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Gambling Disorder

Gambling disorder involves repeated, problem gambling behavior. The behavior leads to problems for the individual, families, and society. Adults and adolescents with gambling disorder have trouble controlling their gambling. They will continue even when it causes significant problems.

A diagnosis of gambling disorder requires at least four of the following during the past year:

  1. Need to gamble with increasing amounts to achieve the desired excitement.
  2. Restless or irritable when trying to cut down or stop gambling.
  3. Repeated unsuccessful efforts to control, cut back on or stop gambling.
  4. Frequent thoughts about gambling (such as reliving past gambling or planning future gambling).
  5. Often gambling when feeling distressed.
  6. After losing money gambling, often returning to get even. (This is referred to as "chasing" one's losses.)
  7. Relying on others to help with money problems caused by gambling

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Expert Q&A: Gambling Disorder

Gambling is a common, legal form of entertainment and recreation that is enjoyed by millions of people every day. The vast majority of people who gamble are able to do so without any long-lasting problems or harm. But, like alcohol, tobacco or drugs of abuse, gambling can become an addiction. Recent research has shown that up to 1 percent of the population is currently has a gambling disorder. There are many different warning signs that gambling is becoming a problem. The most common symptoms are lying about gambling, not stopping or controlling gambling, spending excessive amounts of time gambling, and being preoccupied by gambling.

Any gambling behavior that creates harm, distress and negative life problems could signify a gambling disorder. For example, two simple questions to ask are: “Have you ever had to lie to people important to you about how much you gambled?” and “Have you ever felt the need to bet more and more money?” A yes answer to either question suggests that there may be a gambling problem.

Borrowing money to relieve desperate financial problems caused by gambling is a diagnostic criteria of gambling disorder. Giving money to friends, even with the hope that it will help, often backfires and creates more problems and stress. A healthier way to help out a friend who is asking for money is to share your concern about borrowing money. Friends will appreciate sincere honesty, an expression of concern and an offer to help out emotionally. Maintaining a firm financial boundary of not giving money to a friend “in need” will help to motivate them to seek professional help or help them to see how serious their problem may be.

Gambler’s Anonymous (GA) is a self-help group, based in the principles of 12-step recovery. It is available both for people with gambling disorders and for family members (Gam-Anon). This is an excellent place to start to seek immediate assistance with support, education and learning about the recovery process. GA is not a substitute for professional treatment and anyone with a gambling disorder or affected by someone’s gambling should seek professional help. Many states have problem gambling helplines that can provide referrals to professional treatment providers. The national problem gambling helpline is 1-800-522-4700. For states that do not have gambling treatment services, a good starting place would be to seek help from any locally trained addiction treatment program or specialist.

For the elderly, gambling holds the promise of providing entertainment and activity, but also carries a heightened risk for developing gambling disorders quickly. To prevent the development of a gambling disorder, families are encouraged to have a conversation about the purpose of gambling, reasonable amounts of time and money to be spent, and the goals of the gambling. Families are also encouraged to discuss the warning signs of addiction and to educate all family members about what to do if signs of gambling problems emerge. For elderly parents, this might include establishing a set gambling budget, putting enough money aside each month (that cannot be accessed easily), establishing a core group of peer gamblers (to prevent gambling alone) and having full transparency about gambling behaviors. Gambling should not be the only recreational and leisure time activity for elderly parents. Family members’ concerns about gambling are likely to be reduced if parents participate in a variety of activities.

There are no FDA-approved medications for the treatment of gambling disorder. There is, however, emerging scientific research that has shown that medications can be effective in reducing the intensity of urges and cravings for gambling. Some medications from the family of dopamine agonists, which are usually used for Parkinson’s disease, have been shown to  worsen gambling problems, demonstrating the idea that medication can impact gambling behaviors. Clinically, several medications are available in the United States that have been used in treating gambling disorder, including naltrexone (an opioid antagonist), lithium (a mood stabilizer) and a variety of other antidepressant and antipsychotic medications. In general, medications can be useful for reducing gambling behavior but they are not yet considered an immediate first step in treatment. What is critical is using medications to treat any co-occurring psychiatric disorder, such as depression, bipolar disorder or ADHD, that may drive or make gambling behavior worse.

A person can still have a gambling disorder, even if they have plenty of money left in their bank accounts. The core of gambling disorder is about harmful consequences caused by ongoing gambling. Although financial loss is a common one, there are many other signs and symptoms of gambling disorder, including broken interpersonal relationships, loss of time and productivity, personal distress, and medical consequences of gambling (sleep deprivation, obesity, poor self-care). The total amount of money lost is not nearly as important to understand as the total impact of gambling on a person’s lifestyle and environment.

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About the Experts

Timothy Fong, M.D.
Associate Clinical Professor of Psychiatry
Semel Institute for Neuroscience and Human Behavior at UCLA
Co-director, UCLA Gambling Studies Program

Hector Colon-Rivera M.D., CMRO
APM Medical Director, www.apmphila.org 
President of the APA Hispanic Caucus 

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