Hubbry Logo
Problem gamblingProblem gamblingMain
Open search
Problem gambling
Community hub
Problem gambling
logo
8 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
Contribute something
Problem gambling
Problem gambling
Problem gambling
View on Wikipedia
from Wikipedia

Problem gambling
Other namesLudopathy,[1] ludomania, degenerate gambling, gambling addiction, compulsive gambling, pathological gambling, gambling disorder
SpecialtyPsychiatry, clinical psychology Edit this on Wikidata
SymptomsSpending a lot of money and time in casino/sports betting
Risk factorsVideo game addiction[2]
Addiction and dependence glossary[3][4][5]
  • addiction – a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward
  • addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain reward systems
  • dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)
  • drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose
  • drug withdrawal – symptoms that occur upon cessation of repeated drug use
  • physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., delirium tremens and nausea)
  • psychological dependence – dependence that is characterised by emotional-motivational withdrawal symptoms (e.g., anhedonia and anxiety) that affect cognitive functioning.
  • reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them
  • rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach
  • sensitization – an amplified response to a stimulus resulting from repeated exposure to it
  • substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress
  • drug tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose

Problem gambling, also known as pathological gambling, gambling disorder, or ludomania, is repetitive gambling behavior despite harm and negative consequences. Problem gambling may be diagnosed as a mental disorder according to DSM-5 if certain diagnostic criteria are met. Pathological gambling is a common disorder associated with social and family costs.

The DSM-5 has re-classified the condition as an addictive disorder, with those affected exhibiting many similarities to those with substance addictions. The term gambling addiction has long been used in the recovery movement.[6] Pathological gambling was long considered by the American Psychiatric Association to be an impulse-control disorder rather than an addiction.[7] However, data suggests a closer relationship between pathological gambling and substance use disorders than exists between PG and obsessive–compulsive disorder, mainly because the behaviors in problem gambling and most primary substance use disorders (i.e., those not resulting from a desire to "self-medicate" for another condition such as depression) seek to activate the brain's reward mechanisms, while the behaviors characterizing obsessive–compulsive disorder are prompted by overactive and misplaced signals from the brain's fear mechanisms.[8]

Problem gambling is an addictive behavior with a high comorbidity with alcohol problems.[9] A common tendency shared by people who have a gambling addiction is impulsivity.

Signs and symptoms

[edit]

Research by governments in Australia led to a universal definition for that country which appears to be the only research-based definition not to use diagnostic criteria: "Problem gambling is characterized by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community."[10] The University of Maryland Medical Center defines pathological gambling as "being unable to resist impulses to gamble, which can lead to severe personal or social consequences".[11]

Most other definitions of problem gambling can usually be simplified to any gambling that causes harm to the gambler or someone else in any way; however, these definitions are usually coupled with descriptions of the type of harm or the use of diagnostic criteria.[citation needed] The DSM-5 has since reclassified pathological gambling as gambling disorder and has listed the disorder under substance-related and addictive disorders rather than impulse-control disorders. This is due to the symptomatology of the disorder resembling an addiction not dissimilar to that of a substance use disorder.[12] To be diagnosed, an individual must have at least four of the following symptoms in 12 months:[13]

  • Needs to gamble with increasing amounts of money to achieve the desired excitement
  • Is restless or irritable when attempting to cut down or stop gambling
  • Has made repeated unsuccessful efforts to control, cut back, or stop gambling
  • Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)
  • Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed)
  • After losing money gambling, often returns another day to get even ("chasing" one's losses)
  • Lies to conceal the extent of involvement with gambling
  • Has jeopardized or lost a significant relationship, job, education, or career opportunity because of gambling
  • Relies on others to provide money to relieve desperate financial situations caused by gambling

Risk factors

[edit]

Mayo Clinic specialists and other studies state that compulsive gambling may result from biological, genetic, and environmental factors[14][15] such as:

  • Mental health disorders (the presence of substance use disorders, personality disorders, emotional states)
  • Age and sex (usually found in youth or middle-aged people, and more common to men than women)
  • Impact of family or friends
  • Personality traits
  • Video games (including any factors that resemble gambling such as slot machines or loot boxes)[16]
  • Drugs with rare side-effects (for example, antipsychotic medications or dopamine agonists).[14]

Etiology

[edit]

Biology

[edit]

Evidence indicates that pathological gambling is an addiction similar to chemical addiction.[17] It has been observed that some pathological gamblers have lower levels of norepinephrine than normal gamblers.[18] New studies regarding this link show that norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their under-dosage.[19] Studies have compared pathological gamblers to substance addicts, concluding that addicted gamblers display more physical symptoms during withdrawal.[20] Deficiencies in serotonin might also contribute to compulsive behavior, including a gambling addiction.

The findings in one review indicated that behavioral disorders such as problem gambling and substance use disorder are closely linked; sensitization theory indicates that these disorders are marked by a compulsive drive towards unhealthy behaviors and an inability to control against them.[21] Dopamine dysregulation syndrome has been observed in the aforementioned theory in people with regard to such activities as gambling.[22] A limited study was presented at a conference in Berlin, suggesting opioid release differs in problem gamblers from the general population, but in a very different way from people with a substance use disorder.[23]

Some medical authors suggest that the biomedical model of problem gambling may be unhelpful because it focuses only on individuals. These authors point out that social factors may be a far more important determinant of gambling behavior than brain chemicals, and they suggest that a social model may be more useful in understanding the issue.[24] For example, an apparent increase in problem gambling in the UK may be better understood as a consequence of changes in legislation which came into force in 2007 and enabled casinos, bookmakers, and online betting sites to advertise on TV and radio for the first time and which eased restrictions on the opening of betting shops and online gambling sites.[25]

There have also been studies that showcase how factors like gender and age can affect how a person is affected by gambling; examples include the probability of addiction being 11% stronger in men than in women, and the fact that the age range of 19–29 has the highest risk of developing problem gambling or pathological gambling habits.[26]

Psychology

[edit]

Several psychological mechanisms are thought to be implicated in the development and maintenance of problem gambling.[27] First, reward processing seems to be less developed in problem gamblers. Second, some individuals use problem gambling as an escape from the problems in their lives (an example of negative reinforcement). Third, personality factors such as narcissism, risk-seeking, sensation-seeking, and impulsivity play a role. Fourth, problem gamblers have several cognitive biases, including the illusion of control,[28] unrealistic optimism, overconfidence and the gambler's fallacy (the incorrect belief that a series of random events tends to self-correct so that the absolute frequencies of each of various outcomes balance each other out). Fifth, problem gamblers represent a chronic state of a behavioral spin process, a gambling spin, as described by the criminal spin theory.[clarification needed][29]

Some gamblers often develop learned helplessness—a psychological state in which a person believes they have no control over their situation.[30] This belief is then reinforced through the unpredictable and repeated financial losses that are intrinsic to gambling. This mechanism is significant because it serves to reinforce the cycle of addiction.[31][32] This phenomenon can shift a gambler's locus of control toward the external.[33] The gambler then begins to perceive outcomes as being determined by uncontrollable external systems, rather than from their own volitional behavior.[34] The theory of learned helplessness was first researched by psychologists Martin Seligman and Steven Maier in the 1960s.[35]

Spain's gambling watchdog has updated its 2019–2020 Responsible Gaming Program, classifying problem gambling as a mental disorder.[36]

Similarities to other disorders

[edit]

Pathological gambling is similar to many other impulse-control disorders such as kleptomania.[37] According to evidence from both community- and clinic-based studies, individuals who are pathological gamblers are highly likely to exhibit other psychiatric problems concurrently, including substance use disorders, mood and anxiety disorders, or personality disorders.[38]

There is a partial overlap in diagnostic criteria between problem gambling and substance use disorders; pathological gamblers are also likely to have a substance use disorder. The "telescoping phenomenon" reflects the rapid development from initial to problematic behavior in women compared with men. This phenomenon was initially described for alcoholism, but it has also been applied to pathological gambling. Also, biological data support a relationship between pathological gambling and substance use disorder.[39] A comprehensive UK Gambling Commission study from 2018 has also hinted at the link between gambling addiction and a reduction in physical activity, poor diet, and overall well-being. The study links problem gambling to a myriad of issues affecting relationships, and social stability.

Evolutionary psychology

[edit]

Some researchers propose that human gambling behavior reflects evolved tendencies toward risk-taking that historically conferred adaptive benefits.[40] For example, gambling can be understood as a form of "risky reward-seeking," where individuals overestimate potential gains—an inclination that modern gambling industries exploit.[41] From this view, men tend to gamble more and engage in higher-stakes bets because male reproductive success is often linked to risk-based competition, paralleling other risky activities like big-game hunting or physical aggression. Younger adults may also be more prone to gambling due to the evolutionary advantage of status-seeking during peak reproductive years.

Other evolutionary accounts highlight the role of reward uncertainty. Researchers suggest that unpredictability itself motivates animals (including humans) to persevere in reward-seeking despite repeated failures, which can foster persistent gambling behaviour. Life History Theory further explains why some individuals are more vulnerable to problem gambling, proposing that those with a "fast" strategy (marked by impulsiveness and short-term planning) may be especially drawn to high-risk, high-reward scenarios.[42] In this framework, personality traits favoring present-oriented decision-making increase susceptibility to gambling addiction, mirroring risk-taking behaviors seen in other species.

Diagnosis

[edit]

The most common instrument used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York City.[43] In recent years the use of SOGS has declined due to a number of criticisms, including that it overestimates false positives (Battersby, Tolchard, Thomas & Esterman, 2002).

The DSM-IV diagnostic criteria presented as a checklist is an alternative to SOGS, it focuses on the psychological motivations underpinning problem gambling and was developed by the American Psychiatric Association. It consists of ten diagnostic criteria. One frequently used screening measure based upon the DSM-IV criteria is the National Opinion Research Center DSM Screen for Gambling Problems (NODS). The Canadian Problem Gambling Inventory (CPGI) and the Victorian Gambling Screen (VGS) are newer assessment measures. The Problem Gambling Severity Index, which focuses on the harms associated with problem gambling, is composed of nine items from the longer CPGI.[44] The VGS is also harm based and includes 15 items. The VGS has proven validity and reliability in population studies as well as Adolescents and clinic gamblers.[citation needed]

Treatment

[edit]

Most treatment for problem gambling involves counseling, step-based programs, self-help, peer-support, medication, or a combination of these. However, no one treatment is considered to be most efficacious and, in the United States, no medications have been approved for the treatment of pathological gambling by the U.S. Food and Drug Administration (FDA).

