Compulsive gambling

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 28, 2016
StartDiseasesCompulsive gambling

Gambling is the act of risking money or something of value in the hope of winning more money or something of higher value. For many people, this can be a simple pastime performed in a social setting. However, those who suffer from compulsive gambling or problem gambling often fall victim to an overpowering urge to continue gambling despite negative effects on their lives. While compulsive gambling or gambling addiction is a very serious issue, it can be treated with professional help.


Definitions & Facts

Compulsive gambling is characterized by the pathological need to gamble regardless of past loss of time and/or money that has had a negative impact on one's social, financial, and/or personal circumstances. The effect that gambling has on the brain is comparable to that of various drugs, which is why many of the symptoms of a gambling addiction can resemble those of a drug addiction or substance abuse. Compulsive gambling is considered an addictive disorder by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

When gambling, despite more losses than wins, the occurrence of winning something better than what was risked stimulates the brain and gives a positive feeling or "high." The risking of money also provides high levels of excitement which can feed the addiction. Despite the negative consequences it may have on a person's life, a compulsive gambler will continue to spend his time and resources in pursuit of the rush that gambling provides.

Symptoms & Complaints

Signs and symptoms of compulsive gambling are not limited to but include:

  • Needing to risk more and more money when gambling
  • Experiencing negative changes in mood when trying to reduce time spent gambling
  • Increasing amount of time gambling when distressed
  • Continuing to return to gambling despite suffering losses
  • Behaving suspiciously and/or lying to conceal gambling issues
  • Losing a relationship, employment, education or other significant opportunity as a result of gambling
  • A feeling of regret or guilt after gambling
  • Depending on friends or family for financial support due to the loss of personal finances through gambling


Compulsive gambling is a complicated disorder that can be brought about by a number of causes. There are several common underlying factors that put certain people more at risk for developing a problem gambling habit. Recent studies have shown that some pathological gamblers have lower levels of norepinephrine which is a chemical released by the brain during times of distress or excitement. Those suffering with this disorder may turn to gambling to make up for the amount of norepinephrine they lack.

Those afflicted with the need to compulsively gamble are likely to also experience other psychiatric disorders, especially those related to personality, mood, and anxiety. Many problem gamblers have personality traits that can contribute to their destructive impulses such as having a lack of impulse control, unrealistic levels of optimism, and narcissistic tendencies.

Diagnosis & Tests

The South Oaks Gambling Screen (SOGS) is commonly used to screen for behavior indicative of gambling disorder though complaints from critics that the SOGS can give false positives has resulted in a decline in recent use.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) contains a checklist to identify pathological gambling. To be diagnosed one must meet four or more of the symptoms outlined in the DSM. Currently this manual provides the standard used by most mental health professionals and insurance companies.

An actual diagnosis can only be made by a licensed physician who will perform physical examinations and psychological evaluations. As there are several related disorders to gambling disorder, the acting physician must rule these out before committing to a diagnosis. In such an exam the patient might also be asked about whether any relatives have shown signs of addictive behavior as well as questions about the patient's speech, mood and memory. Due to the nature of gambling disorder there are no physical tests such a blood test or an X-ray that can confirm a diagnosis.

Treatment & Therapy

Treatment for compulsive gambling generally includes counseling and psychotherapy. Cognitive behavioral therapy (CBT), a type of therapy that focuses on recognizing thought processes, has been shown to significantly alleviate gambling addiction symptoms. CBT or any other type of therapy can be supplemented with self-help, support groups, or medication.

It is important to note that as of now there are no medications that have been approved for the treatment of any gambling disorder by the U.S. Food and Drug Administration (FDA). However for problem gamblers who also have related disorders such as depression or obsessive-compulsive disorder using psychiatric medication to treat related mental illnesses can be effective in providing relief from gambling addiction.

Similar to the support group Alcoholics Anonymous (AA), there exists Gamblers Anonymous (GA) which uses a 12-step program to help treat and support those suffering from pathological gambling. Many recovering gamblers have found great success through the use of any combination of these treatment methods.

Prevention & Prophylaxis

While it is very difficult to prevent the onset of a mental illness such as compulsive gambling, there are many warning signs of which at-risk individuals and those around them should be aware. The best preventative method is to be prepared and educated so that upon the manifestation of symptoms early action can be taken.

Compulsive gambling disorder is a real disorder with very real consequences if left untreated, and friends and family of those developing this addiction should remember to be supportive and encourage the gambler to seek help. The most effective course of action to preventing negative outcomes is to be proactive and get help early.