What are the Signs, Symptoms, and Treatment options for Problem Gambling?
For most, placing a bet here or there while visiting a local casino, or while watching sports in the living room of a friend’s house or local bar isn’t really a problem. For others, these small bets can quickly escalate, leading people to feel as though they have less and less control over their behavior. People who struggle with problem gambling often describe that their gambling has led to significant losses over time including their savings, their homes, and even non-monetary losses like ruined relationships and careers.
Many of these individuals struggle with Gambling Disorder, a psychological disorder which affects 1% of adults in the U.S. According to statistics provided by the National Center for Problem Gambling, those most likely to suffer from this disorder include:
- Teens and young adults
- People with existing mental health issues (like anxiety or depression)
- People with existing substance use issues, especially those with alcohol use disorders
- People who identify as Black, Asian American, or American Indian
- People who live in areas where gambling has recently become available
- People disadvantaged with risk factors like low social support or difficulties in their home environment
Regardless of whether a person fits into one or more of these categories, it is still possible to suffer from a Gambling Disorder. There is no specific “type” of person who struggles with a Gambling Disorder and the majority of people who gamble do not suffer from a Gambling Disorder. Caution should be taken to avoid harmful stereotypes and assumptions about people struggling with this disorder.
Signs and Symptoms of Gambling Disorder
Gambling Disorder is characterized by a pattern of compulsive gambling that becomes problematic and leads to the experience of negative consequences in an individual’s life. Symptoms of Gambling Disorder include the experience of at least four of the following:
- A need to gamble with increasing amounts of money to achieve the same level of excitement or “rush”
- Repeated unsuccessful efforts to stop or cut back on gambling
- Restlessness or irritability when trying to cut back or stop gambling
- Persistent preoccupation, or having frequent thoughts about gambling
- A pattern of gambling when emotional or under stress
- Returning to gamble after losing to “recover losses”
- Lying to others or minimizing the extent of the gambling behavior
- Risking or experiencing the loss of a significant relationship, job, or opportunity because of gambling
- Relying on others to provide money to relieve financial strain caused by gambling
Some additional signs that can indicate someone has a Gambling Disorder or is at risk for developing one include:
- Spending more time or money gambling than you originally intended
- Feelings of regret, remorse, or guilt after gambling
- Gambling money that you cannot afford to lose
- Intending, planning, or attempting to stop gambling but not following through
- Feeling unable to control yourself when you start gambling
If you notice these signs or symptoms, it may mean that you are struggling with a Gambling Disorder, or that you are at risk of developing one.
Gambling: A Form of Addiction?
Some people with Gambling Disorder might only struggle periodically with gambling and are able to have prolonged periods of time where they do not gamble or gamble in ways that are moderate. Others, however, find that their gambling patterns are consistently problematic. Regardless of whether gambling is periodic or consistent in nature, people with Gambling Disorders often describe having experienced many serious consequences as a result of their gambling, and most describe feeling a loss of control over their behavior in ways that are similar to what people with Substance and Alcohol Use Disorders describe. Interestingly, research supports these similarities, demonstrating that the same areas of the brain known to be involved in addiction are also active in individuals who struggle with problem gambling.
Dopamine is released when a person uses drugs or alcohol and also in response to certain behaviors, including gambling. Like other forms of addiction, gambling activates the release of dopamine, causing people to experience a rush of excitement and pleasure that reinforces the behavior, making it more difficult to stop. Dopamine is a powerful neurotransmitter known to induce pleasurable feelings and play a role in the formation of “reward pathways”, also sometimes called “addiction pathways” in the brain. Some people might be at higher risk for developing these addiction pathways based on a number of factors that can include genetics, the presence of underlying psychological disorders, the presence of environmental stressors, and many other factors. When these addiction pathways are formed in the brain, a person becomes more likely to repeat the behavior, even when that behavior is known to have caused a lot of problems for them in the past.
Because gambling is known to trigger these addiction pathways, it is often considered to be a behavioral addiction – or behavior that can become compulsive over time, causing a lot of harm to people’s lives. In fact, many of the symptoms of Gambling Disorder mimic symptoms of a drug or alcohol use disorder. Experiences like developing a “tolerance” and needing to do something more to get the same rush, having made multiple attempts to cut back or stop, and continuing the behavior despite having experienced consequences, are all experiences also shared by people struggling with an addiction to drugs or alcohol. It is important to note that the term “addiction” does not necessarily describe a person being physically addicted to something, but instead describes a pattern of behavior that is repeated, despite having caused a lot of problems for a person.
While addiction and the development of reward pathways in the brain can make the urge to repeat the behavior stronger and can make stopping the behavior more difficult, this does not mean that a person is incapable of stopping their behavior, or that they cannot be held accountable for their behavior. In fact, research on the brain demonstrates that by stopping a behavior or starting a new one, the human brain actually rewires certain connections. The old reward pathways in the brain become less active and new pathways are formed which support the new behavior. What this means is that over time, a person recovering from an addiction finds that it becomes easier to avoid the old behavior and easier to continue the new, healthier behavior. Research indicates that about one-third of people with a Gambling Disorder will be able to recover from the disorder on their own without treatment of any kind. For those who have not been able to recover on their own from a Gambling Disorder, there is still a range of different treatment options available.