Gamblers Anonymous (GA) is a commonly used treatment for gambling problems. Modeled after Alcoholics Anonymous, GA is a twelve-step program that emphasizes a mutual-support approach. There are three in-patient treatment centers in North America.[45] One form of counseling, cognitive behavioral therapy (CBT) has been shown to reduce symptoms and gambling-related urges. This type of therapy focuses on the identification of gambling-related thought processes, mood and cognitive distortions that increase one's vulnerability to out-of-control gambling. Additionally, CBT approaches frequently utilize skill-building techniques geared toward relapse prevention, assertiveness and gambling refusal, problem solving and reinforcement of gambling-inconsistent activities and interests.[46]

As to behavioral treatment, some recent research supports the use of both activity scheduling and desensitization in the treatment of gambling problems.[47] In general, behavior analytic research in this area is growing[48] There is evidence that the SSRI paroxetine is efficacious in the treatment of pathological gambling.[49] Additionally, for patients with both pathological gambling and a comorbid bipolar spectrum condition, sustained-release lithium has shown efficacy in a preliminary trial.[50] The opioid antagonist drug nalmefene has also been trialed quite successfully for the treatment of compulsive gambling.[51] Group concepts based on CBT, such as the metacognitive training for problem gambling[52] have also proven effective.

Step-based programs

[edit]

12 Step–based programs such as Gamblers Anonymous are specific to gambling and generic to healing addiction, creating financial health, and improving mental wellness. Commercial alternatives that are designed for clinical intervention, using the best of health science and applied education practices, have been used as patient-centered tools for intervention since 2007. They include measured efficacy and resulting recovery metrics.[medical citation needed]

Motivational interviewing

[edit]

Motivational interviewing is one of the treatments of compulsive gambling. The motivational interviewer's basic goal is promoting readiness to change through thinking and resolving mixed feelings. Avoiding aggressive confrontation, argument, labeling, blaming, and direct persuasion, the interviewer supplies empathy and advice to compulsive gamblers who define their own goal. The focus is on promoting freedom of choice and encouraging confidence in the ability to change.[53]

Peer support

[edit]

A growing method of treatment is peer support. With the advancement of online gambling, many gamblers experiencing issues use various online peer-support groups to aid their recovery. This protects their anonymity while allowing them to attempt recovery on their own, often without having to disclose their issues to loved ones.[medical citation needed]

Self-help

[edit]

Research into self-help for problem gamblers has shown benefits.[54] A study by Wendy Slutske of the University of Missouri concluded one-third of pathological gamblers overcome it by natural recovery.[55]

Pharmaceutical treatments

[edit]
Main article: Addiction § Medication

Numerous pharmaceutical approaches to treating gambling addiction have been suggested including antidepressants, atypical antipsychotic agents, mood stabilizers, and opioid antagonists, however the best approach for treatment, treatment regime including dosage and timing is not clear.[56] There is some evidence to suggest that opioid antagonists, for example, naltrexone or nalmefene, and atypical antipsychotics such as olanzapine, may help reduce the severity of gambling symptoms in the short-term, however it is not clear if these medications are effective at improving other psychological symptoms associated with this disorder or for longer term symptom relief from problem gambling.[56] The evidence suggesting the effectiveness of mood stabilizers is not clear.[56]

A series of anti-depressant studies were conducted to determine their efficacy in treating problematic gambling. These studies produced three critical findings:[39]

  1. Antidepressants can reduce pathological gambling when there is an effect on serotonergic reuptake inhibitors and 5-HT1/5-HT2 receptor antagonists.
  2. Pathological gambling, as part of obsessive–compulsive disorder, requires the higher doses of antidepressants as is usually required for depressive disorders.
  3. In cases where participants do not have or have minimal symptoms of anxiety or depression, antidepressants still have those effect.

Self-exclusion

[edit]
Main article: Self-exclusion

Gambling self-exclusion (voluntary exclusion) programs are available in the US, the UK, Canada, Australia, South Africa, France, and other countries. They seem to help some (but not all) problem gamblers to gamble less often.[57]

Some experts maintain that casinos in general arrange for self-exclusion programs as a public relations measure without actually helping many of those with problem gambling issues. A campaign of this type merely "deflects attention away from problematic products and industries", according to Natasha Dow Schull, a cultural anthropologist at New York University and author of the book Addiction by Design.[58]

There is also a question as to the effectiveness of such programs, which can be difficult to enforce.[59] In the province of Ontario, Canada, for example, the Self-Exclusion program operated by the government's Ontario Lottery and Gaming Corporation (OLG) is not effective, according to investigation conducted by the television series, revealed in late 2017: "Gambling addicts ... said that while on the ... self-exclusion list, they entered OLG properties on a regular basis" in spite of the facial recognition technology in place at the casinos, according to the Canadian Broadcasting Corporation. As well, a CBC journalist who tested the system found that he was able to enter Ontario casinos and gamble on four distinct occasions, in spite of having been registered and photographed for the self-exclusion program. An OLG spokesman provided this response when questioned by the CBC: "We provide supports to self-excluders by training our staff, by providing disincentives, by providing facial recognition, by providing our security officers to look for players. No one element is going to be foolproof because it is not designed to be foolproof".[58]

Impact (Australia)

[edit]

According to the Productivity Commission's 2010 final report into gambling, the social cost of problem gambling is close to 4.7 billion dollars a year. Some of the harms resulting from problem gambling include depression, suicide, lower work productivity, job loss, relationship breakdown, crime and bankruptcy.[60] A survey conducted in 2008 found that the most common motivation for fraud was problem gambling, with each incident averaging a loss of $1.1 million.[60] According to Darren R. Christensen. Nicki A. Dowling, Alun C. Jackson and Shane A. Thomas, a survey done from 1994 to 2008 in Tasmania gave results that gambling participation rates have risen rather than fallen over this period.[61]

Prevalence

[edit]

Europe

[edit]

In Europe, the rate of problem gambling is typically 0.5 to 3 percent.[62] The "British Gambling Prevalence Survey 2007", conducted by the British Gambling Commission, found approximately 0.6 percent of the adult population had problem gambling issues—the same percentage as in 1999.[63] The highest prevalence of problem gambling was found among those who participated in spread betting (14.7%), fixed odds betting terminals (11.2%), and betting exchanges (9.8%).[63] In Norway, a December 2007 study showed the amount of current problem gamblers was 0.7 percent.[64]

With gambling addiction on the rise worldwide and across Europe in particular, those calling gambling a disease have been gaining grounds. The British Gambling Commission announced a significant shift in their approach to gambling[when?] through their reclassification of gambling as a disease, and therefore that it should be addressed adequately by the NHS.

The World Health Organization has also classified gambling a disease. In its 72nd World Health Assembly held on Saturday, May 25, 2019, 'gaming disorder' was recognized as an official illness. The 194-member meet added excessive gaming to a classified list of diseases as it revised its International Statistical Classification of Diseases and Related Health Problems (ICD-11).[citation needed]

North America

[edit]

Lizbeth García Quevedo, director of the Coordination with Federal Entities (CONADIC), spoke of pathological gambling as a strong addiction in Mexico: "It has very similar behaviors, that is why some experts consider it an addiction because it is similar in the behaviors, in the origins, some risk factors that can trigger pathological gambling, it can also trigger drug consumption". In Mexico there could be between one and three million people addicted to gambling. "They should be aware of what their children are doing, and on the other hand, they should motivate pro-active gambling, healthy gambling", commented Lizbeth García Quevedo. The Ministry of Health document highlights that a study on pathological gambling that analyzed 46 studies carried out in Canada, the United States, Australia, Sweden, Norway, England, Switzerland and Spain, revealed that the prevalence of pathological gambling is relatively higher among adolescents, which shows the continuity of the problem considering that many pathological gamblers state that they started their gambling behavior at an early age.[65]

In the United States, the percentage of pathological gamblers was 0.6 percent, and the percentage of problem gamblers was 2.3 percent in 2008.[66] Studies commissioned by the National Gambling Impact Study Commission Act has shown the prevalence rate ranges from 0.1 percent to 0.6 percent.[67] Nevada has the highest percentage of pathological gambling; a 2002 report estimated 2.2 to 3.6 percent of Nevada residents over the age of 18 could be called problem gamblers. Also, 2.7 to 4.3 percent could be called probable pathological gamblers.[68]

According to a 1997 meta-analysis by Harvard Medical School's division on addictions, 1.1 percent of the adult population of the United States and Canada could be called pathological gamblers.[69] A 1996 study estimated 1.2 to 1.9 percent of adults in Canada were pathological.[70] In Ontario, a 2006 report showed 2.6 percent of residents experienced "moderate gambling problems" and 0.8 percent had "severe gambling problems".[71] In Quebec, an estimated 0.8 percent of the adult population were pathological gamblers in 2002.[72] Although most who gamble do so without harm, approximately 6 million American adults are addicted to gambling.[73]

According to a survey of 11th and 12th graders in Wood County, Ohio found that the percentage who reported being unable to control their gambling rose to 8.3 percent in 2022, up from just 4.2 percent in 2018. The reasons for the increase cited, are the time spent online during the COVID-19 pandemic, gambling-like elements put into video games, and the increased legalization of sports betting in a number of U.S. states.[74]

According to Jennifer Trimpey, as the legality of online sport betting and online casino gambling increase across the United States, almost all governments of states with legal online gambling offer state-run self-exclusion programs, and most major online betting operators provide their own self-exclusion programs as well.[75]

South America

[edit]

For Isabel Sánchez Sosa, coordinator of the Compulsive Gamblers Association of Argentina, "gambling addiction is growing a lot in the country because the offer is impressive" and in this sense she asserted that the presence of bingos is a common issue in all neighborhoods. In the province of Buenos Aires there are 46 bingos.[76]

Africa

[edit]

Similar to other parts of the world, Africa's gambling rates are increasing, especially among youths. In East African countries like Kenya and Uganda, more than a majority of youths surveyed reported gambling behaviors in the last 12 months.[77] Additionally, many youths begin gambling before the age of 18, which correlates with the psychological etiologies of risk-taking and low self-control. Gambling in East Africa is correlated with substance use, risky sexual behaviors such as unprotected sex and frequent sexual encounters, and risks of crime.[77] Regarding youths who gamble, almost 50% of them report some form of gambling severe enough to be classified as problematic by the DSM.[77]

In Western Africa, such as countries like Nigeria and Ghana, these trends are mirrored. A majority of youths participate in lifetime gambling behaviors, and of those who gamble, over 70% reported consistent gambling within the last year.[77] Gambling in West Africa is linked with problems with law enforcement and other authorities, substance use, and reckless financial spending.[77] Across all areas of Africa, sports betting and card-games serve to be the most prevalent forms of gambling; a supermajority of individuals gamble on weekends in particular. Sports betting is incredibly common among high-schoolers and college-aged individuals and can be seen most often among young men.[77]

Asia

[edit]

Gambling in Asia is particularly challenging to study because it is prohibited in a majority of countries. In countries such as China and Japan, the only way to gamble legally is through government-ran lotteries or casinos.[78] Regardless of its legality, gambling still occurs in underground networks and through legal loopholes, such as pachinko in Japan. Gambling behaviors are closely connected with homelessness, especially in places such as Osaka City.[79] Among those who live in poverty and experience homelessness, 43.7% of individuals reported as lifetime gamblers.[79] There are a number of risk factors associated with this link; primarily, a long duration of homelessness throughout the life-course and repeated instances of homelessness increase risks of gambling behavior.[78]

