Gambling disorder is where you engage in a repeated pattern of gambling. You may place higher importance on gambling than any other activity, continue to gamble despite knowing the negative consequences and feel that you have lost control of your gambling behaviour.
This article explores gambling disorder in more detail, looking at the symptoms, the risks and potential treatment.
Gambling disorder is classified as a mental health condition in the International Coding of Diseases (ICD-11). The diagnosis may be given if the person engages in recurrent or persistent gambling and if they have either:
- A lack of control over their gambling behaviour
- Place higher importance to gambling than other activities in their life
- Continue to engage in gambling behaviour despite knowing the negative impact it has on themselves and others around them.
The behaviour also needs to persist for 12 months for a diagnosis of gambling disorder. However, it is noted that this length of time may be shortened if all the other criteria are met and if the symptoms are severe according to the ICD-11.
Gambling disorder has also been known as compulsive gambling, gambling addiction and problem gambling.
Causes of gambling disorder
The Royal College of Psychiatrists highlight that, as with many mental health disorders, there is no single clear cause. There are however, certain factors that increase your risk or susceptibility to developing a gambling disorder. For information on factors that might increase your risk of a gambling disorder, see “risk factors” below.
For most people, gambling is a harmless activity to enjoy, however, a person with a gambling disorder will display dysfunctional personality traits as well as cognitive distortions such as illusions of control and impulsive behaviours.1
Signs and symptoms of gambling disorder
- Attributing high importance to gambling, for example, constantly planning gambling activities and how to get more gambling money.
- Finding that you feel the need to take more and more risks in order to gain the same thrill from gambling, such as gambling more money.
- Telling yourself you will stop gambling and unsuccessfully trying to address the behaviour.
- Getting irritable or angry when not gambling.
- Using gambling as a means of escaping low mood, anxiety, low self-esteem.
- “Chasing losses” by making repeated attempts to win back lost money.
- Lying to family members or others to hide the severity of your gambling.
- Continuing to gamble despite the awareness that you could lose your relationship, family, house or job.
- Taking out “payday loans” or asking others for money in order to continue gambling.
Management and treatment for gambling disorder
The best treatment for gambling disorder currently is cognitive behavioural therapy (CBT). It is also the most common and is highly effective in reducing problematic gambling behaviour.2
Despite there being medication to make the behaviour less severe, psychological therapies show better long and short term results.2 Medication serves best to augment therapies such as CBT, when they are felt necessary.
CBT works through cognitive restructuring to help the person better understand their thoughts on gambling, and attempt to change their behaviour. These changes may focus on patterns that maintain the behaviour, irrational thoughts and “magical thinking” associated with gambling disorder.3
Motivational interviewing is another psychological technique to address problematic gambling behaviour. It can either be done as a stand-alone treatment or incorporated into another treatment such as CBT. This is a very promising treatment option. It works by empowering the person to solve their state of ambivalence and change their behaviour.4 When patients come to these conclusions themselves, thereby making the conscious decision to make positive changes, treatment outcomes are usually better. Furthermore, when this drive comes from within, it also seems to reduce the occurrence of relapse.Mindfulness has proven effectiveness in managing your mental state, thus potentially reducing the frequency or the need to engage in gambling behaviours. It can also decrease ruminations about gambling behaviour and increase cognitive and behavioural flexibility.2
The medication used to augment psychological treatment may depend on any underlying issues, such as depression or anxiety. Research supporting the use of medication specifically for gambling disorders is very limited. There is some evidence to support the use of certain SSRI antidepressants, namely paroxetine and fluvoxamine compared to placebo groups.3
Naltrexone, which is used for both alcohol and opioid addiction, was found to have significant improvements over placebo groups.3
For a diagnosis of a gambling disorder you need to meet the criteria stipulated in the ICD-11 (or the DSM-5 in the United States). These criteria are:
A persistent or recurrent pattern of gambling behaviour (online or offline), manifested by:
- Impaired or lack of control over your gambling behaviour
- More importance or priority given to gambling over other activities, commitments, or life interests
- Ongoing or increased gambling despite the negative consequences
The pattern may be continuous or occur in episodes, with the behaviour and its consequences having a significantly negative impact on your life or causing significant distress.
These gambling problems need to have been present for a period of 12 months, although, it is said that this time may be reduced if all other features are present and the symptoms are severe.
Anyone can develop a gambling disorder, however, those with certain risk factors may be more susceptible, and therefore, at higher risk of developing the disorder. These risk factors can include:
Adolescents: all ages have a risk of developing a gambling disorder. Adolescents, although it is illegal for anyone under 18 to gamble, are a high-risk group.5 Adolescents are reported to take part in a wide range of gambling activities and are often introduced to gambling concepts early on through video games, whereby randomly generated in-game purchases can be made with real money, known as microtransactions.6
Older adults: whilst gambling disorder is more prevalent in younger age groups, it is a significant problem for older adults. This age group may use gambling to supplement something lacking in their lives such as poor finances, low self-esteem or limited access to other exciting activities.5
Gender: those assigned male at birth are 4 times higher risk of developing gambling disorder, although the incidence of gambling disorder is rising amongst those assigned female at birth.
Drug and alcohol use: those who use drugs and consume alcohol are at a higher risk of developing a gambling disorder. This is reported to be influenced by the frequency of consumption.7
Personal history of gambling: this refers to those who have experienced a big win previously. The big win acts to reinforce the gambling behaviour, maintaining that behaviour in the hope of another big win.
