Behavioral Approaches to Gambling

Description of the Strategy

Strategies for treating gambling were derived from behavioral and cognitive models accounting for the development of what is commonly termed problem, compulsive, or pathological gambling. As gambling on poker machines or racing can result on occasion in immediate or briefly delayed winnings, behaviorists considered that much intermittent reinforcement maintained the behavior, despite its long-term negative consequences. Intermittent reinforcement is established to significantly retard extinction of a conditioned response, compared with invariable reinforcement. As it was considered that gambling is maintained by conditioning, it was suggested that it could also be inhibited by a procedure considered to act by conditioning: aversion therapy. The aversive stimuli usually employed were electric shocks. They were delivered at random to an electrode on the gamblers' arms, at a level sufficiently unpleasant to cause pronounced arm retraction while the gamblers played poker machines continuously. An aversiveconditioned response to gambling cues was considered to result, so inhibiting the wish to gamble. Reports of the procedure gave no attention to absence of retraction of the arm to gambling cues encountered following treatment, the response expected if the procedure acted by conditioning.

Electrical aversion was also used in the form of aversion relief. The subject read aloud a series of cards, at 10-second intervals, each card having a description of aspects of gambling he or she found exciting. An electric shock was given immediately after each card was read aloud. The final card contained a description of an adaptive behavior, such as “Going straight home after work.” It was not followed by a shock, with the expectation that the behavior would be reinforced by the accompanying sense of relief. Nausea produced by injections of apomorphine was also used as an aversive agent. Covert sensitization was introduced as an aversive procedure not involving physically aversive stimuli. The subject was instructed while relaxed to visualize gambling, and then to visualize an aversive consequence, such as his wife telling him she was leaving him, or men from whom he had borrowed money attacking him.

Cognitive-behavioral theories emphasized the role of physiological excitement in gambling. A commonly observed behavior of pathological gamblers, which appears to be driven by mounting excitement, has been termed chasing losses. Gamblers attempt to recoup losses by increasing the size of the next bet or betting on a horse or dog that in their normal emotional states they would consider unlikely to win. Usually, the chasing cycle ends only when they have spent all their available money. To reduce the excitement associated with gambling, exposure to gambling stimuli combined with response prevention was used. The exposure was usually carried out in reality, commonly termed in vivo, in betting facilities. The patient, accompanied by the therapist, remained in the gambling environment without gambling for periods varying from 15 minutes to over an hour. The expectation was that without reinforcement of the urge to gamble, it would diminish by habituation. Exposure with partial-response prevention was also employed, with restrictions on the amount of time and money spent on gambling. Stimulus control therapy required the gamblers to avoid gambling situations completely, aided by limiting their access to money.

...