Gambling is also closely associated with gaming behaviors, specifically the prevalence of loot boxes.[80] Loot boxes are found within certain games, and they consist of lottery-like in-game merchandising where players can unlock certain items by chance. Loot boxes contain items which are graded by rarity, from common to legendary, and this relationship of rarity to unlock chances closely resembles payouts in certain gambling machines, such as jackpots in slot machines. Jackpots are very high rewards, but the chances of achieving them are very rare; this mimics the rarity of unlocking a legendary item through a loot box. Across 270 studies, there is a significant causal relationship between increasing prevalence of certain gaming behaviors and further risk of gambling addiction.[80]

Oceania (Australia)

[edit]

Casinos and poker machines in pubs and clubs facilitate problem gambling in Australia. The building of new hotels and casinos has been described as "one of the most active construction markets in Australia"; for example, AUD$860 million was allocated to rebuild and expand the Star Complex in Sydney.[81]

A 2010 study, conducted in the Northern Territory by researchers from the Australian National University (ANU) and Southern Cross University (SCU), found that the proximity of a person's residence to a gambling venue is significant in terms of prevalence. Harmful gambling in the study was prevalent among those living within 100 meters of any gambling venue, and was over 50% higher than among those living ten kilometers from a venue. The study's data stated:

Specifically, people who lived 100 meters from their favorite venue visited an estimated average of 3.4 times per month. This compared to an average of 2.8 times per month for people living one kilometer away, and 2.2 times per month for people living ten kilometers away.[82]

According to the Productivity Commission's 2016 report into gambling, 0.5% to 1% (80,000 to 160,000)[83] of the Australian adult population had significant problems resulting from gambling. A further 1.4% to 2.1% (230,000 to 350,000) of the Australian adult population experienced moderate risks making them likely to be vulnerable to problem gambling.[84] Estimates show that problem gamblers account for an average of 41% of the total gaming machine spending.[84]

Long-term health impacts

[edit]

If not treated, problem gambling may cause severe and lasting effects on an individual's life:[85]

  • relationship-related issues
  • problems with money, bankruptcy
  • legal problems, imprisonment
  • health problems
  • suicide, including suicidal thoughts and attempts

Suicide rates

[edit]

A gambler who does not receive treatment for pathological gambling when in a desperation phase may contemplate suicide.[86] Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.[87][88]

Early onset of problem gambling may increase the lifetime risk of suicide.[89] Both comorbid substance use[90][91] and comorbid mental disorders increase the risk of suicide in people with problem gambling.[92] A 2010 Australian hospital study found that 17% of suicidal patients admitted to the Alfred Hospital's emergency department were problem gamblers.[93]

See also

[edit]

References

[edit]

Further reading

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Problem gambling

View on Grokipedia
from Grokipedia
Problem gambling, clinically termed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (), constitutes a marked by a persistent and recurrent maladaptive of that leads to clinically significant impairment or distress in personal, familial, or occupational domains. Key diagnostic criteria include the need to gamble with escalating sums of money to achieve desired excitement, preoccupation with activities, repeated unsuccessful attempts to reduce or cease , and "chasing" losses through further wagers. The condition manifests through neurobiological mechanisms akin to substance addictions, involving dopamine-driven reward pathways reinforced by intermittent variable rewards inherent in many gambling formats, alongside psychosocial risk factors such as early initiation, male sex, , and co-occurring psychiatric disorders like depression or substance use. Empirical studies identify genetic estimates around 50%, underscoring individual vulnerabilities rather than universal inevitability from exposure. stands at approximately 1% among adults worldwide, stable over decades yet showing elevations to 4-7% in subpopulations such as psychiatric inpatients or substance treatment seekers, with recent of online linked to surges in addiction-related help-seeking. Consequences encompass profound financial ruin, interpersonal conflicts, legal entanglements, and heightened risk—up to 20-fold elevated compared to the general —prompting debates on regulatory interventions versus personal accountability in an era of ubiquitous digital access. Treatment approaches, including cognitive-behavioral and pharmacotherapies targeting , yield modest remission rates of 30-50%, highlighting challenges in sustaining recovery amid ongoing environmental cues.

Definition and Symptoms

Diagnostic Criteria

The diagnostic criteria for problem gambling, clinically termed gambling disorder, are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition () as a characterized by persistent and recurrent problematic leading to clinically significant impairment or distress. To meet the threshold, an individual must exhibit at least four of the following nine symptoms within a 12-month period: (1) need to gamble with increasing amounts of to achieve desired excitement (tolerance); (2) restlessness or when attempting to reduce or stop (withdrawal-like symptoms); (3) repeated unsuccessful efforts to control, cut back, or stop ; (4) frequent preoccupation with , such as reliving past experiences or planning future wagers; (5) as a primary means to relieve emotional distress, such as helplessness, guilt, or anxiety (chasing losses); (6) "chasing" losses by returning to gamble after losing ; (7) lying to , therapists, or others to conceal the extent of involvement with ; (8) jeopardizing or losing significant relationships, jobs, or educational/career opportunities due to ; and (9) relying on others to obtain to relieve desperate financial consequences caused by . Severity is graded as mild (4-5 criteria), moderate (6-7), or severe (8-9), with empirical evidence linking higher symptom counts to greater functional impairment, such as financial ruin and relational breakdown, observed in validation studies during development. The International Classification of Diseases, Eleventh Revision (ICD-11) classifies gambling disorder under disorders due to addictive behaviors, emphasizing a pattern of gambling that demonstrates impaired control, prioritization of gambling over other life interests, and continuation despite awareness of harmful consequences. Core features include: (1) impaired control over gambling decisions, such as frequency, duration, intensity, or cessation attempts; (2) escalating priority of gambling to the point of supplanting other activities and responsibilities; and (3) persistence in gambling despite mounting personal, familial, or socioeconomic harms, persisting for at least 12 months at a severity causing significant dysfunction in social, occupational, or other domains. Unlike DSM-5's symptom checklist, ICD-11 focuses on behavioral hallmarks akin to substance addictions, supported by cross-cultural validity data showing these criteria predict real-world harms like debt accumulation and mental health decline independent of cultural context. Longitudinal corroborates these criteria by tracking progression from recreational —defined as occasional, controlled participation without —to problem gambling, where symptoms like loss-chasing and impaired control emerge as thresholds for clinical intervention. For instance, a six-year of adults found that while most recreational gamblers remained stable or desisted, a subset transitioned to problem gambling marked by escalating symptoms and associated risks, with persistence linked to unmet control criteria. These diagnostics prioritize empirical markers of over self-reported intent, distinguishing pathological patterns from excessive but non-disordered through observable dysfunction.

Distinction from Recreational and Excessive Gambling

Recreational gambling involves occasional participation for , typically within predetermined financial limits, without resulting in distress, interpersonal conflicts, or disruptions to daily functioning. Participants maintain , treating it as a budgeted activity akin to other hobbies, with no persistent preoccupation or escalation despite adverse outcomes. Empirical studies indicate that recreational gamblers exhibit health and profiles comparable to non-gamblers, underscoring that controlled engagement does not inherently precipitate pathology. Excessive gambling, by contrast, entails higher frequency or stakes—often observed among higher-income individuals who can absorb financial outlays without existential threat—but remains distinct from problem gambling when it lacks hallmarks of impaired control or cascading harms. For instance, affluent professionals may allocate substantial sums to high-stakes activities like poker tournaments or as a form of risk-managed , preserving overall life stability through deliberate limits and rational assessment of probabilities. data reinforce this boundary: among adult gamblers, only 1-2% progress to severe problems lifetime, implying that 98% or more sustain non-pathological patterns, including those with elevated volume, via innate self-regulation and awareness of probabilistic variance. Short-term losses, attributable to the nature of gambling outcomes rather than compulsion, do not signify disorder; conflating variance-induced downturns with overlooks that most participants experience wins and losses without escalation or borrowing to chase deficits. Media accounts frequently amplify isolated tales of ruin, framing financial setbacks as inevitable precursors, yet longitudinal evidence shows the overwhelming majority of gamblers—approximately 95% in population surveys—never exhibit such trajectories, attributing persistence to reasoned enjoyment rather than dysfunction. This distinction guards against pathologizing normal risk-taking, emphasizing causal markers like recurrent or jeopardized relationships over mere monetary exposure.

History

Early Observations and Moral Frameworks

Excessive gambling was recognized in ancient civilizations as a matter of personal vice and lack of temperance, rather than a medical condition. Archaeological evidence from dating to approximately 2300 BCE reveals tiles used in rudimentary games of chance, with contemporary texts such as those from the (c. 2070–1600 BCE) associating such activities with risks of impoverishment and social disruption, urging restraint as a of self-mastery. Similarly, ancient Indian writings, including the attributed to around 300 BCE, detailed the destructive outcomes of habitual , including financial ruin and familial breakdown, framing it as a controllable lapse akin to other indulgences. By the late , European observations began documenting patterns of uncontrolled leading to personal devastation, as noted in scientific papers from 1798 that described cases of individuals persisting in play despite mounting debts and , attributing the behavior to weaknesses of will rather than inherent . In colonial America, Puritan authorities in the enacted prohibitions against as early as 1638, condemning it as an affront to God's providential order and a catalyst for idleness, theft, and moral decay, with figures like later preaching against it as a rejection of divine sovereignty over chance. The saw temperance advocates in Britain and the draw parallels between excessive and intemperate , both viewed as voluntary pursuits eroding character and provoking ruin, with reformers citing widespread bankruptcies—such as those linked to Regency-era gaming debts that drove participants to desperation, , and familial collapse—as empirical proof of self-inflicted harm without excusing it as . These movements emphasized societal interventions like legal restrictions and moral education to curb the vice, reflecting a consensus that gamblers retained agency and responsibility, distinct from later medical interpretations. Cultural differences persisted, with some societies permitting regulated for recreation while decrying excess as imprudence, underscoring the pre-medical emphasis on ethical discipline over deterministic .

Shift to Medical and Scientific Recognition

In the mid-20th century, initial empirical studies began to document the compulsive dimensions of excessive , moving beyond anecdotal or moralistic accounts to observe patterns of persistent behavior despite adverse consequences, with terms like "compulsive gambler" entering clinical discourse by the . These investigations highlighted similarities to other repetitive behaviors, laying groundwork for psychiatric , though systematic data remained limited until later expansions in gambling access. A pivotal milestone occurred in 1980 with the inclusion of pathological in the DSM-III as an not elsewhere classified, marking its formal recognition as a psychiatric condition characterized by a chronic failure to resist urges that disrupt personal, familial, or occupational functioning. This classification reflected accumulating clinical observations but placed it outside substance-related disorders, emphasizing impulse dysregulation over addiction-like neurobiology. The expansion of legalized , including state lotteries starting in the 1960s (e.g., New Hampshire's in 1964) and casino legalization in via the 1976 Casino Control Act (with operations commencing in Atlantic City in 1978), prompted heightened research scrutiny and modest increases in dedicated funding to assess associated behavioral pathologies. By the publication of the in 2013, pathological gambling was reclassified as gambling disorder—the first non-substance —based on evidence from studies showing overlapping reward pathway activations, such as responses in the ventral similar to those in substance use disorders. Functional MRI findings demonstrated heightened cue-reactivity and deficits in affected individuals, supporting a unified framework over prior impulse-control models. This shift aligned with the Health Organization's , which in 2019 codified gambling disorder under "disorders due to addictive behaviors," defined by persistent gambling patterns leading to impaired control and prioritizing gambling over other interests despite harms.

