Also called: Gambling Problem, Pathological Gambling, Compulsive Gambling
Many people who gamble never develop a problem with the behavior. Some, however, engage in uncontrolled gambling that can lead to serious personal, vocational and financial consequences. This condition is also known as gambling addiction, compulsive gambling or pathological gambling.
Signs of gambling addiction include a preoccupation with gambling, telling lies to friends and family members about the behavior and a need to increase the amount of money bet while gambling. People who do not meet the American Psychiatric Association’s (APA) criteria for a diagnosis of pathological gambling may still be considered problem gamblers.
Pathological gambling affects more men than women, more young people than seniors and more African Americans than other ethnic groups. Exposure to gambling when young, easy access to gambling facilities and a family history of gambling addiction all increase a person’s risk of developing a gambling addiction. A chemical imbalance in the brain may also play a role in developing pathological gambling behavior.
Specific mental health disorders sometimes coexist in people with a gambling addiction. These include depression, alcoholism, panic disorder and narcissistic personality disorder. Pathological gamblers also have a high rate of suicide.
It is important for people with a gambling addiction to visit a psychiatrist for a thorough physical and psychiatric evaluation, which can identify any coexisting disorders that need to be treated. Several specific screening measures may be used to identify signs of a gambling addiction. Treatment for pathological gamblers can include medication, such as antidepressants and mood stabilizers, and/or psychotherapy. There is additional help available for people with a gambling problem. The National Council on Problem Gambling offers a toll-free, 24-hour, confidential phone center: (1-800-522-4700). Also, recovery programs such as Gamblers Anonymous and Gam-Anon can help a person with a gambling problem continue treatment and avoid gambling.
About gambling addiction
Gambling is defined as wagering an item of value in the hope of getting something more valuable in return. It is a very common behavior in the United States. Eighty-five percent of American adults report having gambled at least once in their lives, according to the National Council on Problem Gambling (NCPG). Sixty percent have gambled in the past year.
Most adults are able to gamble responsibly. However, a small percentage of people who gamble develop an addiction to it. Gambling behavior that becomes excessive and continues despite serious financial, relationship and work problems is considered pathological (or compulsive). The American Psychiatric Association (APA) classifies pathological gambling as an impulse control disorder with specific criteria for its diagnosis.
Gambling activities can take many different forms. Among the most common in the United States are lotteries, casinos and sports betting, but card games, cockfights, and horse and dog races are other forms of gambling. In addition, gambling via the internet has become increasingly popular in recent years. In terms of gambling addiction, the type of gambling activity is not as important as the extent to which a person is gambling, and the effects of gambling on the person’s life.
When, how and with whom people gamble can determine the type of their gambling behavior and extent of their addiction:
- Social gambling. Recreational gambling that is done with friends, for a set period of time and with a set limit on acceptable losses.
- Professional gambling. Gambling behavior marked by strict self-discipline and limited risk-taking.
- Problem gambling. Behavior that meets several of the APA criteria for pathological gambling, but not enough for an actual diagnosis. People with this type of behavior usually experience financial and/or social difficulties as a result of their gambling.
- Pathological gambling. Gambling that is repeated, despite a loss of control over betting and serious personal and financial consequences. Pathological gambling is a psychiatric problem classified as an impulse control disorder by the APA.
Pathological gambling affects approximately 2 million adults in the United States, according to the NCPG. In addition, another four to eight million are problem gamblers – people who meet some, but not all of the criteria necessary for a diagnosis of pathological gambling. Although gambling addiction is a mental health disorder that can be treated, many pathological gamblers deny or hide their behavior and are reluctant to seek help, making it difficult to identify and treat the condition.
A gambling addiction may involve distortions of thought (e.g., overconfidence, a sense of control over chance) and develops in a similar manner to substance abuse. This includes a growing tolerance to the risks necessary for the “rush” of a win, requiring the gambler to risk greater amounts of money to achieve the desired level of excitement. Also, pathological gamblers experience withdrawal when not gambling and become preoccupied with anticipating the next occasion in which they can gamble. Finally, relapse of the behavior is common.
For someone with a gambling addiction, the behavior tends to recur in cycles. Gambling success leads to more gambling, which, in turn, leads to overconfidence and greater amounts of risk-taking. Gambling loss leads to more gambling in an effort to recuperate losses. Either way, the behavior is reinforced and continues. Pathological gambling can lead to financial difficulties, loss of family or friends, unemployment, homelessness, spouse or child abuse, legal problems, and suicide. There is a high incidence of substance abuse, mood and other mental health disorders among pathological gamblers. Research also indicates that pathological gamblers are more likely to experience physical problems including migraines, digestive disorders, sleep disorders and heart conditions. Gambling costs society in lost productivity, creditor losses and social services.
Disorders related to gambling addiction
Many different mental health disorders appear to be related to gambling addiction. These include:
- Mood disorders. Affect a person’s mood and ability to function. Includes bipolar disorder and major depression, which can also include suicidal thoughts or behavior as a symptom. Most pathological gamblers experience major depression at some point in their lives. They sometimes use gambling as an escape from feelings of depression.
- Substance abuse. The use of alcohol, tobacco and/or a variety of legal and/or illegal drugs to alter mood or behavior. Drinking and using drugs often accompany pathological gambling behavior. Gambling addiction and substance abuse share a similar course of development – including an increasing tolerance (to monetary risk or substance of choice), preoccupation, withdrawal and relapse.
- Anxiety disorders. Disorders that consist of debilitating apprehension, worry or fear. Obsessive compulsive disorder(OCD), panic disorder and agoraphobia are types of anxiety disorders seen in patients with gambling problems. Pathological gamblers sometimes use gambling as a way to alleviate feelings of anxiety.
- Personality disorders. Behavior patterns that cause stress and relationship problems. Narcissistic, antisocial andborderline personality disorders(BPD)can sometimes occur along with a gambling addiction.
- Attention deficit hyperactivity disorder(ADHD). An inability to concentrate and a tendency toward impulsive behavior and mood swings. A history of these symptoms in childhood may increase the risk of developing pathological gambling later in life.
Risk factors and causes of gambling addiction
Gambling addiction can be found in every social class as well as in men or women of any age. However, certain factors increase a person’s risk of developing a gambling addiction. These include:
- Age at onset of gambling. People who begin gambling in their youth increase their likelihood of developing a gambling addiction.
- Gender. Men are more likely than women to develop a gambling addiction. Two-thirds of people diagnosed with pathological gambling are men, according to the American Psychiatric Association (APA). Men tend to begin gambling in their early teens, whereas women are more likely to begin in later life and to use gambling as an escape from depression.
- Ethnicity. African-Americans have a higher rate of problem and pathological gambling than other racial groups.
- Access. The availability of gambling activity also plays a role in gambling rates. The percentage of American adults who gamble has increased as access to gambling has increased. In 1978, only two states allowed casino gambling (Nevada and New Jersey). By 1998, all but two states (Hawaii and Utah) had legalized gambling in some form. Meanwhile, the number of adults in the United States who gamble went from 61 percent in the 1960s to 80 percent in 1991, according to the American Academy of Family Physicians.
The proximity of gambling facilities such as casinos can also increase the risk of gambling addiction in a community. The National Gambling Impact Study Commission Report indicated a doubling in the rate of pathological gambling when casinos were located less than 50 miles away from a community. In addition, a growing number of Web sites dedicated to gambling provide 24-hour access to individuals who do not live near casinos and other gambling establishments.
- Other mental health disorders. People with substance abuse problems have a greater risk of developing a gambling addiction. People with disorders such as depression, anxiety disorders and personality disorders have an increased risk of pathological gambling. A history of inattention and hyperactive symptoms in childhood (e.g., attention deficit hyperactivity disorder[ADHD]) may also increase a person’s risk of developing pathological gambling later in life.
- Family history. A family history of pathological gambling or alcohol dependence can increase a person’s risk of developing a gambling addiction.
- Biochemical imbalance. A chemical imbalance in the brain may also play a role. In particular, abnormal levels of the following neurotransmitters have been associated with pathological gambling:
- Serotonin. Regulates mood and behavior. Low levels of serotonin are associated with depression, which often occurs along with a gambling addiction.
- Norepinephrine. Released in response to stress. Norepinephrine has been linked to arousal and risk-taking in pathological gamblers. Low levels of norepinephrine may also be associated with depression.
- Dopamine. Part of the body’s reward system. Dopamine is believed to aid the development of addictions.
- Serotonin. Regulates mood and behavior. Low levels of serotonin are associated with depression, which often occurs along with a gambling addiction.
Signs and symptoms of gambling addiction
Pathological gamblers have a number of traits in common. Many are highly competitive, energetic, restless and easily bored. People with gambling addictions can be overly generous, concerned with the approval of others and workaholics.
The following signs or symptoms, when accompanied by gambling behavior, may indicate a gambling addiction:
- Family or relationship problems
- Financial problems
- Remorse about gambling
- Continued gambling despite efforts to quit
- Loss of control over gambling behavior
- Increased levels of betting
- Gambling to win back losses
- Gambling to feel better
- Gambling in secret
- Lying about gambling behavior
- Alcohol or drug abuse
- Suicidal thoughts or attempts
- Stealing money in order to gamble
- Arrest or imprisonment for criminal behavior
Diagnosis of gambling addiction
People who suffer from a gambling addiction may hide or deny their behavior. They are often reluctant to seek help. Thus, pathological gambling is often undiagnosed or overlooked. It may take the efforts of friends or family members to encourage a person with a gambling addiction to seek help.
