LEGEND HAS IT HE DIED holding two pair: aces and eights. For 129 years, the last hand of James Butler “Wild Bill” Hickock — shot in the back of the head while playing poker — has been known as the “dead man’s hand.”

You might say poker was bad for Hickock’s health. Clearly it, along with other games of chance, is bad for those who lose their houses, cars or families
as a result of compulsive gambling. Still, more than 80 percent of the U.S. population gambles without running into trouble.

What determines who will have problems? Why are some compelled to bet, while others never go near a casino, bingo parlor or gaming web site? Does the increased availability of gambling create more pathological gamblers?

Researchers from the Department of Psychiatry and the George Warren Brown School of Social Work are at the forefront of the relatively new field of gambling research. Together, they’re working to understand the parallels between gambling and other forms of addiction.

The Gambling Assessment Module (GAM), a diagnostic tool they developed for detecting pathological gambling disorder, helps the researchers to determine whether a person is a pathological gambler and to learn what type of gambling (e.g., lottery, bingo, poker) causes problems for that individual. The assumption is that different people have problems with different types of gambling, and that researchers probably would do better not to lump football betting, slot machines, bingo and craps under the single umbrella “gambling,” just as they would not consider marijuana, beer, cocaine and heroin simply as “drugs.”

“We hope to be able to move beyond the question of whether a person is a pathological gambler or not and do what we do in substance abuse research,” says Renee M. Cunningham-Williams, PhD, visiting associate professor at the George Warren Brown School of Social Work. “If a person is dependent upon marijuana, for example, he or she might have a very different profile than a person who is dependent upon cocaine. We’re trying to move gambling research in that direction, but we’re not there yet.”

She says substance abuse is a good model for gambling disorders. In fact, many of the diagnostic criteria for gambling disorders are nearly identical to those used for diagnosing substance abuse disorders.

“The American Psychiatric Association lists 10 criteria linked to pathological gambling, things like preoccupation, needing to gamble more often or make larger bets to obtain the same level of excitement, and lying to conceal gambling involvement,” says Cunningham-Williams. “If a person meets five or more of those criteria, that individual is considered a pathological gambler, but if it’s only four, officially that person doesn’t have a psychiatric condition.”

Cunningham-Williams and colleagues call the latter group “problem gamblers” because many have substantial problems whether or not they add up to an official diagnosis.

“Like pathological gamblers, problem gamblers tend to engage in a great variety of gambling behaviors, and possibly increase their risk of crossing the threshold into pathological gambling disorder,” she says.

For that reason, much of her research involves using the GAM to learn whether there are ways to help determine which gamblers might become problem gamblers and which problem gamblers might progress to pathological gambling. A recent study from the Journal of Psychiatric Research points to two activities that might indicate a risk for crossing over: betting on the stock or commodities markets and betting on bingo. It’s unclear why those activities might lead to betting the house on a good poker hand or stealing money from a spouse to go to the casino, but this study does seem to indicate that problem gamblers are at risk.

“That’s important, because it might help health professionals and family members recognize the signs that someone is getting into trouble,” Cunningham-Williams says.

Evidence also suggests that people who gamble tend to smoke and drink more than non-gamblers. However, there’s little corresponding evidence that smokers or heavy drinkers are more likely to gamble.

Cunningham-Williams and her colleagues also have found that the total number of problem gamblers is growing as the availability of legal gambling increases.

“Everywhere it’s been looked at, people have seen increases in problem gambling indicating that the greater availability of casinos increases the number of people who get into trouble with gambling,” says C. Robert Cloninger, MD, the Wallace Renard Professor and director of the Sansone Family Center for Well-Being in the Department of Psychiatry.

Although the total number of people with problems has increased, it’s not clear that the rates of problem and pathological gambling are rising. It’s a conundrum for epidemiologists like Linda B. Cottler, PhD, professor of epidemiology in psychiatry and director of the Epidemiology and Prevention Research Group.

“I don’t know that the availability of casinos has changed the addictive liability of gambling,” Cottler explains. “More people have access, so there are greater numbers with gambling problems, and that needs to be addressed by policy makers. But the rate of pathological gambling remains at about
1.8 percent.”

Cottler and Cloninger say gambling research lags a bit behind research into other addictions, such as alcohol or drug dependence. But they both emphasize that it’s clear the research needs to advance.

That’s where Cunningham-Williams and the GAM come in. She hopes the tool will help researchers learn how prevalent gambling problems are in the population and identify risk behaviors linked to gambling problems. They also are attempting to identify genetic, environmental and personality factors related to pathological gambling.

Cloninger says most advertising for gambling, as well as ads for smoking cigarettes or drinking alcohol, tend to make the activity look like a way to have lots of fun and meet beautiful people.

“If someone is impulsive and not very mature, and you make alcohol easily available to them and encourage it as a way to relax and cope with stress, they’re very likely to develop alcohol problems,” Cloninger says. “In the same way, if you promote casinos as a good way to have fun and get cheap meals and so on, you minimize potential dangers, and some people get seduced into behavior that isn’t good for them.”

Cunningham-Williams worries that the current gambling climate is continually creating new problem gamblers. The proliferation of casinos may be part of the problem, but she predicts a bigger issue may be illegal gambling on the Internet. As televised poker grows in popularity, Internet poker games are becoming more common. It’s an especially big concern in regard to high school and college students.

“Individuals who have pathological gambling disorder tend to have an earlier onset of gambling,” she says. “I am concerned about the level of gambling that I hear about on college campuses, and I think we’re doing a disservice to teens and to college students by not educating them about the dangers of gambling the same way that we talk about the dangers of drugs or alcohol.”

That, says Cottler, is why more studies on gambling are needed.

As the kids who are playing Internet poker become adults, will they spend time in casinos? Or will they outgrow the habit? Learning the answers to those questions will require a study that looks at gambling problems over the course of several years.