Prevalence

Global and National Estimates

Global estimates of problem gambling prevalence, defined as meeting criteria for gambling disorder, indicate a lifetime rate of approximately 0.5% to 3% among adults, based on meta-analyses of international surveys using standardized diagnostic tools like the DSM-IV or criteria. A of studies from 1975 to 2012 reported a pooled past-year prevalence of 2.3% for problem gambling across global adult populations.00126-9/fulltext) These figures derive primarily from self-report instruments such as the Problem Gambling Severity Index (PGSI) or South Oaks Gambling Screen (SOGS), which assess frequency of symptoms like preoccupation, tolerance, and chasing losses. Prevalence appears elevated among gamblers, with rates of problematic ranging from 2.7% to 11.1% in representative samples, reflecting the and rapid reinforcement of digital platforms. This disparity underscores the influence of gambling modality on disorder rates, though estimates vary due to differences in sampling and instrument sensitivity across studies. In the United States, national surveys estimate that 2% to 3% of adults exhibit past-year problem gambling behaviors, as measured by the National Council on Problem Gambling's (NCPG) National Survey on Gambling Attitudes and Gambling Experiences (NGAGE) series. Following the 2018 decision overturning the Professional and Amateur Sports Protection Act (PASPA), which expanded legalized to over 30 states by 2024, some state-level surveys reported increases in disordered gambling rates to 2.5% to 5% among adults in jurisdictions with active sportsbooks. Self-report biases inherent in these prevalence surveys contribute to potential underestimation, as stigma surrounding problems prompts socially desirable responding, where participants minimize symptom endorsement to avoid perceived judgment. For instance, instruments like the or similar national polls rely on anonymous but voluntary disclosure, which correlates with lower reported rates compared to clinical or collateral data validations. This methodological limitation implies true prevalence may exceed survey figures, particularly in contexts of expanding availability.

Demographic Patterns and Risk Groups

Males demonstrate consistently higher rates of problem gambling compared to females, with meta-analyses indicating men are 2 to 3 times more likely to experience gambling-related problems across diverse populations. This disparity persists globally, though it may narrow in regions like where female participation in certain gambling forms has increased. Young adults aged 18-24 represent a high-risk group, with prevalence estimates for problem gambling reaching 6-10% among students in recent surveys. data from 2023-2024 highlight elevated engagement in sports wagering among this cohort, correlating with at-risk behaviors. Individuals from low (SES) backgrounds exhibit greater vulnerability, with longitudinal studies linking lower and neighborhood disadvantage to heightened gambling severity. Poor neighborhoods show approximately twice the problem gambling rates of affluent areas, attributable to factors like proximity to venues and economic pressures rather than inherent traits. Certain ethnic minorities, particularly Indigenous populations, face disproportionately high rates; for instance, Native American adults experience problem gambling at 2.3%, more than double the general U.S. adult prevalence. Similar patterns appear in Canadian Indigenous communities, where past-year gambling participation and problems exceed non-Indigenous benchmarks. Problem gambling often clusters with comorbidities that amplify risk, including substance use disorders and major depressive disorder, with systematic reviews reporting co-occurrence in 40-60% of cases among treatment seekers. Alcohol and other substance dependencies show particularly strong associations, present in up to 64% of pathological gamblers. Mood disorders like depression co-occur in about 60%, suggesting shared pathways that exacerbate gambling persistence. Following the 2018 U.S. decision in Murphy v. NCAA that struck down the federal ban on , legalization expanded rapidly, with online platforms proliferating in states like and . In , a 2024 statewide prevalence survey found that 5.7% of adults exhibited disordered gambling behaviors, an increase from 4.0% in 2022 prior to full online rollout, with nearly 15% of past-year sports bettors meeting disordered criteria. Similarly, in , the proportion of monthly gamblers experiencing problems rose from 20.9% in 2022 to 28% by fall 2024, coinciding with expanded mobile betting access. These upticks, documented in state-commissioned surveys, align with broader patterns where online correlated with a 20-30% rise in problem gambling indicators among frequent bettors, driven by app-based convenience and real-time wagering. Globally, post-COVID-19 shifts amplified 's reach, particularly among , as lockdowns normalized app usage and reduced barriers to digital platforms. A 2025 NCAA survey of over 20,000 student-athletes revealed elevated participation, with education efforts showing modest behavioral shifts but highlighting persistent engagement among young s. students reported problem gambling rates two to four times higher than the general , fueled by ubiquitous mobile access and . International data echo this, with increased cases among students linked to digital ease, though some regions saw temporary dips in venue-based betting offset by virtual surges. Despite these rises, national U.S. surveys indicate participation has stabilized post-legalization, with prevalence holding at approximately 23% of adults across 38 states as of , suggesting that does not universally escalate to disorder for the majority of participants. Problem risk factors remain concentrated among subsets like monthly bettors, while overall adult engagement plateaus, implying that while online formats heighten vulnerability for at-risk groups, broad population-level progression to is limited by self-selection and regulatory mitigations.

Etiology and Risk Factors

Biological and Genetic Influences

Twin studies and meta-analyses indicate that genetic factors account for approximately 50% of the variance in to problem gambling, with the remainder attributable to unique environmental influences rather than shared environment. This heritability estimate derives from comparisons of monozygotic and dizygotic twins, where concordance rates for pathological gambling are higher among identical twins, suggesting polygenic contributions rather than single-gene dominance. Neuroimaging evidence, particularly from functional MRI (fMRI) studies, reveals dysregulation in the brain's -mediated reward circuitry among individuals with gambling disorder, akin to patterns observed in substance use disorders. These studies show blunted activation in the ventral during monetary reward anticipation and processing, potentially reflecting tolerance or hypofrontality that drives escalated risk-taking to achieve reward salience. Additionally, hyper-reactivity to gambling-specific cues in mesolimbic pathways underscores a sensitized response, contributing to compulsive pursuit despite losses. Genetic vulnerabilities often overlap with impulsivity-related traits, as seen in elevated with ADHD, where shared polymorphisms in genes (e.g., DRD2, DRD4) and transporters (e.g., ) heighten susceptibility to both conditions through impaired . However, such biological predispositions confer risk rather than ; the majority of genetically vulnerable individuals do not develop clinical gambling disorder, as expression requires interaction with environmental triggers, underscoring that explains population-level variance without predicting individual outcomes.

Psychological and Cognitive Mechanisms

Problem gamblers exhibit cognitive distortions that perpetuate engagement despite losses, including the , where individuals overestimate their influence over random outcomes. Experimental studies demonstrate this bias in laboratory settings, such as slot machine simulations, where participants who choose their bets or engage in skill-like actions report higher perceived control and persist longer than in purely chance conditions. The near-miss effect further reinforces persistence, as outcomes just short of a win (e.g., two matching symbols on a slot reel) elicit stronger urges to continue than clear losses, with lab manipulations showing near-misses increase bet sizes and trial durations by up to 30% compared to full misses. Similarly, the leads to erroneous expectations of streak reversals, prompting continued play after losses under the belief that wins are "due," as evidenced by reaction time tasks linking this bias to inhibitory control deficits in gamblers. Despite intentions to stop after losses, problem gamblers often continue due to frustration driving loss-chasing behavior to recoup funds; the stimulating casino atmosphere, including lights, sounds, and nearby excitement, impairs judgment and rational decision-making; dopamine-mediated reinforcement from intermittent rewards and near-misses makes cessation difficult; and emotional impulses override self-imposed limits, leading to extended sessions and greater losses. These mechanisms share features with obsessive-compulsive spectrum disorders, particularly in compulsive repetition and impaired behavioral flexibility; twin studies reveal genetic overlaps between gambling disorder and latent obsessive-compulsive traits, with both involving prefrontal-striatal dysregulation in habit formation. Problem gamblers also display elevated personality traits of and sensation-seeking, with meta-analyses confirming higher scores on multidimensional impulsivity scales (e.g., negative urgency and lack of premeditation) correlating with gambling severity, independent of substance use . Sensation-seeking drives initial risk-taking, as adolescents high in this trait show doubled odds of problem gambling onset via longitudinal surveys tracking reward sensitivity. From an evolutionary perspective, modern exploits variable-ratio schedules—unpredictable rewards akin to ancestral successes but mismatched to contemporary low-risk environments—sustaining engagement through dopamine-mediated anticipation without adaptive payoff. Cognitive-behavioral therapies targeting these biases, such as retraining on and exposure to losses, yield moderate efficacy; meta-analyses report symptom reductions in 50-70% of participants post-treatment, with sustained effects at 6-12 months in randomized trials, though relapse remains common without ongoing skill application.

Social, Environmental, and Economic Contributors

Greater physical proximity to gambling venues correlates with elevated rates of problem gambling. Individuals living within 10 miles of a exhibit more than double the prevalence of pathological or problem gambling compared to those farther away (7.2% versus 3.1%). Similarly, residence near a is associated with a 90% increase in the odds of problem gambling. Studies confirm that enhanced accessibility to venues predicts higher gambling involvement and related harms, independent of individual predispositions. Legalization and expansion of opportunities further amplify incidence. States permitting more types of legal report correspondingly higher problem rates, alongside increased frequent . In the United States, the 2018 decision enabling state-level legalization precipitated surges in indicators; for instance, retail sportsbook introductions correlated with a 33% rise in help-seeking searches for in subsequent months. Recent through 2025 indicate an uptick in problematic among those with prior disorder histories, with help-seeking rates climbing from 7.5% to 13%. Online gambling's pervasive access exacerbates these patterns. The format's ease of entry and continuous availability heighten risks of disordered behavior, with 2.7% to 11.1% of online gamblers engaging in problematic activity per representative studies. Post-legalization expansions, including mobile platforms, have driven measurable increases in gambling disorder prevalence, particularly in regions like where rates reached 3.8% after broad legalization. Economic stressors, including , serve as both precursors and consequences in a bidirectional cycle. Neighborhoods with concentrated show twice the problem gambling rates of affluent areas. Lower predicts gambling severity, linking to indicators like , housing instability, and financial distress. Gambling itself, as a regressive activity disproportionately burdening lower-income participants, perpetuates ; affected individuals often experience sustained income declines and heightened financial harms. Cultural normalization through intensifies uptake, especially among youth. Sports betting , surging post-2018 legalization, correlates with elevated problem gambling scores in adolescents and young adults, even after controlling for other factors. Exposure to such ads during sports events boosts betting intentions among those aged 12-17. From 2023 to 2025, intensified campaigns across media have drawn medical concerns over enticing vulnerable youth, contributing to rising participation rates—such as 58% involvement in sports betting among 18- to 22-year-olds by 2023.

