Here are some quotes from _Addiction by Design_, by Natasha Dow Shüll -- a book I highly recommend if you're interested in this subject:
> Julie explains: "If it's a moderate day - win, lose, win, lose - you keep the same pace. But if you win big, it can prevent you from staying in the zone." [...] "You're not playing for money," says Julie, "you're playing for credit -- credit so you can sit there longer, which is the goal. It's not about winning, it's about continuing to play."
> [Pete says:] After sitting at the machine for fourteen hours, so tired I can barely keep my eyes open, no money in my pocket, no gas in my car, and no groceries at home, I still can't leave because I have four hundred credits in the machine. So I sit there for another hour until it's all gone, praying for me to lose: "Please God take this money so I can get up and go home." You might ask, "Why didn't you hit the cash out button?" That never occurred to me -- that was not an option.
I don't think the importance of the monetary payout is particularly clear-cut. The payin is what does the financial damage, by moving money out of the player's control. The incentives and reinforcement are what get the player hooked -- but perhaps those don't have to be financial? I won't discount the importance of the payout entirely; maybe it's critical to get hooked in the first place? But I also wouldn't be surprised if gambling addiction can arise in games which don't provide to ability to cash out.