Forthright discussion of the pro and cons of having a
Middleboro Mashpee Wampanoag Resort Casino

What is compulsive gambling?

Note: The author, Hal Brown, LICSW, a clinical social worker in private psychotherapy practice with 37 years of experience, including having been the director of a rural mental
 health center in Michigan.

Updated, expanded:  June 17, 2007

Compulsive gambling is classified as an impulse-control disorder, and as such isn't considered by the psychiatric community as an addictive disorder. None-the-less, it is sometimes also called pathological gambling, or more often called gambling addiction because many (but not all) of its characteristics are similar or identical to addictive disorder.

I have only treated patients whose compulsive gambling involved scratch tickets. Lottery and scratch tickets are designed by very clever people to be miniature versions of glittery slot machines.  The scratch tickets, the most insidious form of gambling for those with a gambling compulsion, are like with slot machines in that the win-to-loose ratios are carefully calculated to randomly provide positive reinforcement. This induces people to keep playing because the disappointment of losing is randomly reinforced by the pleasure of winning.

Even a $10 win will keep someone buying scratch ticket despite the fact that it cost them $100 to come up with the winning ticket.

Rows of colorful lottery tickets beckon susceptible people from behind just about every convenience story counter.

Because they are everywhere, I found that in treatment my patients rarely followed the clinical advice offered to compulsive casino gamblers; that is, to stay away from any place where lottery gambling was practiced.

I do not minimize the lure of gambling for those whose compulsion rises to the level of addiction. For example I once laid it on the line with a patient and insisted he buy a scratch ticket and bring it, untouched, to therapy. I told him he would have to run it through my paper shredder, never to know whether it was a winner or loser.

He refused to do this and shortly thereafter dropped out of treatment.

I virtually ordered my scratch ticket addicted patients only to use self-service gasoline pumps, because paying inside the store was too much of a temptation. But being a few steps from what I call "paper slot machines" usually triggered an irresistible impulse. In fact, some store even have vending machines for lottery tickets.

Whether brain physiology actually changes or not when some can't resist the impulse to buy a lottery ticket, it appeared to me they were experiencing an anticipatory "rush" of euphoria recalled from previous times when they scratched off a winner.

This is one of the reasons compulsive gambling is classified as an impulse control disorder, and one of the reasons it is so difficult to treat.

With compulsive gambling people are in a sense "addicted" to substances produced inside of the brain which cause sensations of pleasure. This is different than an addiction to psychoactive substances like alcohol, cocaine and heroin which are introduced into the brain and cause various kinds of sought after sensations, and lead to physiological addiction.

Like with other similar disorders involving compulsions or addictions,  childhood education and prevention is often the key. Once the behavior is entrenched and the person has an actual psychiatric disorder, treatment is effective only if the patient is motivated enough to stick with it.

And there is the problem. Some have to hit bottom more than once, and hit very hard, before they are motivated enough to take the steps necessary to change. By then they may have lost their family, friends, jobs, and even homes.

And still some are so badly damaged that they live out their lives on the fringes of society.

Yes, whatever you want to call it, compulsive gambling is bad.

Impact on the family (added 8/2/07)

Not only do compulsive gamblers hurt themselves, but they cause immeasurable pain on their families. They often spend down the families savings and put them into debt thanks to the ability to hide their addiction by getting more and more credit cards and using the new ones to make payments on the old ones. Sometimes when a spouse discovers the addiction the family can do nothing but declare bankruptcy. Gambling addicts aren't abusive in the usual sense to their spouses or children, and they may or may not neglect them depending on the extent and type of the gambling.

Someone can wreck a family just by spending all their money of scratch tickets, they don't have to frequent a casino.

The gambling addict may be as caring and lovable as any member of any family. That is until the spouse or sometimes even the older children try an intervention. Sometimes when faced with "tough love" their addiction is so deep that they lash out and say hurtful things, or even threaten to move out. In some cases a mental health professional can help, and most insurance companies will pay for this.

Unfortunately, if the gambling addiction has reached the point where the gambler has lost his or her job and hence there is no more insurance coverage, it may not be possible to get professional help. This is yet one more reality of compulsive gambling that has gotten so serious a person no longer has any financial resources.

Compulsive gamblers who are otherwise loyal and trustworthy sometimes lie to family and friends in order to cover up their losses. They may borrow money in the vain hope they will be able to pay it back when they hit the jackpot. They may betray the trust of loved ones by concocting outrageous lies as to where lost money has gone.

Compulsive gamblers don't always spend every last cent they can get their hands on. Some are able to live barely within their means by keeping up with the most essential living expenses. But this can vary from those who will pay the bills and household costs to adequately feed and clothe their family to others who are always in danger of having utilities cut off, are barely providng nutritious meals, and are forcing their children to go without new school clothes.

Successful treatment depends on sincere motivation to resist all impulses to gamble, and sometimes a gambler needs to hit rock bottom before that motivation is great enough. With some love and empathy for their family can turn them around, but with others there is a tragic disconnect so they psychologically wall off these feels in pursuit of the always elusive big score.

This is where therapy for the other members of the family can help, because it is often best for them to lay down the law and tell the gambler that, to put it bluntly, it's the no-way or the highway.

When a community near a casino faces the fact that this addiction will increase, as noted elsewhere, being proactive with education is vital. This should not only include children throughout school, but also should include ongoing education for adults. .

Gambling addiction is here to stay, with or without casinos.

