The evolving contribution of gambling research to addiction theory

There have been no serious challenges to the inclusion of gambling and the harm that can arise from it amongst the addictive behaviours, despite the absence of a psychoactive agent. In fact, the latter has served as a key premise in making the case that in the absence of an alcohol or drug effect on the individual's subjective awareness, the processes that cause the development of impaired control—arguably the core construct of the addictive behaviours—may be more readily revealed by research; more significantly, that research into gambling may support an entirely psychological account of the addictions. Orford (2001) has presented the most cogent case for such a psychological model. Preferring ‘excessive appetites’, including the appetites for smoking tobacco, illicit drugs, alcohol, food, sex and gambling, he acknowledges that one form of excess—gambling—is crucial to his whole conceptual model. He goes on: This is because, like alcohol, the penetration of gambling into human social life is deep and long-standing. At the same time, again like alcohol, its potential for excess has long been recognized and is not in dispute. What is strange is why it has been consigned to a peripheral position in the addiction field in modern times. It offers the biggest challenge to the conventional wisdom on the subject, and arguably the greatest opportunity for development of a comprehensive understanding of addiction. (Orford 2001, p. 3) There are a number of reasons why research into gambling has tended to remain at the periphery of addictions research, but the most significant of these has been the low level of research activity. However, the last 5 years have seen dramatic changes that can be linked both to the increased legal availability of the whole range of gambling products world-wide and to increased community and government concerns about the harmful impacts that can arise from gambling. Two significant national reviews of these impacts and gambling research generally, one in the USA [National Research Council (NRC) 1999] and one in Australia (Productivity Commission 1999), have provided direction and impetus for the development of research, the former identifying research principles and methodological requirements and the latter conducting research that has helped refine our knowledge of the types of gambling product particularly associated with harmful impacts (i.e. controlling for accessibility). These have been the continuous forms such as electronic gaming machines, off-course betting, keno and casino table games, all of which comprise a continuously repeated sequence of stake, play and determination. In the absence of a psychoactive agent, for those forms of gambling product found to be most addictive, the analysis of the key structural characteristics and related subjective and behavioural responses of regular players have the potential to reveal the psychological processes that maintain and erode control. The scratch card or ‘scratchie’ is a type of gambling product that appears to have the characteristics of the more addictive forms (and therefore its ubiquity and ease of access for youth gamblers has been a focus of concern) and also the less addictive forms, such as traditional lottery products that have a stake–outcome cycle fixed in time and date over several days or even months. The paper by DeFuentes-Merillas et al. (2003) provides some very strong findings on the ‘addictive’ nature of this form of gambling. The methodological strengths of the research reported address the issues highlighted by the NRC (1999), and the results not only provide answers to the likelihood of harm arising from regular usage of this form of gambling but lead the authors to question whether ‘scratchies’ should be included at all within a mental disorder conceptualization of pathological gambling.