Social, Psychological and Physical Consequences of Pathological Gambling in Sweden Cecilia Bergh, Ph.D. Karolinska Institute, Sweden Eckart Kfihlhorn, Ph.D. University of Stockholm, Sweden
Social, psychological and physical consequences of pathological gambling reported by 42 pathological gamblers recruited mainly by advertising were compared with data on 63 pathological gamblers identified by case-finding within districts of probation, in- and out-patient psychiatric care and social welfare authorities. The two studies gave similar results. Financial breakdown, impaired relations with family and friends, and psychological problems occurred in about 50% of the pathological gamblers. Physical consequences were perceived to be of minor significance. Gambling became a solitary behavior as illegal behaviors to finance gambling increased. The pathological gamblers frequently abused alcohol. Despite these signs of social decay the pathological gamblers strove not to be a burden in society.
INTRODUCTION
Pathological gambling is a disorder of impulse control, i.e., the individual eventually becomes unable to resist impulses to gamble. As a consequence, family, personal and vocational pursuits are damaged. Ensuing problems are indebtedness, disrupted family relationships,
Address correspondence to C. Bergh, Department of Clinical Neuroscience, Karolinska Institute, S-141 86 Huddinge, Sweden.
Journal of Gambling Studies VoL 10(3), Fall 1994 9 1994 Human Sciences Press, Inc.
275
276
JOURNAL OF GAMBLING STUDIES
inattention to work and illegal activities to pay for gambling (American Psychiatric Association, 1987). Over the last 10 years legal gambling in Sweden has increased from six to 18 billion SEK (appr. 2.9 billion US$) (Swedish Government Official Reports, 1991). Yet, there is only limited information on the detrimental effects of pathological gambling. The present paper reports descriptive data on the negative social, psychological and physical effects of pathological gambling.
METHODS There were two samples: The Interview Study and the Case Finding Study. For the interview study, thirty-seven males and five females (median age: 37; range: 20-70) who fulfilled the D S M - I I I - R criteria for pathological gambling (American Psychiatric Association, 1987) were interviewed in person. Nineteen of these were reinterviewed by telephone. For the case-finding study, treatment professionals were asked to examine their case files for pathological gamblers. Individual data were supplied for 57 males and six females (median age: 36 years; range: 2274). To the informants in the case-finding study, alcohol abuse was defined as excessive alcohol use that has caused physical, mental or social problems to the individual or to those closest to him/her and abuse of psychoactive drugs was defined as use of psychoactive drugs in nontherapeutic doses or for intoxication (the Ministry of Health and Social Affairs, 1980). The size of the gambling debt was measured on an ordinal scale, using the midvalue of the median. Data on the general population (Davidson, 1991) were used for some comparisons. Further detail on subject selection and reliability of interviews and limits of the study are provided in the previous article by the authors in this issue (Bergh & Ktihlhorn, 1994).
RESULTS The results from males and females were similar and the data have been combined. The results from the interview and the case-finding
CECILIA BERGH AND ECKART KUHLHORN
277
Table 1 Negative consequences of pathological gambling as experienced by the probands in the interview study, n = 40 Consequence
%
Financial problems Impaired relations with family and friends Depression, low self-esteem "Never being able to live the life of an average person" Social isolation Problems at work Physical health problems Criminality
63 45 40 23 13 13 10 5
More than one of the above
80
study were similar. The results below were obtained from the interview study unless noted. Economic and Social Problems Pathological gambling caused financial problems, impaired relations with family and friends, and psychological problems (Table 1). The amount of money spent weekly on gambling was 2,000 SEK (US$ 320) and did not correlate with age. However, the amount was unknown to the informants in 49 % of the cases (Table 2). The amount of money spent on gambling correlated with debt size and total winnings (Table 2). Winnings were spent (open question, one or several alternatives) on gambling (90 %), consumption (41%) and repayment of debts (32%). Thirty percent had lost their lodgings: 15% had given notice themselves and 18% had been evicted once or several times. Half of the group (50%) had a second job to finance gambling. Forty-four percent reported they had committed crimes to finance their gambling. Out of these the crimes committed were: fraud (72 %), stealing (40%), embezzlement (33%) and forgery (28%). Seventeen percent reported only thoughts of committing crimes. One third (30 %) of the entire group had been convicted. Thirty-six percent gambled at illegal clubs.
