Gambling addiction can be split into two categories: problem gambling and pathological gambling. 1% of the United States population are pathological gamblers while an additional 2-3% are problem gamblers. Though the percentages may seem small, when you take the 318.9 million people in America, 1-4% of the population is between 3 million and 13 million people. Looking at those numbers, the prevalence of gambling addiction seems a bit scarier. You might be curious what exactly constitutes a gambling addiction? If you have never been around someone who struggles with it, it may seem like a foreign concept. Compared to the 1-2% who have a gambling addiction, 86% of Americans report having gambled. A large percentage of the population experiences little to no desire to continue. Many people scoff at the idea of what they may consider “throwing money away” at the card tables and flashing machines in smoke-stuffed casinos across the nation. However, for those with a gambling addiction, it’s not as simple as “just walking away from the game.”
What is gambling addiction?
In 2013, the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, added gambling addiction to their text. Officially called “Gambling Disorder” in the DSM-5, the text diagnoses it as:
- Need to gamble with increasing amount of money to achieve the desired excitement.
- Restless or irritable when trying to cut down on or stop gambling.
- Repeated unsuccessful efforts to control, cut back on or stop gambling.
- Frequent thoughts about gambling (such as reliving past gambling experiences, planning the next gambling venture, thinking of ways to get money to gamble).
- Often gambling when feeling distressed.
- After losing money gambling, often returning to get even (referred to as “chasing” one’s losses).
- Lying to conceal gambling activity.
- Jeopardizing or losing a significant relationship, job or educational/career opportunity because of gambling.
- Relying on others to help with money problems caused by gambling.
As you can see from those criteria, gambling addiction is not as simple as getting stuck at a table for a few hands of Texas Holdem. Those with a Gambling Disorder have a serious inability to stop gambling, despite the impact it is having on an individual’s life. Some individuals with a gambling addiction experience periods where their symptoms are less severe and it may even appear that the problem has disappeared entirely. However, before long the addiction strikes with a vengeance, oftentimes even stronger than before. Gambling addiction tends to run in families and begins to show anywhere from teenage years to later in adult life. Men’s symptoms generally begin when they are younger while women’s symptoms do not often start until later in their lives. 
What makes gambling so addictive?
The American Psychiatric Association defines addiction as “a brain disease that is manifested by compulsive substance use despite harmful consequence.” However, as seen in the DSM-5 entry, addiction is no longer related to just substance abuse. Though they do not consider it an addiction by name, gambling addiction is just as real as being addicted to heroin or alcohol. Gambling addiction riddles an individual’s life and has the potential to take away or destroy all that is important to them. But what makes gambling so addictive? When someone with a gambling addiction wins a hand or spins a straight 777 on the slot machine, dopamine is released in the brain and creates a feeling of a thrill or a rush. It is not restricted only to casinos, though; gambling disorders can be triggered by scratcher cards, lotto tickets, horse races, or even Super Bowl football square pools. The chance of winning big triggers the gambler’s brain to participate, often to disastrous extents. While many people are able to be pleased with their winnings and walk away a few hundred or thousand dollars richer, an individual with a gambling addiction will not stop. They’ll purchase more chips, withdraw money for more credits, buy another few scratcher cards, or participate in next week’s lottery. The insatiable desire to win takes over and no loss can ever overcome the insistence that they will just win it the next time.
Why do people gamble even though it destroys their lives?
When asked why she continues to gamble despite the consequences, one gambler said, “It’s all about the thrill or the rush I get at the thought of winning something I don’t have.” After being let go for calling out from work too often, she spent all of her unemployment money on scratcher cards from the liquor store. Once she used up all of her own money she borrowed money from her husband to continue her habit. However, she kept it well hidden. As she was unemployed at the time it was most severe, her husband was unaware of the extent of her current problem. He knew she struggled with a gambling addiction but did not realize that she was spending all of her money on it. As she scratched the cards while he was away at work during the day, he never realized where all her money went until months later when she broke down and admitted to him that she had had a lapse. Stories like these are all too common, especially in areas like Las Vegas, Reno, and Atlantic City. Even sadder are those who are single and lack familial influence; with few people concerned with their spending habits and everyday activities, they have free reign to blow away hundreds of thousands and land themselves in crippling debts. 
