In the United States, the extent of problem gambling among the homeless community still needs more transparency, but what is clear is that missions everywhere—not just in major gambling communities, but in places like Montana, Ohio, Washington state, and North Carolina—are seeing problem gambling as a growing concern. What Is Gambling Disorder? A better understanding of gambling disorder in the United States may come with the way professionals approach it. Behaviors associated with problem gambling can be interconnected and overlap with behaviors of substance abuse, PTSD, and other mental health conditions. It is sometimes difficult to determine whether patients use gambling as a substitute for other addictions, or whether other addictions spark the drive to gamble. While some refer to the behavior as an addic- tion, Michael Karson, professor of the Graduate School of Professional Psychology at the Univer- sity of Denver, says that term—“addiction”— is somewhat contested. Professionals may be wary to place gambling in the same category as behaviors with a physiological dependence such as opioid or alcohol use. Additionally, professionals and family mem- bers alike may misunderstand what exactly motivates those who suffer from gambling disorder. What makes a person actually continue high-risk behavior after continually losing at games of chance? Karson unfolds how the com- pulsive behavior is maintained primarily by the “varied reinforcement” of gambling and by a lack of interest in everyday life: First, it appears to be a law of nature that random or variable reinforcement creates a much greater response strength than predictable reinforcement. The payoff rate of gambling games is inherently involving, whether for people, rats, or pigeons. Second, while you’re gambling, any other interests in your life are being deprived, and this deprivation ought to give them enough potency to compete with gambling. When life offers few other rewards, gam- bling and drugs and any other reinforcing attractions become very powerful—it feels like there aren’t any other payoffs in life. These two features—the inherent effects of variable reinforcement and the lack of alternative life interests—account for a lot of gambling. Karson also explains that gambling generates two common feelings: “the thrill of victory” and the “agony of defeat,” and understanding a problem gambler is best understood by the former. Psychoanalysts have come to understand a bad outcome—for that person who suffers from gam- bling issues—as a sort of good outcome. People who have multiple accounts of tragedy or failure might identify with being a “loser.” Karson says this generates a sense of being a tragic hero, or a biblical Job: The consolidation of identity has a lot of benefits, including the way life then makes sense, and the way the sense it makes is not that the person is a minor factor in a random world but the main character of a tragedy. Once that happens, the experience of loss can become a reinforcer, consolidat- ing a familiar role of loser…the gambler’s devastation has become what he or she is chasing, not the high. This propensity to identify with the loser role is why problem gambling can be so detrimental 28 WWW.AGRM.ORG MAY/JUNE 2018 It is sometimes difficult to determine whether patients use gambling as a substitute for other addictions, or whether other addictions spark the drive to gamble.