People who experience gambling addiction may be unable to control the impulse to gamble, even when they know their actions are hurting themselves and others. The addiction is also characterized by an urge to gamble in spite of a desire to disengage from the activity.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), gambling addiction is categorized alongside substance-related disorders. This is due to the way gambling similarly impacts the reward centers of the brain. Some of the DSM-5 diagnostic criteria for gambling disorder include failed attempts to decrease or stop gambling, lying to conceal the extent of gambling activities, and negative effects on relationships or career as a result of gambling.
Gamblers Anonymous calls problem gambling “compulsive gambling” and views it as a progressive illness that can be managed but not cured. It is described as a sickness that one must overcome through acceptance, abstinence, and recovery.
Although the DSM-5 and Gamblers Anonymous view problem gambling from slightly different perspectives, both agree that the conditioninvolves an urge to gamble despite damaging effects on one's life.
Gambling in and of itself is not necessarily problematic. Like alcohol consumption, gambling in moderation does not lead to addiction for most people. Gambling becomes problematic when it negatively impacts a person's life. Like most addictions, gambling addiction tends to thrive in secrecy. Loved ones of people experiencing gambling addiction might not be aware there is a problem until it has spiraled out of control.
Warning signs of gambling addiction include:
- An escalation in gambling in either risk or frequency.
- Gambling used as an escape from problems or distress.
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- Feelings of elation immediately before, during, or after gambling.
- Lying about gambling activities.
- Trying to win back gambling losses through more gambling.
- Borrowing money or taking out high-risk loans.
- Ignoring family, work, and other responsibilities to gamble.
- Appearance of or increase in mental health issues such as depression and anxiety.
- Increased alcohol or drug use.
- Restlessness when trying to refrain from gambling or between bouts of gambling.
According to an article in Scientific American (2013), it is estimated that gambling impacts the functioning of around 20 million Americans in one way or another, and approximately 2 million Americans experience gambling addiction. Gambling addiction is more common in men than women and is typically experienced by younger to middle-aged adults. Those with certain mental health issues such as depression, bipolar, or substance-related issues are at increased risk for gambling addiction. Additionally, a person's risk for developing a gambling addiction is greater if his or her parents had issues with gambling.
The secretive nature of addiction and the social stigma that comes with it can make the topic a difficult one to discuss. Whether the concern is for yourself or a loved one, reaching out and getting help can be a challenging first step. These tips and tools may help facilitate the process:
- Educate yourself. Find out as much as you can about gambling addiction, symptoms, and available treatments.
- Be prepared. Choose the right time (e.g. after a gambling spree) and provide objective evidence that there is a problem (e.g. unpaid bills, missed work, etc.).
- Avoid blame. When broaching the subject, avoid accusatory statements that put the individual down. Also, refrain from accepting responsibility for the problem should your loved one attempt to project blame onto you. This is a common defense mechanism for people dealing with addiction.
- Stay supportive. Remain calm and honor the person's struggle. Acknowledge his or her efforts and express your care and concern.
- Maintain healthy boundaries. Say no when you need to and refrain from providing monetary support when possible. Helping the person financially will only contribute to the maintenance of the problematic behaviors.
- Create a network. Utilize family and friends, support groups, and counseling for assistance. Connect with appropriate resources to protect yourself and loved ones from dangerous or abusive situations.
Helpful tools include:
- Gam-Anon’s Website: Informal assessment tools found on the Gam-Anon website help family and friends answer questions like “Are you living with a compulsive gambler?”
- The Brief Biosocial Gambling Screen: This three-item survey can help concerned individuals assess whether they should consider seeking professional help. This tool is based on the criteria found in an older edition of theAmerican Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
- NORC Diagnostic Screen for Gambling Problems Self-administered (NODS-SA):This assessment can be self-administered to determine whether gambling meets criteria for a behavioral addiction that requires professional help.
According to the Arizona Council on Compulsive Gambling, compulsive gamblers can be divided into two main types:
- Action Gamblers: People that fall into this category tend to have low self-esteem but hide it with sociable, energetic, manipulative, and overconfident behavior. They often start gambling at a young age and the behavioral addiction can develop over a period of time ranging anywhere from 10 to 30 years. Action gamblers seem to prefer games of skill like craps and poker, believing that they have a system to beat the game.
- Escape Gamblers:People that fall into this category have often led productive lives for years prior to exhibiting compulsive gambling behavior. They usually turn to gambling as a means of relief from psychological pain brought on by trauma, loss, and/or abuse. Once this occurs, the behavioral addiction can develop rapidly over a few years or less. Escape gamblers tend to prefer the anesthetizing effects of repetitious games of luck like slot machines and bingo.