81
Case-finding
30,000 (800-160,000) 28,000 ( < 8 0 0 - > 160,000)
Debt (US$) Md (rang0
320 (50-11,000) 320 (---80-8,000)
md (range)
@ending(US$/week)
*p < 0.05, **p < 0.01, ***p < 0.001 (Spearman-rankorder coefficient). Data not taken
90
(%)
In debt
Interview
Study
0.50"*
0.62"**
Spending debt r
13,0000 (300-320,000)
Winning(US$) Md(range)
Table 2 I n d e b t e d n e s s , spending and w i n n i n g s a m o n g pathological gamblers in the i n t e r v i e w study and the case-finding study
0.33*
Spending winning r
ra~
~q
f~
t~
9 >
9
>
0
CECILIA BERGH AND ECKART KUHLHORN
279
Time spent on gambling-related behaviour (gambling, borrowing money, reading gambling magazines, thinking about gambling) at its peak was 12 hours daily (median). Those between 20-34 years of age spent 16 hours (median), while those 35 years or older spent eight hours daily (median). Although social isolation was experienced as of minor importance (Table 1), 78 % indicated isolation from friends and family. Gambling caused problems for at least one family m e m b e r for 83 percent of the subjects, e.g., marital problems and having no time for the children. Gambling caused work-related problems in 74 %: lack of concentration (57 %), high rate of sick-leave (46 %), "constantly borrowing money at work" (11%), and work-related theft, fraud and embezzlement (14%). Twelve percent got fired and 29% had given notice themselves.
Physical Health Problems Severe fatigue, colds and influenza, headaches and gastric pain were frequently reported. In the general population 6 % felt tired "all the time" and 12 % reported recurrent headaches in contrast to the high rates for pathological gamblers as outlined in Table 3.
Alcohol and Drug Abuse In the interview study 58 % had more than a couple of drinks at a time. Thirty-eight percent reporting problems related to alcohol (Fig. 1) had experienced black-outs, and many of these (69%) drank to relieve withdrawal. In the case-finding study 19% were classified as alcohol abusers. Thirteen percent in the interview study and 6 % in the case-finding study had previously been treated for alcohol abuse. Some abused both alcohol and drugs (Fig. 1).
Psychological Problems In the interview study, half (53%) reported severe depression; 60% anxiety and distress; 50% severe nervousness; and 25% severe sleeping problems. In the general population, by contrast, severe anxiety was reported by 3 % and insomnia by 16 %. The psychological
JOURNAL OF GAMBLING STUDIES
280
Table 3 Distribution of self-reported severe physical symptoms during the last 12 months (one or more) n = 41 (interview study)
Symptom
%
Fatigue Colds and influenza Headaches, migraine Gastric pain Nausea Others
37 24 20 20 10 17
More than one
32
Figure 1 Frequency of alcohol and drug abuse in the interview (n = 42) and case-finding study (n = 59)
~.
~J ,~
[] interview [] case-finding
I00
5O
_= O
~_
0
e-
.~
ca
CECILIA BERGH AND ECKART K/]IHLHORN
281
status of the pathological gamblers in the case-finding study was classified as "poor" in 32% and "doubtful" in 46% (Fig. 2, see below). Previous treatment for psychological problems was reported by 42 % in both studies. Seventy-four percent (interview study) reported a history of suicidal thoughts and attempted suicide: 56% suicidal thoughts only, 10% one and 8% several suicidal attempts. Excluding "don't know" (29%) the following data were obtained in the case-finding study: suicidal thoughts only (36%) and one or several suicidal attempts (14 %).
