What is Gambling Disorder?
Gambling addiction is an irresistible drive to keep taking gambling risks despite adverse effects on the gambler’s life. The addiction is also sometimes referred to as compulsive gambling. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), the official diagnostic resource of the psychiatric field, calls the problem gambling disorder (GD) and gives it official diagnostic criteria.
Gambling addicts continue to gamble despite mounting losses, often resulting in severe financial difficulties and relationship conflicts. They will often deny that they have a problem, and they will often take steps to hide their gambling behavior. In extreme cases, the gambling problem may lead them to commit crimes.
Symptoms of Gambling Addiction
The symptoms of gambling addiction closely resemble the symptoms of drug addictions. In general, the symptoms show an uncontrollable urge to gamble and evidence that refraining from gambling causes distress in the gambler.
Common symptoms include:
- Persistent thoughts about gambling, including planning how to get more money for gambling
- Needing to take bigger and bigger gambling risks in order to satisfy the urge to gamble
- Unsuccessful attempts to stop or reduce the amount of gambling
- Negative moods (irritability, restlessness, etc.) when unable to gamble
- Using gambling as a coping tool when feeling down
- Gambling even more after losses in an attempt to break even (called “chasing losses”)
- Lying about or attempting to hide gambling activity
- Risking relationships, jobs, or other positive things in order to keep gambling
- Committing crimes (theft, fraud, etc.) or acting unethically to get money for gambling
- Asking for financial help to cover gambling debts
What Causes Gambling Disorder?
The pattern of behavior in gambling addicts appears similar to that of other addicts, but it is not clear why some people develop an addiction to gambling and others don’t. However, several different risk factors appear to increase an individual’s risk of developing gambling addiction:
- Age. Gambling addiction affects people of all ages, but it is most common in young adults and middle-aged people. People who begin gambling at an early age are at a higher risk of developing a gambling addiction.
- Sex. Men are affected more often than women. Men tend to develop gambling problems earlier in life than women do.
- Family history. People who have family members who gamble compulsively are at higher risk.
- Environment. People with friends or associates who gamble are at a higher risk.
- Personality traits. Studies have found a connection between gambling addiction and certain broad personality traits. Associated traits include competitiveness, impulsivity, restlessness, and a tendency toward boredom.
- Associated psychiatric disorders. Gambling addicts often suffer from at least one other mental health problem. Commonly associated disorders include substance abuse disorders, obsessive-compulsive disorder (OCD), bipolar disorder, depression, anxiety, personality disorders, and attention-deficit/hyperactivity disorder (ADHD).
- Medications. Certain medications that stimulate the action of the brain chemical dopamine can cause compulsive gambling and other compulsive behaviors. These drugs, most notably levodopa, are often used to treat Parkinson’s disease and other brain disorders.
Is Gambling Disorder Hereditary?
Studies have found that people who have a first-degree relative (a parent or sibling) with a gambling problem are as much as eight times more likely than the general population to develop a gambling addiction. Close relatives of people with gambling problems are also significantly more likely to suffer from a range of other psychiatric disorders, including major depression, bipolar disorder, social anxiety disorder, substance use disorders, post-traumatic stress disorder (PTSD), and antisocial personality disorder.
Research has not yet discovered a specific gene that appears to be associated gambling disorder. It is likely that gambling addiction arises from a combination of factors, including genetics and environment.
How Is Gambling Disorder Detected?
Many problem gamblers deny that they have a problem and take steps to hide their gambling, making it hard for their loved ones to know there’s a problem before it’s too late. Being alert to the early warning signs can help you detect a gambling problem before it has a profound and lasting negative effect on your loved one’s life.
Common warning signs include:
- Being secretive about money
- Being secretive about time spent away from home
- Not following through on commitments
- Being short of money when they shouldn’t be
- Missing money from accounts or valuables from the home
- Being socially withdrawn
- Being unusually anxious or irritable
- Having difficulties at work or school
- Being depressed
- Exhibiting changes in sleep patterns, sex drive, or other behavioral changes
How Is Gambling Disorder Diagnosed?
To diagnose gambling disorder, a mental health professional will assess the patient’s gambling behavior. The diagnostic process might also include interviews with loved ones or other people who might be familiar with the patient’s behavior.
A diagnosis of gambling disorder requires that the patient meet at least four of the following criteria within the past year:
- Preoccupation. The patient has persistent thoughts about gambling
- Tolerance. The patient needs to take increasingly bigger financial risks to satisfy the gambling urge.
- Withdrawal symptoms. The patient feels irritable or restless when unable to gamble.
- The patient has made unsuccessful attempts to quit gambling or reduce gambling behavior.
- The patient uses gambling to cope with feelings of distress or depressed mood.
- The patient gambles after losses in an attempt to break even.