But considering the numbers, the vast majority of gamblers do so for fun and whether it's church bingo, the lottery, horse racing, a friendly game of cards, or casino gambling, it provide a harmless escape and a form of entertainment that non-gamblers (like me) may not understand.

Here's what the National Institute of Health has to say about compulsive gambling:

Alternative names   

Gambling - compulsive; Compulsive gambling; Addictive gambling


Pathological gambling is the inability to resist impulses to gamble, leading to severe personal or social consequences.

Causes, incidence, and risk factors   

Pathological gambling affects 1-2% of adults, and up to 4% of adults living within 50 miles of a casino. It typically begins in early adolescence in men and between ages 20 and 40 in women.

Pathological gambling is a brain disease that seems to be similar to disorders such as alcoholism and drug addiction. These disorders likely involve problems with the part of the brain associated with behaviors such as eating and sex. This part of the brain is sometimes called the "pleasure center" or dopamine reward pathway.

In people who develop pathological gambling, occasional gambling leads to habitual gambling. Stressful situations can make gambling problems more severe.


People with pathological gambling often feel ashamed and try to avoid letting others know of their problem. The American Psychiatric Association defines pathological gambling as consisting of five or more of the following symptoms:

  • Preoccupation with gambling (spending much of the time thinking about gambling, such as past experiences, or ways to get more money to gamble with)
  • Needing to gamble larger amounts of money in order to feel excitement
  • Repeated unsuccessful attempts to cut back or quit gambling
  • Restlessness or irritability when trying to cut back or quit gambling
  • Gambling to escape problems or feelings of sadness or anxiety
  • Chasing losses (gambling larger amounts of money to try to make back previous losses)
  • Lying about the amount of time or money spent gambling
  • Committing crimes to get money to gamble
  • Loss of job, significant relationship, or educational or career opportunity due to gambling
  • Need to borrow money for survival due to gambling losses

Signs and tests   

A psychiatric evaluation and history can be used to diagnose pathological gambling. Screening tools such as the Gamblers Anonymous 20 Questions may also be used to assist in diagnosis.


Treatment for people with pathological gambling begins with the recognition of the problem. Since pathological gambling is often associated with denial, people with the illness often refuse to accept that they are ill or need treatment. Most people with pathological gambling enter treatment under pressure from others, rather than voluntarily accepting the need for treatment.

Treatment options include individual and group psychotherapy, medications, and self-help support groups such as Gamblers Anonymous. Gamblers Anonymous is a 12-step program similar to Alcoholics Anonymous. Abstinence principles that apply to other types of addiction, such as substance abuse and alcohol dependence, can also be helpful in the treatment of pathological gambling.

A few studies have been done on medications for the treatment of pathological gambling. Early results suggest that antidepressants, opioid antagonists, and mood stabilizers may help treat the symptoms of pathological gambling.

Expectations (prognosis)   

Like alcohol or drug addiction, pathological gambling is a chronic disorder that tends to get worse without treatment. Even with treatment, relapses are common. Nevertheless, people with pathological gambling can do very well with appropriate treatment.


People with pathological gambling often have problems with substance abuse, depression, and anxiety. For example, up to half of people with pathological gambling also have alcohol and drug abuse problems. People with pathological gambling frequently consider suicide, and 15-20% of them attempt it.

People with pathological gambling tend to experience financial, social, and legal problems. These can include bankruptcy, divorce, job loss, and incarceration. The stress and excitement of gambling may lead to heart attacks in vulnerable people. Many of these complications can be prevented with appropriate treatment.

Calling your health care provider   

Call your health care provider or mental health professional if you believe you have symptoms of pathological gambling.


Exposure to gambling may increase the risk of developing pathological gambling. Minimizing exposure may be helpful for vulnerable people. Public exposure to gambling, however, continues to increase in the form of lotteries, electronic and Internet gambling, and casinos. Intervention at the earliest signs of pathological gambling may prevent worsening of the disorder. LINK 

Update Date: 11/1/2005

Updated by: Daniel W. Haupt, M.D., Instructor, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.

Thank you for reading this far.

This tells us you are keeping an open mind as to the pros and cons of having a gambling facility in Middleboro, and I hope it convinces you that we are attempting to be as objective as possible.

If the statistic listed in the article above is true for Middleboro, currently there are between 1% and 2% of residents suffering from some degree of compulsive gambling.

It is important to differentiate between problem gambling and the kind of gambling which is at the level of addiction where an individual gambles himself or herself into a ruined marriage, destroyed family life and bankruptcy. Not all people who gamble away more money than they can afford fall into the later category.

If we say 2% and for the sake of round numbers say that 20,000 residents are old enough to gamble, there are 400 people in need of treatment. I suspect not many of them are getting it. Whether the number increases to the feared 800 because of easy access to a casino or not, we need all the help we can get in making sure the issue of problem gambling is addressed.

There are certainly other general areas of concern and of course, many specific questions to be answered by those of us working on this website, by members of the tribe, by the committee being formed by the Town Moderator and by town officials.

As these questions come up through various venues, when possible we will try to offer our viewpoints here.

Return to top



Clinical Websites

Compulsive gambling -

Compulsive gambling ? Comprehensive overview covers symptoms, causes and treatments for this impulse-control disorder.


National Council on Problem Gambling

A non-profit health agency whose mission is to disseminate information about problem and pathological (compulsive) gambling and to promote the development ...


Welcome to the Massachusetts Council on Compulsive Gambling

A non-profit health agency with information for people seeking help with information about gambling related problems. Helpline services.