Volition, Choice, and Criticisms of the Pathology Model

Some scholars and commentators posit that problem gambling arises primarily from volitional choices and behavioral patterns rather than an inherent pathological compulsion, viewing it as an excess akin to other imprudent habits that individuals can curtail through . This perspective emphasizes agency, arguing that framing the behavior as a undermines personal responsibility and overlooks evidence of self-directed change. Empirical data on natural recovery bolster claims of substantial volitional capacity, with national surveys indicating that approximately 40% of individuals meeting criteria for pathological achieve remission over their lifetime, and 82% of remitters do so without formal treatment or mutual-aid groups. Such findings suggest that many cease or reduce through internal resolve, life changes, or situational factors, rather than requiring medical intervention, with untreated remission rates reaching up to 80% among those who recover. Critics of the model highlight these high patterns—evident in longitudinal studies showing gradual shifts to lower intensity—as inconsistent with chronic, progressive illnesses like substance dependencies, implying greater mutability and choice in the . The of problem gambling, particularly its inclusion and reclassification in the DSM—from in DSM-III (1980) to in (2013)—has drawn for potentially pathologizing normative risks, financial setbacks, or dissatisfaction without demonstrating volitional impairment. Detractors argue this expansion risks labeling habitual losers or discontented participants as disordered, expanding markets for treatments while diverting attention from environmental enablers like accessible gambling venues. Genealogical critiques contend the model's ascent reflects contingent historical and institutional dynamics rather than unequivocal empirical necessity, potentially individualizing failings and insulating broader social or commercial contributors from . Furthermore, some observers note that the "addiction" narrative may inadvertently sustain industry profitability by fostering a of inevitability that discourages of product features promoting persistence, though empirical support for direct profiteering remains debated.

Diagnosis

Assessment Tools and Challenges

The South Oaks Gambling Screen (SOGS), a 20-item self-report questionnaire developed in 1987, assesses lifetime and past-year problems by evaluating frequency of behaviors such as chasing losses and borrowing money to gamble, with scores categorizing individuals as non-problem, problem, or probable pathological gamblers. The Problem Gambling Severity Index (PGSI), part of the Canadian Problem Gambling Index introduced in 2001, uses nine items to measure gambling severity over the past 12 months on a four-category scale from non-problem to problem , emphasizing behavioral consequences like betting beyond means. The National Opinion Research Center DSM Screen for Gambling Problems (NODS), aligned with DSM-IV criteria and updated for , employs a format with 17 items covering diagnostic symptoms, diagnostic orphans, and chasing behaviors to diagnose disorder. Brief screening tools offer efficiency in clinical settings; the Lie/Bet Questionnaire, consisting of two yes/no questions—"Have you ever lied to family or others about how much you gamble?" and "Have you ever felt a need to bet more and more?"—demonstrates high sensitivity exceeding 90% and specificity around 91-99% for detecting problem gambling across diverse populations. These instruments, while validated in multiple studies, rely primarily on self-disclosure, which introduces reliability challenges in practice. Assessment faces significant hurdles from self-report underestimation due to , where individuals minimize gambling frequency or harms to avoid stigma or legal repercussions, leading to estimates 20-50% lower than collateral-verified data. Cultural variations exacerbate this, as East Asian groups often exhibit higher perceived stigma and underreporting compared to Caucasians, influenced by collectivist norms and around financial loss, necessitating culturally adapted tools or probes. Clinicians thus recommend incorporating collateral information from family or financial records to corroborate self-reports, though constraints limit this in non-mandated settings. Recent advancements include digital tools for real-time online monitoring, such as AI-driven platforms like Mindway AI's GameScanner, which analyze betting patterns, session duration, and velocity to flag at-risk behavior with predictive accuracy surpassing traditional screens, deployed by operators since 2023 and refined in 2024-2025 trials. These systems enable proactive interventions but raise data privacy concerns and require validation against clinical outcomes to ensure they do not overpathologize recreational play.

Comorbidities and Differential Diagnosis

Problem gambling exhibits high rates of comorbidity with other psychiatric conditions, with lifetime estimates for mood disorders ranging from 37.9% to 65.5% and for anxiety disorders from 37.4% to 58.7% among affected individuals. Substance use disorders co-occur in approximately 32-50% of cases, reflecting shared neurobiological vulnerabilities such as reward pathway dysregulation, though disorder lacks the physiological intoxication and withdrawal seen in substance dependencies. Personality disorders, particularly those involving like , show notable overlap, with serving as a transdiagnostic trait linking excessive risk-taking across conditions. Longitudinal studies indicate bidirectional causality between problem gambling and internalizing disorders such as depression and anxiety; for instance, adolescent gambling problems predict elevated depressive symptoms in early adulthood, while preexisting depressive symptoms prospectively increase gambling severity. This reciprocity suggests that gambling-related financial losses and can exacerbate mood disturbances, whereas underlying anxiety may drive escapist gambling behaviors, complicating causal attribution without temporal sequencing data. In , problem gambling must be distinguished from manic episodes in , where excessive spending or risk-taking may occur but lacks the persistent, gambling-specific preoccupation and tolerance escalation central to the disorder; criteria explicitly require that symptoms not be better explained by . Unlike substance use disorders, gambling involves no direct pharmacological effects, relying instead on behavioral without tolerance to intoxication or classic withdrawal syndromes, though psychological craving parallels are evident. Overlap with arises via shared impulsivity and affective instability, but gambling disorder emphasizes recurrent maladaptive patterns over broader relational or identity disturbances. Diagnostic challenges include distinguishing true from situational financial desperation, as isolated debt-driven does not meet criteria without of preoccupation, chasing losses, and impaired control persisting despite adverse consequences; overreliance on socioeconomic stressors risks pathologizing adaptive risk-taking in high-stakes environments. Comprehensive assessment tools, such as the checklist, aid in ruling out these confounds by prioritizing functional impairment duration and frequency.

Treatment Approaches

Psychological and Behavioral Interventions

Cognitive-behavioral therapy (CBT) represents the most empirically supported psychological intervention for problem gambling, focusing on restructuring cognitive distortions—such as illusions of control or near-miss interpretations—and replacing habitual gambling behaviors with adaptive alternatives like urge surfing and . In RCTs, CBT has yielded response rates where 65-82% of participants exhibit greater reductions in gambling frequency and severity compared to controls, with meta-analyses confirming large effect sizes (Hedges' g > 0.8) for symptom alleviation at post-treatment. A 2023 of 14 RCTs further indicated CBT's superiority over no-treatment controls in diminishing urges and cognitive biases, though effects on comorbidities like depression were more modest (g ≈ 0.5). Motivational interviewing (MI), a client-centered approach to resolve and build commitment to change, is frequently integrated with CBT to boost treatment initiation and adherence. RCTs demonstrate MI's efficacy in reducing gambling frequency, with one reporting sustained decreases up to 12 months post-intervention, alongside improvements in ( d = 0.4-0.6). However, standalone MI shows smaller impacts on expenditure and severity compared to combined MI-CBT protocols, where group or individual formats both achieve comparable short-term gains in problem resolution. Twelve-step fellowships, such as , provide mutual-aid peer support modeled on abstinence-oriented principles, emphasizing surrender to a and step-work to foster . While observational data link GA attendance to higher abstinence rates (e.g., 20-30% at one year among regular attendees), RCTs reveal mixed efficacy, often no better than alternative behavioral therapies or waitlist controls, with dropout rates exceeding 50% limiting generalizability. A 2023 trial comparing GA to cognitive-motivational behavior therapy found the latter superior in reducing symptoms, attributing GA's limitations to its non-professional, unstructured nature. Digital adaptations of CBT, including app-based and internet-delivered programs, target online 's accessibility by delivering modules on urge management and tracking via smartphones. A 2024 RCT of self-guided iCBT reported significant drops in severity scores (e.g., PGSI reductions of 40-50%) among non-treatment-seeking users, with high acceptability (completion rates >70%) for remote formats. Just-in-time adaptive interventions, like the 2025-evaluated Habit Hacker app, further personalize prompts to interrupt habits, showing preliminary feasibility in mixed-methods trials for craving reduction, though long-term RCTs remain needed to confirm scalability over traditional clinic-based delivery.

Pharmacological and Adjunctive Therapies

Pharmacological interventions for problem gambling, classified as gambling disorder in the , lack specific approval from regulatory bodies such as the U.S. (FDA), with treatments relying on of medications primarily targeting urges, , and comorbid conditions. Opioid antagonists, particularly , have demonstrated the strongest empirical support in randomized controlled trials (RCTs) and network meta-analyses for reducing gambling urges and behaviors, though effect sizes remain modest and relapse rates high. Naltrexone, an opioid receptor antagonist, has been tested in multiple double-blind, placebo-controlled trials, showing statistically significant reductions in gambling severity compared to placebo. In one RCT involving pathological gamblers, low-dose naltrexone (50 mg/day) led to notable decreases in urges and behaviors, with endpoint abstinence rates of 39.7% (at least one month) versus 10.5% on placebo. A meta-analysis of RCTs confirmed naltrexone's superiority over placebo in alleviating core symptoms, though overall efficacy hovers around 30-50% response rates, influenced by factors like comorbid alcohol use disorder where benefits may be amplified. Nalmefene, another opioid antagonist, ranks similarly in network meta-analyses for tolerability and efficacy, but larger trials are needed to confirm comparative advantages. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like and , show limited direct impact on gambling symptoms in meta-analyses, with no significant superiority over for core urges or behaviors. Their utility lies primarily in managing comorbidities such as depression and anxiety, which often exacerbate gambling persistence; for instance, SSRIs may improve associated mood symptoms but do not reliably reduce gambling frequency or severity in isolation. Adjunctive non-pharmacological strategies, such as mindfulness-based interventions, complement drug therapies by targeting and craving reactivity, with pilot studies indicating feasibility in reducing risk when integrated into treatment protocols. Physical exercise programs have been explored as adjuncts to enhance self-regulation and mitigate , though evidence specific to gambling disorder remains preliminary and derived from broader research. Overall meta-analytic evidence underscores pharmacological approaches' modest benefits, emphasizing the need for combined interventions given high responses and variable trial outcomes.

