Australians love a punt - over 80 per cent will gamble at one stage or another.

And yet, for a small fraction of us, gambling will cause very serious problems indeed.

Why and how those problems occur, and what to do about it, are still very much matters of debate. Is severe problem gambling a disease or an illness?

Is it an addiction in the clinical sense?

Are people born with a predisposition to problem gambling? Could there even be a problem-gambling gene? There's no agreement on the answers, and yet they're crucial in shaping our responses to problem gambling: clinically, economically, governmentally, and individually.

This week the first of a two-part series on the mind of the problem gambler.

Transcript

Alan: I was gambling between $10 and $25,000 a day, upwards of sixteen to eighteen hours a day, seven days a week. At that point I was in a hotel, I had the prospect of a broken marriage and limited access to my two young children. I was jobless, I had just turned 40 and I then attached two belts to make up a loop and attempted to commit suicide in the room.

Lynne Malcolm: And luckily Alan's efforts were unsuccessful. And he's now free from gambling and living very happily with his family. More of his amazing spiral into the abyss and his ultimate story of redemption later.

Hello, I'm Lynne Malcolm, filling in while Natasha Mitchell is on another project. And for the next two weeks on All in the Mind we're looking at the mind of the problem gambler. More precisely the minds plural, because as we'll learn from James Carleton's report, the challenge facing researchers is that problem gamblers are an extraordinarily heterogeneous group.

James Carleton: The bookies room at an Australian horseracing track. It's the birthplace of our gambling industry and the birthplace of problem gambling as well. The experts are agreed that Australians love a punt, over 80 per cent of us will gamble at one stage or another and yet for a small fraction of us, gambling can have a devastating impact. And that's where the unanimity of opinion ends.

Is severe problem gambling a disease, an illness, is it an addiction in the clinical sense? Are people born with a predisposition to problem gambling? Could there even be a problem gambling gene?

Well all these questions are still fiercely debated here and overseas and yet the answers to them will go some way in shaping our responses to problem gambling, clinically, governmentally and individually.

For more than 30 years psychiatrist Dr Clive Allcock from Sydney's Cumberland Hospital has been a part of this debate. He's also a very keen punter and he remembers clearly the moment his twin loves of horseracing and science came together.

Clive Allcock: Well as a young, poor medical student, I'd been going to the horse races for quite a while but on this particular day I'd put a little bit more than perhaps I should have, and on a horse which ultimately cantered to the line to win the Grand National Hurdle by an easy ten lengths.

And I felt quite calm and quite relaxed but I thought, well, you're a student, why not do a little bit of science here? And I took my own pulse rate, which then was about 150 beats a minute; so I've never dared repeat that experiment. But outwardly I felt calm. But inwardly obviously a lot of things were happening.

James Carleton: Were those things that were happening unique to the gambling experience?

Clive Allcock: I would think that they're associated with many experiences where there is excitement. They would happen with skydiving, with some participation in athletic sports; these are all parts of the arousal, parts of the excitement process, the entertainment process which can be seen in these sorts of activities.

And for the vast majority of people who do gamble it's not a problem and it can be part of the entertainment. I love a day at the races, I don't bet on every race by any means, I'm a small punter, small amounts of money and small numbers of races, but it's great to see the horses, it's great to mix with the people-and on a fine sunny day like I experienced last Saturday, it's a wonderful experience.

James Carleton: And yet so many people who have been impacted by problem gambling will say that's the great lie. Australia specifically has this affection for gambling and it masks this horrible sickness.

Clive Allcock: It certainly is an activity that Australia has embraced but yes, within that there is a small section of the population for whom this entertainment is a disaster and it ceases to be entertainment and it certainly becomes a very major problem.

James Carleton: More from psychiatrist Clive Alcock later. Professor Jan McMillen is the Director of the Centre for Gambling Research at the Australian National University. Her academic background is sociology, public health and political economy. In Australia these disciplines are being increasingly utilised in gambling research in addition to the traditional psychiatric approach.

Jan McMillen: Well, problem gambling in Australia-in the past it's been seen as some sort of mental disorder or addiction very much based on literature and research that came out of the United States.

But then there was a shift, when researchers tried to apply the American models to problem gambling in Australia-it just didn't seem to fit.

And there was a shift to a more psychological approach, that this was maladaptive behaviour rather than a disorder.

And the shift has gone further now, it's now seen very much as a public health issue, that the problem is not just with the individual, it's with their environment; it affects families and it affects communities.

So we've moved much more towards a sociological public health approach and we're just starting to explore the dimensions of that.

And at the community level we're finding that some communities are much more vulnerable to a high level of problem gambling in the community than others. So we're starting to focus on what are the risk factors that actively precipitate problem gambling.

Certainly the Productivity Commission found that there are no psychological or psychiatric predispositions to problem gambling. Problem gambling can occur with anybody at any time in their life and we've really got to come up with much more sophisticated ways of identifying what the problem actually is.

We know that access to gambling is an issue, the fact that gambling is so widely accessible in the Australian community-particularly poker machines, gaming machines. We know that industry practices also affect problem gambling. The design of the games themselves-when there's repetitive and continuous play, people are much more at risk of developing problems with their gambling.

And tellingly, the Productivity Commission also said governments were liable here too-that the policies had not addressed the issue adequately.

James Carleton: But doesn't that in some ways stand at odds with what you were saying before, namely that problem gambling isn't a addiction, isn't a disorder of compulsion. Shouldn't then the onus be on the individual to take more responsibility?

Jan McMillen: No, I think this is a shared responsibility, I agree that individuals must accept some responsibility for their action. One of the things that concerns me about the neuroscience approach to problem gambling is that it seems to me that people are trying to abdicate responsibility for their own behaviour.

The argument that occurs in the United States, for instance, where there's this culture of blame: 'it's not my fault, it's someone else's fault' or 'I've got an illness and I can't help myself'. What really concerns me about that approach is that it also absolves the industry and governments of any direct responsibility, that there are people who are fundamentally predisposed to problem gambling and that it seems to imply that the industry and government can't do anything but treat these people rather than prevent it.

A public health approach emphasises prevention, it certainly provides support for people who do have problems, but the emphasis should be on prevention. A good public health approach would first of all control the supply of the product, like drugs or alcohol, and it would also regulate or manage the demand for the product. So issues about where the machines are located, issues of access that I talked about before-so the way you define the problem inevitably shapes the solutions that you develop to try and address the problems.

James Carleton: Jan McMillen. So is severe problem gambling a disease? Here again is Dr Clive Alcock.

Clive Allcock: I am one of the people who've argued that it's not, and I have a lot of difficulty with an illness model around this form of behaviour. My reasons for that are-show me the pathological gambler. Now what I mean when I say that is we have certain criteria by which we define the individual who's said to be the problem gambler. But people move into and out of this particular pattern of behaviour for all sorts of reasons. Some may do so when their wife threatens to leave, so they quickly give up the pattern of behaviour; some may do so when they decide for themselves that they're gambling more than they should.

It's very hard to find a clear, descriptive feature which separates out the individual who has the so-called pathological gambling, the so-called illness, from people who have a wide range of problems with gambling-sometimes serious, sometimes not so serious.

So I belong to the group of people whose view is that this is a dimensional characteristic, both across individuals within their own lifespan of gambling, and across the community. And therefore there is no such thing as the discrete entity called the pathological gambler. But in saying that it's important to emphasise none of us are not saying that this is a serious problem; it is for those people who get caught up in this particular behavioural pattern and these people are certainly suffering because of their gambling problems.

We do get into this whole area of debate about what actually is an addiction. Now once upon a time when I started out, well over 30 years ago, working in this field, this seemed to be fairly clear: If you took a substance and you got some sort of reaction to it, and you kept on using that substance, and alcohol is the classic example.

If you had an addiction you needed more and more of that substance to get the same result and when you stopped using that substance you developed some physiological reaction such as a withdrawal pattern. Everybody would be quite happy to call this 'addiction' and so would I, if that was where the usage of the word had stopped.

But what has tended to happen over the last 30 years is that the usage of the term has become so blurred, so widely applied to anything that's vaguely habitual or vaguely problematic, that I think the usefulness of this term is gone.

And with it goes another issue, if you have an addiction you are said to have an illness-as we were talking about disease model. I've had people come to me and say I have this illness called gambling so therefore it's out of my control; it's not my responsibility.

Now if you take on that view it's going to be very hard for you to make the necessary changes in your life with regard to the behavioural patterns that you've got, you're going to be expecting others to do it, or you're going to give up at the slightest hiccup and say, well, that's not me doing it-that's my illness.

And I have therefore these concerns, these philosophical concerns that what we are calling addiction is now so blurred it can be used as an excuse and that people become a victim of the so-called addiction model, when they need to be addressing the issues within their life that are leading them to choose albeit with some difficulty a particular pattern of behaviour. And that would include drug use and obviously gambling.

People have talked about addictions to so many different things, and where do we stop medicalising problems, when in fact it may not be necessary to do so, in order to give people help and to give them some encouragement to change their patterns of behaviour.

See rest of the transcript with relevant links and references at the end.

Also see Video: Who develops a behavioral addiction to gambling?

and book: Born to Lose : Memoirs of a Compulsive Gambler