Gambling Disorder

What is gambling disorder (gambling addiction)?

Gambling disorder (gambling addiction) is a mental health condition characterized by recurrent, maladaptive gambling behavior that causes you clinical stress. It causes major problems with your relationships, work or school, and/or finances.

Gambling refers to an activity in which a person risks something valuable to themselves to win something in return. There are many types of gambling, but common forms include betting in casinos or on sporting events. Not everyone who gambles develops gambling disorder.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) considers gambling disorder as a behavioral addiction. In fact, it’s currently the only behavioral addiction the DSM-5 recognizes. In certain ways, gambling disorder resembles substance use disorder. They both change your brain chemistry and can have features of withdrawal and tolerance.

Gambling disorder is sometimes called compulsive gambling or problem gambling.

Who does gambling disorder affect?

Gambling disorder affects adolescents and adults. In the United States, gambling is illegal for adolescents under the age of 18, but it’s still relatively common for that age group. Gambling at a young age is also a risk factor for developing gambling disorder.

How common is gambling disorder?

Researchers estimate that gambling disorder affects 2% to 4% of the U.S. population. But this may be inaccurate because not everyone with gambling disorder receives a diagnosis or professional treatment.

What are the signs of gambling addiction?

A significant sign of gambling addiction is when gambling interferes with major areas of your life, like your relationships, work and financial stability.

More specific signs of gambling addiction include:

• Frequently thinking about gambling.
• Needing to gamble with greater amounts of money or valuables to receive the same level of pleasure and excitement (tolerance).
• Repeated unsuccessful efforts to control or stop gambling.
• Restlessness or irritability when you try to stop gambling (withdrawal).
• Gambling when you feel distressed (as an “escape” from negative feelings).
• Gambling to regain recent gambling-related losses (called “chasing losses”).
• Downplaying or lying to loved ones about your gambling behaviors.
• Relying on other people to fund your gambling or replace the money you lost from gambling.
• Continuing to gamble even when it negatively affects your finances, work, education or personal relationships.

What causes gambling disorder?

There’s no single cause of gambling disorder or other addictions — it’s a very complex condition. Some of the factors that contribute to gambling disorder include:

• Changes in brain chemistry.
• Genetics.
• Personality traits and coexisting mental health conditions.

Brain chemistry

Gambling affects the reward center of your brain. Humans are biologically motivated to seek rewards. Often, these rewards come from healthy behaviors. When you spend time with a loved one or eat a delicious meal, your body releases a chemical called dopamine, which makes you feel pleasure. It becomes a cycle: You seek out these experiences because they reward you with good feelings.

Gambling can send massive surges of dopamine through your brain, too. But instead of motivating you to do the things you need to do to survive (like eat and work), such massive dopamine levels can have damaging effects on your thoughts, feelings and behavior.

This can create an unhealthy drive to seek more pleasure from gambling and less from healthier activities. Over time, gambling changes your brain chemistry, and you become desensitized to its effects. You then need to gamble more to produce the same effect.

Genetics

Gambling disorder tends to run in families, which suggests a genetic link. Studies on identical twins also show that genetic factors may contribute more to the risk of developing gambling disorder than environmental factors (like adverse childhood experiences).

Personality traits and coexisting mental health conditions

Several studies show that people with gambling disorder are more likely to have extremes of the following personality traits or behaviors:

• Impulsivity.
• Sensation-seeking.
• Compulsivity.
• Difficulties with decision-making and planning.
• Rapid shifts in mood (affective instability).

In addition, people with gambling disorder are more likely to have certain coexisting mental health conditions, including:

• Substance use disorder (SUD), especially alcohol use disorder.
• Impulse control disorders.
• Mood disorders, like depression.
• Anxiety disorders.
• Personality disorders.

Some people may have these conditions before they develop gambling disorder, while others may later develop them.

How is gambling disorder diagnosed?

To diagnose gambling disorder, your healthcare provider may refer you to a psychologist or an addiction counselor. Your provider will ask you (and possibly your loved ones) questions about your patterns of gambling.

Mental health professionals use criteria listed in the DSM-5 to diagnose gambling disorder. You have to have at least four signs of gambling disorder during the past year to receive a diagnosis.

What is the treatment for gambling addiction?

The U.S. Food and Drug Administration currently doesn’t approve any medications to help treat gambling disorder. But several types of psychotherapy can help.

Psychotherapy is a term for a variety of treatment techniques that aim to help a person identify and change unhealthy emotions, thoughts and behaviors. It takes place with a trained, licensed mental health professional, such as a psychologist or clinical social worker.