Support Programs and Self-Management Strategies

Self-exclusion programs permit individuals to voluntarily enroll in databases that restrict their access to venues, casinos, or apps operated by participating providers, serving as a preemptive barrier against impulsive participation. In , the BetStop National Self-Exclusion Register, launched in August 2023, enables users to bar themselves from all licensed interactive wagering services for periods ranging from 24 hours to permanently, with automatic enforcement across operators. International data reveal low overall uptake, with a pooled of self-exclusion from operators estimated at 0.26% across 11 studies. Among at-risk gamblers, self-exclusion utilization reaches approximately 11%, though programs remain underutilized relative to problem . Evaluations indicate partial effectiveness in curbing access, as self-excluders often report decreased gambling time and expenditure post-enrollment compared to non-excluders, yet breaches and circumvention occur frequently. One review found that 70% of participants gambled elsewhere during bans, with contract violations ranging from 11% to 55%, highlighting limitations in enforcement and scope. Qualitative accounts from users describe as helpful for some in fostering temporary and reflection, though sustained impact depends on complementary measures. Community-based support programs, including hotlines and peer-led groups, provide accessible entry points for voluntary assistance without mandating clinical intervention. Australia's Gambling Help Online service delivers 24/7 anonymous counseling via web chat, phone, and forums, connecting users to localized resources for immediate crisis support. Financial counseling programs, often subsidized through government and nonprofit channels, assist with , creditor negotiations, and expenditure tracking tailored to gambling-induced financial distress, as evidenced by case studies from Australian financial counseling agencies. Self-management strategies emphasize personal tools for behavioral regulation, such as establishing strict budgets, pre-setting monetary and time limits before gambling sessions, and designating accountability partners to oversee adherence, which may include temporarily entrusting bank cards and salary to a trusted relative or adopting a temporary limited allowance system to limit access to funds and reduce relapse risk; individuals are encouraged to seek support from organizations like Gamblers Anonymous if these measures prove insufficient. Problem gamblers commonly employ time-restriction tactics alongside financial controls, with surveys indicating these self-directed methods are used more intensively by those experiencing issues than recreational gamblers. Coping-oriented approaches, including self-directed workbooks for goal-setting and prevention, constitute another prevalent strategy, adopted by over a third of individuals in reviewed studies seeking informal . These voluntary practices underscore individual agency in harm mitigation, distinct from formalized treatment pathways.

Evidence of Effectiveness and Recovery Rates

Empirical studies indicate that natural remission occurs in approximately 30-50% of cases of problem gambling over periods of 1-7 years, often without formal intervention. For instance, a longitudinal of pathological gamblers found a 40% recovery rate, with 82% of remitters achieving this through self-resolution rather than treatment. Similarly, population-based surveys report that around 80% of individuals who remit do so without professional help, attributing success to factors such as life changes, financial constraints, or personal resolve rather than therapeutic input. Treatment interventions, including cognitive-behavioral therapy, demonstrate incremental efficacy, with meta-analyses showing 20-30% additional reductions in gambling severity compared to control conditions on an intent-to-treat basis. However, absolute outcomes remain modest, as only about 43% of participants in trials achieve substantial symptom reduction, versus 8% in waitlist groups, underscoring limits in and sustained impact. Relapse rates post-treatment are high, ranging from 40-60% within the first year, with some estimates reaching 90% over longer follow-ups, frequently linked to environmental cues and unresolved comorbidities rather than intervention failure per se. Treatment-seeking remains rare, affecting only about 10% of individuals with problem gambling, due to stigma, , and perceived self-sufficiency in resolution. Success in both treated and untreated cases correlates more strongly with intrinsic and volitional factors than with specific modalities, as evidenced by higher remission among self-changers who leverage personal over external supports. Recent pilots of online therapies from 2023-2024, such as self-guided internet-based cognitive-behavioral programs, report promising short-term reductions in symptoms, with effects maintained at follow-up in randomized trials. Nonetheless, challenges in adherence and broad scalability persist, as dropout rates exceed 50% in unassisted formats, limiting population-level benefits without enhanced motivation strategies.

Impacts

Individual and Familial Consequences

Problem gamblers often accumulate significant debts, with studies documenting average unsecured debts exceeding $50,000 among those seeking treatment for pathological gambling. This financial strain frequently culminates in bankruptcy, as evidenced by county-level analyses linking casino expansions to elevated bankruptcy filings, particularly in areas with increased gambling access. Additionally, problem gambling correlates with heightened criminality, including fraud and theft to finance losses; approximately half of individuals with gambling problems engage in such crimes, compared to far lower rates in the general population. Familial relationships suffer markedly, with pathological gambling associated with marital discord, separation, and rates substantially higher than in non-gambling households. Spouses and partners report elevated instances of linked to the gambler's financial desperation and emotional volatility. Children in these families face increased risks of and abuse, with research identifying elevated rates of physical and emotional maltreatment in 10-20% of affected households based on self-reported and clinical data. These consequences scale with gambling intensity: severe problem gamblers experience disproportionate harms, while low-risk or recreational participants exhibit minimal to no such financial, criminal, or relational disruptions, underscoring that harms arise from excessive engagement rather than gambling per se.

Broader Health and Mental Health Effects

Problem gambling is associated with elevated rates of comorbid mental health disorders, particularly , with meta-analyses indicating odds ratios ranging from 2.5 to 4.0 for depression among individuals with gambling problems compared to the general population. Anxiety disorders and other mood disturbances also show strong bidirectional links, where gambling severity exacerbates depressive symptoms and vice versa, independent of shared risk factors like . Suicidality represents a severe outcome, with systematic reviews reporting lifetime prevalence of approximately 32% and suicide attempts around 13% among those with problems, compared to 4-5% and 1-2% in the general population, yielding relative risks of 10- to 15-fold for deaths in some cohorts. These elevations persist after adjusting for comorbidities, underscoring disorder as an independent risk factor. Physical health consequences arise primarily from chronic stress and disrupted sleep, including affecting up to 50% of problem gamblers, tension headaches, peptic ulcers, and due to autonomic hyperarousal and neglect of . Indirect effects stem from high with substance use disorders, such as alcohol use disorder ( 20-40% in gambling disorder samples), which amplifies risks for , cardiovascular issues, and accidents. In chronic cases, all-cause mortality is elevated by 1.5- to 2-fold, driven largely by and substance-related deaths, with Swedish registry data showing a 1.8-fold increase overall and 15-fold for suicides among diagnosed individuals followed longitudinally. These patterns highlight the need for integrated health monitoring beyond behavioral interventions.

Economic Costs, Benefits, and Societal Trade-offs

Problem gambling imposes significant economic costs on society, estimated at $7 to $14 billion annually , encompassing expenditures on , healthcare, and lost due to and reduced workplace efficiency among affected individuals. These figures derive from analyses by organizations tracking gambling-related harms, which attribute roughly $5 billion yearly to direct crime-related costs, including and linked to pathological gambling, alongside broader losses from and job turnover estimated at over $1,300 per affected gambler per month in some employer studies. Such costs disproportionately burden lower (SES) groups, where problem gambling prevalence rises inversely with income and education levels, amplifying regressive impacts through heightened financial distress and reliance on public services. In contrast, the broader industry generates substantial economic benefits, contributing $329 billion in total U.S. economic output in 2022 through commercial and tribal gaming operations, supporting 1.8 million jobs in sectors like and retail. revenues from gambling reached $52.7 billion in 2023 across federal, state, and local levels, funding public services including and , while developments boost and ancillary spending in host communities. legalization, expanded in over 30 states since 2018, added $1.8 billion in state for fiscal year 2023 alone, illustrating revenue windfalls from increased participation. Societal trade-offs arise in balancing these dynamics, with post-legalization studies indicating net economic gains from industry expansion—such as heightened state revenues and —despite correlated upticks in problem gambling rates, provided harms are mitigated through targeted interventions. However, empirical evidence highlights that legalization amplifies irresponsible spending particularly among low-income households, potentially offsetting benefits if unaddressed social costs escalate, as seen in analyses linking expanded access to elevated and burdens without proportional containment of externalities. Overall, while industry contributions yield fiscal positives in contained scenarios, the regressive concentration of harms underscores challenges in achieving Pareto improvements across socioeconomic strata.

Controversies and Debates

Overpathologization and Diagnostic Inflation

Critics of the diagnostic framework for disorder contend that evolving criteria have contributed to overpathologization by encompassing a wider array of behaviors, potentially diluting attention and resources away from individuals with severe, persistent impairments. The Problem Gambling Severity Index (PGSI), a common screening tool for population-level assessment, categorizes individuals scoring 3-7 as experiencing "moderate risk" problems, which may include transient or low-severity patterns rather than entrenched disorders; qualitative analyses reveal ambiguities in item interpretations that lead to misclassifications, prompting recommendations to raise the threshold to 5+ for identifying true problem . Similarly, the lowered the diagnostic threshold for disorder from five to four criteria met within a 12-month period compared to DSM-IV pathological , resulting in higher estimates—such as a 19.2% increase in one sample—without commensurate evidence of improved clinical utility. This expansion traces back to the initial inclusion of pathological gambling in DSM-III in 1980 as an , with subsequent reclassifications and refinements through the shifting it to an addictive disorder under substance-related categories, broadening applicability to non-substance behaviors and raising concerns of diagnostic inflation akin to patterns observed in where lowered thresholds inflate caseloads without clarifying causal distinctions. Such inflation risks fostering over normative risk-taking, as evidenced by warnings against pathologizing everyday life activities under umbrellas, potentially stigmatizing occasional gamblers while overburdening treatment systems with cases that self-resolve or lack significant harm. Peer-reviewed commentaries highlight that empirical validation for these extensions often prioritizes neurobiological analogies over longitudinal outcome data, echoing broader psychiatric critiques where institutional incentives in academia and treatment sectors amplify claims. Prevalence surveys using tools like the PGSI frequently report elevated "at-risk" rates—up to 8.7% for any risk among adults—but longitudinal tracking indicates many such cases do not to severe disorder, suggesting overemphasis on early detection may divert focus from high-need subgroups. Industry-funded helplines and programs, while promoted for , often rely on these broad screens to quantify , potentially incentivizing inflated reporting to demonstrate corporate responsibility amid regulatory scrutiny, though direct causal of deliberate exaggeration remains limited. Overall, these dynamics underscore the need for criteria grounded in verifiable impairment thresholds rather than expansive models that risk medicalizing volitional behaviors.

Regulatory and Industry Influences

The rapid expansion of legalized , particularly , has coincided with elevated rates of problem gambling in affected jurisdictions. Following the 2018 U.S. decision overturning the federal ban on sports wagering, 38 states plus Washington, D.C., had implemented legal by mid-2025, enabling widespread online and retail access. Studies indicate this legalization has driven measurable increases in gambling-related harms, including a 33% surge in help-seeking behaviors for in the initial rollout phases of retail sportsbooks, and upticks in disordered gambling prevalence in states like post-2022 online legalization. Regulatory frameworks have often failed to curb aggressive marketing, with lax oversight allowing pervasive that appeals to vulnerable demographics, including , through ubiquitous promotions during broadcasts and . The industry's self-regulatory efforts have proven inadequate in mitigating these risks, prioritizing revenue growth over amid a global market projected to generate $449.67 billion in 2025. Independent analyses highlight failures in voluntary codes, such as persistent breaches in restrictions during high-profile events, where self-policing yields low compliance and enables unchecked volume-driven strategies. From 2023 to 2025, advocacy groups and researchers intensified calls for statutory ad limitations, citing insufficient deterrence against tactics that normalize and target at-risk groups, though industry has sustained permissive environments to maximize participation. While outright bans aim to restrict access, suggests they can exacerbate harms by shifting activity to unregulated black markets lacking consumer protections, as observed in jurisdictions like where advertising prohibitions correlate with a 23% illegal and heightened vulnerability to exploitation. Regulated , when paired with robust enforcement, may better channel demand into monitored channels, though current U.S. policies demonstrate how profit incentives often undermine such safeguards, perpetuating policy shortfalls.

