Super Bowl Sunday, it has been said, is to gambling addicts what New Year's Eve is to alcoholics. That is, an occasion to go off on a dangerous bender.

An estimated $90 million will be bet at Nevada casinos on today's game between the Arizona Cardinals and Pittsburgh Steelers. And that's not counting the illegal gambling taking place in living rooms and sports bars, via the Web with offshore bookies, as well as the friendly wager at the office.

Just how much does gambling permeate the Super Sunday gestalt? You can bet on everything from which team wins the coin toss to the duration of the national anthem to how long it takes for the first penalty to be called. "The Super Bowl," says Mike Osborne, executive director of Harbour Pointe, a compulsive gambling treatment center in Maryland, "is a gateway to a long road of self-destruction for many people."

Osborne should know. He is a recovering gambling addict, starting as a teenager betting on football and other sports, and watching it take over his life as an adult.

His self-destruction was nearly total: He lost his job and served jail time for embezzlement; he lost his family after pawning his wife's wedding ring and returning his kids' Christmas presents unopened; he lost his sense of self as he wandered the streets homeless and suicidal.

Those days are behind Osborne now. But he knows that gambling addiction, like alcoholism and substance abuse, never really goes away. It's a constant battle to stay vigilant in a society where gambling is not only tolerated more than other addictions but actually is state-sanctioned in the form of lotteries and tribal casinos.

"The largest enemy we face is public ignorance," Osborne says. "It may seem like it's harmless fun. It is not."

Indeed, pathological gambling has been classified since 1980 as an impulsive control disorder in the Diagnostic and Statistical Manual of Mental Disorders.

According to a 2007 study in the journal Analysis of Gambling Behavior, 6.2 percent of visits to a general practitioner involved problem gambling. A 2006 report by the California attorney general's office found that gaming addicts cost the state an estimated $1 billion annually in lost work time and crime.

And although it's been estimated in several studies that as much as 3 percent of the population has a gambling problem, awareness and treatment lag behind that of alcohol and drug abuse.

Dr. Timothy Fong, co-director of the UCLA Gambling Studies Program, says "a single bet doesn't make somebody a quote- unquote addict. But when we see an ongoing pattern of continued gambling – not losses, gambling – then it's a problem."

Treating the problem differs greatly from other forms of addiction, even though gambling compulsions share similar brain chemistry components as substance abuse. Fong says the most successful form of treatment is behavioral modification mixed with cognitive therapy. He also says medications, mostly antidepressants, are sometimes prescribed – though the FDA has not approved them for that use.

Dr. Eric Geffner, a Southern California psychologist who specializes in gambling therapy, says the addiction needs specific treatment not found in drug rehab centers, where compulsive gamblers often are placed.

Geffner says gamblers need individual treatment.

"Cognitively, you need to deal with the distortions and delusional thinking (such as) 'I'm supposed to win' and that 'A win is going to help me,' when in fact, you're not supposed to win, and if you do win, you'll gamble more because you have this problem.

"It's also important to have an ego dissection, find out what's lacking in their life, the never-good-enough message that most of my male patients got growing up from their parents. And there's a social component where you're in an unhappy marriage or lonely, and gambling is an escape from dealing with life."

Osborne checked himself into gambling treatment centers four times, relapsing three times before he kicked the habit. He said it took time to face the truth about himself and the damage he had done to his family.

"You need to take the blinders off long enough to finally get help," he says. "Most drug and alcohol treatment centers are group-focused. Gambling is a hidden addiction, and (addicts) are manipulators and liars. Gamblers need individual help to deal with finding what's fueling their fire."

As with other addictions, admitting there is a problem is crucial, and often family and friends are the last to know.

"It's difficult because you're not going to smell it on the person's breath, and you're not going to see it in their eyes," Osborne says. "But you can pick up the signs. You'll see someone being more concerned with the final score of a game or waking up early to look in the paper to see what the late scores were. Watch for new credit cards coming in the mail."

What makes problem gambling so difficult to treat is that often there are no physical symptoms that accompany the pathology.

"Substance abusers know if they do too much at one time or too much for too long, they'll probably die or die earlier than they would if they weren't using," says Bruce Roberts, executive director of the California Council on Problem Gambling. "The compulsive gambler looks at it a little differently. It's the only addiction that holds out one false promise and that is that you're just one big win away from being OK."

Osborne, at one time, held that belief. That was before both his cars were repossessed, before his wife was harassed by bookies seeking payment, before he lost the house and declared bankruptcy.

"You often don't realize it until it's too late," he says. "What keeps me from gambling now is not wanting to go back to jail and realizing exactly what consequences my actions had on my kids. I work on it every day."

Call The Bee's Sam McManis, (916) 321-1145. Read his Sacramento Health & Fitness Blog postings at sacbee.com/blogs.