BEATING THE ODDS

—by Marilyn Davis

Forty years ago, if you wanted to gamble—legally—in the United States, you packed your suitcase, counted your stash, and headed for Vegas or Reno. By the late 1970s, you could have booked a ticket to Atlantic City instead, but that was still your only other choice.

Today, you can gamble online in your pajamas from the comfort of your home computer, pick up lottery tickets 24/7 at your local convenience store, or, in many places, take a short drive to hit the slots at a riverboat or tribal casino. Every state except Utah and Hawai'i permits some form of gambling. Even cable television is profiting greatly from the boom, thanks to the fact that people will now tune in just to watch other people playing Texas Hold 'Em.

"Gambling has shifted from being sort of taboo to being thought of as a sport," says Mark Dixon, a professor of behavior analysis and therapy with SIUC's Rehabilitation Institute.

Not surprisingly, gambling losses have skyrocketed. Every year, American consumers blow more money on gambling than we spend on music, movies, professional sports, theme parks, and cruises combined, says Dixon—an estimated $68 billion in 2002, according to one source.

Has that brought social problems as well as economic benefits? You bet.

"The most recent data suggest that we've gone from 1 percent of our population having problems with pathological gambling up to 3 percent in the last 20 years," Dixon says. A 1999 New York Times article by Jane Brody noted, "By the time most compulsive gamblers seek help, they are hugely in debt...and their families are in a shambles. About 80 percent seriously consider suicide, and 13 to 20 percent actually attempt it or succeed in killing themselves."

Unfortunately, the only study done to date of Gamblers Anonymous, the most common treatment option for the problem, recorded a success rate of only 8 percent after two years of treatment. Therapy can boost the success rate considerably, but many people still don't respond well or simply don't have access to it.

Dixon is an emerging expert in the field of gambling addiction. President of Behaviorists Interested in Gambling, a special interest group of the Association for Behavior Analysis, he has co-edited Gambling: Behavior Theory, Research, and Application (Context Press), a new book that sums up the state of the field. He studies environmental and behavioral factors in gambling so that gambling problems can be treated more effectively.

Dixon started down this path as a graduate student at the University of Nevada at Reno. Arriving there from Wisconsin in the mid-1990s, he says, "I was shocked by the amount of gambling you see going on. My first week there, I heard on the news about three different people who had literally walked out of a casino and jumped off a parking structure to kill themselves due to gambling losses.

"With gambling problems growing exponentially across our country, it seemed like a logical thing to start investigating—an area of research that had the potential to help people's lives.

Researchers are, in a sense, scrambling to catch up with the problem: one-third of all gambling studies ever reported have been published in just the last five years, Dixon says. Even as a graduate student, however, he was frustrated that most gambling research was observational or based on self-reports from gamblers. There's only so much you can learn without controlled experimentation, he explains. The problem? "You can't go into a casino and manipulate the machines to give somebody a string of wins or losses." And for ethical and legal reasons you can't run a real-life gambling situation in the laboratory, with study subjects winning and losing money.

Dixon and his graduate student team conduct research surveys in various public places, both gambling-related and non-gambling-related. But to get accurate findings, it's also important to test people's behavior in as realistic a gambling scenario as possible. Dixon has taken two routes to achieve that.

First, he's set up a "casino room" in his lab. This room, equipped with a one-way mirror for observing subjects, has slot machines, a roulette wheel, a craps table, and a poker table. No money is used to play these games, only tokens, but the physical experience of gambling is otherwise the same. (Research subjects do sometimes get extra course credit or gift cards as incentives for participating.)

Dixon's other strategy relied on his computer skills. Using a program called Visual Basic, he has created computer simulations of video poker, slot machines, and roulette. The advantage of these programs is that researchers can control variables such as wins, losses, and "near misses." By manipulating aspects of the gambling situation, Dixon can get a better understanding of what influences people's gambling behavior and beliefs.

His research has looked at a number of issues:

• Impulsivity and the gambling environment. Pathological gamblers will act more impulsively on a test administered in a gambling environment (such as an off-track betting parlor) than they will on the same test administered in a neutral setting. "The environment itself stokes the behavior," says Dixon. Gamblers may not appreciate the extent to which they're susceptible to this phenomenon.

• Immediate gratification. Pathological gamblers differ from non-gamblers on something called "delay discounting"—a measure of how often a person will turn down a small, immediate reward in favor of a larger reward at some point in the future. Whether or not someone decides to take the immediate reward varies, depending on the money amounts and the waiting time in question. That creates a curve of responses for each individual.

Pathological gamblers "don't have rational discounting curves," says Dixon. "They would rather have smaller amounts of money immediately than more later."

• Irrational beliefs. "Near misses"—for example, a slot machine pull that results in two matching symbols on the win line and the third on the line above—make most people feel they're closer to winning and spur them to continue gambling, but Dixon's team found that the effect was strongest for pathological gamblers.

After asking subjects to rate certain results as losses, wins, or near misses, the researchers followed up by pairing the word "loss" or "near miss" with symbol combinations that hadn't been rated that way by the subjects. Afterwards, gamblers changed their assessments of what constituted a near miss and what didn't—seemingly in defiance of what their own eyes were telling them.