- The patient lies about gambling activity.
- The patient continues to gamble despite risks to relationships, job, school, or other positive situation.
- The patient seeks financial help from others as a result of gambling losses.
It is possible for gambling addicts to experience periods of remission during which gambling activity slows or stops. These periods are usually temporary, however, and gambling problems are likely to return.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Gambling Disorder Treated?
Treatment for gambling disorder usually involves one or more types of psychotherapy. In some cases, medications may be prescribed to treat co-existent psychiatric disorders, and these medications may help to manage the symptoms of gambling addiction as well.
Common treatment approaches include:
- Psychotherapy. Cognitive behavioral therapy (CBT) is commonly used to treat gambling disorder. This therapeutic approach begins by teaching the patient to recognize the unhealthy thought patterns associated with their gambling behavior. CBT then focuses on helping the patient develop strategies for coping with the negative thought patterns without resorting to gambling behaviors.
- Other therapies. Family and/or group therapies are sometimes used. Some people with gambling disorder have successfully used self-help programs such as Gamblers Anonymous, although research data on the effectiveness of these programs is mixed.
- Medications. Medications such as antidepressants may be used to treat the symptoms of co-existent disorders such as depression or anxiety. In some cases, these medications may also reduce the symptoms of gambling disorder.
How Does Gambling Disorder Progress?
By its nature, gambling disorder is progressive, meaning that the sufferer takes more and more gambling risks and is likely to experience increasingly serious negative impacts from gambling. When it is uncontrolled, gambling addiction can eventually lead to significant problems, some of them even life-threatening.
Potential long-term complications of gambling disorder include:
- Relationship losses, including divorce and estrangement from family and friends
- Social isolation
- Loss of employment
- Bankruptcy and other serious financial hardships
- Legal problems, including imprisonment
- Poor nutrition and overall poor physical health
- Suicide or suicide attempts
How Is Gambling Disorder Prevented?
There is no treatment or intervention that can prevent gambling disorder. If you are at risk of gambling problems (if you have family members with gambling problems, for example), it is a good idea for you to avoid risky behaviors and situations.
- Do not gamble in any way.
- Avoid places and situations where gambling takes place.
- Avoid people who gamble.
Avoiding risk may help you control urges to gamble. Finding a support group for gambling addicts may also help. Be alert for the warning signs of problematic gambling, and seek help as soon as they occur.
Gambling Disorder Caregiver Tips
In addition to hurting the sufferer, gambling addiction can have a direct negative impact on the lives of the gambler’s loved ones. This makes it especially difficult for loved ones and caregivers to cope with the disorder and help their loved one to improve. If your loved one has a gambling problem, keep these tips in mind:
- Be compassionate. Keep in mind that your loved one is in the grip of an addiction that is very difficult to control. Try to keep your anger and frustration in check as you address the gambling problem, and be supportive of any treatment efforts.
- Be firm. Protect yourself from financial harm by staying in control of your family’s finances. Be very aware of your financial situation, and don’t let the gambler make financial decisions that affect you. If your loved one asks for your help in settling gambling debts, don’t bail them out.
- Be open. Denial of the problem makes it much harder to overcome. Be honest with your loved one, yourself, your family, and friends about what you’re going through.
Gambling Disorder Brain Science
Under normal circumstances, pleasurable activities (eating good food, exercising, sex, positive social interactions, etc.) trigger the release of a brain chemical called dopamine. Reactions to the presence of dopamine in our brains produce feelings of satisfaction, contentment, and happiness. This pleasure-reward cycle serves an important biological function in that it encourages us to seek out positive, beneficial situations.
Some drugs alter the normal pleasure-reward system by triggering the release of large amounts of dopamine. The result is an intense good feeling (a “high”) that can only be reproduced by taking the drug. In some cases, the elevated level of dopamine eventually causes the brain to lose sensitivity to the chemical. The drug user must take higher and higher doses of the drug to achieve the same good feeling. This condition leads to addiction.
Studies have shown that gambling addiction functions in much the same way that drug addiction does. In gambling addicts, gambling triggers the release of dopamine, and the pattern of brain activity in gambling addicts is similar to that of drug addicts. Some people seem to be genetically predisposed to be at risk of substance addictions, and the same may be true of gambling addictions.
The link between dopamine and gambling addiction is illustrated by studies of patients suffering from Parkinson’s disease. Parkinson’s is caused by a deficiency of dopamine activity, and some Parkinson’s medications (levodopa and others) increase dopamine levels. Studies have shown that Parkinson’s patients have a significantly higher rate of problem gambling than the general population, suggesting that dopamine-boosting medications could be to blame.
