The numerous forms of gambling – state lotteries, sports betting, slot machines, poker, internet gambling, and many others – are legal in certain states, fostering tourism or sometimes supporting education or other social programs. Although many people enjoy gambling as an occasional activity, for those who develop gambling disorder, the consequences can be devastating. Pathologic gambling was only recently reclassified from an "impulse disorder" to a "behavioral addiction" in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5); thus, gambling disorder is not yet as well understood as many substance addictions. Still, the information that has emerged is alarming:

  • About 1% of American adults have gambling disorder. [1]
  • Minority groups have higher rates of gambling disorders than do their counterparts in the general population. For example, Blacks, Native Americans, and Asians (2.2 – 2.3%) were nearly twice as likely as Hispanics and Whites (1.0 – 1.2%) to develop problematic gambling behaviors at some point during their lives. [2]
  • Young adults seem to be disproportionately affected with an estimated prevalence of 6 to 9% struggling with impulsive gambling. [1]
  • The Internet has only made problem gambling worse, with 24/7 opportunity from any location and poorly enforced age requirements (compared to casinos). [3]

Additionally, multiple studies have attempted to estimate the social cost of gambling disorder, which accounts for millions of dollars in lost productivity, law enforcement, and other expenses each year. But where is the line? When does gambling change from a socially acceptable activity to a diagnosable condition?

Signs and Symptoms

Prior to its addition to the DSM-5, gambling problems were often categorized as either "problem" or "pathological," depending on the severity. Although this distinction does reinforce the idea that gambling behaviors fall on a healthy-unhealthy continuum, when problems that are directly or indirectly related to the addiction begin to emerge in the gambler's life, it may be considered "disordered gambling" (including both problem and pathological). The DSM-5 outlines 9 criteria that may appear in individuals with gambling disorder:

  1. Spending increasing amounts of money to obtain a sought-after thrill.
  2. Irritability and restlessness when taking a break or trying to stop.
  3. Attempts to control the behavior on multiple occasions without success.
  4. Thinks about gambling often – reliving past situations, planning for future gambling, brainstorming ways to get more gambling money.
  5. Gambling behaviors are often linked to distressing emotions like guilt, anxiety, helplessness, etc.
  6. Returning the day after a loss to try to win the lost money back.
  7. Lies about gambling activity (frequency, amount lost, etc.).
  8. Has lost or nearly lost a job or relationship because of gambling.
  9. Has been bailed out of serious debt by family and friends.

Although a person can be diagnosed with a gambling disorder with as few as 4 criteria (4-5 = mild; 6-7 = moderate; 8-9 = severe), any of the above behaviors should be discussed with a professional to determine if the person is developing an addiction.

The above criteria help physicians get a better picture of and quantify a person's condition, but how might these points show up in an individual's behavior?

  • Withdrawal from social situations. Any addiction shifts the person's attention balance from friends, family, career, and activities to the addiction, and gambling is no different.
  • Increased Internet use. Combined with other signs, increased internet use may indicate that the addiction persists at home. This is a particularly important sign for adolescents who would not otherwise be admitted to casinos or other gambling venues.
  • Repeated requests for money. The person always seems to be short on cash or needs a loan to pay bills; may resort to stealing (e.g., cash, credit cards, items to sell for cash).
  • Problems at work or school. As with other addictions, phone calls from a boss or a principal inquiring about health or performance could signal a problem.
  • Evasiveness. Gamblers will try to dodge direct questions about missing money and will try to conceal the extent of the problem.

Effects and Complications

Regardless of severity, gambling disorder can have many negative consequence for the individual, family, and society as a whole.

  • Chronic financial problems and increased likelihood of bankruptcy and poor credit.
  • Co-occurring mental health conditions like anxiety and depression. These often need to be treated simultaneously because they can fuel the addiction and vice versa. In other words, the gambler may increase gambling when feeling distressed (anxious, hopeless, etc.), but losses and everyday life can increase these feelings thereby creating a cycle.
  • Higher risk for suicide attempts than in the general population. [4]
  • Health problems related to extended gambling binges. Gamblers can be so focused on the activity that they go without food or sleep for multiple days. This combined with mounting stress from repeated losses and fears of being discovered by loved ones can lead to medical conditions like peptic ulcer disease, heart problems, and high blood pressure. Inadequate sleep alters mood, impairs cognition, and impedes the immune system. [5]
  • Increased risk of developing a substance-use disorder: particularly, alcohol and nicotine. [5]
  • Elevated risk for marital conflict and divorce compared to the general population. [6]

Families suffer as well because of the damage done to their financial stability and the loss of time with their loved one. As a social problem, gambling disorder can result in lost productivity, unemployment, crime, increased use of social services, illness, bankruptcy, and other issues, amounting to an average of over $9,000 per gambler. [7]

Causes and Risk Factors

Although the exact causes of gambling disorder are not fully understood, some factors have been identified as occurring more frequently among problem gamblers.

  • Males seem to develop gambling disorder more often – and at a younger age – than do women. [8]
  • Those with co-occurring conditions – including ADHD, depression, bipolar disorder (during manic episodes), and substance addictions – are more likely to struggle with gambling than the general population.
  • Problematic gambling behaviors often run in families, so having a relative with gambling disorder increases your own risk of developing it.
  • Having experienced maltreatment or family dysfunction during childhood increases risk for a gambling disorder in adulthood. [6]
  • Taking medications for Parkinson's disease. [9]

Treatment

As with most addictions, gambling addicts often deny that they have a problem; thus, the first step is recognizing and admitting this, which may only be possible with pressure from family and friends. Cognitive behavioral therapy and support groups (like Gamblers Anonymous) can help people with gambling disorder gain further insight into their condition and develop tools to avoid triggers and cope with distressing emotions more appropriately. Because gambling addiction has not yet been the subject of extensive research, doctors do not know if gambling disorder will respond to certain medications. Initial results, however, report some benefit to treatment with naltrexone (an opioid agonist) and antidepressants. [10]

Given the complicated nature of the condition, gambling disorder can be difficult to overcome alone. For this reason, it is best to enlist the help of a physician, therapist, or other health care professional to ensure that you are on the path to recovery and that any co-occurring conditions are being treated as well.