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“Just one more thing”: The psychology of ‘Columbo’

My favourite TV detective has always been Columbo (played by Peter Falk). I have watched every single one of the 69 episodes (as my family will attest) many times. While I am working, I will often have Columbo on in the background in the way that other people have music on in the background (although I do the latter as well). For those reading this that have not come across Columbo, here is a brief synopsis from Wikiquote:

“Columbo (1968, 1971-1978, 1989-2003) was an American crime fiction television show about Lieutenant Columbo, a homicide detective with the Los Angeles Police Department. He uses his deferential and absent-minded persona to lull criminal suspects into a false sense of security, by harassing and pestering suspects non-stop – without letting them know that they’re suspects – under the pretense that he’s simply being a pesky detective, in order to spy on them and agitate them into giving up clues”.

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I have asked myself many times why I love the iconic show so much and it’s hard to put my finger on any single reason. One of the things I love about the show is that almost all the episodes are a ‘reverse whodunit’ (often referred to as an ‘open mystery’) in which the viewer knows the identity of the murderer(s) and we watch to see how Lt. Columbo uncovers who the killer or killers are. (I say “almost all” because there are actually a few episodes that are more typical ‘whodunits’ such as 1976’s ‘Last Salute To The Commodore’, 1992’s ‘No Time To Die’ [involving a kidnapping rather than a murder] and 1994’s ‘Undercover’). Another aspect I love is the inherent contradictions in Lt. Columbo’s day-to-day behaviour. His dishevelled clothing (the infamous beaten-up raincoat), his apparently bumbling absent-minded nature, and his habit of going off-topic in conversations, but knowing that he is actually one of the most astute and clever detectives that you are ever likely to meet (he would no-doubt fit the description of the stereotypical ‘absent-minded professor’). As a psychologist I find him fascinating. As an article about Columbo on the Cult TV Lounge rightly notes:

“The emphasis is on the psychological duel between detective and suspect, with (mercifully) no interest in social commentary and few concessions to the ‘realism’ that would become more and more of a fetish in TV cop shows during the course of the 70s. This is pure entertainment and it’s all the better for it”.

And finally, it is Lt. Columbo’s brilliant trademark ‘false exits’ that wrongfoot all the murderers. After most informal interrogations with the murderer, Columbo leaves the scene, only to return a few seconds later with the opening gambit of “there’s just one more thing” (or a variant of the phrase) only for it to be the most important question that he “forgot to ask”. As an obituary at the In The Dark website on Peter Falk noted:

“The more trivial the “thing” is, the more damning it proves. As an application of psychology, it’s a superb tactic and it slowly but surely grinds down the criminal’s resistance. Often the murderer’s exasperation at Columbo’s relentless badgering leads to rash actions and errors; the second murder, if there is one, is never as carefully planned as the first”.

As the selected (emboldened) quotes above show, psychology is an integral part of Columbo’s appeal. I was also surprised to find that clinical psychologists and forensic psychologists have used Lt. Columbo’s modus operandi in their day-to-day work. (In fact, even some writers claim that if you want to be a better writer you should watch Columbo according to an article by Shahan Mufti in the New York Times; also, a number of marketing gurus claim that Lt. Columbo can teach marketers a thing or two – check out ‘10 things marketeers can learn from Columbo’). For instance, in an article on motivational interviewing (MI) via the Australian Mental Health Academy describe the ‘Columbo approach’:

“Proponents of motivational interviewing owe a debt of gratitude to the 1970s television series Columbo…[Columbo] was a master of the skill of ‘deploying discrepancies’, and MI therapists/practitioners can use the same skill to get clients to help them make sense of their (the clients’) discrepancies. With the Columbo approach, an interviewer makes a curious enquiry about discrepant behaviours without being judgmental or blaming. In a non-confrontational manner, information that is contradictory is juxtaposed, allowing the therapist to address discrepancies between what clients say and their behaviour without evoking defensiveness or resistance. Wherever possible when deploying discrepancies, practitioners are encouraged to end the reflection on the side of change, as clients are more likely to elaborate on the last part of the statements”

The article then goes on to explicitly describe specific MI interventions using the ‘Columbo approach’. Another online article by Greg Lhamon (‘A simple trick to make a powerful last impression’) describes the ‘Columbo Technique’. Here is an abridged version:

“One way in which you can leave someone with a powerful last impression is to use…“the Columbo Technique”…named after the lovable yet shrewd TV detective from the 1970s…He was unassuming and appeared almost absent-minded as he questioned a murder suspect. Yet his seemingly random line of questioning was the process by which he built an airtight case against the suspect. At the conclusion of every interview, he did something unique: he’d thank the suspect profusely, step toward the door, stop, and then turn back, and say, “Oh, just one more thing.” Then he’d ask one last question, a particularly damning question that let the suspect know that Lieutenant Columbo was onto him. Like every form of good communication, sincerity is critical. It cannot be contrived. The goal is simply to make a strong, memorable point, not to manipulate someone. The process is simple: (1) hold back a critical piece of information and reserve it for the end of the meeting, (2) right before you part company, share the information or ask a question, and (3) enjoy the response you receive”.

A 2009 article in the American Bar Association Journal reported that the best way to interrogate a suspect is to ‘Think Columbo’. The advice given was that police should focus on what suspects say rather than their behaviour (such as fidgeting, sweating, and averting eyes during an interview). After reviewing interrogation tapes, Professor Ray Bull, a British forensic psychologist told the Times newspaper that British police use an investigative interviewing technique:

“These interviews sound much more like a chat in a bar. It’s a lot like the old Columbo show, you know, where he pretends to be an idiot but he’s gathered a lot of evidence.”

The ABA article also included comments from American psychologist Kevin Colwell, who said that suspects that lie in police interviews “often prepare a script that doesn’t have much detail”. Colwell recommended using interview techniques where the individual undergoing questioning should talk about the event in question more than once “adding details in retelling the event about things such as sounds and smells” and asking the person “to recall the event in reverse” and that:

“Those who tell the truth tend to add 20% to 30% more external detail than do those who are lying. Those who are adept at lying may start to feel more strain if the interviewer introduces evidence throughout the questioning that has been previously uncovered. Detective Columbo, it turns out, was not just made for TV”.

Another reason I love Columbo because a number of episodes featured psychologists and/or psychiatrists as the killer, most of who used their psychological expertise to carry out an ingenious murder. This included the episodes ‘Prescription Murder’ (1968 – the first ever episode; Dr. Ray Flemming who uses his high intelligence rather than his psychiatric expertise to murder his wife), ‘Double Exposure’ (1973; Dr. Bart Kepple, a consumer psychologist who uses subliminal advertising to lure his victim to be killed), ‘A Deadly State Of Mind’ (1975; Dr. Marcus Collier, a psychiatrist who uses hypnosis to make his victim jump from a high rise apartment), ‘How To Dial A Murder’ (1978; Dr. Eric Mason, a behavioural psychologist who uses classical conditioning to train his dogs to kill his victim), and ‘Sex And The Married Detective’ (1998; Dr. Joan Allenby, a sex therapist who uses her knowledge of psychosexual roleplay to ensnare and kill her lover). In one episode (‘How To Dial A Murder’), Columbo and the psychologist Dr. Eric Mason have an interesting exchange:

Dr. Eric Mason: You’re a fascinating man, Lieutenant. Columbo: To a psychologist, sir? Dr. Eric Mason: You pass yourself off as a puppy in a raincoat happily running around the yard digging holes all up in the garden, only you’re laying a mine field and wagging your tail.

