Gambling Disorder

Gambling Disorder

Gambling can be socially acceptable when in moderation. But it can easily become a compulsive behavior leading to an addiction. Gambling disorder (GD) is a psychiatric condition which can adversely affect a person’s quality of life when left untreated.

What Is Gambling Disorder?

Gambling disorder (GD) is an impulse-control disorder and is considered as a progressive addiction that can affect the sufferers family and social lives. A 2009 study 1 explains that “Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment.” Also known as pathological gambling, compulsive gambling or gambling addiction, this condition can lead to feelings of helplessness and despondency in sufferers. Compulsive gambling can cause issues with career, finances, relationships, social life and even legal problems. Moreover, gambling addiction can also result in numerous negative physical and mental health issues, like –

  • Stress
  • Migraine
  • Intestinal disorders
  • Anxiety
  • Depression
  • Suicidal behaviors

According to American Psychiatric Association, “Gambling disorder involves repeated problematic gambling behavior that causes significant problems or distress. It is also called gambling addiction or compulsive gambling.” As the effects of gambling addiction can be similar to that of alcoholism, non-substance or behavioral addictions are now identified as “Substance-Related and Addictive Disorders” 2 in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Some people gamble to experience thrill and excitement while some others may gamble to escape from life’s problems. Gambling addiction is often associated with other behavioral or mood disorders. Individuals having this disorder may also suffer from substance abuse, stress, depression, unmanaged ADHD, anxiety, or bipolar disorder. However, with timely identification, treatment and prevention, individuals suffering from this condition can successfully recover and live healthier, happier lives.

Gambling Disorder At A Glance

  1. Gambling disorder (GD) is an impulse-control disorder and is considered as a progressive addiction that can affect the sufferers family and social lives.
  2. Gambling disorder is a condition defined by an unruly or obstinate urge to keep betting irrespective of the toll it takes on your life.
  3. People with gambling disorder are often found to be alcoholic, depressed, and anxious.
  4. The addiction of gambling affects 1 to 3% of adults across all ages with men more than women.
  5. Gambling increases in an individual with stress or depression and during the periods of substance use or denial.
  6. Apart from therapy and medication, certain self-help strategies can also help a sufferer overcome compulsive gambling.

How Gambling Addiction Affects Us

Gambling disorder is a condition defined by an unruly or obstinate urge to keep betting irrespective of the toll it takes on your life. It can happen to anyone irrespective of their social status. Gambling or betting can transform from entertainment, harmless diversion to a deadly obsession backed by serious outcomes. Whether you bet on sports, roulette, poker, or slots in a casino or at the track, a gambling problem can interfere with personal and professional life, eventually leading to financial disaster. You may even end up doing things that you could never think of doing, like suffering from huge debts or even stealing money to gamble.

If you are suffering from compulsive gambling, you won’t be able to control the impulse to gamble, overlooking the negative consequences waiting for you or your near ones. The urge to gamble pushes you to indulge in this activity whether you’re up or down, broke or flush, and even when you know that the odds are against you. Moreover, you may hide your gambling addiction and lie to others to seek financial support.

Onset Of Compulsive Gambling

The advent of gambling disorder happens during adolescence or young adulthood, while it gradually manifests itself during middle or even older adulthood. Generally, gambling addiction becomes a deep-rooted condition over the years. However, the progression is more rapid in females than in males. Additionally, individuals suffering from this disorder follow a pattern of gambling that steadily increases in terms of frequency and amount of wagering.

The majority of sufferers have reported that there are one or two types of gambling which are problematic for them while some individuals participate in multiple forms of gambling. The severity of gambling disorder is measured by the frequency of gambling and the type of gambling. Moreover, the amount of money invested in betting is not an accurate indicator of compulsive gambling.

Prevalence Of Gambling Disorder

The growth of gambling disorders has significantly risen across the globe over the last few years. According to recent research from the National Council on Problem Gambling, around 2% of Americans are affected by problem gambling. Moreover, around 5.77 million people 3 in the United States had a gambling disorder that called for urgent treatment in 2012. In Italy, as per the CNR (National Research Council), over 17 million, that is 42.8% 4 of the population within the age group of 15-64 years suffer from gambling disorder.

