The symptoms include headaches, stomach cramps, body chills and nausea. No medication can ease the pain. The only quick cure is another fix. And for compulsive gamblers, a fix is never hard to find.
"Gambling is so available in this country, you can do it year round," says Dr. Robert Custer, the leading U.S. authority on compulsive gambling, who has spent the last 12 years treating such patients as clergymen, professional football players and Wall Street stockbrokers -- patients as addicted to gambling as junkies are to drugs.
But don't expect Doc Custer to rail against the evils of betting, or to advocate public flogging of bookies. Give him good odds on a fast finisher at Charles Town and he is liable to take the bet.
"I've gambled for most of my adult life," says Custer, the acting director of mental health for the Veterans Administration in Washington, D.C., the head of the first resident program for compulsive gamblers in 1972 and the therapist for Art Schlichter, the Indianapolis Colts' quarterback who was suspended last year after sinking more than $350,000 into debt to bookies. "It's a lot of fun. For the vast majority of people . . . gambling can be therapeutic."
Custer declined to discuss specifics of Schlichter's problems, but says the quarterback's addiction seems to be under control.
He also says it takes at least two years to determine if treatment has been effective. He still talks to Schlichter regularly, and he considers him a friend.
For compulsive gamblers, who spend an estimated $34 billion annually on legal and illegal bets, according to the Washington Center for Pathological Gambling in Rockville, there is nothing therapeutic about their obsession.
In early stages, the compulsive gambler neglects job, family and friends. In extreme cases, the compulsion can lead to crime and suicide. Custer is no longer shocked when a desperate gambler calls to confess he has just bought a gun.
"It's a sickness, a disease of the mind," says Custer, who has testified in court cases involving gambling-related crimes.
Earlier this year he was an expert witness at a presentence hearing for a Toronto bank executive who embezzled $10.2 million of his bank's funds and lost all but $1,000 of it at Atlantic City casinos.
"One of the four major groups of gamblers is the stock options and commodities gambler," says Custer, a middle-aged, heavy-set man with hooded eyes and a rich, hypnotic voice.
"Most of them won't admit it. They say, 'I'm a businessman,' or 'I'm a trader,' but they are no different than casino gamblers."
The other serious gambling categories involve horse racing, betting on sporting contests such as football and basketball games, and casino-type gambling. State-run lotteries may give gambling an air of respectability, says Custer, but they rarely spawn their own addicts.
"No compulsive gambler is going to wait a week to see if he won," Custer says. "They want constant action. The shorter the time between making the bet and the payoff, the more addictive it is."
He did not know anything about compulsive gambling until 1972, when Gamblers Anonymous persuaded him to counsel members who needed more than emotional support.
"They said they had people much too sick for them to handle; people who were suicidal and thinking of crime," remembers Custer, who at the time was treating alcoholics and drug addicts for the Veterans Administration.
"They (gamblers) didn't really attract my attention until I saw them go into withdrawal. I thought they were in some kind of alcohol or drug withdrawal. Tests proved they weren't. I tried librium and valium, which work well with alcoholics. It didn't work with them and they didn't like it. Nothing would relieve it."
Custer began studying compulsive gamblers like no one ever had before.
He recorded everything they said, conducted lab tests and studied X-rays and psychological histories. He discovered some remarkable similarities among his patients.
"Almost all compulsive gamblers are workaholics," he says. "They are bright, competitive, have immense amounts of energy and they like stimulation. They tolerate boredom poorly."
He also learned that the great majority of compulsives began betting as adolescents and almost every one could remember in vivid detail the first big win, at an age when he was not mature enough to have developed strong self-control.
"I've never known a social gambler to have a 'big win' ", says Custer, who defines that amount as three times the monthly salary of whoever is betting. "The real losing phase starts with the big win. That's the hook. What locks them in is the 'bailout.' "
The bailout occurs when a friend or family member puts up money to pay a gambler's debt. For the gambler, says Custer, it's like another big win. "I've seen families literally give their homes away."
He has a realistic attitude about the power he must counter in the compulsive gambler. He has been to race tracks and seen former patients who have slipped back into the game, men and women who are in a literal "trance-like" state so strong they don't even recognize him.
"It's euphoric and analgesic, a stimulant and a tranquilizer at the same time. When compulsives are gambling, they don't have a care in the world. You're asking them to come out of a fantasy world, 20 miles high. Anything that good is hard to break."
Despite that, Custer claims a 70 to 75 percent success rate with compulsives who live close enough to treatment centers to get periodic therapy.
After an initial treatment that emphasizes hours of conversation and exercise, Custer encourages them to formulate their own plan to pay off their debts. And because of the psychological makeup of most compulsives, that plan most often involves immersing themselves in work.
"Because so many compulsive gamblers are workaholics, they get into work. They enjoy it and they make money which they need.
"It's much easier to treat a gambler than an alcoholic," says Custer.
He travels the country urging states that sanction gambling to use part of their winnings to maintain treatment centers for compulsive gamblers. There are now five states, including Maryland, that fund treatment programs and four states with legislation pending to provide it.
"The compulsive gambler has too much emotion involved in the bet," says Custer. "If they win, it proves they're smart. If they lose, they feel dumb and worthless. And it doesn't matter how smart you are, sooner or later you're going to lose."