Perspectives on Personal Responsibility vs. Systemic Harms

Proponents of emphasizing personal responsibility in problem gambling view it as a volitional akin to excessive spending or risk-taking in other domains, where individuals retain agency over their actions despite potential for . Surveys of gamblers indicate that the majority attribute responsibility for minimizing primarily to the individual rather than external entities like governments or operators. This perspective holds that recovery hinges on self-discipline and cessation of gambling, without necessitating victimhood narratives or mandatory interventions, as evidenced by high rates of natural remission where individuals quit independently. Empirical data underscore this agency, with studies showing that over 80% of recoveries from pathological gambling occur without formal treatment, often through personal resolve to abstain or reduce play. A substantial portion of those with a history of the disorder eventually remit spontaneously, suggesting that internal factors like motivation and self-control play decisive roles over purely deterministic models of compulsion. Critics of disease-oriented framings argue that such views may inflate perceived helplessness, paralleling debates in other behavioral domains where choice and accountability correlate with better outcomes. In contrast, systemic perspectives frame problem gambling predominantly as a consequence of environmental and structural factors, such as widespread of gambling venues and products, socioeconomic deprivation, and aggressive , which disproportionately affect vulnerable populations. Public health models advocate treating it as a societal issue requiring regulatory curbs, policies, and population-level interventions to mitigate these externalities, often downplaying individual volition in favor of causal chains rooted in inequality and industry practices. These approaches, common in academic and policy literature, posit that personal failings are symptoms of broader systemic harms, though they frequently originate from institutions with documented ideological biases toward collectivist explanations. The debate pits these views against each other, with responsibility advocates citing self-recovery statistics to argue against over-reliance on structural , which may excuse and prolong engagement. While systemic analyses highlight correlations with , causal remains contested, as quitting rates independent of environmental changes affirm that individual agency often overrides purported structural inevitability. This tension reflects broader philosophical divides on , where empirical patterns of unaided resolution favor models prioritizing over expansive .