Dixon's team also has found that superstitious associations—for example, that one color is "luckier" than another—can be created in gamblers' minds by various laboratory exercises and then will carry over to their choices about, say, which color slot machine to play.

"We've created a preference for one machine over another without ever changing the outcome of the game," Dixon says. "It shows how malleable gamblers' beliefs are and how insensitive people are to the actual winning or losing. Their own verbal behavior (the messages they give themselves) tends to override that.

"It's easy for someone to come under the control of irrational beliefs, and those beliefs are strengthened by occasional wins. That's really, I think, how people end up becoming problem gamblers. It's the interaction of what you're telling yourself and what's going on in the environment—from casino advertising to your own history of winning and losing—that sustains problem gambling, and it's only by looking at both of those that you're going to be able to treat the problem effectively."

• Perceptions of winning and losing. After a session with the computer games or in the casino room, study participants are asked how many times they won or lost. "Across the board, they overestimate their losses and underestimate their wins," Dixon says.

This seems to be a counterintuitive result for problem gamblers. "You'd think somebody who gambles a lot would overestimate their wins," he says. But perhaps it's a key to addiction: problem gamblers may keep trying to turn their (perceived) luck around, chasing a thrill that never quite satisfies. They can never win enough.

• The illusion of control. Many subjects in Dixon's experiments will choose to pick their own numbers in a game of roulette or draw their own card in poker rather than have the researcher do it for them. "Personal choice has no bearing on the outcome of the game, but they believe they will somehow be able to do better than the experimenter," Dixon says.

Perhaps that's not so surprising: after all, lots of us pick our own "lucky" lottery numbers rather than buy a Quick Pick. What did surprise Dixon's team was finding that people would pay for this illusion of control, forfeiting a certain number of their tokens for the privilege.

Also, says Dixon, "These chips were redeemable for absolutely nothing, not even course credit—but if we raised the price too high, they'd say, Forget it, it's too expensive. We got the same effect that you would with real money."

Similarly, subjects in the lab get excited at "wins" just like people in an actual casino do—even though the jackpots aren't real. "If we keep 'payoffs' high, people will keep playing for nothing much longer than they are required to" by the experimenter, Dixon says. He feels confident that the lab is simulating the gambling experience well and that their findings are valid.

The fact that money isn't the only motivation for gambling is something that Dixon and his students know from the Gambling Intervention Program, which he began at SIUC in early 2005. This free eight-week program, closely modeled after a program developed by psychologist Nancy Petry at the University of Connecticut School of Medicine, is tailored to the individual.

The program screenings show that problem gamblers gamble for different reasons. For some, it's a form of thrill-seeking. For others, it's an escape from office stress or a bad home life or boredom. For still others, it's about socializing. Only for a small group does the main draw seem to be the prospect of winning a lot of money (or enough to pay the bills).

Trained graduate students use techniques from cognitive/behavioral therapy to help clients explore why they gamble, how their perceptions about gambling may be faulty, what things in their environment trigger their gambling, and what activities they can substitute to fill the role that compulsive gambling plays in their life.

"Even the worst problem gambler doesn't gamble all of the time," Dixon says. "When does the person not gamble? We try to increase these activities. When did a trigger not result in gambling? Gradually they start to see that they're not just a victim—that they have some self-control. We work to help them expand that."

The program explicitly does not label gambling addiction as a disease.

"People weren't born with a gambling addiction; it evolved based on circumstances in their lives," Dixon says. "We teach them to identify those circumstances and navigate around them."

Problem gamblers who also have problems with depression or substance abuse, which often go hand-in-hand with gambling addiction, are helped to get treatment for those problems as well.

The one-year post-treatment date hasn't been reached yet for everyone in the first group of clients, so Dixon hesitates to cite figures, but he will say that the abstinence rate for those who completed the eight-week program is "fantastic—well over 50 percent" and that the program's dropout rate is lower than the average for treatment interventions.

"I'm proud of what my therapists have done," he says.

For obvious reasons, clients don't take part in any research that simulates gambling. But what Dixon and his students learn from working with them will guide the design of further research studies, and those research findings will be used in turn to improve the treatment program.

Exploring problem gambling from a different dimension, Dixon and assistant professor of psychology Reza Habib have begun using magnetic resonance imaging to identify possible differences in brain activity between these gamblers and other folks. On a computer screen, subjects are shown a series of slot machine displays and are asked to tap a keyboard to identify each as a win, a loss, or a near miss. As they carry out the exercise, their brains are being scanned to see which areas are lighting up.

Early results indicate that there are differences in brain activity between the two groups of subjects—a finding that, if confirmed, could have profound implications for treatment possibilities down the line.

Dixon is unusual among gambling scholars in tackling both research and treatment issues, but he believes that many treatment models have failed because of a lack of connection between the two.

"I want to make sure the bridge is there between treatment and research," he says. "Let research outcomes guide treatment, and treatment needs guide the kinds of research questions that are asked."

Doing both is intensive work for Dixon and his students. But as he says, "We've changed lives—and that makes all of the work worthwhile."