Gambling Disorder (Compulsive Gambling, Pathological Gambling)

How do you know if you are a compulsive, or pathological, gambler?

Although some people gamble occasionally, the pathological gambler usually progresses from occasional gambling to habitual gambling. As this progresses, the gambler will risk more and more, leading to severe personal problems, financial ruin, and possibly criminal behavior.

Signs and symptoms as cataloged by the DSM-5; persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, is indicated by the individual exhibiting four (or more) of the fol­lowing in a 12-month period:

• Needs to gamble with increasing amounts of money to achieve the desired excitement.

• Is restless or irritable when attempting to cut down or stop gambling.

• Has made repeated unsuccessful efforts to control, cut back, or stop gambling.

• Is often preoccupied with gambling (for example, having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).

• Often gambles when feeling distressed (for example, helpless, guilty, anxious, depressed).

• After losing money gambling, often returns another day to get even (“chasing” one’s losses).

• Lies to conceal the extent of involvement with gambling.

• Has jeopardized or lost a significant relationship, job, or educational or career op­portunity because of gambling.

• Relies on others to provide money to relieve desperate financial situations caused by gambling.

• The gambling behavior is not better explained by a manic episode.

Gambling addiction affects 1 to 3 percent of adults of all ages, men more often than women. It normally begins in adolescence in men and later in women.

People with pathological gambling behavior often have problems with alcohol and other substances, depression, and anxiety. People with this behavior do sometimes consider suicide.

People with pathological gambling behavior tend to have personal, financial, and legal problems, including bankruptcy, divorce, job loss, and prison time. The stress of gambling can also lead to heart attacks in people at risk for them. The right treatment can help prevent many of these problems.

The onset of gambling disorder can occur during adolescence or young adulthood, but in other individuals, it manifests during middle or even older adulthood. Generally, gambling disorder develops over the course of years, although the progression appears to be more rapid in females than in males. Most individuals who develop a gambling disorder demonstrate a pattern of gambling that gradually increases in both frequency and amount of wagering. Certainly, milder forms can develop into more severe cases.

Most individuals with gambling disorder report that one or two types of gambling are most problematic for them, although some individuals participate in many forms of gambling. Individuals are likely to engage in certain types of gambling (buying scratch tickets daily) more frequently than others (playing slot machines or blackjack at the casino weekly). The frequency of gambling can be related more to the type of gambling than to the severity of the overall gambling disorder. For example, purchasing a single scratch ticket each day may not be problematic, while less frequent casino, sports, or card gambling may be part of a gambling disorder. Similarly, amounts of money spent wagering may not be necessarily in­dicative of gambling disorder. Some individuals can wager thousands of dollars per month and not have a problem with gambling, while others may wager much smaller amounts but experience substantial gambling-related difficulties.

Gambling patterns may be regular or episodic, and gambling disorder can be persis­tent or in remission. Gambling can increase during periods of stress or depression and during periods of substance use or abstinence. There may be periods of heavy gambling and severe problems, times of total abstinence, and periods of non-problematic gambling. Gambling disorder is sometimes associated with spontaneous, long-term remissions. Nevertheless, some individuals underestimate their vulnerability to develop gambling disorder or to return to gambling disorder following remission. When in a period of re­mission, they may incorrectly assume that they will have no problem regulating gambling and that they may gamble on some forms non-problematically, only to experience a return to gambling disorder.

There are age and gender variations in the type of gambling activities and the preva­lence rates of gambling disorder. Gambling disorder is more common among younger and middle-aged people than among older adults. Among adolescents and young adults, the disorder is more prevalent in males than in females. Younger individuals prefer different forms of gambling (sports betting), while older adults are more likely to develop problems with slot machines and bingo gambling. Although the proportions of individuals who seek treatment for gambling disorder are low across all age groups, younger individ­uals are especially unlikely to seek treatment.

Males are more likely to begin gambling earlier in life and have a younger age at the on­set of gambling disorder than females, who are more likely to begin gambling later in life and to develop gambling disorder in a shorter time frame. Females with gambling disorder are more likely than males with gambling disorder to have depressive, bipolar, and anxiety disorders. Females also have a later age at onset of the disorder and seek treatment sooner, although rates of treatment-seeking are low among individuals with gam­bling disorder regardless of gender.

Prevention may not always be possible. Limiting exposure can be helpful for people who are at risk. But with easy access to lotteries, online gambling, and casinos, prevention is difficult. Early intervention helps the individual from getting worse. People with close family and friends at high risk should remain attentive.

Compulsive gambling is treatable. Recognizing the problem is the first step toward treatment.

• Therapy or support groups: Psychotherapy in the form of individual or group settings can help. For some people, support groups such as the 12-step Gamblers Anonymous are useful. This program adheres to abstinence principles similar to that of substance use and alcohol use.
• Medications: In combination with psychotherapy, the individual may benefit from antidepressants, mood stabilizers, opioid antagonists, or narcotic antagonists.

Compulsive gambling is much like alcohol or drug addiction, it tends to worsen after the start of treatment. Pathological gambling is a chronic disorder, and relapse does happen. But with the right treatment, the chronic gambler can gain control over their life.