Arielle Cruz
Gambling disorders, including pathological gambling, affect 0.2–5.3% of adults worldwide. Pathological gambling is highly comorbid with other mental health and substance use disorders. The current prevalence of pathological gamblers is equivalent to about one-third of the estimated rate of drug-dependent persons and one-eighth of the estimated rate of alcohol-dependent persons. Studies have shown that there is a high rate of alcohol and drug abuse in pathological gamblers and their biological families. Furthermore, a report from the Harvard Medical School Division of Addictions found that monetary rewards in gambling experiments produced brain activation similar to that observed in a cocaine addict receiving an infusion of cocaine.
| Characteristics | Values |
|---|---|
| Prevalence of pathological gamblers compared to alcoholics | One-eighth the rate of alcohol-dependent persons |
| Prevalence of pathological gamblers compared to drug addicts | One-third the rate of drug-dependent persons |
| Pathological gamblers with substance abuse in their families | High rate |
| Pathological gamblers with alcohol abuse | High rate |
| Pathological gamblers with drug abuse | High rate |
| Pathological gamblers with personality disorders | Common |
| Pathological gamblers with lower levels of norepinephrine | Common |
| Pathological gamblers with serotonin deficiencies | Common |
| Pathological gamblers with more physical symptoms during withdrawal | Common |
| Pathological gamblers with suicidal ideation | Common |
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What You'll Learn
- Pathological gambling and substance abuse are both addictions
- The prevalence of pathological gambling and substance abuse
- Treatment for pathological gambling and substance abuse
- The link between pathological gambling, substance abuse and suicide
- The biological factors that cause pathological gambling and substance abuse
Pathological gambling and substance abuse are both addictions
Gambling disorders, including pathological gambling, affect 0.2–5.3% of adults worldwide. This percentage varies depending on screening methods and the availability of gambling opportunities. Pathological gambling is highly comorbid with other mental health and substance use disorders. There is a partial overlap in the diagnostic criteria between problem gambling and substance use disorders. Pathological gamblers are likely to also have a substance use disorder.
A study by Alec Roy, M.D., formerly of the National Institute on Alcohol Abuse and Alcoholism, found that norepinephrine is secreted under stress, arousal, or thrill, and pathological gamblers gamble to make up for their under-dosage. According to Hans Breiter, MD, of the Massachusetts General Hospital, "Monetary reward in a gambling-like experiment produces brain activation very similar to that observed in a cocaine addict receiving an infusion of cocaine." Studies have compared pathological gamblers to substance addicts, concluding that addicted gamblers display more physical symptoms during withdrawal.
The prevalence of pathological gambling is equivalent to about one-third of the rate of drug-dependent persons and one-eighth of the rate of alcohol-dependent persons. The National Comorbidity Survey provides data showing that the prevalence rates for gambling problems are lower than those for alcohol and drug problems. However, the few instances of repeated surveys in the same state show either significant increases in the prevalence of pathological gamblers or no significant change, indicating a possible upward national trend.
Problem gamblers are at an increased risk of suicide, with gambling disorder carrying the highest suicide risk out of any other substance use or addictive disorder. Both comorbid substance use and comorbid mental disorders increase the risk of suicide in people with problem gambling. Treatment for problem gambling involves counseling, step-based programs, self-help, peer support, medication, or a combination of these. Gamblers Anonymous is a commonly used treatment for gambling problems, modeled after Alcoholics Anonymous.
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The prevalence of pathological gambling and substance abuse
Gambling disorders, including pathological gambling, affect 0.2–5.3% of adults worldwide. However, the measurement and prevalence vary according to the screening methods and the availability of gambling opportunities. The prevalence of pathological gambling is equivalent to about one-third of the estimated rate of drug-dependent persons and one-eighth of alcohol-dependent persons.
Pathological gambling is highly comorbid with other mental health and substance use disorders. There is a partial overlap in the diagnostic criteria between problem gambling and substance use disorders. Pathological gamblers are also likely to have a substance use disorder, and biological data supports this relationship. Studies have shown that there is a high rate of alcohol and drug abuse among pathological gamblers and their biological families.
The telescoping phenomenon reflects the rapid development from initial to problematic behaviour in women compared to men. This phenomenon was initially used to describe alcoholism but has also been applied to pathological gambling. The findings of one review indicated that behavioural disorders such as problem gambling and substance use disorder are closely linked.
The DSM-5 has reclassified pathological gambling as a gambling disorder, and it is now listed under substance-related and addictive disorders. This reclassification reflects research findings that indicate gambling disorder is similar to substance-related disorders in clinical expression, brain origin, comorbidity, physiology, and treatment. Both comorbid substance use and comorbid mental disorders increase the risk of suicide in people with problem gambling.
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Treatment for pathological gambling and substance abuse
Problem gambling, also known as gambling disorder, is repetitive gambling behaviour despite harm and negative consequences. It is often associated with increased suicidal ideation and attempts compared to the general population. Problem gambling is highly comorbid with other mental health and substance use disorders.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has reclassified pathological gambling as a gambling disorder, listing it under substance-related and addictive disorders. This reclassification reflects the research findings that show similarities between gambling disorder and substance-related disorders in clinical expression, brain origin, comorbidity, physiology, and treatment.