As an ex-Professor of Gambling Studies, another aspect that I have noticed is how many episodes of Columbo feature gamblers and gambling that are often integral to the storyline. Gambling is a key feature in the episodes ‘Double Shock’ (1973; the murderer Norman Paris, a banker, is featured at a Las Vegas casino running up gambling debts), ‘A Friend in Deed’ (1974; the murderer Mark Halperin, a deputy police commissioner, is shown in his opening scene to be a regular casino gambler), ‘Uneasy Lies The Crown’ (1990; the murderer, Dr. Wesley Corman is a dentist and a compulsive gambler), ‘Death Hits The Jackpot’ (1991; photographer and murder victim Freddy Brower wins a $30 million on the lottery and is killed by his uncle Leon Lamarr), ‘A Bird In The Hand’ (1992; would-be murderer Harold McCain, a compulsive gambler tries to murder his millionaire uncle, owner of a US football team), ‘All in The Game’ (1993; murder victim Nick Franco is a playboy and high stakes poker player killed by his lover Laura Staton), and ‘Strange Bedfellows’ (1995; Randy McVeigh the murder victim owes money for gambling debts to the Mafia and is killed by his brother Graham who has ‘inherited’ his brother’s debt).

In another episode (‘Troubled Waters’, 1975), it turns out that the killer (Hayden Danzinger, an autocar executive) is also a regular casino gambler but this only comes to light late in the episode when Lt. Columbo talks to his wife (Sylvia Danzinger). Here we learn that Lt. Columbo thinks about slot machines:

Columbo: You see that fellow over there playing the slot machines? Waste of money. I’ve played it 44 times. I won once right at the beginning and I never won again. Sylvia Danzinger: You can’t beat ‘em. I don’t even try. Columbo: You’re not a gambler? Sylvia Danzinger: No, I prefer more quiet activities. Columbo: That’s funny. I was under the impression you and your husband went to Las Vegas quite a few times. Sylvia Danzinger: Oh, no. Hayden goes often but without me. I wouldn’t be caught dead there.

I’ve often wondered if gambling was an important issue (positive or negative) for Peter Falk in his private life, because when he wasn’t playing Lt. Columbo, it wasn’t unusual for him to be in gambling-related acting roles. Most notably, he played an ageing bookmaker Vinnie in the 1988 film Money Kings (also known under the title Vig, a film about the illegal world of gambling), and the 1988 film Pronto he played Harry Arno, a sports bookmaker who stole money from the local mafia boss Jimmy Capatorto. He also played the poker player Waller in a 1960 episode of Have Gun – Will Travel (‘Poker Fiend‘), and in the 1970 film Husbands he played Archie Black, one of three men undergoing mid-life crises following the death of their friend who then who all go to Europe to gamble, drink, and womanise.

If you’ve got this far, I’ll just leave you with the answers to a couple of my favourite Columbo trivia questions. The most asked question concerning Lt. Columbo (like Inspector Morse) is what was his first name. (When asked the same question in the series itself, Columbo would answer ‘Lieutenant’!). Lt. Columbo never once revealed his first name verbally in the series but did once flash his police badge in an early episode (‘Dead Weight’; Episode 3, Series 1) and accidentally revealed his name was Frank. The second most asked question is how Peter Falk lost his eye. Falk had his eye removed at the age of three years (due to cancer) and had a glass eye for the rest of his life. Although Falk had a glass eye, fans debated for years whether Lt. Columbo had only one eye. The answer was revealed in the 25th anniversary episode (‘A Trace of Murder’) when Lt. Columbo asked the murderer (Patrick Kinsley, a forensic expert) to look at something with him because “three eyes are better than one”!

Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Burns, S. (2016). The Columbo Episode Guide. Located at: http://www.columbo-site.freeuk.com/episode.htm

Changing Minds (2013). The Columbo Technique. Located at: http://changingminds.org/techniques/questioning/columbo_technique.htm

Dawidziak, M. (1989). The Columbo Phile. Mysterious Press.

D For Doom (2015). Columbo, Season 1 (1971). Cult TV Lounge, July 3. Located at: http://cult-tv-lounge.blogspot.co.uk/2015/07/columbo-season-one-1971.html

Haynes, N. (2012). Guide to TV detectives: No.1. The Guardian, January 23. Located at: https://www.theguardian.com/tv-and-radio/tvandradioblog/2012/jan/23/natalie-haynes-detectives-columbo

Henley, J. (2013). 10 things marketeers can learn from Columbo – yes, Columbo. Rock The Deadline, November 24. Located at: http://rockthedeadline.com/blog/content-marketing/10-things-marketers-can-learn-from-columbo-yes-columbo/

Mental Health Academy (2015). Principles and techniques of motivational interviewing. January 12. Located at: http://www.aipc.net.au/articles/principles-and-techniques-of-motivational-interviewing/

Mufti, S. (2013). Want to write better? Watch Columbo. New York Times (The 6th Floor), September 25. Located at: http://6thfloor.blogs.nytimes.com/2013/09/25/want-to-write-better-watch-columbo/?_r=2

Telescoper (2011). In memorium: Peter Falk (1927-2011). In The Dark, https://telescoper.wordpress.com/2011/06/25/in-memoriam-peter-falk-1927-2011/

Weiss, D.C. (2009). The best way to interrogate: Think Columbo. American Bar Association, May 12. Located at: http://www.abajournal.com/news/article/the_best_way_to_interrogate_think_columbo/

Wikipedia (2016). Columbo. Located at: https://en.wikipedia.org/wiki/Columbo

Wikipedia (2016). List of Columbo episodes. Located at: https://en.wikipedia.org/wiki/List_of_Columbo_episodes

Wikipedia (2016). Peter Falk. Located at: https://en.wikipedia.org/wiki/Peter_Falk

Wikiquote (2016). Columbo. Located at: https://en.wikiquote.org/wiki/Columbo

Back tracking: A brief look at using big data in gambling research

I’ve been working in the area of gambling for nearly 30 years and over the past 15 years I have carrying out research into both online gambling and responsible gambling. As I have outlined in previous blogs, one of the new methods I have been using in my published papers is online behavioural tracking. The chance to carry out innovative research in both areas using a new methodology was highly appealing – especially as I have used so many other methods in my gambling research (including online and offline surveys, experiments in laboratories and ecologically valid settings, offline focus groups, online and offline case study interviews, participant and non-participation observation, secondary analysis of survey data, and analysis of various forms of online data such as those found in online forums and online diary blogs).

Over the last decade there has been a big push by gambling regulators for gambling operators to be more socially responsible towards its clientele and this has led to the use of many different responsible gambling (RG) tools and initiatives such as voluntary self-exclusion schemes (where gamblers can ban themselves from gambling), limit setting (where gamblers can choose how much time and/or money they want to lose while gambling), personalized feedback (where gamblers can get personal feedback and advice based on their actual gambling behaviour) and pop-up messages (where gamblers receive a pop-up message during play that informs them how long they have been playing or how much money that have spent during the session).

However, very little is known about whether these RG tools and initiatives actually work, and most of the research that has been published relies on laboratory methods and self-reports – both of which have problems as reliable methods when it comes to evaluating whether RG tools work. Laboratory experiments typically contain very few participants and are carried out in non-ecologically valid settings, and self-reports are prone to many biases (including social desirability and recall biases). Additionally, the sample sizes are also relatively small (although bigger than experiments).