Perception of Health A higher proportion of the probands (43 %) than in the general population (5 %) evaluated their health as poor. Also, a higher proportion (45 %) perceived their health as poorer than did a similarly aged group in the general population (8%) (Table 4). The perception of health as poor was associated with hiding of gambling more frequently (63%) than was the perception of health as good (36%). The pathological gamblers' perception of health in relation to others appears realistic (Table 4). Thus, 55 % of those perceiving their health as poor and worse than their age-mates had received psychiatric treatment and 100% reported suicidal thoughts or attempts at suicide. The negative effects of pathological gambling were of a social nature followed by psychological impairment. Physical problems were perceived as of minor significance (Table 1). The order was confirmed by the informants (case-finding study) who ranked the overall status of the pathological gambler as: poor social status (42 %), poor psychological status (32%) and poor physical health (8%) (Fig. 2).
Requestsfor Help and "Cures"for Pathological Gambling Although only 3 % believed in greater governmental control as a "cure" to stop gambling, 57 % felt there are too few gambling rules and regulations. Thirty-six percent wanted to limit gambling advertisments and commercials and 27% wanted legislation against it. Only 14% believed in debt retirement as a "cure" for gambling, yet 50 % viewed this as the main method to obtain help. Thirty-six percent both believed in and sought treatment as a "cure". Further, "cures" believed in were "to reach rock bottom" (24%) and an intimate relationship
JOURNAL OF GAMBLING STUDIES
282
Table 4 Perceived condition of health during the last y e a r and in relation to others of the same age, n = 38 ( i n t e r v i e w study)
Perceived condition of health
Perceived condition of health in relation to others of the same age (%)
Total (%)
Good Acceptable Poor
Better 13 5 8
Same 21 5 3
Worse 0 13 32
34 23 43
Total (%)
26
29
45
100
(19 %). Twenty-five percent requested ADL- (activities of daily living) training.
DISCUSSION
Support System The urge "to get even" is illustrated by the order of which the winnings usually were spent. To recoup losses constitutes the impetus to borrow (Lesieur, 1979). As shown in the present study the more money spent per week the larger the accumulated debts. Lesieur (1979) also discusses stages in support systems. With increasing threat and fewer options to finance gambling, gamblers resort to legal and illegal behaviours. Changes in self-image revolve around the sequential use of options. The present study indicates a striving not to be a burden to the public e.g., having a second job, resigning voluntarily from their job or lodging rather than being fired or evicted. Typically gamblers start by using justifiable options (Lesieur, 1979). The probands in the present study were most commonly indebted to credit institutions, family and friends. Overall the pathological gamblers described their families as financially loyal and tried to keep debts within the family. Debts to close friends and acquaintances were paid back and seldom perpetuated. A small group resorted to illegal acts perceived to be partially moral e.g., indebtedness to pawn shops and illegal creditors. To pawn family goods was partially justi-
CECILIA BERGH AND ECKART K/s
283
Figure 2 E v a l u a t i o n of the gamblers' overall status according to the informants of the case-finding study [mental (n = 63), social (n = 60) and physical status (n = 60)]
9 psychological status [] social status [] physical status
100
50
0 O
~
O
fled by using a "borrowing rather than a fraud definition". According to Lesieur (1979) the compulsive gambler resorts to options perceived as immoral when all morally justifiable options are used. Threat excuses the crime. In this study of 50 compulsive gamblers 10 % reported committing one or more non-morally justifiable crimes, while twothirds engaged in illegal activities to finance gambling. As opposed to Lesieur (1979) the present data revealed a considerably lower frequency of criminal activity. In agreement with Lesieur (1979) acts of violence were rare, only one pathological gambler in the present study admitted robbery.
Psychological Problems Consistent with other surveys (Roy, Custer, Lorenz & Linnoila, 1988a, Roy et al., 1988b; Blaszczynski & McConaghy, 1988) the present study showed a high level of depressive symptoms in pathological gamblers. Treatment for mental problems was comparable to previous reports (Roy et al., 1988b).
J O U R N A L OF GAMBLING STUDIES
284
The incidence of attempted suicide is more frequent among pathological gamblers than in the general population but similar to other psychiatric groups (Prasad, 1988). The findings by McCormick, Russo, Ramirez & Taber (1984) on suicidal tendencies in pathological gamblers correspond closely to the present interview data but differs from those in the case-finding study, possibly because the informants stated "don't know" in one third of the cases.
Alcohol and Drug Abuse The pathological gamblers frequently presented concomitant alcoholism. This is in line with other studies (Lesieur, 1984; Ramirez, McCormick, Russo & Taber, 1983; McCormick et al., 1984), where alcohol and drug abuse occurred between 10 and 39 %. Lesieur, Blume & Zoppa (1986) found that patients abusing only alcohol were less likely to show signs of pathological gambling than those abusing some other drug, or alcohol and another drug. Evidence for mixed abuse was found in this study. In conclusion, as gambling became a solitary behaviour there was an increase in illegal activities used to finance it. The consequences of pathological gambling are severe. Consistent with other surveys a high level of depressive symptoms and concomitant alcohol and other drug abuse were found. Despite these signs of social decay the pathological gambler attempted not to be a burden in society.
ACKNOWLEDGMENTS
This work was supported by grants from The Commission for Social Research (DSF) (D 89/0185). We thank Dr P. S6dersten for helpful discussions.
REFERENCES American Psychiatric Association(1987). Diagnostic and Statistical Manual of Mental Disorders (DSMIII-R). Washington, DC: Author. Blaszcynski, A.P., & McConaghy, N. (1988). SCL-90 assessed psychopathology in pathological gamblers. PsychologicalReports, 62, 547-552.
CECILIA BERGH AND ECKART K/~IHLHORN
285
Davidson, U. (1991). Living conditions: social relations. In S. Johansson (Ed.) Living conditions. Stockholm: Statistics Sweden. Lesieur, H.R. (1979). The compulsive gambler's spiral of options and involvement. Psychiatry, 42, 79-87. Lesieur, H.R. (1984). Dual addiction: Pathological gambling and alcoholism~drug abase. NY: South Oaks Hospital. Lesieur, H.R., Blume, S.B., & Zoppa, R.M. (1986). Alcoholism, drug abuse and gambling. Alcoholism: Clinical and Experimental Research, 10, 33-38. McCormick, R., Russo, A., Ramirez, L., & Taber, J. (1984). Affective disorders among pathological gamblers seeking treatment. American Journal of Psychiatry, 141, 215-218. Ministry of Health and Social Affairs (1980). Drug abuse: The national case-finding study. Stockholm: AllmS.nna F6rlaget. Prasad, A. (1988). Gambling and its pathology. New Zealand Medical Journal, 101, 232-233. Ramirez, L.F., McCormick, R.A., Russo, A.M., & Taber, J.I. (1983). Patterns of substance abuse in pathological gamblers undergoing treatment. Addictive Behaviours, 8, 425-428. Roy A., Custer, R., Lorenz, V., & Linnoila, M. (1988a). Depressed pathological gamblers. Acta Psychiatrica Scandinavica, 77, 163-165. Roy, A., Adinoff, B., Roehrich, L., Lamparski, D., Custer, R., Lorenz, V., Barbaccia, M., Guidotti, A., Costa, E., & Linnoila, M. (1988b). Pathological gambling. A psychobiological study. Archives of General Psychiatry, 45, 369-373. Swedish Government Official Reports (SOU) (1991). Sportslig och ekonomisk utveckling inom trav-och galoppsporten. Betiinkande av 1990 drs utredning om trav-och galoppsporten. Stockholm." AUmiianna F~rlaget.
Social, psychological and physical consequences of pathological gambling reported by 42 pathological gamblers recruited mainly by advertising were compared with data on 63 pathological gamblers identified by case-finding within districts of probation, in- and out-patient psychiatric care and social welfare authorities. The two studies gave similar results. Financial breakdown, impaired relations with family and friends, and psychological problems occurred in about 50% of the pathological gamblers. Physical consequences were perceived to be of minor significance. Gambling became a solitary behavior as illegal behaviors to finance gambling increased. The pathological gamblers frequently abused alcohol. Despite these signs of social decay the pathological gamblers strove not to be a burden in society.
INTRODUCTION
Pathological gambling is a disorder of impulse control, i.e., the individual eventually becomes unable to resist impulses to gamble. As a consequence, family, personal and vocational pursuits are damaged. Ensuing problems are indebtedness, disrupted family relationships,
Address correspondence to C. Bergh, Department of Clinical Neuroscience, Karolinska Institute, S-141 86 Huddinge, Sweden.
Journal of Gambling Studies VoL 10(3), Fall 1994 9 1994 Human Sciences Press, Inc.
275
276
JOURNAL OF GAMBLING STUDIES
inattention to work and illegal activities to pay for gambling (American Psychiatric Association, 1987). Over the last 10 years legal gambling in Sweden has increased from six to 18 billion SEK (appr. 2.9 billion US$) (Swedish Government Official Reports, 1991). Yet, there is only limited information on the detrimental effects of pathological gambling. The present paper reports descriptive data on the negative social, psychological and physical effects of pathological gambling.
METHODS There were two samples: The Interview Study and the Case Finding Study. For the interview study, thirty-seven males and five females (median age: 37; range: 20-70) who fulfilled the D S M - I I I - R criteria for pathological gambling (American Psychiatric Association, 1987) were interviewed in person. Nineteen of these were reinterviewed by telephone. For the case-finding study, treatment professionals were asked to examine their case files for pathological gamblers. Individual data were supplied for 57 males and six females (median age: 36 years; range: 2274). To the informants in the case-finding study, alcohol abuse was defined as excessive alcohol use that has caused physical, mental or social problems to the individual or to those closest to him/her and abuse of psychoactive drugs was defined as use of psychoactive drugs in nontherapeutic doses or for intoxication (the Ministry of Health and Social Affairs, 1980). The size of the gambling debt was measured on an ordinal scale, using the midvalue of the median. Data on the general population (Davidson, 1991) were used for some comparisons. Further detail on subject selection and reliability of interviews and limits of the study are provided in the previous article by the authors in this issue (Bergh & Ktihlhorn, 1994).
RESULTS The results from males and females were similar and the data have been combined. The results from the interview and the case-finding
CECILIA BERGH AND ECKART KUHLHORN
277
Table 1 Negative consequences of pathological gambling as experienced by the probands in the interview study, n = 40 Consequence
%
Financial problems Impaired relations with family and friends Depression, low self-esteem "Never being able to live the life of an average person" Social isolation Problems at work Physical health problems Criminality
63 45 40 23 13 13 10 5
More than one of the above
80
study were similar. The results below were obtained from the interview study unless noted. Economic and Social Problems Pathological gambling caused financial problems, impaired relations with family and friends, and psychological problems (Table 1). The amount of money spent weekly on gambling was 2,000 SEK (US$ 320) and did not correlate with age. However, the amount was unknown to the informants in 49 % of the cases (Table 2). The amount of money spent on gambling correlated with debt size and total winnings (Table 2). Winnings were spent (open question, one or several alternatives) on gambling (90 %), consumption (41%) and repayment of debts (32%). Thirty percent had lost their lodgings: 15% had given notice themselves and 18% had been evicted once or several times. Half of the group (50%) had a second job to finance gambling. Forty-four percent reported they had committed crimes to finance their gambling. Out of these the crimes committed were: fraud (72 %), stealing (40%), embezzlement (33%) and forgery (28%). Seventeen percent reported only thoughts of committing crimes. One third (30 %) of the entire group had been convicted. Thirty-six percent gambled at illegal clubs.
81
Case-finding
30,000 (800-160,000) 28,000 ( < 8 0 0 - > 160,000)
Debt (US$) Md (rang0
320 (50-11,000) 320 (---80-8,000)
md (range)
@ending(US$/week)
*p < 0.05, **p < 0.01, ***p < 0.001 (Spearman-rankorder coefficient). Data not taken
90
(%)
In debt
Interview
Study
0.50"*
0.62"**
Spending debt r
13,0000 (300-320,000)
Winning(US$) Md(range)
Table 2 I n d e b t e d n e s s , spending and w i n n i n g s a m o n g pathological gamblers in the i n t e r v i e w study and the case-finding study
0.33*
Spending winning r
ra~
~q
f~
t~
9 >
9
>
0
CECILIA BERGH AND ECKART KUHLHORN
279
Time spent on gambling-related behaviour (gambling, borrowing money, reading gambling magazines, thinking about gambling) at its peak was 12 hours daily (median). Those between 20-34 years of age spent 16 hours (median), while those 35 years or older spent eight hours daily (median). Although social isolation was experienced as of minor importance (Table 1), 78 % indicated isolation from friends and family. Gambling caused problems for at least one family m e m b e r for 83 percent of the subjects, e.g., marital problems and having no time for the children. Gambling caused work-related problems in 74 %: lack of concentration (57 %), high rate of sick-leave (46 %), "constantly borrowing money at work" (11%), and work-related theft, fraud and embezzlement (14%). Twelve percent got fired and 29% had given notice themselves.
Physical Health Problems Severe fatigue, colds and influenza, headaches and gastric pain were frequently reported. In the general population 6 % felt tired "all the time" and 12 % reported recurrent headaches in contrast to the high rates for pathological gamblers as outlined in Table 3.
Alcohol and Drug Abuse In the interview study 58 % had more than a couple of drinks at a time. Thirty-eight percent reporting problems related to alcohol (Fig. 1) had experienced black-outs, and many of these (69%) drank to relieve withdrawal. In the case-finding study 19% were classified as alcohol abusers. Thirteen percent in the interview study and 6 % in the case-finding study had previously been treated for alcohol abuse. Some abused both alcohol and drugs (Fig. 1).
Psychological Problems In the interview study, half (53%) reported severe depression; 60% anxiety and distress; 50% severe nervousness; and 25% severe sleeping problems. In the general population, by contrast, severe anxiety was reported by 3 % and insomnia by 16 %. The psychological
JOURNAL OF GAMBLING STUDIES
280
Table 3 Distribution of self-reported severe physical symptoms during the last 12 months (one or more) n = 41 (interview study)
Symptom
%
Fatigue Colds and influenza Headaches, migraine Gastric pain Nausea Others
37 24 20 20 10 17
More than one
32
Figure 1 Frequency of alcohol and drug abuse in the interview (n = 42) and case-finding study (n = 59)
~.
~J ,~
[] interview [] case-finding
I00
5O
_= O
~_
0
e-
.~
ca
CECILIA BERGH AND ECKART K/]IHLHORN
281
status of the pathological gamblers in the case-finding study was classified as "poor" in 32% and "doubtful" in 46% (Fig. 2, see below). Previous treatment for psychological problems was reported by 42 % in both studies. Seventy-four percent (interview study) reported a history of suicidal thoughts and attempted suicide: 56% suicidal thoughts only, 10% one and 8% several suicidal attempts. Excluding "don't know" (29%) the following data were obtained in the case-finding study: suicidal thoughts only (36%) and one or several suicidal attempts (14 %).
Perception of Health A higher proportion of the probands (43 %) than in the general population (5 %) evaluated their health as poor. Also, a higher proportion (45 %) perceived their health as poorer than did a similarly aged group in the general population (8%) (Table 4). The perception of health as poor was associated with hiding of gambling more frequently (63%) than was the perception of health as good (36%). The pathological gamblers' perception of health in relation to others appears realistic (Table 4). Thus, 55 % of those perceiving their health as poor and worse than their age-mates had received psychiatric treatment and 100% reported suicidal thoughts or attempts at suicide. The negative effects of pathological gambling were of a social nature followed by psychological impairment. Physical problems were perceived as of minor significance (Table 1). The order was confirmed by the informants (case-finding study) who ranked the overall status of the pathological gambler as: poor social status (42 %), poor psychological status (32%) and poor physical health (8%) (Fig. 2).
Requestsfor Help and "Cures"for Pathological Gambling Although only 3 % believed in greater governmental control as a "cure" to stop gambling, 57 % felt there are too few gambling rules and regulations. Thirty-six percent wanted to limit gambling advertisments and commercials and 27% wanted legislation against it. Only 14% believed in debt retirement as a "cure" for gambling, yet 50 % viewed this as the main method to obtain help. Thirty-six percent both believed in and sought treatment as a "cure". Further, "cures" believed in were "to reach rock bottom" (24%) and an intimate relationship
JOURNAL OF GAMBLING STUDIES
282
Table 4 Perceived condition of health during the last y e a r and in relation to others of the same age, n = 38 ( i n t e r v i e w study)
Perceived condition of health
Perceived condition of health in relation to others of the same age (%)
Total (%)
Good Acceptable Poor
Better 13 5 8
Same 21 5 3
Worse 0 13 32
34 23 43
Total (%)
26
29
45
100
(19 %). Twenty-five percent requested ADL- (activities of daily living) training.
DISCUSSION
Support System The urge "to get even" is illustrated by the order of which the winnings usually were spent. To recoup losses constitutes the impetus to borrow (Lesieur, 1979). As shown in the present study the more money spent per week the larger the accumulated debts. Lesieur (1979) also discusses stages in support systems. With increasing threat and fewer options to finance gambling, gamblers resort to legal and illegal behaviours. Changes in self-image revolve around the sequential use of options. The present study indicates a striving not to be a burden to the public e.g., having a second job, resigning voluntarily from their job or lodging rather than being fired or evicted. Typically gamblers start by using justifiable options (Lesieur, 1979). The probands in the present study were most commonly indebted to credit institutions, family and friends. Overall the pathological gamblers described their families as financially loyal and tried to keep debts within the family. Debts to close friends and acquaintances were paid back and seldom perpetuated. A small group resorted to illegal acts perceived to be partially moral e.g., indebtedness to pawn shops and illegal creditors. To pawn family goods was partially justi-
CECILIA BERGH AND ECKART K/s
283
Figure 2 E v a l u a t i o n of the gamblers' overall status according to the informants of the case-finding study [mental (n = 63), social (n = 60) and physical status (n = 60)]
9 psychological status [] social status [] physical status
100
50
0 O
~
O
fled by using a "borrowing rather than a fraud definition". According to Lesieur (1979) the compulsive gambler resorts to options perceived as immoral when all morally justifiable options are used. Threat excuses the crime. In this study of 50 compulsive gamblers 10 % reported committing one or more non-morally justifiable crimes, while twothirds engaged in illegal activities to finance gambling. As opposed to Lesieur (1979) the present data revealed a considerably lower frequency of criminal activity. In agreement with Lesieur (1979) acts of violence were rare, only one pathological gambler in the present study admitted robbery.
Psychological Problems Consistent with other surveys (Roy, Custer, Lorenz & Linnoila, 1988a, Roy et al., 1988b; Blaszczynski & McConaghy, 1988) the present study showed a high level of depressive symptoms in pathological gamblers. Treatment for mental problems was comparable to previous reports (Roy et al., 1988b).
J O U R N A L OF GAMBLING STUDIES
284
The incidence of attempted suicide is more frequent among pathological gamblers than in the general population but similar to other psychiatric groups (Prasad, 1988). The findings by McCormick, Russo, Ramirez & Taber (1984) on suicidal tendencies in pathological gamblers correspond closely to the present interview data but differs from those in the case-finding study, possibly because the informants stated "don't know" in one third of the cases.
Alcohol and Drug Abuse The pathological gamblers frequently presented concomitant alcoholism. This is in line with other studies (Lesieur, 1984; Ramirez, McCormick, Russo & Taber, 1983; McCormick et al., 1984), where alcohol and drug abuse occurred between 10 and 39 %. Lesieur, Blume & Zoppa (1986) found that patients abusing only alcohol were less likely to show signs of pathological gambling than those abusing some other drug, or alcohol and another drug. Evidence for mixed abuse was found in this study. In conclusion, as gambling became a solitary behaviour there was an increase in illegal activities used to finance it. The consequences of pathological gambling are severe. Consistent with other surveys a high level of depressive symptoms and concomitant alcohol and other drug abuse were found. Despite these signs of social decay the pathological gambler attempted not to be a burden in society.
ACKNOWLEDGMENTS
This work was supported by grants from The Commission for Social Research (DSF) (D 89/0185). We thank Dr P. S6dersten for helpful discussions.
REFERENCES American Psychiatric Association(1987). Diagnostic and Statistical Manual of Mental Disorders (DSMIII-R). Washington, DC: Author. Blaszcynski, A.P., & McConaghy, N. (1988). SCL-90 assessed psychopathology in pathological gamblers. PsychologicalReports, 62, 547-552.
CECILIA BERGH AND ECKART K/~IHLHORN
285
Davidson, U. (1991). Living conditions: social relations. In S. Johansson (Ed.) Living conditions. Stockholm: Statistics Sweden. Lesieur, H.R. (1979). The compulsive gambler's spiral of options and involvement. Psychiatry, 42, 79-87. Lesieur, H.R. (1984). Dual addiction: Pathological gambling and alcoholism~drug abase. NY: South Oaks Hospital. Lesieur, H.R., Blume, S.B., & Zoppa, R.M. (1986). Alcoholism, drug abuse and gambling. Alcoholism: Clinical and Experimental Research, 10, 33-38. McCormick, R., Russo, A., Ramirez, L., & Taber, J. (1984). Affective disorders among pathological gamblers seeking treatment. American Journal of Psychiatry, 141, 215-218. Ministry of Health and Social Affairs (1980). Drug abuse: The national case-finding study. Stockholm: AllmS.nna F6rlaget. Prasad, A. (1988). Gambling and its pathology. New Zealand Medical Journal, 101, 232-233. Ramirez, L.F., McCormick, R.A., Russo, A.M., & Taber, J.I. (1983). Patterns of substance abuse in pathological gamblers undergoing treatment. Addictive Behaviours, 8, 425-428. Roy A., Custer, R., Lorenz, V., & Linnoila, M. (1988a). Depressed pathological gamblers. Acta Psychiatrica Scandinavica, 77, 163-165. Roy, A., Adinoff, B., Roehrich, L., Lamparski, D., Custer, R., Lorenz, V., Barbaccia, M., Guidotti, A., Costa, E., & Linnoila, M. (1988b). Pathological gambling. A psychobiological study. Archives of General Psychiatry, 45, 369-373. Swedish Government Official Reports (SOU) (1991). Sportslig och ekonomisk utveckling inom trav-och galoppsporten. Betiinkande av 1990 drs utredning om trav-och galoppsporten. Stockholm." AUmiianna F~rlaget.