Studies also reveal that 0.2-12.3 % of youth meet symptomatic criteria for gambling disorder across five continents. Additionally, there were some differences in gambling disorder prevalence rates in different continents. In Oceania, the rates were within the percentage bracket of 0.2 to 4.4 %. In Europe, the prevalence rates ranged from 0.2 to 12.3 %. Furthermore, the lowest adolescent problem gambling prevalence rate was portrayed via European studies. The disorder affects 1 to 3% of adults across all ages, with more men than women. It normally begins in adolescence in men and later in women. Older adults are more defenceless than other age groups as their dependence on fixed incomes and limited ability to recover from gambling losses.

Owing to its devastating consequences, gambling disorder has become a vital public health concern in many countries. According to international studies, gambling is part of our life experiences, mainly catering to the youth. The World Health Organization (WHO) explains “Males, young adults, low-income and non-married people are almost universally found to be at elevated risk. Indigenous and some ethnic minority groups also have high incidence and prevalence rates,” for this disorder. It has also been observed individuals residing in high deprivation neighbourhoods and lacking education and employment are more prone to gambling addictions.

Gambling Disorder vs Bipolar Disorder

Psychology experts have observed that people who have bipolar disorder indulge in gambling a lot while they suffer from a manic episode. However, that is not a gambling disorder, even though the behaviours and the outcomes may look similar. But that does not mean that gambling problems occurring during mania are not as severe as gambling disorders.

However, this differentiation is made to distinguish gambling problems that develop following a pattern of addiction from those that take place during a certain phase of bipolar disorder. One 2019 study 5 found that comorbid bipolar disorder (BD) and gambling disorder (GD) patients “experience a more severe course of illness and poorer treatment outcome, due to a range of clinical and psychosocial factors that collectively impede remission and recovery.”

Read More About Bipolar Disorder Here

Symptoms Of Gambling Disorder

Symptoms Of Gambling Disorder
Gambling Disorder


While some people gamble occasionally only for fun, a pathological gambler usually advances from occasional gambling to habitual gambling. With this development, the gambler will risk more with each passing day, resulting in critical personal life problems, financial ruin, and perhaps criminal behavior.

Here are some of the most common signs and symptoms of the disorder to help you understand your condition if you are facing the same.

  • Being obsessed about gambling
  • Inability to stop gambling
  • Feeling anxious or annoyed when trying to control gambling
  • Gambling when feeling stressed or upset
  • Avoiding responsibilities or other commitments for gambling
  • Strong urge to gamble with bigger risks and more money
  • Selling items and possession to gather money for gambling
  • Using money from daily expenses and neglecting bills
  • Stealing or borrowing money to gamble
  • Trying to win back money after losing it while gambling
  • Depending on others to overcome financial problems caused by gambling
  • Lying about your gambling addiction
  • Feeling shame and guilt after gambling
  • Jeopardizing education, career or relationships for gambling

A person suffering from gambling disorder may also experience these adverse consequences:

  • Deteriorating friendships and relationships
  • Loss of material possessions, like house, car etc

People with gambling disorder are often found to be alcoholic, depressed, and anxious. “Pathological gambling and alcohol use disorders frequently co-occur at greater than chance levels,” states a 2017 study 6 . Another 2011 systematic analysis 7 found that “alcohol use disorder, depression, substance use disorders, nicotine dependence, anxiety disorders and antisocial personality disorder,” are common comorbid disorders observed in problem and pathological gamblers. The stress of gambling can also result in heart attacks. However, with the right treatment, such problems can be prevented.

A compulsive gambler can have periods when the symptoms may subside and they may not engage in gambling as much. However, it may be followed by periods of intense and severe symptoms.

Causes Of Gambling Disorder

Causes Of Gambling Disorder
Gambling Disorder


Experts are yet to identify the exact causes that lead to the development of compulsive gambling. However, it is believed a combination of genetic, environmental and biological factors may play a crucial role. “Gambling disorder tends to run in families, but environmental factors may also contribute,” explains the American Psychiatric Association. Although many people suffering from gambling addiction can be reliable and responsible individuals, certain factors can result in a dramatic change in their behavior.

Here are some common triggers that may lead to gambling disorder:

  • Loneliness
  • Traumatic event or experiences
  • Depression or anxiety
  • Boredom
  • Career-related stress
  • Retirement
  • Environmental factors, like easily accessible opportunities
  • Coping with other addictions 8
  • Relaxing after a stressful day
  • Seeking adrenaline rush
  • Money problems
  • Numbing unpleasant thoughts and emotions

Apart from these, neurological and genetic factors may also be significant contributing factors as well. One study published in the journal Translational Psychiatry found that genetics play a crucial role in gambling addiction. Co-author of the study, Dr Henrietta Bowden-Jones explains “We know the condition may have a genetic component – and that the children of gambling addicts are at higher risk of gambling addiction themselves – but we still don’t know the exact parts of the brain involved.”