To be diagnosed with a gambling disorder, an individual must exhibit at least four of the following symptoms within a 12-month period:
- A need to gamble with increasing amounts of money to achieve the desired level of excitement
- Restlessness or irritability when attempting to cut down or stop gambling
- Repeated unsuccessful efforts to control, cut back, or stop gambling
Treatment for gambling disorders can involve various approaches, including:
- Counselling and therapy: Cognitive behavioural therapy (CBT) has been shown to reduce symptoms and gambling-related urges. Other types of therapy used include psychodynamic therapy, group therapy, and family therapy. Counselling can help individuals understand how gambling affects them and their families and make informed decisions.
- Support groups: Gamblers Anonymous (GA) is a commonly used twelve-step program modelled after Alcoholics Anonymous. It emphasizes peer support and mutual aid.
- Medication: While no medications have been specifically approved by the FDA for the treatment of gambling disorders, pharmacological interventions may be explored.
- Responsible gaming initiatives: These initiatives aim to minimize harm and involve multiple stakeholders, including government, regulators, gaming industry operators, and consumers.
It is important to note that no single treatment is considered universally effective for gambling disorders, and different approaches may work better for different individuals. Additionally, seeking professional help is crucial, as only one in ten people with gambling disorders currently seek treatment.
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The link between pathological gambling, substance abuse and suicide
Gambling disorders, including pathological gambling, affect 0.2–5.3% of adults worldwide. The prevalence of pathological gambling is equivalent to about one-third of the rate of drug dependence and one-eighth of the rate of alcohol dependence. While the rates of alcohol and drug dependence are higher, gambling disorders are highly comorbid with other mental health and substance use disorders.
Pathological gambling is an addiction similar to chemical addiction. It has been observed that pathological gamblers have lower levels of norepinephrine than normal gamblers, and they gamble to make up for their under-dosage. Studies have compared pathological gamblers to substance addicts, concluding that addicted gamblers display more physical symptoms during withdrawal. Deficiencies in serotonin might also contribute to compulsive behaviour, including a gambling addiction.
The link between pathological gambling and substance abuse is well-established. A comprehensive UK Gambling Commission study from 2018 hinted at the link between gambling addiction and a myriad of issues, including a reduction in physical activity, poor diet, and overall well-being. The study also links problem gambling to issues affecting relationships and social stability.
The National Comorbidity Survey (Kessler et al., 1994) provides data collected in 1990-1992 from a national probability sample of non-institutionalized persons ages 15 to 54 for DSM-III-R psychiatric disorders. The survey found that the prevalence rates for gambling problems were lower than those for alcohol and drug problems. However, the survey also showed that the rates of pathological gambling were equivalent to about one-third of the rate of drug dependence and one-eighth of the rate of alcohol dependence.
The early onset of problem gambling may increase the lifetime risk of suicide. Both comorbid substance use and comorbid mental disorders increase the risk of suicide in people with problem gambling. A study published in JAMA followed teens for years and evaluated addictive behaviours, as well as suicidality. The study found that addiction to social media, mobile phones, and video games is linked to a higher risk of suicidal thoughts and behaviours.
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The biological factors that cause pathological gambling and substance abuse
Gambling disorders, including pathological gambling, affect 0.2–5.3% of adults worldwide. Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population. It is also linked to a myriad of issues affecting relationships and social stability.
There are several biological factors that cause pathological gambling and substance abuse. Firstly, pathological gamblers have been found to have lower levels of norepinephrine than normal gamblers. Norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers may gamble to compensate for their under-dosage. According to a study, the brain activation produced by monetary reward in a gambling-like experiment is very similar to that observed in a cocaine addict receiving an infusion of cocaine.
Secondly, deficiencies in serotonin may also contribute to compulsive behaviours, including gambling addiction. Serotonin is a neurotransmitter that plays a crucial role in regulating mood, appetite, sleep, learning, and memory. It is often referred to as the "feel-good" hormone, as it contributes to feelings of well-being and happiness. Low levels of serotonin can lead to depression, anxiety, and impulsive behaviour.
Thirdly, gambling can stimulate the brain's reward system in a way that is similar to drugs or alcohol, leading to addiction. The constant pursuit of bets, despite losses, can create a cycle of debt and further mental health issues. This is a significant factor in the development of compulsive gambling behaviour.
Finally, there is a genetic component to both pathological gambling and substance abuse. Research has shown that these behaviours can run in families, indicating a potential genetic predisposition. Additionally, environmental factors, such as early exposure to gambling or substance use, can also contribute to the development of these disorders.
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Frequently asked questions
Pathological gambling, or gambling disorder, is a behavioural addiction that resembles a substance use disorder in clinical expression, brain origin, comorbidity, physiology, and treatment.
Pathological gambling is highly comorbid with other mental health and substance use disorders. According to a study, there is a high rate of alcohol and drug abuse in pathological gamblers and their biological families. Another study found that pathological gamblers have more physical symptoms during withdrawal than substance addicts.
Treatment options for pathological gambling include counselling, step-based programs, self-help, peer support, medication, or a combination of these. Gamblers Anonymous is a commonly used twelve-step program modelled after Alcoholics Anonymous, emphasizing mutual support. Cognitive behavioural therapy (CBT) has also been shown to reduce symptoms and gambling-related urges.