Gambling addiction and co-occurring disorders
The woman mentioned previously also struggled with alcoholism, incredibly common for individuals who experience gambling addiction. Those with Gambling Disorder have a high potential for co-occurring disorders such as drug and alcohol addiction or mental health disorders. A co-occurring disorder is an individual with a substance dependence or substance abuse problem who also experiences mental health issues. As gambling addiction, or Gambling Disorder, is now categorized under the addiction category in the DSM-5, it could be considered co-occurring with either alcohol and drug abuse or a mental health disorder. A study conducted in 2014 looked at the relationship between four mental health disorders (depression, mood disorders, generalized anxiety disorder, and PTSD) and gambling. Their results showed that, of those studied, 86% of gamblers also experienced one or more of the four mental health disorders they were screened for. It is estimated that 10 to 20% of individuals with substance use disorder also have experience as a pathological or problem gambler. Gambling is common among the drug- and alcohol-addicted population as a means of getting money to purchase substances. Though it isn’t 
Gambling addiction and legal troubles
Although gambling is a legal activity in many locations and most who gamble do not experience any addictive behaviors, for those with gambling addiction the story is different. Oftentimes once they run out of money, pathological and problem gamblers resort to illegal methods of obtaining more money to gamble. Theft, burglary, and In places where gambling is illegal, gamblers will also run into trouble with the law for seeking out opportunities to bet. 
How to treat gambling addiction
When seeking treatment for gambling addiction it is important to consult with a doctor about the possibility of a co-occurring disorder. With such large rates of co-occurring disorders in those with gambling addiction, well-rounded treatment is often necessary. It is difficult to manage the gambling problem without also addressing the other issues such as substance abuse and mental health disorders. If the co-occurring disorders are left untreated, the chances of recovery are minimal. Once the co-occurring disorder is being treated, or if the gambler does not struggle with one, there are programs and other types of help available to help them address their gambling addiction.
Gamblers Anonymous
Based on the 12-step methods of Alcoholics Anonymous, Gamblers Anonymous is a 12-step program intended to help those with a gambling addiction. Originally founded in 1957 in Los Angeles, California, today Gamblers Anonymous has over 1,000 groups that meet worldwide. Through practicing the 12 Steps of Gamblers Anonymous, these men and women come together to work through their gambling problems and remain “clean” from gambling. The 12 Steps also help those with gambling addictions to live their everyday lives as happier, healthier individuals. A meeting directory for Gamblers Anonymous can be found here.
Cognitive-Behavioral Therapy
Though Gamblers Anonymous is incredibly beneficial in helping those with gambling addictions stop gambling, it is even more effective when used in combination with cognitive-behavioral therapy (CBT). CBT is a form of therapy that focuses on the idea that what you think impacts the behaviors you make. By working on the habitual thought patterns of an individual, therapists hope to combat the impulsive behavioral patterns that are characteristic of a gambling addiction.
Treatment Programs
For those with extreme cases, in particular when in combination with a substance abuse problem, inpatient or outpatient treatment may be necessary. Inpatient treatment will separate an individual from the problem at hand and provide intensive programs with both a CBT and sometimes 12-step-based approach. Those in inpatient receive the opportunity to focus on treatment alone with few outside distractions to maximize the potential for recovery. If intensive inpatient treatment is not an option due to work or school, outpatient treatment is another intensive way to address addiction issues head-on. Often offered in the evenings for those with daytime occupations, outpatient treatment provides care for a few hours a day, three to five days a week. Individuals learn to cope with daily life and manage triggering situations. Both inpatient and outpatient prove to be helpful in initiating long-term recovery from substance abuse, but effectiveness on gambling has yet to be studied extensively. 
Problems with current gambling addiction treatment
In 2013, Dr. Flora Matheson and her researchers at St. Michael’s Hospital’s Center for Research on Inner City Health collaborated with the Centre for Addiction and Mental Health to look over the current literature and studies regarding drug use and gambling addiction. They noticed a high correlation between pathological and problem gambling and substance abuse, but also realized these individuals are not as responsive to the present methods of treatment. There is a significant amount of people struggling with both substance abuse and gambling addiction, and treatment centers specific for their needs would prove to be beneficial. However, some treatment centers are beginning to incorporate the treatment of pathological and problem gambling into their programs due to the large amount of gamblers they see coming through their doors. In order to provide proper treatment for all patients, the issue of gambling addiction must be taken into consideration during treatment. As the awareness of gambling addiction increases, so will the number of treatment centers dedicated to the rehabilitation of these individuals. Additionally, greater numbers of existing treatment centers will equip themselves with the capabilities to provide the proper care. Like all addictions and mental health disorders, with more awareness comes more understanding.
Resources
“Prevalence of the Addictions” Steve Sussman, Nadra Lisha, and Mark Griffiths https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134413/#R12 “Gambling, Alcohol, and Other Substance Use Among Youth in the United States” Grace M. Barnes, Ph.D; John W. Welte, Ph.D; Joseph H. Hoffman, Ph.D; and Marie-Cecile O. Tidwell, Ph.D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629630/ “Pathological gambling, co-occurring disorders, clinical presentation, and treatment outcomes at a university-based counseling clinic” Soberay A, Faragher JM, Barbash M, Brookover A, Grimsley P https://www.ncbi.nlm.nih.gov/pubmed/23297170 “Co-Occurring Disorders” SAMHSA https://www.samhsa.gov/disorders/co-occurring “Links made between problem gambling and substance abuse, and lack of treatment options” St. Michael’s Hospital https://www.sciencedaily.com/releases/2013/09/130904105353.htm