Gambling addiction, also called problem gambling or compulsive gambling, is characterized by the uncontrollable urge to continue gambling despite continued financial losses and potential risk to self, family, and quality of life. Although the concept of gambling addiction has existed among psychologists and medical professionals for several decades, the recent publication of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) updated the disorder, classifying it as an addiction, like alcohol use disorder or opioid addiction.
Researchers have concluded that gambling can stimulate the reward system in the brain in the same way that abusing drugs or alcohol can, and this can develop into a pattern of dangerous but reinforcing compulsive behaviors. Since mental illnesses and addictions often overlap, people who struggle with gambling addiction are at risk for developing addictions to substances like drugs and alcohol, too.
What Is Gambling Addiction?
The DSM-5 classifies compulsive gambling and gambling disorder among addiction disorders for the first time since the concept of gambling addiction was proposed. The definition of gambling addiction, as published in the new DSM-5, states that this compulsive disorder is a persistent and recurrent behavioral issue around gambling, which leads to clinically significant distress or impairment. Four or more of the following symptoms must be exhibited by a person within a 12-month period:
- The need to gamble with increasingly greater sums of money to attain the initial and desired excitement
- Restlessness or irritability when unable to gamble, similar to drug withdrawal
- Repeated unsuccessful attempts to stop gambling or reduce how often gambling occurs
- Being preoccupied with gambling, which includes
- Reliving past gambling experiences
- Persistent thoughts about gambling in the future
- Planning the next gambling event
- Thinking about ways to get money in order to gamble
- Using gambling to change mood, especially when feeling distressed, anxious, depressed, etc.
- “Chasing” losses, which involves returning to gambling the following day in an attempt to win back losses
- Lying, concealing, or downplaying the extent of the gambling problem
- Losing one’s job or educational opportunities due to the gambling problem
- Relying on others to provide money through requests, lying, stealing, or borrowing from loan sharks
This problematic behavior cannot be explained by an underlying condition, like a manic episode from a previously undiagnosed bipolar disorder.
The Prevalence of Gambling Addiction
Much like cocaine, alcohol, or marijuana, behaviors like gambling stimulate the release of dopamine, serotonin, and other neurotransmitters that control mood. While drugs and alcohol stimulate the release of these important mood-related chemicals by forcing other chemicals to bind to receptors in the brain, behaviors like gambling, shopping, and even sex can also prompt these receptors to release an intoxicating dose of these neurotransmitters, stimulating the reward center and eventually changing its structure. The individual will seek out the experience, again and again, that forces these neurotransmitters to be released in such intense amounts, which eventually turns into compulsive behaviors associated with addiction. The more the individual performs these behaviors, the harder it is for them to stop going through the motions, even when the original dose or experience is not enough to stimulate the same amount of neurotransmitters.
Current medical research shows that the brains of people struggling with gambling addiction and substance abuse are similar. They share genetic predispositions that put them at risk as well as environmental factors and early childhood experiences. They display consistent ramping up of compulsive behaviors to acquire more drugs or money and even experience withdrawal symptoms in similar ways. A UK study published in 2017 found that, among 38 participants who were shown images associated with gambling, those with a history of problem gambling experienced cravings, which looked like cravings for drugs in the brains of people struggling with substance abuse.
The National Council on Problem Gambling (NCPG) estimates that about 1 percent of the US adult population, or about 2 million people, can be defined as pathological gamblers; 2-3 percent of the population, which is about 4-6 million individuals, could be defined as problem gamblers. These categories are comparable to drinking problems in the US. The 2015 National Survey on Drug Use and Health (NSDUH) found that about 15.1 million adults, ages 18 and older, had a diagnosable alcohol use disorder, an addiction and physical dependence on alcohol, while 1.3 million people were considered heavy drinkers.
Surprisingly, according to NCPG’s findings, more young people may experience problems with gambling compared to adults. About 6-9 percent of adolescents and teenagers may show signs of problem gambling compared to 1 percent of the adult population. This is also in contrast to alcohol abuse statistics, in which 2.7 percent of adolescents ages 12-17 had a diagnosable alcohol use disorder – about 623,000 kids per the 2015 NSDUH.
Co-Occurring Gambling and Substance Addictions
People who struggle with gambling addiction, like those who struggle with substance use disorders, are more likely to have co-occurring mental illnesses, especially depression and anxiety. Per data from the National Comorbidity Survey Replication, 96.3 percent of people who pathologically gamble also meet lifetime criteria for other psychiatric disorders, especially depression. The close association between mental health and gambling addiction also puts this group at greater risk for developing substance use disorders.
An Australian medical survey conducted by St. Michael’s Hospital found that 10-20 percent of people with a diagnosable addiction to drugs or alcohol had a co-occurring gambling addiction. NPCG published a report from the Substance Abuse and Mental Health Services Administration (SAMHSA) regarding behavioral health from 2014 that featured statistics on the relationship between gambling and substance abuse. About 85 percent of US adults have participated in gambling at least once in their lives while 60 percent have done so in the past year. Among those with pathological gambling problems, there is a 47-52 percent rate of comorbid substance abuse. Close to 6 million adults are either addicted to gambling or meet the criteria to be problem gamblers. In addition:
- 2 percent of this group had a co-occurring alcohol use disorder
- 1 percent had a co-occurring addiction to another drug
- 6 percent had a mood disorder
- 3 percent had an anxiety disorder
- 15-20 percent attempted suicide at least once
People with a co-occurring gambling addiction and substance abuse issues were less likely to complete a three-month rehabilitation program to remain abstinent from drugs and problem behaviors, likely because these two conditions were not treated at the same time. A lifetime history of a mood disorder, which was likely to co-occur with both substance abuse and gambling addiction, decreased the potential for a person to maintain abstinence for at least three months. Problem drinking in particular put those struggling with gambling addiction at a higher risk for relapse and reduced their ability to maintain abstinence from substances.
SAMHSA found that people who struggle with co-occurring substance abuse and gambling addiction may experience a sequential addiction pattern. For example, a person recovering from alcohol use disorder with a history of long-term alcohol dependence may develop a gambling addiction while they are trying to remain sober. There are several instances of people overcoming a substance use disorder switching to a different compulsive behavior, most often problem gambling, to manage stress, which unfortunately has a negative impact on their lives due to impulse control problems.
Treatment for Gambling Addiction and Co-Occurring Disorders
Cognitive Behavioral Therapy works well for both substance abuse and gambling addiction. Case studies on gambling addiction show that the work between a therapist and their client can help to eliminate erroneous beliefs, which influence people struggling with gambling addiction to have an inflated sense of their ability to win, focus their luck, or predict winning lottery tickets. This same kind of therapy can help a person struggling addiction to understand how their compulsive behaviors and personal beliefs negatively impact their life, and how reactions to mental states can be changed to make healthier decisions.
While there are no specific medication interventions to treat the disorder, naltrexone has shown some potential to help people who struggle with gambling addiction. This medication reduces cravings through similar pathways for opioid and alcohol cravings. In the future, this medication may be approved for prescription use among those with gambling addiction. Typically, however, a combination of therapeutic treatments like group and individual therapy, along with financial therapy, help people overcome gambling addiction. With co-occurring disorders like mental illness and substance abuse, getting appropriate treatment with a therapist, along with needed prescription medications, can help to manage symptoms of all conditions. Support groups after rehabilitation can then reinforce behavioral changes.