SPARKS, NEV. — Pathological gambling is a serious and increasingly prevalent addiction, Denise F. Quirk said at the annual meeting of the American College of Preventive Medicine.

During the last decade, restrictions on gambling have eased substantially. Today, the only states that do not have some form of legalized gambling are Utah and Hawaii. At the same time, Internet-based “casinos” have dramatically increased accessibility. This can be particularly problematic for young people who would otherwise encounter age restrictions, said Ms. Quirk, a certified problem gambling counselor and the assistant clinical director of the Problem Gambling Center in Reno.

Two questions are helpful for screening someone with a suspected problem: “Do you lie about any aspect of your gambling?” and “Have you bet more than you intended?” said Ms. Quirk, who is also an advisory board member of the Nevada Council on Problem Gambling.

For a more detailed screening, she recommended using the DSM-IV criteria for pathological gambling (see box).

Families dealing with an Internet-based problem should put the computer in a public space, so it's relatively easy to see how people are using it. Parents should check the browser history, so they can see what sites have been visited, Ms. Quirk suggested. “They should pay a reasonable degree of attention to their credit card usage, so they notice any unusual debts,” she said.

In any year, about 1% of the U.S. population experiences a condition known as “pathological” or “compulsive” gambling, a progressive addiction characterized by an increasing preoccupation with gambling, a need to bet more money more frequently, and restlessness or irritability when attempting to stop.

A national survey found that about 14% of adults have never gambled; 75% are low-risk, social gamblers; nearly 8% are at risk; and 1.2% are pathological gamblers. Problem gamblers, who meet one or more of the criteria for pathological gambling and are experiencing problems due to their gambling behavior, constitute another 1.5% of the adult population.

Problem gambling typically results in difficulties in personal, social, and work lives and can lead to depression, anxiety, and stress. For example, one study found that 32% of pathological gamblers and 36% of problem gamblers had been arrested, compared with 4.5% of those who had never gambled.

In another comparison, 53% of pathological gamblers and 40% of problem gamblers had been divorced, compared with 18% of those who had never gambled. About 19% of pathological gamblers and 10% of problem gamblers had had mental health treatment, compared with 4% of those who had never gambled.

Compulsive gambling is a treatable disorder. For many patients, psychotherapy combined with active participation in Gamblers Anonymous has proved effective, Ms. Quirk said. Only 8 or 10 states offer inpatient or intensive outpatient treatment for pathological gambling. Ms. Quirk refers patients who need residential treatment to the Center of Recovery in Shreveport, La. “I have sent several clients there and they've done well,” Ms. Quirk said in an interview. “They have state funding, so most clients can get 4 weeks of residential treatment for about $3,000.”

Intensive outpatient treatment typically takes 2.5 hours a day, 4 days a week, for 6 weeks. Patients meet for group therapy, with a few individual appointments included. Cognitive-behavioral therapies are effective and “group therapy works very well for these patients. There are so many delusional and irrational beliefs associated with gambling, and those patterns must be confronted during therapy. Another gambler can sniff out irrational thinking and say directly: 'You're slipping; you want to get back into the action.'”

To find local treatment resources for gamblers, call the National Council on Problem Gambling's 24-hour helpline, 800-522-4700. For more information, visit the National Council on Problem Gambling's Web site, www.ncpgambling.orgwww.nevadacouncil.org

DSM-IV Criteria

The patient with a diagnosis of pathological gambling:

▸ Is preoccupied with gambling (relives past gambling experiences, plans the next venture, or thinks of ways to get gambling money).

▸ Needs increasing amounts of money for gambling to achieve the desired level of excitement.

▸ Loses control (has made repeated unsuccessful efforts to reduce or stop gambling).

▸ Is restless or irritable when attempting to reduce or stop gambling.

▸ Gambles to escape problems or relieve feelings of helplessness, guilt, anxiety, or depression.

▸ After losing money, returns another day to get even (known as “chasing” one's losses).

▸ Lies to family members, therapists, or others to conceal the extent of the gambling.

▸ Has committed illegal acts (forgery, fraud, theft, or embezzlement) to finance gambling.

▸ Has jeopardized or lost a relationship, job, or educational or career opportunity because of gambling.

▸ Seeks bailouts or relies on others for money to relieve a desperate financial situation caused by gambling.

Screen for Problem Gambling, Refer for Treatment