The datasets to analyse player behaviour are huge and can include hundreds of thousands of online gamblers. Given that my first empirical paper on gambling published in the Journal of Gambling Studies in 1990 was a participant observational analysis of eight slot machine gamblers at one British amusement arcade, it is extraordinary to think that decades later I have access to datasets beyond anything I could have imagined back in the 1980s when I began my research career. The data analysis is carried with my research colleague Michael Auer who has a specific expertise in data mining and we use traditional statistical tests to analyse the data. However, the hardest part is always trying to work out which parameters to use in assessing whether the RG tool worked or not. The kind of data we have includes how much time and money that players are spending on the gambling website, and using that data we can assess to what extent the amount of time and money decreases as a result of using limit setting measures, or receiving personalized feedback or a pop-up message.

One of the biggest problems in doing this type of research in the gambling studies field is getting access to the data in the first place and the associated issue of whether academics should be working with the gambling industry in the first place. The bottom line is that we would never have been able to undertake this kind of innovative research with participant sizes of hundreds of thousands of real gamblers without working in co-operation with the gambling industry. (It should also be noted that the gambling companies in question did not fund the research but provided simply provided access to their databases and customers). In fact, I would go as far as to say the research would have been impossible without gambling industry co-operation. Data access provided by the gambling industry has to be one of the key ways forward if the field is to progress.

Unlike other consumptive and potentially addictive behaviours (smoking cigarettes, drinking alcohol, etc.), researchers can study real-time gambling (and other potentially addictive behaviours like video gaming and social networking) in a way that just cannot be done in other chemical and behavioural addictions (e.g., sex, exercise, work, etc.) because of online and/or card-based technologies (such as loyalty cards and player cards). There is no equivalent of this is the tobacco or alcohol industry, and is one of the reasons why researchers in the gambling field are beginning to liaise and/or collaborate with gambling operators. As researchers, we should always strive to improve our theories and models and it appears strange to neglect this purely objective information simply because it involves working together with the gambling industry. This is especially important given the recent research by Dr. Julia Braverman and colleagues published in the journal Psychological Assessment using data from gamblers on the bwin website showing that self-recollected information does not match with objective behavioural tracking data.

The great thing about online behavioural tracking data collected from gamblers is that it is totally objective (as it provides a true record of what every gambler does click-by-click), is collected from real world gambling websites (so is ecologically valid), and has large sample sizes (typically tens of thousands of online gamblers). There of course some disadvantages, the main ones being that the sample is unrepresentative of all online gamblers (as the data only comes from gamblers at one website) and nothing is known about the person’s gambling activity at other websites (research has shown that online gamblers typically gamble at a number of different websites and not just one). Despite these limitations, the analysis of behavioural tracking data (so-called ‘big data’) is a reliable and cutting-edge way to assess and evaluate online gambling behaviour and to assess whether RG tools actually work in real world gambling settings with real online gamblers in real time.

To get access to such data you have to cultivate a trusting relationship with the data providers. It took me years to build up trust with the gambling industry because researchers who study problem gambling are often perceived by the gambling industry to be ‘anti-gambling’ but in my case this wasn’t true. I am ‘pro-responsible gambling’ and gamble myself so it would be hypocritical to be anti-gambling. My main aim in my gambling research is to protect players and minimise harm. Problem gambling will never be totally eliminated but it can be minimised. If gambling companies share the same aim and philosophy of not wanting to make money from problem gamblers but to make money from non-problem gamblers, then I would be prepared to help and collaborate.

You also need to be thick-skinned. If you are analysing any behavioural tracking data provided by the gambling industry, then you need to be prepared for others in the field criticizing you for working in collaboration with the industry. Although none of this research is funded by the industry, the fact that you are collaborating is enough for some people to accuse you of not being independent and/or being in the pockets of the gambling industry. Neither of these are true but it won’t stop the criticism. Nor will it stop me from carrying on researching in this area using datasets provided by the gambling industry.

Dr. Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Auer, M. & Griffiths, M.D. (2013). Behavioral tracking tools, regulation and corporate social responsibility in online gambling. Gaming Law Review and Economics, 17, 579-583.

Auer, M. & Griffiths, M.D. (2013). Voluntary limit setting and player choice in most intense online gamblers: An empirical study of gambling behaviour. Journal of Gambling Studies, 29, 647-660.

Auer, M. & Griffiths, M.D. (2014). Personalised feedback in the promotion of responsible gambling: A brief overview. Responsible Gambling Review, 1, 27-36.

Auer, M. & Griffiths, M.D. (2014). An empirical investigation of theoretical loss and gambling intensity. Journal of Gambling Studies, 30, 879-887.

Auer, M. & Griffiths, M.D. (2015). Testing normative and self-appraisal feedback in an online slot-machine pop-up message in a real-world setting. Frontiers in Psychology, 6, 339. doi: 10.3389/fpsyg.2015.00339.

Auer, M. & Griffiths, M.D. (2015). Theoretical loss and gambling intensity (revisited): A response to Braverman et al (2013). Journal of Gambling Studies, 31, 921-931.

Auer, M. & Griffiths, M.D. (2015). The use of personalized behavioral feedback for problematic online gamblers: An empirical study. Frontiers in Psychology, 6, 1406. doi: 10.3389/fpsyg.2015.01406.

Auer, M., Littler, A. & Griffiths, M.D. (2015). Legal aspects of responsible gaming pre-commitment and personal feedback initiatives. Gaming Law Review and Economics, 6, 444-456.

Auer, M., Malischnig, D. & Griffiths, M.D. (2014). Is ‘pop-up’ messaging in online slot machine gambling effective? An empirical research note. Journal of Gambling Issues, 29, 1-10.

Auer, M., Schneeberger, A. & Griffiths, M.D. (2012). Theoretical loss and gambling intensity: A simulation study. Gaming Law Review and Economics, 16, 269-273.

Braverman, J., Tom, M., & Shaffer, H. J. (2014). Accuracy of self-reported versus actual online gambling wins and losses. Psychological Assessment, 26, 865-877.

Griffiths, M.D. (1990). Addiction to fruit machines: A preliminary study among males. Journal of Gambling Studies, 6, 113-126.

Griffiths, M.D. & Auer, M. (2011). Approaches to understanding online versus offline gaming impacts. Casino and Gaming International, 7(3), 45-48.

Griffiths, M.D. & Auer, M. (2015). Research funding in gambling studies: Some further observations. International Gambling Studies, 15, 15-19.

Child at heart: A brief look at ‘IVF addiction’

“The quest to have children can become a vortex that gets faster and faster and sucks people in. Women will sell everything and anything to have the treatment if they are short of funds. They will risk their lives, there’s no doubt about it. I have treated young women with cancer who have refused to have treatment for their illness until they have got pregnant and given birth, knowing they are risking their lives. Some of these women do, indeed, go on to die [from cancer], but they die happy, feeling that they have achieved something greater than their own continued existence. Everyone involved in these scenarios is trying to do the right thing, but the extraordinary energy of a couple’s determination creates a vicious circle. [Some couples are driven by] an urge stronger than addiction and more powerful than obsession” (Professor Sammy Lee, Chief Scientist of the IVF [in-vitro fertilization] programme at Wellington Hospital, London; The Guardian, 2009).

Today’s blog started as an email from one of my PhD students, Manpreet Dhuffar, who sent me an interesting article in the New York Times entitled ‘Addicted to IVF, or addicted to hope?’ The opening quote by one of the UK’s pioneers in IVF egg donation certainly believes that the urge for childless couples to have children is stronger than the urges addicts feel for their drugs or behaviours of choice and that their pursuit is obsessive. In the UK, the maximum number of IVF cycles is three but Professor Lee admitted that some couples had gone through 12 cycles and that he knew of clinicians that had continued providing IVF treatment even when they knew there was little chance of pregnancy success.

On one level, I obviously don’t believe that undergoing IVF can be a genuine addiction. To me, undergoing IVF treatment appears to be similar to those people who claim to be addicted to plastic surgery or having more and more tattoos. These are activities that are salient and preoccupying but are not activities that are engaged in day-in, day-out. Although there are no papers on ‘IVF addiction’ a 2002 paper in the journal Nursing Inquiry by Dr. Sheryl de Lacey analysed the discourse of women with infertility problems and that had undergone IVF and discontinued. Dr. de Lacey reported:

“[IVF treatment was described as] a metaphor of lottery in discourses of infertility…showing how when women are situated as gamblers, the metaphor is instrumental in polarising them into ‘winners’ or ‘losers’ in relation to the subjectivity of motherhood. I further deconstruct these subjectivities, showing how ‘winners’ are valorised and ‘losers’ are pathologised. But importantly, I show how infertile women who are not mothers resisted locating themselves as ‘losers’ in a metaphor of lottery and instead situated themselves in a contesting metaphor of investment as diligent ‘workers’ and as active agents in choosing the best employment of their bodily and monetary resources”.

I found these types of discourse myself in various online parenting and infertility forums. For instance, at websites such as babycenter.com and the Pursuit of Motherhood blog, women wrote:

  • Extract 1: “I once read/heard a storyline that started with ‘Addicted to IVF’. I never thought that I might be one of them. The hope that comes with each cycle erases all the negativity, pain, injections, miscarriages, etc. that has already happened. The hope makes you think that it’s possible, even when no one really knows why my babies are sticking around long enough to grow. Each time, I say that I’ve had enough, yet I find myself going back. Even now, I’m ‘taking a break’ to lose the 30 pounds I’ve gained and lower my now raised blood pressure. Now that I’m 4 months off and halfway to my goals, I’m ready to jump in to IVF again. But, really, what’s different? There are no answers to why I can’t seem to hold on to a healthy pregnancy, yet my prognosis is ‘favorable’ since I have always responded ‘textbook’. Am I doing this out of vain, or is there, sometime in my future, a baby waiting to be mine? Thank goodness my insurance limits my tries to 6 fresh cycles because I don’t know if I’ll ever lose hope or stop trying
  • Extract 2: “I’ve been thinking about New Year’s resolutions. I know it’s only the 29th of December but there’s nothing I like more than a resolution. I want to be brave enough to make Number 1 on the list: Give up IVF. And if that sounds like IVF is an addiction as much as drugs and alcohol that’s because it is. In fact, it’s definitely more expensive than a Class A habit. Even as I think and write it, my heart starts to palpitate because where IVF is concerned maybe I have become an addict. Just like an alcoholic who is convinced that happiness lies in that next drink, I’ve become convinced that happiness lies in our next round of IVF. I should start a support group. IVF Anonymous”

Some have even gone as far to write a whole book on their ‘addiction’ to IVF (for instance, check out Tertia Albertyn’s (funny, yet moving) book So Close: Infertile and Addicted to Hope). In researching this article, I also came across a good article (‘Are you addicted to IVF?) on the Fertility Lab Insider website written by ‘Carole’. She made reference to the research of Dr. Janet Blenner who developed a stage theory relating to those passing through infertility treatment (in the Journal of Nursing Scholarship). Using grounded theory, Blenner explored the perceptions of 25 couples as they underwent infertility assessment and treatment. Her theory consists of three concepts – engagement, immersion, and disengagement. To me this sounds like something that successfully treated addicts also go through. Blenner also describes eight stages that individuals pass through: (i) experiencing a dawning of awareness, (ii) facing a new reality, (iii) having hope and determination, (iv) intensifying treatment, (v) spiralling down, (vi) letting go, (vii) quitting and moving out, and (viii) shifting the focus. As Carole notes in relation to these eight stages:

“They seem similar to stages of grief or stages of finding sobriety after addiction. Some patients get stuck at Step 5, ‘spiralling down’. They are the patients who are confronted with repeated failures and evidence of new hurdles to their fertility, patients for whom even Herculean efforts in terms of effort and expense can be expected to be successful less than 5% of the time. If someone told you that you should bet $12,000, $15,000, even $20,000 on a horse that has a 5% or less chance of winning the race, you’d tell them to get lost, that’s crazy…Yet, IVF patients that go in for multiple rounds of IVF, beyond two or three are doing exactly that. Most clinics have pulled out all the stops, applied all the tricks they know by the third IVF cycle. If it still isn’t working, either the clinic is incompetent or IVF is not the right solution for that patient”.

Here, there is yet another gambling analogy which – given my ‘day job’ as a Professor of Gambling Studies – didn’t pass me by. Another online article by Mia Freedman also talked of infertility treatment as a form of gambling addiction and echoes the preceding quote. Freedman asserted:

“I am writing to express my extreme distress at what appears to be the most expensive lottery ticket in town for over 40s these days – IVF. I know of four women who have undergoing the process – one for the ninth time – and it appears they are constantly being told the next time they will be lucky. At around $10k a cycle, that is a lot of money on a chance that is less than one in 10. I am seeing marriages crumble, hearts break, hormones go wild and mental and physical devastation as a result of every cycle that doesn’t produced much longed for babies. I am seeing women almost lose their minds and empty their bank accounts to feed their obsession to be pregnant. Don’t get me wrong, I think IVF is a wonderful gift and I don’t deny anyone wanting a baby – no matter what their age – to give it a go. But surely, when chances are so low there should be comprehensive counselling where financial, marital, mental and physical heath issues are discussed before a 40 plus woman buys yet another expensive lottery ticket in hope of a baby?”

Although I personally wouldn’t conceptualize persistent IVF treatment as an addiction, there are certainly addiction-like elements in most of the stories I have read. Furthermore, and irrespective of whether such behaviour can be classed as addictive, there is no doubt that the need and want for a child appears to be the single most important thing in the lives of such individuals and that based on some of the accounts that I have come across, the need for children could perhaps be classed as an obsession – at least at the time of undergoing IVF.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Albertyn, T.L. (2009). So Close: Infertile and Addicted to Hope. Gauteng: Porcupine Press.

Blenner, J. L. (1990). Passage through infertility treatment: A stage theory. Journal of Nursing Scholarship, 22(3), 153-158.

De Lacey, S. (2002). IVF as lottery or investment: Contesting metaphors in discourses of infertility. Nursing Inquiry, 9(1), 43-51.

Fertility Lab Insider (2013). Are you addicted to IVF? June 5. Located at: http://fertilitylabinsider.com/2013/06/are-you-addicted-to-ivf/

Freedman, M. (2010). When does IVF become an addiction? Mama Mia, January 18. Located at: http://www.mamamia.com.au/parenting/when-does-ivf-become-a-form-of-gambling-addiction/

Hill, A. (2009). Women are risking their lives to have IVF babies. The Guardian, September 13. Located at: http://www.theguardian.com/lifeandstyle/2009/sep/13/motherhood-fertility-treatment-cancer-ivf

Klein, A. (2014). Addicted to IVF, or addicted to hope? New York Times, January 27. Located at: http://parenting.blogs.nytimes.com/2014/01/27/addicted-to-i-v-f-or-addicted-to-hope/

Winslow, A. (2014). Addicted to IVF. Laughter Through Tears, January 29. Located at: http://laughterthroughtearsblog.com/2014/01/29/addicted-to-ivf/

Zoll, M. (2013). Generation IVF. Making a Baby in the Lab: 10 Things I Wish Someone Had Told Me. Lilith. Located at: http://lilith.org/articles/generation-i-v-f/

Track to the future: Online behavioural tracking and problem gambling

Almost everyone reading this will be aware that problem gambling lies towards one end of a continuum that ranges from non-gambling at one end through to pathological gambling at the other. However, it should also be noted that there will always be some behaviours that are typically engaged in by problem gamblers that some non-problem gamblers may also engage in at least occasionally (e.g., chasing behaviour when gamblers try to recoup their losses).

Worldwide, there are many different screening instruments that can be used by clinicians and researchers to help identify problem gambling. One of most regularly used is the Diagnostic and Statistical Manual, Fourth Edition (of which the fifth edition has just been published) that includes criteria that can aid the diagnosis of problem and pathological gambling (but now called disordered gambling in its latest incarnation). The previous (DSM-IV) criteria were used in the most recent British Gambling Prevalence Survey published in 2011. If a person answered positively to at least five of the criteria, a diagnosis of pathological gambling would be made whereas endorsement of three or four of the criteria would indicate a diagnosis of problem gambling. Using the DSM-IV, the latest BGPS reported a problem gambling rate of 0.9% among British adults.

In contrast to offline gambling, the use of online behavioural tracking presents an opportunity for researchers to examine the actual and real-time behaviour engaged in by gamblers. Analysis of behavioural tracking data has been carried out by various groups of researchers. For instance, one group affiliated to Harvard University have published a series of papers examining a data set of online gamblers provided by the bwin gaming company. My own research unit has also been publishing data using behavioural tracking data provided by the win2day gaming company.

During my consultancy for various online gaming companies, I have been informed by industry insiders that problem gambling can be identified online by examining the patterns and behaviours of online gamblers. If this is true, it has implications for current problem gambling screens (including the new DSM-V). This is because most criteria found in these screens are associated with the consequences of problem gambling rather than the gambling behaviour itself. Take the DSM-IV. I have argued that only a few of the behaviours in the DSM criteria for pathological gambling can be reliably spotted online using online behavioural tracking (the most obvious being chasing losses, salience/preoccupation, and tolerance). The following list highlights each of the DSM-IV questions for pathological gambling and the component of pathological gambling that each criterion is assessing. This is followed by an assessment as to what extent each criterion can be identified online.

  • Salience/Preoccupation (Do you find that you are becoming preoccupied with past gambling successes or find yourself spending increasingly more time planning future gambling?) – An online problem gambler is likely to spend a lot of time gambling online although this behaviour in itself does not necessarily indicate a problem. Anything above four hours daily play over a protracted period could be considered excessive although some forms of online gambling (e.g., online poker) may take up a lot of time and be played relatively inexpensively.
  • Tolerance (Do you find that you need to increase the amount of money you gamble to achieve the same enjoyment and excitement?) – If experiencing tolerance to gambling, an online problem gambler is likely to have changed their gambling behaviour in one of two ways over time. The first example of tolerance is a gradual increase of daily play in terms of time. For instance, the gambler might start off playing 30-60 minutes a day but over the course of a few months starts to play increasing amounts of time. The second example of tolerance is the act of gambling using gradually bigger stakes over time. An online problem gambler is more likely to experience both of these combined (i.e., gambling for longer and longer periods of time with bigger and bigger amounts of money).
  • Relapse (Have you recently tried to stop gambling but were unsuccessful?) – Although this is difficult to detect with absolute certainty online, a typical pattern would be a gambler who gambles heavily, day-in day-out, for a period of time and then “disappears” for a period of time (which could be days, weeks, and sometimes even months), only to suddenly re-appear and gamble heavily again.
  • Withdrawal  (Do you become moody or impatient when you are cutting down how much you gamble?) This is again difficult to detect with absolute certainty online but is most likely to surface with the use of verbally aggressive comments in those games that have chat room facilities (such as online poker).
  • Escape from reality (Do you ever use gambling a way of ignoring stress in your in life or even pick you up when you feel down?) – This is almost impossible to detect online although those players who play for long hours every day are more likely to experience escape-like feeling.
  • Chasing losses (Do you ever try to win back the money you lost by increasing the size or frequency of your wagers?) – This is one of the key indicators of problem gambling and can be spotted online more easily than many other problem gambling criteria. Typical chasing patterns will include repeated ‘double or quit’ strategies in an effort to recoup losses. Although many gamblers use this strategy on occasion, the online problem gambler will do it repeatedly. This behaviour, above and beyond any other criteria, is most likely to signal problem gambling.
  • Conceal Involvement (Do you ever hide how much or how often you gamble from significant others?) – There is no way that an online gambling operator can spot this during online gambling unless such admissions are given to other players in online chat rooms.
  • Unsociable Behaviour (Have you ever committed fraud or theft to get money to gamble with?) – Again, there is no way that an online gambling operator can spot this during online gambling unless such admissions are given to other players in online chat rooms.
  • Ruin a Relationship/Opportunity (Has gambling ever ruined a personal relationship or an occupational or educational opportunity?) – As with the previous two criteria, there is no way that an online gambling operator can spot this during online gambling unless such admissions are given to other players in online chat rooms.
  • Bail-out  (Have you ever needed others to relieve a financial problem created by gambling?) – When an online gambler has exhausted all their own funds, they will often ‘beg, borrow and (eventually) steal’ money to continue gambling. A player whose account is constantly ‘topped up’ by people other than themselves may be a problem gambler.

This brief analysis of the extent to which each DSM criterion of problem gambling can be identified online shows that only a few behaviours can be reliably spotted via online behavioural tracking. The following list contains a number of behaviours that are engaged in by online problem gamblers. This was devised and based on my conversations with members of online gaming industry. These are additional to those identified above (i.e., chasing losses, spending high amounts of time and money, and increasing the amount of gambling over time). As a general ‘rule of thumb’, it is assumed that the more of these online behaviours that are engaged in by an individual, the more likely that person is to be a problem gambler.

  • Playing a variety of stakes – Playing a variety of different stakes (in games like online poker) indicates poor planning and may be a cue or precursor to chasing behaviour.
  • Playing a variety of games – Evidence from national prevalence surveys (e.g. Wardle et, al, 2011) demonstrates that the more types of gambling engaged in, the more likely the person is to be a problem gambler. Although this factor on its own is unlikely to indicate problem gambling, when combined with other indicators on this list may be indicative of problem gambling.
  • Player ‘reload’ within gambling session – Although any gambler can engage in such behaviour, players who deposit more money within session (‘reload’) are more likely to be problem gamblers. This indicates poor planning and is a cue to chasing behaviour.
  • Frequent payment method changes – The constant changing of deposit payment methods indicates poor planning and is may be a cue to chasing behaviour. This online behaviour usually indicates shortage of funds and need to extract monies from a variety of sources. Such behaviour can also indicate bank refusal.
  • Verbal aggression – Aggressive verbal interaction via relay chat is common among problem gamblers although any gambler losing money may cause such behaviour. Such behaviour may be evidence of gamblers going on ‘tilt’ (i.e., negative cognitive and emotional reaction to losing) or withdrawal effects if out of money to gamble.
  • Constant complaints to customer services – Constant complaints to the customer service department is common among problem gamblers although any gambler losing money may cause such behaviour. As with verbal aggression, such behaviour may be evidence of gamblers going on ‘tilt’ (i.e., negative cognitive and emotional reaction to losing).

Clearly, each of these behaviours needs to be examined in relation to at least three or four other indicative behaviours. Perhaps most importantly, and according to online gambling companies who use socially responsible behavioural tracking tools, it is a significant change in usual online behaviour that is most indicative of a problem gambler. Most statistical modelling of player behaviour predicts future problematic behaviour on the basis of behavioural change over time. The behaviours highlighted suggest that screening instruments in the future may be able to be developed that concentrate on the gambling behaviour itself, rather than the associated negative consequences.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Auer, M. & Griffiths, M.D. (2013). Limit setting and player choice in most intense online gamblers: An empirical study of online gambling behaviour. Journal of Gambling Studies, in press.

Auer, M. & Griffiths, M.D. (2013). An empirical investigation of theoretical loss and gambling intensity. Journal of Gambling Studies, in press.

Delfabbro, P.H., King, D.L & Griffiths, M.D. (2012). Behavioural profiling of problem gamblers: A critical review. International Gambling Studies, 12, 349-366.

Dragicevic, S., Tsogas, G., & Kudic, A. (2011). Analysis of casino online gambling data in relation to behavioural risk markers for high-risk gambling and player protection. International Gambling Studies, 11, 377–391.

Griffiths, M.D. (2009). Social responsibility in gambling: The implications of real-time behavioural tracking. Casino and Gaming International, 5(3), 99-104.

Griffiths, M.D. & Auer, M. (2011). Approaches to understanding online versus offline gaming impacts. Casino and Gaming International, 7(3), 45-48.

Griffiths, M.D. & Whitty, M.W. (2010). Online behavioural tracking in Internet gambling research: Ethical and methodological issues. International Journal of Internet Research Ethics, 3, 104-117.

LaBrie, R.A., Kaplan, S., LaPlante, D.A., Nelson, S.E., & Shaffer, H.J. (2008). Inside the virtual casino: A prospective longitudinal study of Internet casino gambling. European Journal of Public Health, DOI:10.1093/eurpub/ckn021.

LaPlante, D.A., Kleschinsky, J.H., LaBrie, R.A., Nelson, S.E. & Shaffer, H.J. (2009). Sitting at the virtual poker table: A prospective epidemiological study of actual Internet poker gambling behavior. Computers in Human Behavior 25, 711-717.

Wardle, H., Moody, A., Spence, S., Orford, J., Volberg, R., Jotangia, D., Griffiths, M., Hussey, D. & Dobbie, F. (2011). British Gambling Prevalence Survey 2010. London: The Stationery Office.

Acting up: Do gambling films accurately portray pathological gambling?

The media undoubtedly has a large impact on how we perceive the world in which we live, especially on matters we know little or nothing about. Pathological gambling is one social concern that has been portrayed by a number of movie-makers around the world, although the depth to which each film explores the issue differs greatly. The world of gambling and gamblers has been portrayed in many films and in many different ways throughout the years (e.g., The Sting, The Cincinnati Kid, Casino, Owning Mahoney, Rain Man). However, I argued in a 1989 issue of the Journal of Gambling Behavior that many of these film representations tend to cast gambling in an innocuous light, and often portray gamblers, largely male, as hero figures.

One film that has dealt entirely with the downside of gambling is The Gambler (1974; directed by Karel Reisz), and starring James Caan in the lead role as Professor Alex Freed, a university lecturer in literature and a compulsive gambler. The film is probably the most in-depth fictional film about the life of a pathological gambler. Back in 2004, I published an academic paper in the International Journal of Mental Health and Addiction on this film and assessed the extent to which the film accurately portrayed the “typical” pathological gambler by using the diagnostic criteria for pathological gambling in the last three editions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. I concluded that the film accurately portrayed most of the criteria in the DSM-III, the DSM-III-R, and the DSM-IV. In addition, I also examined other parts of the film’s text and scenarios to examine the film’s theoretical perspective and its relevance to contemporary representations of pathological gambling.

The start of the film sees Freed go into $44,000 debt after gambling and losing at blackjack, craps and roulette in a casino. The film’s main story revolves around Alex’s attempt to pay back his debt to mobsters. His mother, a doctor, gives him the money that he then gambles away almost immediately through sports betting. Faced with no money to pay the mobsters, and no family to bail him out, he cancels his debt by illegally fixing a basketball game for the mobsters with the help of one of his students who is on the basketball team. The film’s main theme, aside from pathological gambling, is Freed’s masochistic tendency that is highlighted in the final scene. Here, Freed walks into a white “no-go” area of New York, walks into a bar, hires a prostitute, refuses to pay her and is then confronted by her knife-wielding pimp who he dares to kill him. Freed then batters the pimp, but is cut across the face by the prostitute using her pimp’s knife. The film ends with Freed leaving the room with a heavily bleeding face.

When Freed is asked by his girlfriend why he gambles to excess, he responds:

“It’s just something I like to do. I like the uncertainty of it … I like the threat of losing…the idea that…uh…I could lose but that somehow I won’t because I don’t want to…that’s what I like… and I love winning even though it never lasts”.

This reply by Freed, to some extent, hints at the film’s outlook on pathological gambling. However, the film’s basic premise is that gamblers gamble because they want to lose, thereby partially adhering to Edmund Bergler’s [1957] psychodynamic account of gambling. Bergler extended Freud’s ideas about guilt-relief in losing, and argued that gambling is a rebellious act, an aggression against logic, intelligence, moderation and morality. Ultimately, gambling is the denial of parental authority – a denial of the reality principle (i.e., even the gambler’s parents – who symbolize logic, intelligence and morality – cannot predict a chance outcome). According to Bergler, the unconscious desire to lose arises when gambling activates forbidden unconscious desires (e.g., parricidal feelings). The financial loss provides the punishment to maintain the gambler’s psychological equilibrium. According to this view, gambling is, in essence, masochistic. While the psychodynamic perspective highlights the fact that reasons for gambling may involve unconscious desires, there is very sparse in contemporary research literature that supports Bergler’s theoretical perspective on gambling.

In the course of the film, the viewpoint that gambling is masochistic and motivated by a desire to lose is forwarded only once in a conversation by Freed and ‘Hips’, one of the mobsters who is also one of Freed’s friends:

Hips: “Listen, I’m gonna tell you something I’ve never told a customer before. Personally I’ve never made a bet in my life. You know why? Because I’ve observed first hand what we see in the different kinds of people that are addicted to gambling, what we would call degenerates. I’ve noticed there’s one thing that makes all of them the same. You know what that is?”

Freed: “Yes. They’re all looking to lose” Hips: “You mean you knew that?”

Freed: “I could have wiped the floor with your ass” Hips: “Yeah? How?”

Freed: “By playing just the games I knew I’d win”

Hips: “Then why didn’t you?”

Freed: “Listen, if all my bets were safe there just wouldn’t be any juice”

The masochistic tendencies run throughout the film until the very final scene. However, another interpretation was put forward by psychologists Dr Richard Rosenthal and Dr Lori Rugle in a 1994 issue of the Journal of Gambling Studies. These authors said that there is a group of gamblers for whom it is not winning that is all-important, but losing. According to an earlier paper by Dr Rosenthal, it is the risk of getting hurt and losing everything that is exciting for them (i.e., “living on the edge”), which he described as omnipotent provocation. Such omnipotent provocation is akin to a deliberate flirting with fate (and danger) to prove one is in control. Rosenthal and Rugle argue this thesis on the basis of the final scene from The Gambler:

“In the climactic scene, the compulsive gambler-protagonist…walks the streets of Harlem, alone and at night, fully aware of the taunts and the threats that follow him. He enters a bar and provokes a fight with a prostitute and her knife-wielding pimp. After getting slashed, he staggers out, blood pouring from his face. In the final frame, he has stopped to look in the mirror, and while examining what will soon be a huge scar, he smiles. His expression says it all. He has gone to the edge, escaped with his life, and that, for him, is a big win”.

From the synopsis of the film presented above, it could be argued that, for Alex Freed, life in itself was one big gamble. Although the theme of desired losing is the film’s message, the desire to lose is suppressed when Freed talks to most people. To his students, Freed intellectualizes his gambling using the work of Dostoevsky (who was indeed a pathological gambler himself). For instance, quoting from Notes from Underground (Dostoevsky, 1864), Freed lectures his students on reason and rationality. Although not alluding to gambling, he quotes Dostoevsky’s assertion:

“Reason only satisfies man’s rational requirements, desire on the other hand accompanies everything, and desire is life”.

To others around him (i.e., his family, girlfriend, fellow gamblers, and bookmakers), much of Freed’s gambling talk is bravado. For instance, just as he is about to pay his debt to the mobsters with the money his mother had given him, he takes an impulse trip to Las Vegas with his girlfriend.

My analysis of the film The Gambler argued that the Freed character is a fairly accurate representation of a pathological gambler and of what is known about pathological gambling. There is anecdotal evidence that pathological gamblers identify with the film and that it is an accurate portrayal-at least of the typical male gambler seen in treatment. The actions of Alex Freed (e.g., pre-occupation with gambling, deterioration of relationships due to gambling, gambling to win back losses, and illegal acts performed to solve problems) are (a) familiar to anyone who encounters pathological gamblers in either a professional or personal capacity, and (b) would be similar to any pathological gambler, regardless of the rhetorical justifications and subjective motivations (i.e., excessive gamblers will display the same observable behaviour despite different etiological roots or theoretical perspectives). If The Gambler was the only film regarding pathological gambling that the general public ever saw, then it is fair to say they would go away with a good perspective on what pathological gambling is and what it can do to people. What the film does not adequately do is explain that there is more than one reason as to why people might gamble excessively.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bergler, E. (1957). The psychology of gambling. New York: Hill & Wang, Inc.

Griffiths, M.D. (1989). Gambling in children and adolescents. Journal of Gambling Behavior, 5, 66-83.

Griffiths, M. (2004). An empirical analysis of the film ‘The Gambler’. International Journal of Mental Health and Addiction, 1(2), 39-43.

Rosenthal, R. J. (1986). The pathological gambler’s system for self deception. Journal of Gambling Behavior, 2, 108- 120.

Rosenthal, R. J., & Rugle, L. J. (1994). A psychodynamic approach to the treatment of pathological gambling: Part 1. Achieving abstinence. Journal of Gambling Studies, 10, 21-42.

Playing the name game in the development of gambling problems

There has never been a shortage of adjectives to describe the small sub-sample of the population who develop gambling problems and come to the attention of psychologists, psychiatrists, and/or self-help agencies.  Over the last 70 years, problem gambling has been described as ‘neurotic’, ‘compulsive’, ‘addictive’, ‘dependent’, impulsive’ and/or ‘pathological’ in a wide variety of scholarly outlets.

At present, the most commonly used terms by practitioners and treatment agencies are arguably ‘pathological’ and ‘compulsive’. The term ‘compulsive’ arose largely from Sigmund Freud’s 1928 description of the Russian novelist Dostoyevsky based on his semi-autobiographical book, The Gambler. Some gamblers clearly display compulsive behaviour and is currently the preferred terminology of Gamblers Anonymous. However, if compulsions are defined as being the behavioural component of the obsessional state in which the individual finds the abnormal behaviour alien and attempts to resist it, then clearly some gamblers cannot be described as compulsive as there is no element of resistance (i.e., they actually enjoy gambling), and their behaviour is not alien to them. In addition, some gamblers may be oblivious to the fact that they have a problem at all.

Influenced by the American Psychiatric Association’s Diagnostic and Statistical Manual, there seems to be an increased preference amongst professionals for the term ‘pathological gambling’ to describe individuals with severe gambling problems. Arguably, this owes much to the pioneering work of the psychiatrist Dr Emmanuel Moran who in the late 1960s and early 1970s argued in a series of seminal papers that the phrase ‘pathological gambling’ is descriptive as opposed to terms like ‘compulsive’ or ‘addictive’ which might suggest specific and homogenous etiologies. Estimates for the numbers of people who have a gambling problem are therefore a direct function of the particular criteria used in defining the problem in the first place. Others in the gambling studies field have agreed that the pathological gambling problem of impulse control is dissimilar to other obsessive and compulsive disorders.

Moran also pointed out in his many papers that it was highly unlikely that problem gamblers were a homogenous group of individuals, and that therefore ‘compulsive gambling’ to describe this diverse group was an unsatisfactory term. Professor Mark Dickerson (formerly of the University of Western Sydney before his retirement) also rejected the ‘compulsive’ typology. He said the label was merely functional, and the term ‘compulsive gambling’ acted as a legitimate way for individuals to seek the help of psychologists and psychiatrists. He also argued that the compulsive gamblers may just be a subset of regular gamblers except that they seek treatment for their behaviour.

The problem is therefore how to differentiate between those who gamble a lot but do not seek help, and those gamblers who end up seeking help at agencies such as Gamblers Anonymous. What difference is there? Is it cognitive? Is it genetic and/or physiological? Is it behavioural? All of the above? Due to the heterogeneous nature of gambling, there is probably no parsimonious answer but it would be useful for research and practitioner communities to choose an appropriate name that clearly distinguishes between those who need help with their gambling problem from those who do not.

Clearly there is more than one type of problem gambler as evidenced by the early classification of different problem gamblers by Moran (i.e., subcultural, psychopathic, neurotic, symptomatic and impulsive) through to the more recent ‘pathways’ model of Professor Alex Blaszczynski and Dr Lia Nower who assert there are three fundamentally different types of problem gambler (behaviourally conditioned, emotionally vulnerable, and antisocial impulsivist). I will return to these typologies in a subsequent blog. The real point I would make is that these typologies have good face validity but it is unlikely that all these types of problem gambler are pathological gamblers – particularly if pathological gambling implies the gambling abnormality comes from within the individual. Can problematic gambling that is due to a situational disposition (e.g., subcultural gambling where people gamble excessively because others do) really be defined as pathological?

