“Addiction is a brain disease – and it matters. Understanding that addiction is, at its core, A consequence of fundamental changes in brain function means that a major goal of treatment must be either to reverse or compensate for those brain changes.” ~ Dr. Alan Leshner, former head of the National Institute on Drug Abuse For most people, gambling is a harmless diversion – sometimes you win, sometimes you lose, but it’s all in good fun. 80% of Americans have gambled at least once in their life, and 48 out of the 50 states have some form of legalized gambling. But when does such a form of legal amusement turn into a problem? Is it possible to become ADDICTED to gambling? Can gambling REALLY become an illness? According to the American Psychiatric Association, the answer is “YES”. In their 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), pathological gambling was, for the first time, identified as an impulse-control disorder. This means that the symptoms are very much like those of a substance abuse disorder – alcoholism or drug abuse.
The Symptoms of a Gambling Disorder
The chief characteristic of a gambling disorder is an inability to the time or money spent on gambling, which in turn, results in negative consequences for the gambler, their family, or society as a whole. According to the DSM-V, there is a list of symptoms that may be exhibited by a person with a gambling disorder that could confirm such a diagnosis:
- Needing to gamble with increasing amounts of money in order to achieve the desired level of excitement
- Restlessness/irritability when attempting to stop or cut down gambling
- Multiple, unsuccessful attempts to cut back, control, or stop gambling
- Preoccupied/obsessed with gambling – planning how to get more money to gamble, poring over handicapping reports, continually talking about the “next” event, etc.
- Gambles in response to negative feelings such as anxiety, depression, loneliness, etc.
- “Chases” losses – continually tries to break even by gambling again immediately
- Lies about gambling – when, on what, the amount of money lost, etc.
- Has lost or put in jeopardy an important relationship because of gambling – marriage, significant other, job, career opportunity, etc.
- Has major money problems because of gambling losses – desperate financial situation, borrowing from others, etc.
The DSM-V says that an individual who exhibits at least four of the symptoms within a 12-month span meets the criteria for a diagnosis of a gambling disorder.
How Gambling and Substance Abuse Disorders Are Alike
Within every person’s brain, there are neural pathways known as the reward system, involving movement, memory, motivation, and pleasure. When we engage in activities necessary for survival – eating or sex, for example – the reward system produces a neurotransmitter called dopamine, which gives us pleasurable feelings and sensations in order to reinforce the behavior we just engaged in. That is why drugs are so addictive – some substances stimulate the reward system into dispensing 10 times the regular amount of dopamine – or even more. Over time, the brain’s reward systems become disrupted because of the addicted behavior, and four things happen as a result:
- The brain starts producing less and less dopamine naturally, and only does so in response to the stimulus.
- More and more of the drug, alcohol, or activity are required to achieve the same effect.
- The addicted person loses the ability to feel pleasure – or even normal – when they are NOT engaged in the activity.
- When they are not engaged in the activity, they experience withdrawal – unpleasant physical and mental distress, such as anxiety, insomnia, confusion, physical pain, etc.
In other words, just as a heroin junkie needs continually-larger hits to get high, pathological gamblers needs to engage in bitter, riskier bets to get the same thrill. And when a gambler is denied a chance to bet, they go through withdrawal. Substance abuse and gambling disorders are like in other ways, as well:
- Research has shown that drug addicts, alcoholics, and pathological gamblers alike shares a genetic predisposition for poor impulse control and a need to seek rewards. Their reward system is underactive, which is one of the reasons why they seek outside stimulation in the first place.
- Neuroscientists have even conducted tests measuring the electrical activity in people’s brains that suggest that drug use and gambling both affect the same brain pathways. Both drug addicts and pathological gamblers exhibit unusually-low electrical activity within their prefrontal cortex – the area of the brain responsible for risk assessment and impulse control.
Interestingly, the study of gambling as a disorder has helped redefine the concept of addiction. Whereas the theory once was that people become addicted to substances (drugs or alcohol), addiction is now defined as obsessively engaging in a behavior despite negative consequences. Timothy Fong, and addiction expert and psychiatrist at the University of California Los Angeles, says “The past idea was that you need to ingest a drug that changes neurochemistry in the brain to get addicted, but we now know that just about anything we do alters the brain. It makes sense that some highly-rewarding behaviors, like gambling can cause dramatic (physical) changes, too.”
Getting Help for a Gambling Disorder
Even though gambling disorder is now recognized as a real condition, 80% of pathological gamblers never seek treatment, and out of those who do, 75% return to gambling. It is tragically ironic that people with gambling disorders are a victim of the worst odds. Gambling addicts, like substance abusers can benefit from professional help – individual psychotherapy, peer group counseling, behavioral modification, and 12-Step fellowship support. Medication-Assisted Therapy (MAT) may have particular benefits for people with gambling disorders, specifically the same medications that are used for substance abusers. Although antidepressants are commonly used for other impulse-control disorders, they are not particularly effective for problem gamblers. Naltrexone, an opioid agonist, on the other hand, has shown the ability to reduce cravings in pathological gamblers. It is possible for even the worst pathological gambler to restore manageability and sanity to their life. The important thing is not to ignore the science – pathological gambling is not a moral weakness or failure, it is not a bad habit, it is not even a compulsion – it is a disorder of the brain, and the only way to truly treat it is with timely and effective professional help.