Robert Custer: The Man Who Legitimized Gambling Addiction

For decades, people struggling with gambling problems were tagged as irresponsible or morally weak. There was little recognition that compulsive gambling could function as a diagnosable clinical disorder. That perception began to change in the late 1970s, largely due to the work of the late psychiatrist Robert Custer.

At a time when gambling disorder was barely acknowledged by the medical community, Custer pushed clinicians and policymakers to take it seriously. His work helped shape standards that guide care today and laid the foundation for modern gambling addiction treatment. Today, with gambling more accessible than ever before through online platforms, Custer’s legacy feels even more relevant and important.

Who was Robert Custer? 

Robert L. Custer was born in 1927 in Midland, Pennsylvania. He attended Ohio State University before serving in the U.S. Army and later earned his medical degree from Western Reserve University in Cleveland. After years in general medicine, he completed psychiatric training and joined the Veterans Administration, eventually working at the VA Hospital in Brecksville, Ohio.

In the late 1960s and early 1970s, Custer began encountering veterans whose lives were unraveling due to gambling. Through involvement with Gamblers Anonymous and direct patient care, Custer began to recognize the recurring psychological distress, financial ruin and strained familial relations akin to substance use disorders.

In 1972, Custer opened the first inpatient treatment program at the Brecksville VA. The program combined individual therapy, group therapy and meetings. According to a retrospective study conducted by VA colleagues, more than half of participants reported abstaining from gambling one year after treatment, an early signal that structured care could make a meaningful difference.

Custer later expanded his work and established civilian treatment programs in Maryland and Nevada. He also mentored clinicians entering the field, and his influence spread nationally through lectures and workshops. He passed away in 1990.

Convincing the world that gambling addiction is a medical disorder, not a moral failing

One of Custer’s most important contributions was reframing gambling addiction as a “pain-avoidance mechanism,” a psychological coping strategy rooted in repressed emotions rather than greed or thrill-seeking. He rejected Freudian theories that identified compulsive gambling as a substitute for sexual behavior. In his view, people gambled not to feel pleasure, but instead to often escape anxiety and despair.

In a 1987 Gamblers Anonymous meeting in Dallas, Chris Anderson recalled Custer listening quietly before acknowledging his suffering with simple empathy, “You’re really hurting, aren’t you.” For individuals struggling, being told their gambling struggles had a name was treatable, proved life-changing.

Custer emphasized the gradually progressive nature of problem gambling. What might begin as occasional betting could escalate into a compulsive behavior marked by deteriorating mental health. He helped dismantle the idea that gambling problems were isolated lapses in judgment.

Laying the groundwork for modern gambling addiction treatment

Custer’s observations and advocacy played a key role in the inclusion of pathological gambling in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. While the diagnosis was initially placed under impulse control disorders, Custer pushed for criteria that reflected addiction-like progression and real-world consequences, such as borrowing money, defaulting on debts and family conflict.

Custer co-founded what would become the National Council on Problem Gambling, helping bring awareness, prevention initiatives and nationwide funding. His 1985 book, When Luck Runs Out, serves as a comprehensive guide for those affected by gambling addiction.

Although his early patient populations were relatively limited, later scholars have noted that his work still forms the backbone of how gambling disorder is measured, studied and treated today.

How gambling addiction is diagnosed today 

Today’s diagnosis builds directly on the foundation Custer helped establish. Gambling disorder is now formally recognized in both the DSM-5 and the World Health Organization’s ICD-11 as a behavioral addiction. Clinicians assess ties to impaired control, prioritizing gambling and unchanged behavior in light of serious consequences.

In the DSM-5, a diagnosis requires at least four of nine qualifying symptoms within a 12-month period, with severity classified as mild, moderate or severe. The ICD-11 further distinguishes between online and offline gambling disorder, reflecting how technology has reshaped risk and exposure. These diagnostic tools guide treatment planning and insurance coverage, making accurate recognition essential for effective care.

Gambling Addiction treatment options

As gambling continues to evolve, Custer’s core message remains unchanged: compassion, clinical understanding and early intervention save lives. 

And today, a modern solution is emerging: online (virtual) counseling. Birches Health offers specialized teletherapy for gambling addiction and related behavioral disorders. The mission: remove the main three traditional barriers to the necessary specialized care.

1. Supply of Specialized Counselors

Birches has built a national network of licensed therapists trained in evidence-based methods for treating gambling disorder.

2. Cost

Birches partners with major insurance companies and select state organizations to help (or completely) cover care costs. For many Birches clients, sessions are covered by insurance, with just a small copay involved, or are even free.

3. Scheduling and Logistics

Birches Health’s gambling addiction treatment program is fully virtual. Clients can access care from anywhere with an internet connection, without needing to travel to an appointment or meeting, take time off work, worry about childcare or sit in a waiting room. 

If you or someone you love is struggling with gambling, there is now specialized help available, and you can access it today.

Here’s how you can get started confidentially with Birches:

• Book an Appointment Online 

• Call 833-483-3838 

• Email help@bircheshealth.com