Level of education: poor academic performance in adolescents and young adults has been strongly linked to problem gambling and gambling disorder in later life.7
Poor physical health: the risk of developing a gambling disorder is higher in those with poor physical health. This is particularly related to those who have difficulty leaving the house or accessing more healthy, exciting activities. This poor health can lead to people seeking excitement through gambling, especially online gambling.
Poor mental health: conditions such as depression, anxiety, personality disorder and some psychotic disorders can increase your risk of developing a gambling disorder.
Financial difficulties: unemployment, low income or debt can lead to people taking desperate measures to try and resolve their financial issues. More often than not, gambling acts to compound their problems, leading to more desperation and despair.
There are several complications that arise from a gambling disorder. Even big wins, whilst rare, can act to reinforce and compound the gambling behaviour. Below are some of the complications that may arise from a gambling disorder:
- Relationship problems
- Financial problems, including bankruptcy
- Legal problems or imprisonment
- Poor work performance or job loss
- Poor general health
- Suicide, suicide attempts or suicidal thoughts
How can I prevent gambling disorder?
The best way to prevent a gambling disorder is to be aware of your reason for wanting to gamble. If you are gambling as an activity to enjoy then this can be harmless. However, if you consider gambling as a way of resolving financial issues, as a distraction from depression, anxiety, or a difficult time in your life; the temporary boost of dopamine you get from gambling can lead to a dependence on this behaviour. This will lead someone to continue to seek that feeling, therefore establishing a cycle of maintaining gambling behaviour.
In order to reduce your risk of developing gambling disorder is it important to develop mental and emotional resilience as well as a strong support network. In this way you are fostering the ability to overcome adversity without the need to engage in problem behaviours such as gambling.
How common is gambling disorder?
Research suggests that the prevalence of gambling disorder worldwide is between 0.5 and 2.5% in the general population.1 These figures are more or less reflected in the UK, where an article by the Guardian newspaper reported 2.7% of people in the UK were problem gamblers. The gambling industry regulator (the Gambling Commission) stated that the figures for those with a diagnosable gambling addiction represented 0.7%.
When should I see a doctor?
Whilst you can get help for a gambling disorder without seeing a doctor, by attending support groups specifically for gambling, there are benefits to seeing a doctor. This is because gambling disorder can have a significant impact on your mental health, resulting in depression and anxiety. You may benefit from an assessment of your mental health to explore complementary treatment options. These could include medication, but also psychological therapy such as CBT may be recommended to look at ways of working through the underlying issues and aid relapse prevention.
It is most likely that a family member or someone close to you notices the need for you to see a doctor or get some form of help. Someone with a gambling disorder may be in denial about how serious the problem is, or may feel unable to stop the behaviour. When you or someone close to you notice changes in your behaviour and personality, it is time to seek help.
Gambling disorder is a mental health condition characterised by a recurring or persistent pattern of gambling that negatively impacts your mental health, your relationships, your job, and your finances. It can manifest for a number of reasons such as a means of attempting to resolve financial issues, or as a form of escapism from a difficult situation in your life.
There is no specific cause that results in a gambling disorder but there are certain factors that increase your susceptibility to developing this disorder.
Treatment is effective when the person is aware of the need to change and engages well in the therapy. There are a number of treatment options including CBT and medication. You may also benefit from seeking out support groups which can offer invaluable support and insight through people’s shared experiences.
- Moragas L, Granero R, Stinchfield R, Fernández-Aranda F, Fröberg F, Aymamí N, et al. Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences. BMC Psychiatry [Internet]. 2015 Apr 15 [cited 2023 Jun 15];15(1):86. Available from: https://doi.org/10.1186/s12888-015-0459-0
- Gooding P, Tarrier N. A systematic review and meta-analysis of cognitive-behavioural interventions to reduce problem gambling: Hedging our bets? Behaviour Research and Therapy [Internet]. 2009 Jul 1 [cited 2023 Jun 15];47(7):592–607. Available from: https://www.sciencedirect.com/science/article/pii/S0005796709000874
- Menchon JM, Mestre-Bach G, Steward T, Fernández-Aranda F, Jiménez-Murcia S. An overview of gambling disorder: from treatment approaches to risk factors. F1000Res [Internet]. 2018 Apr 9 [cited 2023 Jun 15];7:434. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5893944/
- Grant JE, Donahue CB, Odlaug BL, Kim SW, Miller MJ, Petry NM. Imaginal desensitisation plus motivational interviewing for pathological gambling: randomised controlled trial. The British Journal of Psychiatry [Internet]. 2009 Sep [cited 2023 Jun 15];195(3):266–7. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/imaginal-desensitisation-plus-motivational-interviewing-for-pathological-gambling-randomised-controlled-trial/7A2F7986A04C4DDE62C30BDD38B4258F
- Parker M. Introduction to the gambling disorder special issue. Issues in Mental Health Nursing [Internet]. 2020 Dec 1 [cited 2023 Jun 15];41(12):1058–62. Available from: https://www.tandfonline.com/doi/full/10.1080/01612840.2020.1830614
- Ferrara P, Franceschini G, Corsello G. Gambling disorder in adolescents: what do we know about this social problem and its consequences? Italian Journal of Pediatrics [Internet]. 2018 Dec 4 [cited 2023 Jun 15];44(1):146. Available from: https://doi.org/10.1186/s13052-018-0592-8
- Dowling NA, Merkouris SS, Greenwood CJ, Oldenhof E, Toumbourou JW, Youssef GJ. Early risk and protective factors for problem gambling: A systematic review and meta-analysis of longitudinal studies. Clinical Psychology Review [Internet]. 2017 Feb 1 [cited 2023 Jun 15];51:109–24. Available from: https://www.sciencedirect.com/science/article/pii/S0272735815301963