Getting Help for A Gambling Disorder
The goal of treatment for addictions of any kind is behavior modification, or, simply put, a behavior change. Most people who struggle with a Gambling Disorder or other form of addiction find that it is necessary to completely stop the behavior, as opposed to just cutting down or learning to moderate. This is true because of the way that the addiction pathways in the brain will continue to strengthen the more the behavior is repeated, creating strong urges to continue or increase the behavior. While some people who have struggled with addiction find that they can control or moderate their behavior for a period of time, most experience a loss of control and ultimately a return to the problem behavior. As addiction progresses, these honeymoon periods tend to become shorter and the consequences of gambling tend to become more serious.
Seeking help from a mental health professional or addiction counselor can be helpful to break the cycle and support lasting behavior change. There are a variety of different options for those looking for help, including programs that offer group, individual, and/or family counseling. In some cases, people may decide it is necessary to seek inpatient treatment for a period of time, where they stay in a secured facility with trained medical and mental health professionals. In other cases, people may opt for an outpatient program that meets multiple times each week and offers group counseling and in other cases, people may choose to see a counselor less frequently for either individual or family counseling.
When selecting a treatment, there are a number of different factors to consider. For many people, there are logistical matters like financial considerations and scheduling considerations that are primary factors in this decision. If you have health insurance, it is likely that there are some treatment options that will be at least partially covered by your insurance plan. For people interested in seeing about options that may be covered by their insurance, a good first step would be to call the number on the back of your health insurance card to speak with a customer service representative about the options available under your plan. In some plans, the behavioral or mental health coverage is separate from the medical coverage and so if there is a specific number for mental or behavioral health, this would be the right number to call. When you speak with someone from your insurance, you should ask them about your coverage for mental and behavioral health and ask them for specific details about what the out of pocket costs would be for different types of treatment. You could also ask them to provide you with a list of in-network treatment providers or facilities that are close to you and then could follow up with these providers.
Regardless of whether you are using insurance or not, it is important to be an informed customer when you are selecting a treatment provider. This means having at least two or three different options identified and looking into each of these options to find more information about which would be the best fit for you. Often, the preliminary information can be found online but it is also helpful to either call or visit a facility or provider before making a final decision to make the initial appointment. Providers and facilities will be used to this and should be willing to accommodate you for a free consultation either over the phone or in person. During this consultation, it is a good idea to plan ahead and think about the specific questions you have. Some questions you could consider asking is how long the treatment will last, what the time and financial obligations will be, what treatment will involve, and information about treatment success rates.
There is no “gold star” treatment approach for Gambling Disorder, but many programs will utilize treatments which have been proven to be effective in the treatment of other types of addiction or impulse control disorders. Cognitive Behavioral Therapy, or CBT, is a commonly used treatment approach that has a lot of research to support its effectiveness in treating a variety of behavioral and mental health issues. CBT involves working to change behavior by identifying and changing unhelpful patterns of thoughts that tend to lead to the problem behavior, learning to manage impulses and regulate stress and emotions, working to think through choices more carefully, and working to build new behavior patterns over time. Another common approach to treatment is family therapy, which involves the support system of the person in the treatment process through a blend of family and individual sessions. This approach can be especially helpful for those who have damaged important relationships as a result of their problem gambling. Through the treatment process, the person is able to work on repairing damage to the relationship and rebuilding trust and the support person is provided with tools to be positive support for the person in recovery. Search TherapyTribe therapist directory for an addiction specialist in your area.
Helping Yourself: Alternatives to Treatment
For a variety of reasons, some people struggling with Gambling Disorders may not feel that treatment is the right option for them. Some may find that time or money is a barrier and others might feel confident in their ability to change their behavior without formal treatment. For those who are not interested in treatment, there are a variety of non-medical options available that provide a “middle ground” between formal treatment and no treatment. These options include resources like self-help groups, which are available in most communities. In many communities, there are specific self-help groups for problem gambling like the popular Gambling Anonymous groups that are based on the 12 step recovery program. In addition, there are national agencies like the National Problem Gambling Helpline as well as many state-run programs and helplines, many of which are offered at no cost.
People who are working to stop their problem gambling may also benefit from involving their support system- including friends and family members who can provide assistance and help you stay accountable for making changes. In some instances, it might be important to ask a support person to assist with restricting or helping to manage money, especially in the early stages of making the change. This can help to ensure that you are able to meet your financial obligations and can also make it more difficult for you to use your money to gamble. In many cases, you can also take some of these steps on your own by doing things like leaving cash at home, not bringing your credit and debit cards with you when you go out or making a plan to avoid specific triggers like a place you used to gamble or a person you gambled with. These safeguards can help set you up for success, especially as you are in the beginning stages of making changes, which is often when people describe feeling the most vulnerable.
When you notice the signs of problem gambling, it is important to take a first step in getting help or changing your behavior, regardless of what this first step is. Often, people who struggle with addictions also describe sometimes struggling with denial, minimizing their behavior or the impacts it has had or making other excuses about why “this time will be different”. Denial and excuses like these provide the chance for addictions to continue to grow, progressively becoming more destructive over time. As people with this issue know, there is more at stake than just money.
Resources for Problem Gambling
- National Problem Gambling Helpline: 1-800-522-4700 or online at ncpgambling.org
- Gamblers Anonymous at www.gamblersanonymous.com
- Search TherapyTribe therapist directory for an addiction specialist in your area.
- Free Online Support Group: AddictionTribe
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Mann, K., Fauth-Bühler, M., Higuchi, S., Potenza, M. N., & Saunders, J. B. (2016). