Thank you for the opportunity to testify this morning about research issues related to
pathological gambling. As other testimony this morning illustrates compellingly, for those
who lose control and gamble compulsively, there can be devastating
consequences--professionally and personally.
As the National Gambling Impact Study Commission recognizes in its report, gambling
involves an array of policy, scientific, and other issues that go well beyond the clinical
scientific research focus of the National Institute of Mental health (NIMH) or the
National Institutes of Health (NIH). I will focus here solely on the issues within our
scientific domain. We are, of course, open to scientific exchanges with other agencies so
that tools, methods, and findings of importance are widely and quickly shared with those
who can benefit from them. In fact, it is possible that the broader impacts that problem
and pathological gambling may have on the health and welfare of individuals, families, and
communities may suggest the utility of developing a more comprehensive approach within the
Department of Health and Human Services to transform scientific findings into other
programmatic activity.
We welcome the Commission's recognition of the importance of peer review to ensure that
research funded by NIH is of the highest scientific value. Science of the highest quality
is essential to the responsible use of taxpayer funds, to the credibility of the findings,
and to efficient research progress in addressing all public health problems, including
pathological gambling. We also welcome the Commission's encouragement of scientific
knowledge that could contribute to the effective prevention of pathological gambling. Last
year, NIMH, along with its sister institutes--the National Institute on Drug Abuse (NIDA)
and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) --issued a special
Program Announcement (PA) to alert investigators of our interest in funding excellent
science focused on pathological gambling. We are already planning to issue an amendment to
this Program Announcement this year, and we will incorporate into our communications to
the field the Commission’s recommendations for longitudinal research regarding the
initiation, nature, and course of youth gambling in the context of other youth behaviors
and factors. We will also incorporate the Commission’s recommendation for research on
risk and protective factors for adults' transition to pathological gambling.
We at NIMH approach pathological gambling--as we do all research on pathological
behavior and mental illness--in a broad context of basic and clinical research spanning
multiple disciplines and diverse perspectives. We believe that our understanding of
pathological gambling, like all disorders within our purview, will benefit both from
research specifically targeted to its diagnosis, prevention, and treatment, as well as
from a large body of other NIMH basic and clinical research that provides a relevant
context. That broader body of research includes basic behavioral studies on
decision-making, risk-taking, self-control, and compulsive behavior; neurobiological
studies on how behaviors such as gambling alter brain funding resulting in compulsion and
loss of control; clinical studies on mood disorders, compulsive behaviors, and the
relationship between the two; as well as rigorous evaluation of treatments and preventive
interventions and their delivery in diverse real-world settings. Indeed, as we look
forward to developing further research on pathological gambling, it is important to make
sure that this research benefits from knowledge, methods, and perspectives in related but
more fully developed areas of basic and clinical study. These may offer clues to common
biological and psychological origins, and may suggest some new avenues for prevention and
treatment.
We need to understand why certain people seem to lack the mechanisms necessary to
regulate their behavior with regard to gambling. Perhaps these mechanisms--or lack of
them--are the same as those involved in better understood mental disorders or in
addictions to alcohol or drugs of abuse. We need to find these answers in order to make
real headway in developing a solid scientific foundation for understanding, diagnosing,
treating, and preventing pathological gambling through research of high quality. It is
very early in the development of this research field. Little is now known through rigorous
research about the underlying biological and psychological features of pathological
gambling, about developmental risk and protective factors, or about its natural course,
effective treatments, or the prevention of relapse. But what we do know about other
compulsive behaviors may offer clues.
The bulk of the NIH research is conducted through grants to researchers around the
country who submit research application that are rated of high scientific merit through a
rigorous scientific peer review process. Until this past fall, only a few researchers had
applied to study pathological gambling. But with increased interest shown by the gambling
research community, in combination with basic and clinical research in related areas, we
are beginning to move forward.
I am very pleased to announce that NIMH is in the process of funding the first rigorous
scientific evaluation of psychosocial treatment for pathological gamblers. This research,
which received virtually the best possible rating of scientific merit in our rigorous
scientific peer review process, will receive almost $1.2 million in NIMH support over 5
years. The research plan is to involve 220 pathological gamblers in a study determining
whether cognitive-behavioral treatment might offer therapeutic effects over and above
those obtained through Gamblers Anonymous, a self-help approach modeled on Alcoholics
Anonymous. Cognitive-behavioral treatment has been found effective in use for various
relevant disorders (mood disorder, conduct disorder, addictions, obsessions and
compulsions) and, in a smaller scale study in Canada, with pathological gamblers. Mindful
of constraints on service funding, the investigator has designed the treatment to be
administered briefly (in 8 weeks). The effectiveness of providing this treatment in
groups, with professional leaders, will be compared to providing it through a self-help
manual. What works best for whom will also be determined. This investigator has also
developed--with benefit of her multidisciplinary training in experimental psychology,
prevention and addiction treatment--plans for other research concerning the treatment of
pathological gamblers, and we look forward to her additional clinical research
contributions.
Questions about the nature of the underlying mechanisms in compulsive gambling, and its
frequent co-occurrence with substance abuse make pathological gambling of interest to
other components of NIH, such as NIDA and NIAAA. Each of these institutes has funded a
research grant concerning pathological gambling. NIDA’s is concerned with
pathological gambling as a non-pharmacological addiction, and is examining several
relevant biological systems for clues to underlying factors that could then be targets for
intervention. NIAAA’s grant involves a large survey to explore the relation of
substance abuse disorders and pathological gambling in the context of community factors
that include the availability of gambling.
As stated earlier, in order to stimulate more such research applications, NIDA and
NIAAA joined with NIMH last summer in issuing a Program Announcement (PA) for research on
pathological gambling. This PA encouraged all disciplines to consider basic, clinical, and
services research in this area, and provided for a date for receipt of applications and a
special review group devoted specifically to these applications. Consistent with our
general experience with research grant applications in a relatively new research area, the
scientific peer review of the first submissions under the PA resulted in no applications
with ratings of scientific merit in the normally fundable range. Many of the applications
in response to the PA were very promising, and if the applicants adequately address the
various concerns of the reviewers and resubmit their applications at a later date, some
may well improve sufficiently in scientific quality to be within the fundable range in the
next round of review.
We feel very strongly that funding studies of low or questionable scientific quality
does not advance the scientific knowledge base and is not a responsible use of taxpayers'
funds. It is likely that over the next several years we will be able to support research
studies of high scientific merit that will help us understand the roots of pathological
gambling and offer more effective techniques for its prevention and treatment. To this
end, NIMH staff provides technical assistance to investigators with promising
applications. Thus, the initial submissions in response to the PA are not lost
opportunities, but first steps for some on the road to funding.
NIMH staff have also been encouraging research grant applications from interested
scientific investigators working in the gambling area by conducting a workshop on applying
for a grant at the recent conference of the National Council on Problem Gambling held just
a few weeks ago.
My testimony would not be complete without noting that NIMH also contributed
financially and scientifically to the National Gambling Impact Study Commission's national
survey on the social and economic costs of gambling. NIMH staff looks forward to examining
the final report on the survey and its data for possible additional analyses concerning
the relation of mental health variables to pathological gambling.
Pathological gambling, has complex origins and, like so many other disorders examined
by NIMH researchers, requires a broad multidisciplinary approach. These disciplines span
epidemiology, genetics, neuroscience, developmental psychopathology, as well as
behavioral, cognitive, and social science. The kinds of questions we are encouraging
researchers to answer are these:
- For many persons, gambling is an interesting and enjoyable activity, with no or
minimal adverse effects on their finances, work, or relationships with family members and
others. But for some people, gambling becomes seriously maladaptive and results in major
financial losses, interferes with work, and disrupts relationships with family and others.
What explains such "out of control," dysfunctional and injurious behavior? What
are the underlying factors?
- Is it primarily a reflection of another disorder (e.g., depression) or a
nonpharmacological addition, a result of social-cognitive factors (e.g., faulty cognitions
and reinforcement schedules), or a reflection of other factors?
- What are the predisposing factors? Are there different types of pathological
gamblers for which different models are required to explain their gambling? Does risk run
in families, and perhaps reflect the contribution of genes?
- What occurs in the transition to pathological gambling at the behavioral level and
in the brain? What factors influence that transition?
- To what extent, and in what ways, is alcohol and drug use concurrent with
pathological gambling? In these cases, is the gambling and substance abuse a reflection of
common or different factors, and what are the nature and interactive effects of
pathological gambling and substance abuse
- How prevalent is pathological gambling? How is it defined? What are the reliability
and validity of various definitions?
- What strategies are most effective for preventing pathological gambling?
- For pathological gamblers, what treatments are effective for this behavior and
for co-occurring disorders and problems, such as
and related
problems?
- What is the effectiveness of treatments delivered in clinical and community
settings?
These questions are strikingly elemental. They tell you both where we are
scientifically, and where we need to go. It is a difficult research agenda. But we are on
our way.
I would be happy to answer any questions.
