Gambling addiction: symptoms and treatment

By Cristiano Antonino On Apr 30, 2023

Gambling addiction is placed in the Manual of Mental Disorders (DSM-5) in the area of pathological addictions

It is characterised by the inability to resist the ‘persistent, recurrent and maladaptive’ temptation to gamble large sums of money.

The most direct consequences are seen in the deterioration of personal, family and work activities.

It is possible that the person suffering from gambling addiction will also jeopardise a meaningful emotional relationship, job or school opportunities just to pursue gambling.

What is gambling disorder

Gambling disorder (gambling) is problematic, persistent or recurrent gambling-related behaviour.

It occurs over a 12-month period and involves clinically significant distress and impairment (DSM-5, 2013).

It includes betting on certain games (e.g. cards, sports activities, lotteries, slot machines).

Gambling addiction differs from recreational gambling in that it is maladaptive, recurrent and persistent.

It exerts a negative influence on personal, professional, family and social domains and is often accompanied by financial losses and legal problems.

Gambling Addiction Symptoms

Gambling disorder (or gambling addiction) has many similarities with substance use disorder.

These include: addiction to gratification, hedonic (pleasure-seeking) behaviour, impulsivity in decision-making/underestimation of consequences, loss of control, craving (an uncontrollable need to seek out gambling), risk-seeking and tolerance and withdrawal.

The DSM-5 (2013) identifies the following symptoms (at least 4 are required for diagnosis):

Need for an increasing amount of money to achieve the desired excitement (tolerance)
Restlessness or irritation following attempts to reduce or interrupt play (withdrawal)
Repeated unsuccessful attempts to control, reduce or stop gambling
Concern about gaming (persistent thoughts about gaming)
Often gambling is preceded by negative emotions, anxiety and depression
After loss the person is driven to try again
Lies to hide extent of involvement with gambling
Jeopardises or loses a significant relationship
Counts on others to get money

Gambling addiction and obsessive-compulsive disorder

Like Trichotillomania, gambling addiction can also be considered a variant of Obsessive-Compulsive Disorder on the basis of the compulsive nature of the action associated with the inability to stop.

What clearly differentiates Obsessive-Compulsive Disorder from behavioural addictions, however, is that whereas in the case of OCD the compulsion has the function of reducing a negative emotion (usually anxiety), in gambling addiction the compulsion produces positive emotions that the subject cannot give up.

In fact, he or she often continues to gamble despite strenuous efforts to control, reduce or stop the behaviour.

Characteristics of persons addicted to gambling

The vast majority of gambling addicts seem to seek adventure and excitement in gambling, which are satisfied by wagering larger and larger amounts of money.

In an attempt to recoup the money wagered and lost, the person will be forced in a continuous race, to gamble higher and higher sums, in order to undo the loss or series of losses.

When the possibilities of obtaining loans run out, the person suffering from gambling addiction may also resort to anti-social behaviour such as forgery, fraud or theft in order to obtain money.

Many persons suffering from Pathological Gambling may be highly competitive, energetic, restless and easy to get bored.

They also seem to be overly concerned with the approval of others and surprisingly generous.

Onset and spread of the disorder

The onset of gambling addiction generally dates back to adolescence or early adulthood but can also occur during middle or late adulthood.

The prevalence of gambling addiction is influenced by the availability and degree to which gambling is legalised, with high rates in both sexes.

Lately, there has been a proliferation of gaming rooms and slot machines in public places, resulting in an exponential increase of the phenomenon in both adults and adolescents.

Gambling addiction and psychological disorders

Many people also suffer from other disorders, the most common of which is depression, but also some personality disorders characterised by impulsivity, such as borderline personality disorder and narcissistic personality disorder.

Individuals with a gambling disorder often resort to gambling when they feel depressed.

Suicidal ideation is a very frequent feature in pathological gamblers and 17% have a history of attempted suicide.

Treatment of gambling disorder

Gambling addiction can be treated, especially with targeted cognitive-behaviourally oriented psychotherapy.

Cognitive-behavioural psychotherapy has made considerable contributions to addiction therapy.

In particular, it aims to promote abstinence by helping the patient learn some practical coping strategies for stressful events as alternatives to gambling.

Specifically, it consists of functional analysis of gaming, recognition of situations in which the person is most vulnerable to gaming, learning practical strategies for managing craving, psycho-education on ‘seemingly irrelevant’ decisions (DAI) related to gaming, and implementation of relapse prevention training.