Therapy can help you:

• Gain control over your gambling.
• Handle stress in a healthy manner.
• Find other ways to spend your time.
• Better manage your finances.
• Heal relationships with loved ones.
• Maintain recovery and avoid triggers.
• Address any other mental health conditions that may be affecting your gambling behaviors.

Specific types of therapy for gambling disorder include:

• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented type of therapy. A mental health professional helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT for gambling disorder, you can unlearn negative and obsessive thoughts and behaviors and learn to adopt healthier thinking patterns and habits. CBT is the most common psychological intervention for treating gambling disorder.
• Motivational interviewing: This type of therapy empowers you to identify and solve your uncertainty about healthy change. Through this technique, you analyze your problematic gambling behavior, comparing it with gambling patterns of the general population. This helps push you to make behavioral changes. Providers often use this in combination with other therapies.
• Psychodynamic therapy: This therapy looks at how unconscious processes affect your behavior. The goal is to increase your self-awareness and understanding of how past behavior influences present behavior.
• Group therapy: This is a type of psychotherapy in which a group of people meets to describe and discuss their problems together under the supervision of a mental health professional. Group therapy is a valuable source of motivation and moral support for people who have gambling disorder, especially if they’ve lost contact with friends or family as a result of the condition.
• Family therapy: This type of therapy can help educate your loved ones about the disorder and create a more stable home environment.

Gambling affects people in different ways. And there are several types of gambling. Certain approaches may work better for different people. It may take time to find the right strategy or therapist for you. But it’s important to keep trying.

Can I prevent gambling disorder?

There are steps you can take to reduce your risk of gambling disorder, including:

• Avoiding or limiting gambling behaviors: Try to avoid or limit gambling. This can mean how frequently you gamble, how long you gamble at one time and how much money you gamble with. If you feel like gambling is starting to take over your life, see a healthcare provider or mental health professional right away.
• Knowing your family history: If you have a family history of substance use disorders or behavioral addictions, you may be more vulnerable to gambling disorder. Talk to your provider about ways to lower your risk.
• Healthily managing stress: The risk of addictions increases greatly during times of stress and change. It’s important to turn to healthy coping mechanisms during these times, such as exercising, meditating or learning a new hobby. Consider seeing a mental health professional if you’re having issues managing your stress or any mental health conditions.

What is the prognosis for gambling disorder?

The prognosis (outlook) for gambling disorder depends on a few factors, like:

• Its severity.
• If you get treatment.
• If you have other mental health conditions.

Unfortunately, less than 10% of people with gambling disorder seek professional treatment. Many try to fix it themselves. Know that therapy with a mental health professional can help manage the condition.

In comparison with the general population, people with gambling disorder have an increased risk for suicide. One study of people who sought treatment reported that 32% had suicidal ideation and 17% had attempted suicide at least once.

If you’re having thoughts of suicide, call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24 hours a day, seven days a week.

How can I help myself if I have gambling disorder?

Aside from seeking professional help, here are some steps you can take to manage gambling disorder:

• Consider joining a support group, like Gamblers Anonymous (GA). Many states in the U.S. also have gambling helplines and other types of assistance.
• If you’re craving gambling, distract yourself with other activities.
• If you’re feeling the urge to gamble, hold off. Giving yourself time may allow the urge to pass or weaken.
• Avoid isolation and reach out for support from trusted loved ones.

How can I help someone with gambling disorder?

It can be very challenging and stressful to learn that someone you love has gambling disorder. Here are some tips to help your loved one and yourself:

• Speak up sooner rather than later: The earlier a person with gambling addiction receives treatment, the better. Address your concerns and help them find treatment as soon as possible. Suggest calling a helpline, talking to a healthcare provider or mental health professional, or going to Gamblers Anonymous. Offer your help and support without being judgmental.
• Practice empathy: Even when you don’t agree with your loved one, listen thoughtfully to them. The more your loved one feels heard, the more they’ll see you as someone they can trust.
• Be patient: Don’t expect a single conversation or action to fix your loved one’s addiction. Gambling disorder is a complex chronic condition, and there’s no quick fix to overcoming it.
• Take care of yourself: The friends and family members of people with gambling disorder often experience stress, depression, grief and isolation. It’s important to take care of your mental health and seek help if you’re experiencing these symptoms.

A note from Cleveland Clinic

You may feel shame about having issues with gambling or maybe you think you can fix it yourself. Know that it’s OK to admit you have problems with gambling. The sooner you get help, the better. Talk to your healthcare provider or a mental health professional if you’re concerned about your gambling behaviors. They’re available to help and support you.