Gambling addiction, also known as gambling disorder, is a behavioral addiction characterized by the inability to control gambling impulses, even when facing significant negative consequences. This condition affects approximately 2.5 million U.S. adults who likely meet criteria for gambling disorder, with an additional 5 to 8 million experiencing problematic gambling behaviors.
Gambling disorder is a common and problematic behavioral disorder associated with depression, substance abuse, domestic violence, bankruptcy, and high suicide rates. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), pathological gambling was renamed "gambling disorder" and moved to the Substance-Related and Addiction Disorders chapter to acknowledge that research suggests that pathological gambling and alcohol and drug addiction are related.
Table of Contents
- What Is Gambling Addiction?
- Warning Signs and Symptoms
- Neurobiological Mechanisms
- Risk Factors
- Types of Gambling Problems
- Prevalence and Demographics
- Assessment and Screening Tools
- Treatment Options
- Frequently Asked Questions
- How Therapy Can Help
What Is Gambling Addiction?
Gambling disorder is the only behavioral addiction recognized as a clinical disorder in DSM-5, and Internet gaming disorder is included as a condition requiring further research. While gambling can be a harmless recreational activity for many people, it becomes problematic when individuals lose control over their gambling behavior despite experiencing significant distress or functional impairment.
The central feature of behavioral addictive disorders is the loss of control over engaging in and continuing behaviors, even when facing negative consequences. The neurobiological underpinnings primarily involve impairments in the reward circuitry, encompassing the ventral tegmental area, nucleus accumbens in the ventral striatum, and prefrontal cortex.
Warning Signs and Symptoms
The DSM-5 identifies specific criteria for diagnosing gambling disorder. Individuals who meet four or more of the following criteria in a 12-month period meet the criteria for having a gambling disorder:
- Needing to gamble with increasing amounts of money to achieve the desired excitement
- Feeling restless or irritable when attempting to cut down or stop gambling
- Making repeated unsuccessful efforts to control, cut back, or stop gambling
- Having frequent thoughts about gambling (reliving past gambling experiences, planning future ventures, or thinking of ways to get money to gamble)
- Often gambling when feeling distressed (helpless, guilty, anxious, or depressed)
- After losing money gambling, often returning to "chase" losses
- Lying to conceal the extent of involvement with gambling
- Jeopardizing or losing significant relationships, jobs, or educational/career opportunities because of gambling
- Relying on others to provide money to relieve desperate financial situations caused by gambling
Neurobiological Mechanisms
The Role of Dopamine
Dopamine plays a critical role in addictive disorders. Addictive substances and behaviors directly or indirectly enhance dopamine release in the reward system. The reward system is a dopaminergic pathway physiologically implicated in the processing of pleasure and motivational stimuli.
The emergence of behavioral addictive disorders involves dopamine synthesis, release, receptor availability, dopamine transporter function, and enzymatic function. Dopamine system disruption and heightened reward circuit activity underlie control loss and impulsivity.
The reinforcing effects rely primarily on dopamine signaling in the nucleus accumbens. Altered dopaminergic functioning has been observed in participants with gambling disorder.
Beyond Dopamine
While dopamine has long been associated with the reward process, recent research highlights the role of other key neurotransmitters like serotonin, glutamate, and endorphins in the development of behavioral addictions. These neurotransmitters interact within the reward circuitry, creating potential targets for therapeutic intervention.
Multiple neurochemical systems have been implicated in gambling and pathological gambling. Adrenergic systems have been hypothesized to contribute to arousal and excitement, serotonin to impulse control, dopamine to rewarding and reinforcing aspects, opioids to pleasure/urges, cortisol to stress responsiveness, and glutamate to cognitive functioning including cognitive flexibility.
Risk Factors
Demographic Factors
A systematic review acknowledges as risk factors for developing/maintaining a gambling disorder being a single young male, or married for less than 5 years, living alone, having a poor education, and struggling financially.
Young men are at a higher risk for gambling and drinking problems. Young or emerging adults, specifically those between 18 and 24, face the highest risk for developing gambling disorders. Several factors contribute to this heightened vulnerability, including impulsivity, ongoing brain development, and the increasing normalization of gambling through easily accessible apps and video games.
Sports Betting and Online Gambling
The number of states with operational sportsbooks increased from 1 during 2017 to 38 during 2024. Total sports wagers increased from $4.9 billion during 2017 to $121.1 billion during 2023, with 94% of wagers during 2023 being placed online.