Some other common factors influencing the development of this condition may include:

  • Mental health and emotional regulation issues
  • Personality disorders
  • Use of certain medications

Risk Factors Associated With Gambling Disorder

Risk Factors Associated With Gambling Disorder
Gambling Disorder


While people who casually indulge in gambling in the form of playing cards or wager do not develop the disorder, there are certain factors that are frequently associated with this disorder, such as:

1. Mental health issues

People who suffer from gambling disorder often suffer from abusive behavior, personality disorders, depression or anxiety. Compulsive gambling is also associated with bipolar disorder, attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) On recent scientific review 9 found that most people addicted to gambling “also suffer from other psychiatric conditions.” It concluded that “the association seems to be stronger for women.”

2. Age

Compulsive gambling is more common in younger and middle-aged people. Indulging in gambling activities since childhood or teenage years increases the risk of developing the disorder. However, it is equally risky if found in the older population.

3. Gender

Gambling disorder is more common in men than in women. However, women tend to start gambling later in life and may get addicted faster. Under any circumstances, gambling patterns among men and women have become increasingly similar.

Read More About Gender Here

4. Social influence

If someone from your family or friends has a gambling problem, then it is highly likely that you will start gambling too.

5. Personality traits

Personality traits, like being highly competitive, impulsive, a workaholic, restless or getting easily bored may increase the chances of getting gambling disorder.

Read More About Personality Here

6. Medications

Medications used to treat Parkinson’s disease & restless legs syndrome can also be risk factors. Drugs named Dopamine Agonists come with a rare side effect that may lead to compulsive behaviours, including gambling, in some people.

How Age And Gender Influences Gambling Addiction

The addiction of gambling affects 1 to 3% of adults across all ages with men more than women. It normally begins in adolescence in men and later in women. Older adults are more defenceless than other age groups as their dependence on fixed incomes and limited ability to recover from gambling losses. Early diagnosis of gambling disorder is more prevalent in males than in fe­males. Individuals who start gambling at a very young age often do so with family members or friends. The advancement of early-life gambling disorder is associated with impulsivity and substance abuse. While some high school and college students suffering from gambling disorders grow out of it over time, for some it happens to be a lifelong problem.

Furthermore, there are age and gender variations associated with different gambling activities and the preva­lence rate of gambling disorder. This form of mental condition is more common in adolescents and young adults. While younger individuals indulge in various types of gambling, older adults are more likely to get drawn to slot machines and bingo gambling. While the percentage of people who seek therapy for gambling disorder is low across all age groups, younger individ­uals are more unlikely to seek treatment.

Females who suffer from gambling disorder are more likely to have depressive, bipolar, and anxiety disorders. Females also suffer from a late onset of the disorder, however, seek treatment sooner.

Can Gambling Disorder Resume After Remission?

Gambling increases in an individual with stress or depression and during the periods of substance use or denial. Additionally, gambling disorder is at times associated with casual, long-term remissions. Individuals fail to understand their vulnerability to develop gambling disorder post-remission. When in a break from gambling, a person might feel that he/she can control his/her urges of gambling by indulging in some forms of non-problematic gambling only to experience a return to gambling disorder.

Diagnosis Of Gambling Disorder

According to the DSM­-5 diagnostic criteria for gambling addiction, the sufferer must experience at least 4 of the following over a period of one year:

  • A strong need to gamble with higher amounts of money to feel the desired thrill and excitement
  • Feeling anxious, irritable or annoyed when attempting to reduce or stop gambling
  • Constant unsuccessful attempts to prevent or stop gambling
  • Repeated thoughts about gambling defined by remembering past experiences, preparing for the future gambling activities and seeking new ways to obtain money to gamble
  • Gambling when feeling stressed
  • Chasing losses and gambling again to get even
  • Hiding gambling activity by deceiving and lying
  • Endangering or losing a significant relationship, job or educational/career opportunity for gambling
  • Depending on others to solve money problems caused by excessive gambling

Treatment For Gambling Disorder

Overcoming gambling disorder can be a challenging task. Hence, it is essential to seek professional treatment. However, that does not mean that you’re weak to handle your problems. Additionally, it is important to learn that every gambler is different, thus you need a recovery program tailored specifically to suit your situation.

Gambling disorder can be treated using some of the most effective treatment methods available, including:

  • Psychotherapy
  • Medications
  • Other programs

Let us take a closer look at each of these treatment strategies below:

1. Psychotherapy

Different types of psychotherapy 10 can be recommended for the treatment of gambling addiction. These may include cognitive behavioral therapy, Gambler’s Anonymous, psychodynamic therapy, family therapy and behavioral therapy.

A. Cognitive-Behavioral Therapy (CBT)

CBT concentrates on enhancing unhealthy gambling behaviors and thoughts with logic and wrong beliefs. It can also supervise you to fight gambling urges and solve fiscal, work, and relationship problems. The therapy can also provide you with tools for coping with your obsession that will last a lifetime. According to a 2017 study 11, CBT is the “most widely used treatment” available for gambling disorder (GD).

B. Gambler’s Anonymous (GA)

Based on the Alcoholics Anonymous model, Gamblers Anonymous is a popular treatment method used for gambling addictions. The program involves a 12-step approach that values mutual-support. A 2016 review 12 titled ‘Gamblers Anonymous as a Recovery Pathway’ concludes that Gamblers Anonymous “GA is a cost-effective and widely available resource for individuals experiencing problem gambling issues, and is an accessible treatment option.” It is perhaps the most referred type of treatment for compulsive gamblers and can be especially helpful for people with low income.

C. Psychodynamic Psychotherapy

Psychoanalysis can help pathological gamblers by enabling them to cope with interpersonal conflicts through therapy. It can also help them to manage their urge and gambling behavior. This form of therapy usually focuses on recognizing the purpose of the gambling addiction and inner conflicts. It also helps to reduce shame and guilt related to pathological gambling. According to a research 13 by Richard J Rosenthal M.D., Department of Psychiatry and Biobehavioral Sciences, University of California, “Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler’s need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.”

D. Family Therapy

Gambling Disorder can adversely affect family functioning. Compulsive gambling may result in domestic violence, internal conflict, divorce etc. Family therapy can help sufferers recognize problematic behaviors and its effects on the family dynamics. It can also help the gambler to cope with denial of obsessive gambling behavior. Studies 14 show that short-term group therapy involving the gambler and their spouse can be highly effective in improving marital functioning.

Moreover, marriage, career, & credit counseling can assist sufferers to work through particular issues that have been created by their gambling obsession, thereby laying the foundation for restoring their relationships and finances.

Read More About Family Dynamics Here

E. Behavioral therapies

These forms of therapies rely on the concept of operant theory or classical conditioning. It aims to reshape the patient’s behavior by altering their learned responses. Moreover, it decreases arousal and other rewarding sensations associated with gambling. These therapies usually involve –

  • Aversion therapy
  • Imaginal desensitization
  • In-vivo exposure with response prevention

2. Medications

Although there are no specific medications for the treatment of gambling disorder, certain medications can help relieve the symptoms and other conditions associated with it. Research 15 shows that mood stabilizers, serotonergic antidepressants and opioid antagonists may be helpful. Narcotic antagonists, used for the treatment of drug addictions can also help people suffering from pathological gambling. A study 16 on medication management for gambling disorder found that antidepressants can –

  • Effectively help with reducing symptoms of compulsive gambling
  • Higher doses of antidepressants may be required for GD than for depressive disorders
  • Even though the sufferer may not have anxiety or depression, antidepressants can still effectively relieve gambling disorder symptoms

3. Other programs

A. Residential Treatment & Rehab Programs

This type of treatment is suggested to a patient who is suffering from a severe gambling addiction and who is unable to avoid gambling without a constant check upon him/her.

B. Treatment for Underlying Conditions

This type of treatment is apt for individuals suffering from substance abuse or mental health problems such as depression, anxiety, OCD, or ADHD. The treatment includes therapy, medication, and lifestyle changes. The symptom of gambling disorder can sometimes look like a symptom of bipolar disorder, hence, your doctor or therapist needs to understand the same first before making a diagnosis.

Self-Help Strategies For Gambling Disorder

Apart from therapy and medication, certain self-help strategies can also help a sufferer overcome compulsive gambling. If you feel that you have a gambling addiction, then it can surely be difficult for you to start the recovery process, especially if you have lost money and relationships. However, it is possible to control your urges and self-soothe difficult emotions that lead to unhealthy addictions. Here are a few ways to consider:

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References:
  1. Potenza, M.N., Balodis, I.M., Derevensky, J. et al. Gambling disorder. Nat Rev Dis Primers 5, 51 (2019). https://doi.org/10.1038/s41572-019-0099-7 []
  2. Yau, Y. H., & Potenza, M. N. (2015). Gambling disorder and other behavioral addictions: recognition and treatment. Harvard review of psychiatry, 23(2), 134–146. https://doi.org/10.1097/HRP.0000000000000051 []
  3. Marotta, J., Bahan, M., Reynolds, A., Vander Linden, M., & Whyte, K. (2014). 2013 National Survey of Problem Gambling Services. Washington DC: National Council on Problem Gambling. []
  4. Ferrara, P., Franceschini, G. & Corsello, G. Gambling disorder in adolescents: what do we know about this social problem and its consequences?. Ital J Pediatr 44, 146 (2018). https://doi.org/10.1186/s13052-018-0592-8 []
  5. Di Nicola M, De Risio L, Pettorruso M, Caselli G, De Crescenzo F, Swierkosz-Lenart K, Martinotti G, Camardese G, Di Giannantonio M, Janiri L. Bipolar disorder and gambling disorder comorbidity: current evidence and implications for pharmacological treatment. J Affect Disord. 2014;167:285-98. doi: 10.1016/j.jad.2014.06.023. Epub 2014 Jun 19. PMID: 24999863. []
  6. Tackett, J. L., Krieger, H., Neighbors, C., Rinker, D., Rodriguez, L., & Edward, G. (2017). Comorbidity of Alcohol and Gambling Problems in Emerging Adults: A Bifactor Model Conceptualization. Journal of gambling studies, 33(1), 131–147. https://doi.org/10.1007/s10899-016-9618-6 []
  7. Lorains FK, Cowlishaw S, Thomas SA. Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys. Addiction. 2011 Mar;106(3):490-8. doi: 10.1111/j.1360-0443.2010.03300.x. PMID: 21210880. []
  8. Potenza, M. N., Fiellin, D. A., Heninger, G. R., Rounsaville, B. J., & Mazure, C. M. (2002). Gambling: an addictive behavior with health and primary care implications. Journal of general internal medicine, 17(9), 721–732. https://doi.org/10.1046/j.15251497.2002.10812.x []
  9. Sundqvist, K., & Rosendahl, I. (2019). Problem Gambling and Psychiatric Comorbidity-Risk and Temporal Sequencing Among Women and Men: Results from the Swelogs Case-Control Study. Journal of gambling studies, 35(3), 757–771. https://doi.org/10.1007/s10899-019-09851-2 []
  10. Fong T. W. (2005). Types of psychotherapy for pathological gamblers. Psychiatry (Edgmont Pa. : Township), 2(5), 32–39. []
  11. Challet-Bouju, G., Bruneau, M., IGNACE Group, Victorri-Vigneau, C., & Grall-Bronnec, M. (2017). Cognitive Remediation Interventions for Gambling Disorder: A Systematic Review. Frontiers in psychology, 8, 1961. https://doi.org/10.3389/fpsyg.2017.01961 []
  12. Schuler, A., Ferentzy, P., Turner, N. E., Skinner, W., McIsaac, K. E., Ziegler, C. P., & Matheson, F. I. (2016). Gamblers Anonymous as a Recovery Pathway: A Scoping Review. Journal of gambling studies, 32(4), 1261–1278. https://doi.org/10.1007/s10899-016-9596-8 []
  13. Rosenthal RJ. Psicoterapia psicodinâmica e o tratamento do jogo patológico [Psychodynamic psychotherapy and the treatment of pathological gambling]. Braz J Psychiatry. 2008 May;30 Suppl 1:S41-50. Portuguese. doi: 10.1590/s1516-44462008005000004. Epub 2008 Jan 31. PMID: 17992358. []
  14. Tepperman, J.H. The effectiveness of short-term group therapy upon the pathological gambler and wife. J Gambling Stud 1, 119–130 (1985). https://doi.org/10.1007/BF01019865 []
  15. Matteo Lupi, Giovanni Martinotti, Tiziano Acciavatti, Mauro Pettorruso, Marcella Brunetti, Rita Santacroce, Eduardo Cinosi, Giuseppe Di Iorio, Marco Di Nicola, Massimo Di Giannantonio, “Pharmacological Treatments in Gambling Disorder: A Qualitative Review”, BioMed Research International, vol. 2014, Article ID 537306, 7 pages, 2014. https://doi.org/10.1155/2014/537306 []
  16. Grant, J. E., & Kim, S. W. (2006). Medication management of pathological gambling. Minnesota medicine, 89(9), 44–48. []