Pathological Gambling: A Review of the

Literature (Prepared for the American

Psychiatric Association Task Force on D S M - I V
Committee on Disorders of Impulse Control
Not Elsewhere Classified)*
Henry R. Lesieur, Ph.D.
Department of Sociology & Anthropology, St. John's University

Richard J. Rosenthal, M.D.

Department of Psychiatry, UCLA School of Medicine

This is a review of the literature on pathological gambling prepared for the work
group on disorders of impulse control, not elsewhere classified of the A m e r i c a n
Psychiatric Association. It introduces the new D S M - I V criteria as well as outlines the
phases of the career of the pathological gambler. Research discussed includes that on
pathological gambling and psychiatric disorders, substance abuse, family issues, chil-
dren, finances, and crime. Psychoanalytic, personality, behavioral, sociological, psy-
chologically based addiction theories, and physiological research are also summarized.
Finally, t r e a t m e n t outcome studies are outlined.

INTRODUCTION
In 1980 the American Psychiatric Association formally recognized
pathological gambling as a disorder of impulse control (A.P.A., 1980).

Send reprint requests to: Henry R. Lesieur, Ph.D., Department of Sociology & Anthropol-
ogy, St. John's University, Jamaica, NY 11439, USA
*Note: This article is dedicated to the memory of Robert L. Custer, MD whose inspiration
and encouragement stimulated much of the research discussed herein.

Journal of Gambling Studies Vol. 7(1)~ Spring 2991

9 1991 Human Sciences Press 5
6 JOURNAL OF GAMBLING STUDIES

The criteria were modified in DSM-III-R (A.P.A., 1987). DSM-IV

will recommend changes which incorporate features of both sets of
criteria. These changes will be placed in the context of a tradition of
extensive research into the problem.
In 1974, 61 percent of the adult population in the U.S. gambled.
At that time, there was $17.346 billion wagered legally (Commission,
1976). According to Gaming and Wagering Business estimates, there was
$210 billion in legal wagering in 1988 (Christiansen, 1989). This is
over a 1,200 percent increase. Gambling is now legal in some form in
48 of the 50 states as well as in over 90 countries worldwide. Current
estimates are that approximately 80 percent of the U.S. population
gambles. One could hypothesize that there should be an increase in the
number of individuals who are becoming pathological gamblers. Pre-
liminary data seem to support this impression. A national survey in
1974 reported that 0.77 percent of the U.S. population were "probable
compulsive gamblers" (Kallick, et al., 1979). Polls done in Ohio, the
Delaware Valley (parts of New Jersey and Pennsylvania), Maryland,
New Jersey and New York State between 1984 and 1988 pointed to
between 1.4 and 3.4 percent prevalence rates of "probable pathological
gamblers" (Culleton, 1985; Sommers, 1988; Volberg and Steadman,
1988; 1989).
Maryland, Connecticut, Delaware, Iowa, Massachusetts, Minne-
sota, New York, and New Jersey all have some state funding for the
public education and/or treatment of pathological gambling. As a
result of such support, the entry of private hospitals into treatment,
and the efforts of the National Council on Problem Gambling and its
thirteen state affiliates, both outpatient and inpatient facilities have
opened up in many areas of the country.
The 1980s have produced a burgeoning of interest in research into
compulsive gambling. Scores of professional articles have appeared in
some of the most highly respected journals. In 1985 the Journal of
Gambling Behavior (currently the Journal of Gambling Studies) was foun-
ded. Not a day goes by today without something appearing in the
professional literature or mass media about compulsive gambling.

PATHOLOGICAL GAMBLING-- DEFINITION

While Compulsive Gambling is the popular or layman's term, and

the one used by Gamblers Anonymous, it was felt to be something of a