In general, males with high impulsivity have greater tendencies for sports betting. Impulsive males may be particularly prone to sports gambling and related problems.
Co-occurring Conditions
There is a high comorbidity of problematic and pathological gambling with other mental health disorders, particularly substance and alcohol use and mood disorders. Frequent online gambling and cannabis use are linked with greater gambling severity, suggesting a need for comprehensive treatment approaches.
While not always co-occurring, evidence suggests that problematic drinking and gambling share similar risk factors. It has been shown that men, young people, and single individuals are more likely to engage in problem gambling and drinking.
Types of Gambling Problems
Action vs. Escape Gambling
Historically, people who gamble problematically have been categorized into two main types based on their motivations and patterns:
Action Gamblers typically:
- Start gambling in adolescence
- Prefer games of skill like sports betting, poker, or craps
- Believe they have a system to beat the game
- May take 10-30 years before seeking treatment
- Are predominantly male
Escape Gamblers typically:
- Start gambling after age 30
- Use gambling to numb emotional pain or trauma
- Prefer luck-based games like slot machines or bingo
- Can develop addiction within months
- Seek help within 2-3 years of developing problems
- Include more women than action gamblers
Modern Understanding
Recent systematic review findings indicate that problem gamblers likely rely heavily on avoidant coping strategies. These reasons for gambling will likely negatively reinforce gambling behaviour, leading to increased gambling frequency and problem gambling risk in the longer term.
Prevalence and Demographics
General Population
A 2022 review of studies since 2016 (from 23 studies covering 14 countries) estimated an adult prevalence of problem or pathological gambling of 1.29%, and estimated that 2.43% of adults engaged in moderate risk or at-risk gambling.
The NGAGE 3.0 findings confirm the need for a comprehensive system of care for the estimated 2.5 million adults likely to suffer from gambling disorder, as well as the 5 to 8 million more who exhibit some problematic behavior.
Gender Differences
Men outnumber women at a ratio of about 2 to 1 among people with gambling addictions, although there are a growing number of women with gambling disorders. Research shows that 2.9% of women were problem gamblers compared to 4.2% of men.
Age and Risk
People in their early 20s are the fastest-growing group of gamblers. Up to 5% of adolescents and young adults who gamble develop a disorder. Harvard Medical School reports that 7% of college students meet the criteria for problem gambling.
Online Gambling Trends
Online gambling participation rose significantly, from 15% in 2018 to 22% in 2024, and is closely associated with risk. Parlay betting nearly doubled, with 30% of sports bettors making parlay wagers in 2024, up from 17% in 2018—raising concerns about loss-chasing behaviors.
Assessment and Screening Tools
Brief Biosocial Gambling Screen (BBGS)
The BBGS is a screening tool used to identify individuals who may have a gambling disorder. This three-item screen was designed for use with the general population and with individuals seeking treatment services. Among the general population, the BBGS yielded a sensitivity index of .96 on a 0 to 1 scale and a specificity index of .99 on a 0 to 1 scale.
Problem Gambling Severity Index (PGSI)
The PGSI is part of the Canadian Problem Gambling Index and consists of nine items that assess problem gambling behavior and consequences over the past 12 months. It categorizes individuals into non-problem, low-risk, moderate-risk, and problem gambling categories.
Clinical Assessment
A comprehensive clinical assessment should include:
- Detailed gambling history
- Financial impact assessment
- Screening for co-occurring mental health conditions
- Assessment of family and social functioning
- Evaluation of suicide risk
- Medical history review
Treatment Options
Cognitive-Behavioral Therapy (CBT)
Cognitive behavioral therapy has become the most common psychological intervention for treating gambling problems, and it is effective in reducing gambling behavior. CBT is effective in reducing gambling severity.
CBT has been shown to be especially effective for this behavioral addiction. Literature in this field stresses the importance of including motivational components and cognitive restructuring in CBT programs in order to facilitate patients' understanding of cognitive distortions related to gambling behavior.
Online Treatment Options
Internet-delivered cognitive behavioral therapy (iCBT) programs for gambling disorder, provided with therapist support in routine addiction care, are well-received by patients, associated with expected symptom decrease during treatment, and appear to result in posttreatment registry outcomes similar to face-to-face treatment.