Gambling addiction can be difficult to manage due to the accessibility of gambling, particularly online and mobile gambling. Although some gamblers prefer one method over another, all types can be addictive. These types include but are not limited to:
- Casino games (e.g. blackjack or Texas hold 'em)
- Remote gambling (e.g. Internet-based gaming)
- Slot machines
- Dice games (e.g. craps)
- Betting (e.g. betting on sporting events, horse races)
- Lottery tickets and scratch-offs
Although there is no known specific cause of gambling addiction, biological, social, and environmental factors can contribute to its development.
Researchers who compiled the DSM-5 found that there were significant similarities between gambling addiction and substance abuse problems. Much like with drug use, the reward centers of the brain are activated by gambling activities. Dopamine is released in high doses and provides the gambler with a strong sense of satisfaction, making the behavior powerfully addictive.
According to an article from the Indian Journal of Psychological Medicine (2012), studies have shown that people who experience gambling addiction have lower levels of norepinephrine, which the brain releases when we experience feelings of arousal and thrill. The rush that comes with the risk and potential reward of gambling may supplement biochemical needs.
Gambling addiction can also co-occur with other mental health conditions. Generally, this is referred to as dual diagnosis. A person experiencing depression, for example, might turn to gambling to ease feelings of sadness and emptiness. People with borderline personality traits might engage in impulsive gambling. Because of the complexity of mental health issues and addiction, a variety of approaches are used to treat a person experiencing dual diagnosis.
Although the effects of gambling addiction can be devastating, the good news is that help is available in many communities. Treatments are many and varied and may include:
- Residential treatment centers: There are many types of residential treatment facilities across the United States that specialize in the treatment of addiction and mental health issues. Specially trained staff provide care 24 hours a day, seven days a week in settings that range from hospitals to non-medical environments. Inpatient settings offer a comprehensive, biopsychosocial approach to treatment by providing daily therapeutic activities.
- Intensive outpatient programs: Intensive outpatient services are designed to provide nine or more hours of structured therapy per week in order to support recovery. Intensive outpatient treatment can be used as a step-down service from a residential treatment center, or as a means to prevent the need for a higher level of care.
- Psychotherapy: Research demonstrates that psychotherapy appears to be more effective than medications in treating gambling addiction. Therapies like cognitive-behavioral therapy and systematic exposure therapy help individuals “retrain” their brains to reduce the urge to gamble.
- Support groups: Most treatment for problem gambling or addiction revolves around state hotlines, self-help programs, peer support, counseling, and step-based programs such as Gamblers Anonymous, which is modeled after Alcoholics Anonymous as a 12-step program. Related to Gamblers Anonymous, Gam-Anon is a support group for the family and friends of those experiencing gambling addiction.
- Medication: Research indicates that medications used to treat substance addiction may prove effective for gambling addiction as well. Opioid antagonists like naltrexone, which inhibit the production of dopamine, seem to reduce the urge to gamble. Other medications that show promise include anti-seizure medications, mood stabilizers, and antidepressants.
- Developing a Gambling Addiction While Hiding Addictive Behaviors: Henry, 43, has been feeling a bit down lately. He occasionally goes to the casino with some friends to enjoy a night out, but the last time he enjoyed himself so much that he has begun returning there on his own, spending hours at a time at a single blackjack table. His friends ask him about it, wondering why he is suddenly making trips to the casino by himself, but he brushes off their concerns. He begins to spend more and more time at the casino, hoping to win money, since when he wins, he feels good. Sometimes, especially after nights of big losses, he lies to his wife about where he has been. When he begins to dip into his children's college fund to make up for his gambling losses, he decides to see a therapist, feeling that he may be losing control. In therapy, he realizes that he is not even enjoying the gambling, but that he is using it as a means of numbing his recent symptoms of depression. His therapist helps Henry discover several underlying emotional reasons for his behavior at the casino, many of which he was not even aware of. In therapy, Henry learns skills to cope with his impulses to gamble, becomes aware of a greater range of his emotions, and finds other activities to sublimate his urges and work toward overcoming his feelings of depression.
- Grief Fuels a Gambling Addiction and Risky Behavior: About two years ago, Virginia, 55, lost her husband of 25 years to cancer. She felt the loss of her best friend and biggest support immensely, and the event left her traumatized. Two months after the funeral, Virginia's best friend arranged a trip to Las Vegas to cheer her up. Virginia quickly took to the slot machines and found herself feeling better. After the trip, she started playing online slots for hours at a time, and before long, she was spending thousands of dollars a month on Internet slot machines. Virginia stops paying the mortgage and spends nearly all of the money from her husband's life insurance policy. When she receives notice that her house is at risk of foreclosure, Virginia realizes that she has a problem. She connects with a therapist who helps her work through her underlying issues of grief which lead her to gamble for the "high" that winning gives her. She now attends weekly Gamblers Anonymous meetings and shares her recovery story on a regular basis.
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