally upset.

For some of us, then, a deadly combination of environmental influences, game features, and personality can set into motion a process that leads to an irrational, progressive, and eventually irresistible urge to gamble again and again. No one really knows what actually causes pathological gambling; we only know some of the complex forces that lead a person in that direction. In all probability, no two pathological gamblers get to the point of losing control by the same route, or for the same set of reasons. There is no simple, single cause. If you are looking for a single cause theory of pathological gambling, you are looking for an easy way out of a dense forest.

Knowing the causes would not fix the problem anyway. As we shall see, getting a compulsive gambler to stop gambling involves none of the forces that created the merry-go-round in the first place. In view of our present psychological knowledge, it would probably be a lot easier to create new compulsive gamblers than to stop old ones. In the long run, it will not be our task to understand gambling, but to understand instead the abstinence-oriented lifestyle. That has always proved to be the harder task, especially for gamblers. But it is the only one that works.

Well, all of these points I’ve made were points I tried to get across to addicts every time     I spoke to them about gambling. In other lectures, our staff would point out the need for personal discipline and for tough love in overcoming addictions. To admit that love has limits and conditions is hard; this idea smashes our romantic dreams and ideals. It contradicts many of the teachings of religion and psychology. But it is the choice we must make if we are to work effectively with addiction. It is a choice, not a mandate. But tough love works.

Will the families of mankind ever be able to do the same with gambling itself? I suspect they will eventually, but not during my time on earth. We can take the first step, however, by realizing that gamblers who lose control of gambling do not do so because of moral weakness or willful misbehavior. Surely they have flaws of character, but so do children and adults. Gamblers’ character defects are not really their fault, and defects can be corrected through therapeutic programs. Problem gamblers may have problems that predispose them to getting caught in the trap of excessive gambling, but they are not bad people. Modern science interprets their behavior in a non-moralistic and non-judgmental way. We say they have a disease, a disorder, or a maladaptive coping response.

This puts some of the responsibility for corrective action on the rest of us. A moralistic approach actually would avoid our responsibility and leave the victim to fend for himself.

Although the theoretical interpretations of scientists vary, none of them place the blame for the problem on the gambler. He or she is certainly accountable, and we hold the gambler responsible for taking control of personal growth and recovery, but we do not blame him for getting sick or falling victim to forces beyond his control.

In fact, the very nature of gambling obviously attracts and exploits some of the most valued human qualities. Our country was built by risk-takers who sought a special destiny and somehow managed to beat the odds in defiance of established authority. Many times, in talking with patients, I describe pathological gambling—and all of the addictions, in fact—as a disorder of strength, not of weakness.

The problem in recovery from addiction seems to be that having been steeped in action, having lived on the edge for so long, a quiet and normal life appears to the gambler to be dull by comparison. We see the same problem in soldiers who have fought in a long war. Civilian life is far less dramatic, significant, and exciting than combat and preparation for it. What we value in battle, we disdain in peacetime. Of what value is the impulsive courage, the incredible physical stamina, or the willingness to risk everything, when the smoke of war has passed away? Those veterans who cannot adjust to peaceful, dull, civilian occupations tend to remain social misfits, waiting either for the next war or some exciting substitute. It is little wonder that many veterans of combat resort to gambling, alcoholism, or drugs to replace what is missing in their lives.

The professional soldier taken from the battle, like the gambler removed from action, suffers a drastic blow to self-worth and self-esteem. He or she finds nothing to lift the depression, nothing to replace the old excitement, and so chafes under the expectations of others to act, think, and feel differently, as a civilian.

By the time I had ramble on in my lecture for nearly an hour, most of the men in the room were fingering cigarette packages and looking fidgety. I brought my remarks to an end with a reminder of the special meeting at 3 p.m.

Benjie, the old alcoholic, was quickly at my elbow. “You make gambling sound real interesting,” he said.

Whoops. That hadn't been my purpose.

“You know, Dr. Taber,” he continued, “I always wanted to try my hand picking winners at the racetrack. Do you think that would be a good hobby for me when I get out of the hospital?”

“Not really, Benjie,” I replied. “For one thing you don't drive anymore, and they do charge admission. By the way, be sure to stay around the ward. I think Nursing Home Care might want you to go over there for a little look-see this afternoon.”

I found Amy, we divided the phone messages up, and then locked ourselves in our offices to make the calls. My first call was to Hank, an aide in the Nursing Care Unit. He agreed to pick Benjie up at about 2:45 that afternoon, for a tour of the unit. This little deceit would spare Benjie having to hear about the destruction of his pet mouse. I'd break that news to him myself, before I left for the day. And I didn't want to think how Benjie would react to the mouse-killing housekeeper, who was sure to be at the meeting. I had already explained to our staff that Amy and I were so swamped with phone work we would have to miss the Great Mouse Meeting.

Next, I talked to prospective patients on the phone trying to explain the waiting list, describing what the program was like, and covering all the other details that mark the transition from life in the fast track to life in a VA hospital. One man wanted to be sure I would help him with legal problems, and I explained the conditions under which I would be willing to cooperate with his attorney. Another man wanted to get his father into the Gambling Treatment Program before the old man lost the rest of the dwindling family fortune on the stock market. So it went.

Finally, about 45 minutes after normal quitting time, Amy and I met briefly in the hall as we got ready to leave. I noticed none other than Tom, the subject of this morning's family conference, standing with a few of the gambler patients in one of the side halls near the patient bedrooms. Concerned, I walked over to ask what was up.

They were as excited and as pleased as grade school boys looking at a girlie magazine in the boys’ washroom. “You know what Tom did, Dr. Taber?” asked Steve. “He went out and bought a mouse at a pet store, and we got it sneaked into Benjie's jar while he was gone. Benjie never noticed the difference.”

I knew then we were going to be spending a lot of group therapy time on such topics as obedience to rules, misplaced generosity, impulse control, and the nature of reality. I went to check on Benjie and found him staring sadly at his mouse habitat, which he quickly tried to shove into his locker when he saw me. He knew that I knew what was going on, however.

And I knew that he knew that this was not his pet mouse. It was too skinny, too young, and besides it was a girl, without the usual prominent boy mouse testicles.

He was pleased when I offered to get rid of it for him, so in one last act of deceit, I smuggled it off the ward and set it free in a field near my home. After that, when any of the other guys asked Benjie about his pet, he smiled and put a finger to his lips to silence them.

“I may be a drunk, but I ain't stupid,” he’d tell them.