References

  1. https://www.apa.org/monitor/2023/07/how-gambling-affects-the-brain
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC9994414/
  3. https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t39/
  4. https://www.ncbi.nlm.nih.gov/books/NBK230632/
  5. https://www.ncbi.nlm.nih.gov/books/NBK230625/
  6. https://psychiatryonline.org/doi/10.1176/appi.books.9781615373987.lg01
  7. https://www.yalemedicine.org/conditions/gambling-disorder
  8. https://today.ucsd.edu/story/study-reveals-surge-in-gambling-addiction-following-legalization-of-sports-betting
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC3004711/
  10. https://www.who.int/news-room/fact-sheets/detail/gambling
  11. https://pmc.ncbi.nlm.nih.gov/articles/PMC7612512/
  12. https://www.psychiatry.org/patients-families/gambling-disorder/what-is-gambling-disorder
  13. https://www.tandfonline.com/doi/abs/10.3109/16066359.2012.731116
  14. https://www.umass.edu/seigma/media/469/download
  15. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5988-2
  16. https://pmc.ncbi.nlm.nih.gov/articles/PMC9653360/
  17. https://pmc.ncbi.nlm.nih.gov/articles/PMC5370365/
  18. https://www.sciencedirect.com/science/article/pii/S2468266724001269
  19. https://www.psychologytoday.com/us/blog/in-excess/202003/problem-gambling-vs-gambling-addiction
  20. https://govinfo.library.unt.edu/ngisc/reports/4.pdf
  21. https://basisonline.org/2020/02/25/understanding-the-pathways-model-of-problem-gambling/
  22. https://www.theworldofchinese.com/2023/05/dice-dominoes-and-deadly-games-of-chance-gambling-in-ancient-china/
  23. https://theconversation.com/millions-of-americans-are-problem-gamblers-so-why-do-so-few-people-ever-seek-treatment-197861
  24. https://www.health.harvard.edu/blog/when-gambling-might-be-a-problem-2018020113202
  25. https://newenglandhistoricalsociety.com/puritans-ban-gambling-and-whole-lot-things/
  26. https://www.gty.org/sermons/90-164/gambling-the-seductive-fantasy-part-1
  27. https://www.victorianweb.org/history/leisure/gambling1.html
  28. https://www.ncbi.nlm.nih.gov/books/NBK216414/
  29. https://www.ncbi.nlm.nih.gov/books/NBK230618/
  30. https://jssw.thebrpi.org/journals/jssw/Vol_3_No_1_June_2015/1.pdf
  31. https://pmc.ncbi.nlm.nih.gov/articles/PMC3722301/
  32. https://pmc.ncbi.nlm.nih.gov/articles/PMC3549319/
  33. https://pmc.ncbi.nlm.nih.gov/articles/PMC4753073/
  34. https://link.springer.com/article/10.1007/s12144-022-03915-0
  35. https://www.who.int/docs/default-source/substance-use/the-epidemiology-and-impact-of-gambling-disorder-and-other-gambling-relate-harm.pdf
  36. https://pmc.ncbi.nlm.nih.gov/articles/PMC8518930/
  37. https://www.addictionjournal.org/posts/over-10-million-adults-have-sought-help-for-problem-gambling
  38. https://pmc.ncbi.nlm.nih.gov/articles/PMC8997231/
  39. https://www.ncpgambling.org/training/ngage-survey/
  40. https://www.ncpgambling.org/news/national-council-on-problem-gambling-survey-shows-drop-in-problem-gambling-risk-highlights-ongoing-challenges/
  41. https://www.researchgate.net/publication/304192325_Understanding_the_Effects_of_Social_Desirability_on_Gambling_Self-Reports
  42. https://pmc.ncbi.nlm.nih.gov/articles/PMC9440767/
  43. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.00235/full
  44. https://www.researchgate.net/publication/5482315_The_Impact_of_Social_Desirability_Biases_on_Self-Report_Among_College_Student_and_Problem_Gamblers
  45. https://pubmed.ncbi.nlm.nih.gov/39269778/
  46. https://www.sciencedirect.com/science/article/abs/pii/S030646031500012X
  47. https://pausebeforeyouplay.org/2024/11/why-10-of-college-students-have-a-gambling-disorder/
  48. https://nyproblemgambling.org/resource-lib-item/college-young-adult-research-data-summary/
  49. https://www.ncaa.org/news/2023/5/24/media-center-ncaa-releases-sports-wagering-survey-data.aspx
  50. https://ncaaorg.s3.amazonaws.com/research/wagering/2025RES_WageringExecutiveSummary.pdf
  51. https://pmc.ncbi.nlm.nih.gov/articles/PMC10498297/
  52. https://www.greo.ca/en/topics/socioeconomic-status.aspx
  53. https://www.buffalo.edu/news/releases/2014/01/001.html
  54. https://responsiblegambling.org/for-the-public/safer-play/whos-at-risk/
  55. https://sites.wustl.edu/budercenter/native-americans-face-greater-risk-of-becoming-problem-gamblers/
  56. https://www150.statcan.gc.ca/n1/pub/75-006-x/2022001/article/00006-eng.htm
  57. https://www.greo.ca/Modules/EvidenceCentre/files/Kowatch%2520%282017%29%2520Gambling%2520in%2520Indigenous%2520Populations%2520in%2520Canada.pdf
  58. https://pmc.ncbi.nlm.nih.gov/articles/PMC11980244/
  59. http://www.biblioteca.cij.gob.mx/Archivos/Materiales_de_consulta/Drogas_de_Abuso/Articulos/57856716.pdf
  60. https://pubmed.ncbi.nlm.nih.gov/21210880/
  61. https://www.mdproblemgambling.com/wp-content/uploads/2025/09/2024-MD-Gambling-Report.pdf
  62. https://www.medschool.umaryland.edu/news/2025/new-survey-shows-rising-rates-of-disordered-gambling-among-marylanders-since-legalization-of-online-sports-betting-.html
  63. https://bircheshealth.com/resources/problem-gambling-stats-massachusetts
  64. https://massgaming.com/wp-content/uploads/OPS23-Report_2024-07-05_clean.pdf
  65. https://www.umass.edu/public-health-sciences/news/rates-sports-betting-problem-gambling-increased
  66. https://phys.org/news/2025-07-sports-boom-surge-tax-revenue.html
  67. https://www.ncaa.org/news/2025/1/14/media-center-ncaa-study-education-shows-promise-in-changing-sports-betting-behaviors-harassment-from-bettors-prevalent-in-di.aspx
  68. https://today.uconn.edu/2025/08/pulling-the-plug-on-problem-gambling/
  69. https://www.researchgate.net/publication/391235707_The_Impact_of_Ease_of_Digital_Access_on_the_Increase_in_Online_Gambling_Cases_Among_Students
  70. https://pmc.ncbi.nlm.nih.gov/articles/PMC5723410/
  71. https://www.cambridge.org/core/journals/psychological-medicine/article/genetic-and-environmental-influences-on-gambling-disorder-liability-a-replication-and-combined-analysis-of-two-twin-studies/57CBD2085F9F938889DA330280640687
  72. https://link.springer.com/article/10.1023/A:1013652328999
  73. https://pmc.ncbi.nlm.nih.gov/articles/PMC3858640/
  74. https://www.sciencedirect.com/science/article/abs/pii/S0166432814005762
  75. https://pmc.ncbi.nlm.nih.gov/articles/PMC2222549/
  76. https://adntro.com/en/blog/genetic-predispositions/addiction-gambling-genetics/
  77. https://pmc.ncbi.nlm.nih.gov/articles/PMC9292938/
  78. https://pmc.ncbi.nlm.nih.gov/articles/PMC10867214/
  79. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2013.00072/full
  80. https://pmc.ncbi.nlm.nih.gov/articles/PMC3055672/
  81. https://pmc.ncbi.nlm.nih.gov/articles/PMC4096325/
  82. https://pmc.ncbi.nlm.nih.gov/articles/PMC3986897/
  83. https://news.yale.edu/2015/02/11/gambling-and-obsessive-compulsive-behaviors-linked
  84. https://www.nature.com/articles/s41598-019-57117-z
  85. https://pmc.ncbi.nlm.nih.gov/articles/PMC7731405/
  86. https://pubmed.ncbi.nlm.nih.gov/12856479/
  87. https://www.ncbi.nlm.nih.gov/books/NBK77345/
  88. https://link.springer.com/article/10.1007/s40429-022-00428-5
  89. https://stoppredatorygambling.org/site/wp-content/uploads/2012/12/Casino-Proximity-Study.pdf
  90. https://www.buffalo.edu/news/releases/2005/06/7369.html
  91. https://responsiblegambling.vic.gov.au/documents/969/VRGF_RR-JUNE2021_Proximity_to_gambling_venues_gambling_behaviours_and_related__avlwmAe.pdf
  92. https://pmc.ncbi.nlm.nih.gov/articles/PMC4671822/
  93. https://www.newsfromthestates.com/article/new-study-finds-uptick-problematic-gambling-legalization-online-sports-betting
  94. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2824%2900126-9/fulltext
  95. https://www.sciencedirect.com/science/article/pii/S2667193X24001820
  96. https://nyproblemgambling.org/resource-lib-item/socioeconomics-research-data-summary/
  97. https://www.greo.ca/Modules/EvidenceCentre/files/Hahmann_and_Matheson_%282017%29_Problem_gambling_and_poverty.pdf
  98. https://pmc.ncbi.nlm.nih.gov/articles/PMC11557612/
  99. https://onlinelibrary.wiley.com/doi/10.1111/add.16761
  100. https://www.cbc.ca/news/health/youth-sports-betting-advertisements-enticing-doctors-1.7627752
  101. https://www.psychologytoday.com/us/blog/addiction-outlook/202503/march-2025-sports-gambling-madness
  102. https://pmc.ncbi.nlm.nih.gov/articles/PMC4458066/
  103. https://www.ncbi.nlm.nih.gov/books/NBK230629/
  104. https://econtent.hogrefe.com/doi/10.1024/0939-5911/a000561
  105. https://link.springer.com/article/10.1007/s10899-023-10195-1
  106. https://www.criticalgamblingstudies.com/index.php/cgs/article/download/72/44
  107. https://pmc.ncbi.nlm.nih.gov/articles/PMC3223781/
  108. https://digitalcommons.osgoode.yorku.ca/cgi/viewcontent.cgi?article=3565&context=ohlj
  109. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7391-z
  110. https://oasas.ny.gov/system/files/documents/2024/01/approved-gambling-screening-and-assessment-tools.pdf
  111. https://www.naadac.org/assets/2416/2019NWRC_John_Bundrick_Handout2.pdf
  112. https://www.sciencedirect.com/science/article/pii/S027273581930296X
  113. https://www.researchgate.net/publication/49726596_Cultural_Influences_on_Stigmatization_of_Problem_Gambling_East_Asian_and_Caucasian_Canadians
  114. https://pmc.ncbi.nlm.nih.gov/articles/PMC2651150/
  115. https://mindway.ai/
  116. https://www.reuters.com/press-releases/responsible-gambling-ai-tools-2025-10-07/
  117. https://responsiblegambling.org/wp-content/uploads/Stark-2022-Gambling-digital-tools-across-the-player-spectrum-Promising-practices-and-future-opportunities.pdf
  118. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2010.03300.x
  119. https://journals.sagepub.com/doi/10.1177/14550725251380172
  120. https://pmc.ncbi.nlm.nih.gov/articles/PMC4803266/
  121. https://pmc.ncbi.nlm.nih.gov/articles/PMC6912817/
  122. https://pmc.ncbi.nlm.nih.gov/articles/PMC4784242/
  123. https://www.gatewayfoundation.org/blog/dsm-5-gambling/
  124. https://www.sciencedirect.com/science/article/abs/pii/S0272735823000946
  125. https://onlinelibrary.wiley.com/doi/abs/10.1111/add.16221
  126. https://pubmed.ncbi.nlm.nih.gov/37381589/
  127. https://pubmed.ncbi.nlm.nih.gov/25577724/
  128. https://www.researchgate.net/publication/41426474_Effectiveness_of_Group_and_Individual_Formats_of_a_Combined_Motivational_Interviewing_and_Cognitive_Behavioral_Treatment_Program_for_Problem_Gambling_A_Randomized_Controlled_Trial
  129. https://www.greo.ca/Modules/EvidenceCentre/Details/a-comparison-of-cognitive-motivational-behaviour-therapy-and-gamblers-anonymous-f
  130. https://link.springer.com/article/10.1007/s10899-023-10224-z
  131. https://pmc.ncbi.nlm.nih.gov/articles/PMC11447416/
  132. https://pmc.ncbi.nlm.nih.gov/articles/PMC12139257/
  133. https://www.psychiatry.org/patients-families/gambling-disorder/expert-q-and-a
  134. https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.PP4a1
  135. https://www.sciencedirect.com/science/article/pii/S0010440X24001172
  136. https://pubmed.ncbi.nlm.nih.gov/39675219/
  137. https://pubmed.ncbi.nlm.nih.gov/18384246/
  138. https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2012.04457.x
  139. https://www.ikonrecoverycenters.org/naltrexone-in-behavioral-addiction-treatment/
  140. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008936.pub2/full
  141. https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-017-0146-2
  142. https://ajgiph.springeropen.com/articles/10.1186/2195-3007-4-2
  143. https://pmc.ncbi.nlm.nih.gov/articles/PMC5884944/
  144. https://www.cambridge.org/core/journals/acta-neuropsychiatrica/article/placebo-and-nocebo-effects-in-gambling-disorder-pharmacological-trials-a-metaanalysis/F93531063943E243FFDBB1882B8154D1
  145. https://link.springer.com/article/10.1007/s10899-018-09815-y
  146. https://www.dss.gov.au/gambling/gambling-support-services
  147. https://link.springer.com/article/10.1007/s40429-023-00510-6
  148. https://pmc.ncbi.nlm.nih.gov/articles/PMC6376385/
  149. https://www.mdpi.com/1660-4601/21/8/998
  150. https://pmc.ncbi.nlm.nih.gov/articles/PMC4016676/
  151. http://www.gamblinghelponline.org.au/
  152. https://www.financialcounsellingaustralia.org.au/fca-content/uploads/2019/10/Problem-Gambling-Financial-Counselling-Survey-and-Case-Studies.pdf
  153. https://www.addictioncenter.com/behavioral-addictions/gambling-addiction/debt/
  154. https://pmc.ncbi.nlm.nih.gov/articles/PMC6489359/
  155. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6755-8
  156. https://pmc.ncbi.nlm.nih.gov/articles/PMC2975751/
  157. https://www.nature.com/articles/s41598-021-92242-8
  158. https://pmc.ncbi.nlm.nih.gov/articles/PMC5714688/
  159. https://pmc.ncbi.nlm.nih.gov/articles/PMC2443228/
  160. https://pmc.ncbi.nlm.nih.gov/articles/PMC9796401/
  161. https://psychiatryonline.org/doi/full/10.1176/appi.ajp.163.2.297
  162. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820236
  163. https://www.ncbi.nlm.nih.gov/books/NBK230628/
  164. https://www.sciencedirect.com/science/article/abs/pii/S1053535707000364
  165. https://www.researchgate.net/publication/356422012_Problem_Gambling_Crime_and_their_Costs
  166. https://pubmed.ncbi.nlm.nih.gov/17667890/
  167. https://www.sciencedirect.com/science/article/abs/pii/S0022395609001733
  168. https://cdspress.ca/wp-content/uploads/2022/09/Tomonari-Irie-Yokomitsu-Kengo.pdf
  169. https://pmc.ncbi.nlm.nih.gov/articles/PMC6174604/
  170. https://www.tandfonline.com/doi/full/10.1080/16066359.2023.2238608
  171. https://psycnet.apa.org/record/2020-82623-008
  172. https://pubmed.ncbi.nlm.nih.gov/38095933/
  173. https://pmc.ncbi.nlm.nih.gov/articles/PMC9645554/
  174. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762%2824%2900295-3/fulltext
  175. https://800gambler.org/how-does-problem-gambling-affect-physical-health/
  176. https://www.uclahealth.org/news/article/gambling-addiction-can-cause-psychological-physiological-health-challenges
  177. https://pmc.ncbi.nlm.nih.gov/articles/PMC6953879/
  178. https://pubmed.ncbi.nlm.nih.gov/31881248/
  179. https://pmc.ncbi.nlm.nih.gov/articles/PMC6376387/
  180. https://link.springer.com/article/10.1007/s10899-025-10415-w
  181. https://www.ncpgambling.org/help-treatment/faqs-what-is-problem-gambling/
  182. https://bircheshealth.com/resources/what-will-be-the-social-costs-of-increased-gambling-who-will-pay-them
  183. https://dbhdd.georgia.gov/sites/dbhdd.georgia.gov/files/imported/DBHDD/AD/Gambling/economic_09_11.pdf
  184. https://gamblinghelp.org/wp-content/uploads/2023/05/Think_Tank_on_Gambling_and_Crime.pdf
  185. https://www.americangaming.org/wp-content/uploads/2023/10/2023-Gaming-Industry-Economic-Report.pdf
  186. https://www.dcreport.org/2024/06/14/americas-economic-growth-opportunity-through-the-casino-industry/
  187. https://taxfoundation.org/research/all/state/sports-betting-tax-revenue/
  188. https://www.census.gov/library/stories/2024/02/legal-sports-betting.html
  189. https://www.americangaming.org/wp-content/uploads/2018/12/AGA-Oxford-Sports-Betting-Economic-Impact-Report1-1.pdf
  190. https://today.ucsd.edu/story/legalized-gambling-increases-irresponsible-betting-behavior-especially-among-low-income-populations
  191. https://www.anderson.ucla.edu/sites/default/files/document/2025-05/Hollenbeck_The_Financial_Consequences_of_Legalized_Sports_Gambling.pdf
  192. https://pmc.ncbi.nlm.nih.gov/articles/PMC7434121/
  193. https://pmc.ncbi.nlm.nih.gov/articles/PMC4019046/
  194. https://akjournals.com/view/journals/2006/11/2/article-p191.xml
  195. https://pmc.ncbi.nlm.nih.gov/articles/PMC4627665/
  196. https://serval.unil.ch/resource/serval:BIB_28DB082AFB8F.P001/REF.pdf
  197. https://naadgs.org/wp-content/uploads/2022/06/NAADGS_2021_Survey_of_Publicly_Funded_Problem_Gambling_Services_in_the_United_States_v2.pdf
  198. https://www.legalsportsreport.com/sports-betting-states/
  199. https://marylandmatters.org/2025/10/23/new-study-finds-uptick-in-problematic-gambling-since-legalization-of-online-sports-betting/
  200. https://thevarsity.ca/2025/03/24/opinion-gambling-companies-are-targeting-the-youth-and-dealing-us-a-losing-hand/
  201. https://kindbridge.com/gambling/sports-betting-advertising-regulation-not-enough-to-protect-youth/
  202. https://www.statista.com/outlook/amo/gambling/worldwide
  203. https://igamingbusiness.com/marketing-affiliates/marketing/premier-league-gambling/
  204. https://www.bristol.ac.uk/media-library/sites/business-school/documents/Premier_League_Report_2024.pdf
  205. https://www.theregreview.org/2025/09/06/seminar-how-should-regulators-address-sports-betting-advertisements/
  206. https://www.casino.org/news/sports-betting-advertising-should-be-banned-says-national-consumers-league/
  207. https://bettingandgamingcouncil.com/news/new-research-reveals
  208. https://www.sciencedirect.com/science/article/pii/S2949791424000204
  209. https://pmc.ncbi.nlm.nih.gov/articles/PMC9004097/
  210. https://www.sciencedirect.com/science/article/abs/pii/S0306460320307905
  211. https://academic.oup.com/eurpub/article/31/6/1217/6375595
  212. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-019-0342-2
  213. https://academic.oup.com/eurpub/article/31/6/1217/6375595/
Add your contribution
Related Hubs
Contribute something
User Avatar
No comments yet.