The first step in diagnosing a gambling addiction is to visit a psychiatrist. A physical examination can rule out any underlying disorders or help to identify any other mental health disorders that may also be present. A thorough mental health evaluation can help identify the extent of the gambling behavior.
The American Psychiatric Association (APA) classifies pathological gambling as an impulse control disorder with very specific criteria. To obtain a diagnosis of pathological gambling, the behavior must not be caused by a manic episode (mania may include symptoms of excessive gambling and loss of judgment). In addition, a patient must meet at least five or more of the following criteria from the Diagnostic and Statistical Manual of Mental Disorders:
- Preoccupation with gambling
- More and more money is needed to achieve desired excitement
- Continues gambling despite repeated efforts to control behavior
- Restless or irritable when trying to stop gambling
- Uses gambling to feel better
- Gambles to win back losses
- Lies to family members, therapist to conceal gambling behavior
- Steals money in order to continue gambling
- Puts relationships, job in danger
- Seeks money from others to pay debts related to gambling
Other screening methods for gambling addiction include:
- South Oaks Gambling Screen (SOGS). A 20-item scale questionnaire used to identify pathological gambling. However, its accuracy has been questioned and parts may be outdated.
- NORC DSM Screen for Gambling Problems (NODS). Developed by the National Opinion Research Center (NORC) and based on APA criteria.
- Canadian Problem Gambling Index (CPGI). A 31-item measure of problem gambling and gambling involvement that can be used to produce gambling profiles.
There are also self-assessment tools to help gamblers to determine if their behavior is compulsive. Gamblers Anonymous has a 20-question survey that may be helpful in identifying gambling addiction. The Lie/Bet questionnaire is perhaps the easiest for physicians to administer. It consists of just two questions regarding lying and betting behavior in relation to gambling that can indicate a need for further investigation.
Treatment and prevention
A psychiatrist may use the following treatment approaches for a gambling addiction:
- Medication. Antidepressants may be used to treat any co-existing mood or anxiety disorders. Also, lithium and other mood-stabilizing medications have been found to be effective whether or not there is co-existing bipolar disorder.
Some medical trials seem to indicate that antidepressants may effectively treat gambling behavior – even without an underlying mood disorder. However, further study is needed to confirm this. Other medications, including naltrexone (primarily used in treatment of alcohol and opioid abuse) and nalmefene (a medication similar to naltrexone), have shown some promise in treating gambling addiction. However, further research is needed.
- Psychotherapy. The focus of psychotherapy for gambling addiction is similar to that of depression or substance abuse – a person’s thoughts and behavior. Cognitive behavior therapy(CBT) can help identify the reasons for the gambling, confront the gambler’s defenses and stop gambling as a means to recuperate losses. This involves overcoming irrational thoughts (e.g., that a person can control chance through superstitious behavior) and skill development (e.g., learning relaxation techniques, improving social skills).
Emergency intervention may be necessary if the pathological gambler is suicidal. For friends and family members, this can include calling emergency services (911) or taking the loved one to a hospital emergency room, if necessary.
There are two national self-help groups that deal specifically with gambling addiction. Gamblers Anonymous is an abstinence-based, 12-step program similar to Alcoholics Anonymous. It can help people with gambling addictions deal with their symptoms and prevent relapse. Gam-Anon is designed for family and friends of people addicted to gambling.
In addition, anyone with a gambling problem can call the National Council on Problem Gambling’s toll-free, 24-hour, confidential phone center (1-800-522-4700) to get help for their gambling addiction.
Some research suggests that in some cases, compulsive gamblers can recover on their own without the need for treatment. However, this is controversial and only applies to a small minority of people who are pathological gamblers. The only proven method of preventing gambling addiction is to refrain from gambling, especially when risk factors for pathological gambling are present. Learning to recognize the signs of pathological gambling can help problem gamblers to seek treatment early before their behavior worsens.
Questions for your doctor on gambling addiction
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients and their families and friends may wish to ask the doctor the following questions related to gambling addiction:
- How can I tell if my gambling is out of control?
- If I only gamble occasionally, do I have a problem?
- Do I have any disorders that coexist with my gambling addiction?
- What type of treatment may be right for me? Can you recommend a therapist, mental health professional, group or other setting that may benefit me?
- What types of medications should I take, and what are their side effects?
- What type of psychotherapy may be appropriate for me?
- What treatment side effects or changes should I immediately report to you?
- Can I still gamble once in treatment for a gambling addiction?
- When am I no longer at risk of pathological gambling?
- Are my children at greater risk for compulsive gambling or other addictions? What can I do to help prevent the development of this behavior?