What is needed is a unambiguous term that not only differentiates gamblers who seek treatment from those who do not, but that also incorporates the different sub-types of problem gambler. Terms such as ‘habitual’, ‘high frequency’, ‘heavy’ and ‘persistent’ would accurately describe the most regular gamblers but would not include the small minority who gamble only in short binges. Perhaps the most useful terms (and to some extent the most obvious) are those such as ‘excessive’ and/or ‘problematic’. However, both ‘excessive’ and ‘problematic’ are to some extent personal and subjective judgments where the gamblers (or those around them) perceive an imbalance of negative outcomes over the positive outcomes resulting in what is felt to be problematic behaviour. Evidently, these debates are not unique to gambling and can be found across the whole addiction studies field. However, whether the gambling studies field will ever reach consensus remains to be seen.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Blaszczynski, A. & Nower, L. (2002). A pathways model of pathological gambling. Addiction, 97, 487-500.

Dickerson, M.G. (1989). Gambling: A dependence without a drug. International Review of Psychiatry, 1, 157-172.

Griffiths, M.D. (2006). An overview of pathological gambling. In T. Plante (Ed.), Mental Disorders of the New Millennium. Vol. I: Behavioral Issues. pp. 73-98. New York: Greenwood.

Moran, E. (1970). Varieties of pathological gambling. British Journal of Psychiatry, 116, 593–597.

Is excessive gambling compulsive, impulsive and/or addictive?

In 1980, pathological gambling was for the first time recognized as a mental disorder in the third edition of the Diagnostic and Statistical Manual (DSM-III) by the American Psychiatric Association, under the section “Disorders of Impulse Control” along with other illnesses such as kleptomania and pyromania. Adopting a medical model of pathological gambling in this way displaced the old image that the gambler was a sinner or a criminal.

In diagnosing the pathological gambler, the DSM-III stated that the individual was chronically and progressively unable to resist impulses to gamble and that gambling compromised, disrupted or damaged family, personal, and vocational pursuits. The behaviour increased under times of stress and associated features included lying to obtain money, committing crimes (e.g. forgery, embezzlement, fraud, etc.), and concealment from others of the extent of the individual’s gambling activities. In addition the DSM-III stated that to be a pathological gambler, the gambling must not be due to Antisocial Personality Disorder.

These criteria were later criticized for (i) a middle class bias (i.e. the criminal offences like embezzlement, income tax evasion were typically  ‘middle class’ offences), (ii) lack of recognition that many compulsive gamblers are self-employed, and (iii) exclusion of individuals with Antisocial Personality Disorder. It was argued that the same custom be followed for pathological gamblers as for substance abusers and alcoholics in the past (i.e., allow for simultaneous diagnosis with no exclusions). Consequently, the revised criteria (DSM-III-R) that appeared in 1987 were subsequently changed and took on board these criticisms. More importantly, the criteria were modelled extensively on substance abuse disorders due to the growing acceptance of gambling as a bona fide addictive behaviour.

Research carried out among treatment professionals the end of the 1980s highlighted some dissatisfaction with the DSM-III-R criteria and that there was some preference for a compromise between the DSM-III and the DSM-III-R. As a consequence, the criteria were changed for DSM-IV. The DSM-IV criteria represented a combination of DSM-III and DSM-III-R with the addition of “escape” which was added on the basis of empirical research.

Although many researchers have recognized that there appear to be different types of problem gambler, it was arguably Dr Moran’s typology based upon male gamblers receiving psychiatric help for their gambling problems that proved most influential. The typology comprised the following types of problem gambler:

Subcultural – Gambles excessively due to others in their social environment gambling heavily. This type lacks independence and conforms to the social group.

Neurotic variety – Gambles excessively as a means of relief to stress and emotional difficulties.

Impulsive variety – Gambles excessively due to a “loss of control”. Money is gambled until it runs out and ‘symptoms of craving’ appear.  This variety of pathology is the most serious and produces an economic and social functioning disturbance.

Psychopathic variety – Gambles excessively as part of general global disturbance (i.e. the psychopathic state. Criminality usually occurs but is on the whole unrelated to gambling).

Symptomatic variety – Gambles excessively because of an associated mental illness (e.g., depression) in which the illness is primary and the gambling a secondary symptomatic manifestation.

As with most other typologies, Moran’s classification may be clinically useful but the distinctions between each group were not clear and many patients may have had characteristics of more than one sub-type. More recently, Professor Alex Blaszczynski and Dr Lia Nower postulated a pathway model of the determinants of problem gambling based upon a series of clinical observations with problem gamblers and through integration with the literature. In some ways, this model was very similar to that formulated by Moran.

They argue that there are common influences that affect all problem gamblers, such as availability and access, classical and operant conditioning reinforcements, arousal effects, and biased cognitive schemas. However, they suggested that there are three distinct pathways into problem gambling, representing three primary motivating forces that drive different problem gamblers to gamble. The first of these, behaviourally conditioned problem gamblers, are not pathologically disturbed, but instead gamble excessively as a result of poor decision-making strategies and bad judgments. Any features such as preoccupation with gambling, chasing, depression, anxiety and related substance abuse are seen as the consequence, not the cause of their excessive gambling. These gamblers are usually motivated to seek and attend treatment, and re-establish controlled levels of gambling post-treatment.

The second group, emotionally vulnerable problem gamblers, are characterized by a predisposition to be emotionally susceptible. This group use gambling as a means of modifying mood states and/or to meet specific psychological needs. These gamblers display higher levels of pre-morbid psychopathology including depression, anxiety, substance dependence and deficits in coping or managing stress. They tend to engage in avoidant or passive aggressive behaviour, and use gambling as a means of emotional relief through dissociation and mood modification. The psychological dysfunction in these gamblers makes them more resistant to treatment and not suitable to permit controlled gambling. Treatment must focus the underlying vulnerabilities as well as the gambling behaviour.

The third group, ‘antisocial impulsivist’ problem gamblers, have biological dysfunctions, either neurological or neurochemical. They also possess similar psychosocial vulnerabilities as the pathway two gamblers. However, they are characterized by antisocial personality disorder and impulsivity and/or attention-deficit disorders. It is argued that these gamblers have a propensity to seek out rewarding activities (such as gambling) in order to receive stimulation. They tend to be clinically impulsive and display a broad range of problems independent of their gambling. These problems include substance abuse, low tolerance for boredom, sensation seeking, criminal acts, poor relationship skills, family history of antisocial behaviour and alcoholism. Gambling usually begins at an early age, has a rapid onset and occurs in binges. These gamblers are less motivated to seek treatment, have poor compliance rates and respond poorly to all interventions. All three subgroups are affected by environmental variables, conditioning effects and cognitive processes. However, in terms of treatment intervention each subgroup will have specific needs.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (Vol. III). Washington, D.C.: American Psychiatric Association.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders – Text Revision. Washington, D.C.: American Psychiatric Association.

Blaszczynski, A. & Nower, L. (2002). A pathways model of pathological gambling. Addiction, 97, 487-500.

Griffiths, M.D. (2006). An overview of pathological gambling. In T. Plante (Ed.), Mental Disorders of the New Millennium. Vol. I: Behavioral Issues. pp. 73-98. New York: Greenwood.

Moran, E. (1970). Varieties of pathological gambling. British Journal of Psychiatry, 116, 593–597.