Pharmacological Interventions
A network meta-analysis of 16 RCTs (n = 977 participants) found that compared with placebo, moderate confidence evidence indicated that nalmefene reduced gambling severity (SMD: −0.86; 95% CI: −1.32, −0.41), followed by naltrexone (SMD: −0.42; 95% CI: −0.85, 0.01). Naltrexone and nalmefene were also more beneficial than placebo in terms of quality of life.
Although the number of randomized controlled trials assessing the effectiveness of pharmacological treatments is limited, some pharmacological treatments, notably opiate antagonists, have been employed in the treatment of gambling disorder.
Combined Approaches
Treatment strategies for substance use disorders have increasingly incorporated principles of Motivational Interviewing (MI). Empirical evidence suggests that MI is effective in reducing addictive behaviors, enhancing treatment retention, and extending periods of abstinence, particularly when used in combination with other therapeutic modalities such as Cognitive Behavioural Therapy (CBT). Research has corroborated its efficacy, indicating that MI is a promising intervention, especially in achieving short-term outcomes.
Mindfulness-Based Interventions
Studies suggest that the practice of mindfulness has a significant impact on improving the affective state, reducing the levels of anxiety and perceived stress. In the field of addictions, mindfulness has shown positive effects in gambling disorder, reducing the levels of severity, abstinence, and craving. Even brief mindfulness intervention can decrease ruminations associated with gambling, increase cognitive and behavioral flexibility, and improve quality of life.
Treatment Effectiveness
During the 12-month follow-up period, 84% of participants (N = 102) reported a significant reduction in their gambling behavior. Participants who received an intervention involving motivational phone calls and a self-help workbook demonstrated better outcomes compared to those who only received the workbook. By the 12-month follow-up, the benefits of motivational interviewing and workbook intervention were evident primarily in participants with less severe gambling problems.
Frequently Asked Questions
What's the difference between problem gambling and gambling disorder?
Problem gambling refers to gambling behavior that causes disruptions in any major area of life (psychological, physical, social, or vocational) but may not meet the full clinical criteria for gambling disorder. Gambling disorder is the clinical diagnosis requiring at least four DSM-5 criteria to be met within a 12-month period, indicating more severe impairment.
Can someone recover from gambling addiction?
Studies suggest that with treatment and support, about one-third of people with gambling disorder achieve long-term recovery. Access to therapy, support groups, and financial counseling improves outcomes. Of those who do seek treatment for their gambling problem, over 70% relapse and return to gambling. Gambling addiction can be a challenging condition to treat, but full recovery from the condition is possible with the right treatment and support.
What types of gambling are most addictive?
Research shows that nearly half of participants (49.3%) seeking treatment preferred electronic gaming machines (EGMs), approximately one-third (32.1%) favoured sports betting, and 15.8% preferred roulette. These preferences indicate that the favoured activities are those typically associated with a higher addictive potential.
Is gambling addiction hereditary?
Research suggests genetic factors play a role in gambling disorder. People with a family history of addiction (gambling or substance use) have an increased risk. However, environmental factors, personal experiences, and individual choices also significantly influence whether someone develops gambling problems.
How does online gambling affect addiction risk?
Online gambling addiction is associated with the relationship between internet gambling and disordered gambling. The 24/7 accessibility, faster play speed, and ability to gamble in isolation can intensify gambling problems. The greatest predictors of risk identified in 2024 include participation in many different gambling activities, gambling weekly or more often, gambling online, and being male and/or under the age of 35.
What should family members do if they suspect a gambling problem?
Family members should approach the situation with empathy and without judgment. Encourage the person to seek professional help, set clear boundaries about enabling behaviors (like lending money), and consider seeking support for themselves through organizations like Gam-Anon. Remember that recovery is possible with appropriate treatment and support.
How Therapy Can Help
Therapy provides essential support for overcoming gambling addiction through evidence-based approaches tailored to individual needs. A qualified therapist can help identify triggers, develop coping strategies, address underlying issues, and rebuild damaged relationships.
Find a Therapist
If you or someone you care about is struggling with gambling addiction, professional help is available. You can find a therapist who specializes in addiction treatment through the GoodTherapy directory. Look for professionals with experience in:
- Gambling disorder treatment
- Cognitive-behavioral therapy for addiction
- Co-occurring disorder treatment
- Family therapy for addiction issues
Remember, seeking help is a sign of strength, not weakness. With proper treatment and support, recovery from gambling addiction is achievable.
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