Gambling Disorder Research
Title: Don’t Go There: A Geospatial mHealth App for Gambling Disorder
Stage: Not Yet Recruiting
Principal Investigator: Jeremiah Weinstock, PhD
Saint Louis University
Saint Louis, MO
The goal of this project is to develop and to test the efficacy of a novel mHealth app for gambling disorder. The app capitalizes on smartphones’ global positioning software (GPS) that recognizes a user’s location to within 15 feet. Users will receive an alert if they go near a gambling venue. The project will conduct a 12-week pilot randomized clinical trial to test the short-term efficacy of the app with gambling disorder individuals.
Title: Milk Thistle in Pathological Gambling
Contact: Jon E Grant, JD, MD, MPH
University of Chicago
Gambling disorder is a significant public health problem that often results in a distinctive pattern of persistent and disabling psychological symptoms. Although once thought to be relatively uncommon, studies estimate that gambling disorder has a lifetime prevalence among adults of 1.6% and past-year prevalence of 1.1%. Patients with gambling disorder also experience significant social and occupational impairment as well as financial and legal difficulties.
Individuals with gambling disorder report chronically high levels of stress, and vulnerability to gambling addiction is enhanced by stressful events (4), particularly as stress may result cognitive problems leading to impulsive and unhealthy decisions. A stress response is elicited when sensations and Observations do not match existing or anticipated expectations. A primary endocrine response to stress is the secretion of glucocorticoids through the activation of the hypothalamic-pituitary-adrenal axis. Although their release serves to maintain homeostasis during acute episodes of stress, prolonged stress responses have been associated with structural brain damage both in humans and animals. In humans, stress also enhances addictive craving, and relapse to addiction is more likely to occur in individuals exposed to high levels of stress. Since oxidative stress may be implicated in the etiology of addictive behaviors, use of antioxidants to reduce relapse, improve cognitive functioning, and reduce addictive urges may be a sensible step.
Silymarin, a flavonoid and a member of the Asteraceae family, is extracted from the seeds of milk thistle (Silybum marianum) and is known to own antioxidative and anti-apoptotic properties. Silymarin has been reported to decrease lipid peroxidation. Furthermore, it has been demonstrated that its anti-oxidative activity is related to the scavenging of free radicals and activation of anti-oxidative defenses: increases in cellular glutathione content and superoxide dismutase activity. Milk thistle has been used for a range of psychiatric disorders including methamphetamine abuse and obsessive compulsive disorder, two psychiatric disorders with similarities to gambling disorder. The flavanoid complex silymarin in preclinical studies has been found to increase serotonin levels in the cortex, and ameliorate decreases in dopamine and serotonin in the prefrontal cortex and hippocampus associated with methamphetamine abuse. In the frontal cortex one of the functions of dopamine is to increase the signal to noise ratio, increased dopamine correlating with increased frontal performance. Studies have shown that the higher cortical dopamine levels are associated with improved frontal cortical cognitive performance. Cortical inhibition is felt to be the basis for top-down control of motivated behaviors. A recent randomized controlled study with milk thistle was conducted in Iran Thirty five participants with moderate OCD were randomly assigned to 200 mg of milk thistle leaf extract or 10 mg of fluoxetine three times daily for eight weeks. Results revealed no significant difference in treatment effects between milk thistle and fluoxetine from baseline to endpoint as both interventions provided a highly significant reduction in symptoms.
Silymarin or Milk Thistle may therefore offer promise for the treatment of individuals with gambling disorder. Pharmacological management of gambling symptoms has produced mixed results, with some studies showing a superiority of medication to placebo.
The current pilot study examines the tolerability and efficacy of milk thistle in the treatment of gambling disorder. We hypothesize that milk thistle will reduce the severity of gambling symptoms and improve patients’ overall functioning.
Title: Online Coping Skills Counseling for Problem Gambling and Trauma
Contact: Lisa Najavits, PhD
Newton Center, MA
Our key study question is whether an integrated focus on PG and PTSD (Seeking Safety; SS) offers a useful new option for clinical care compared to a purely problem gambling approach (Cognitive-Behavioral Therapy for PG; CBT-PG). This question—the impact of integrated versus non-integrated treatment for co-occurring disorders—is one of the key issues in the field currently and has never been studied in relation to PG and PTSD.
Our aims are:
To conduct an RCT of SS versus CBT-PG in a sample of 84 people with current PG and PTSD (full or subthreshold).
To evaluate outcomes from baseline to end of treatment and 12 month followup on two primary variables (money lost gambling and number of gambling sessions) and several secondary variables.
Our hypotheses are: (a) SS will do no worse than CBT-PG on the primary PG outcomes as both treatments are designed to address addiction; i.e., both will show improvement from baseline to end of treatment and maintenance of gains through the followup. (b) SS will show superior results on trauma symptoms as SS is designed to address those, whereas CBT-PG is not.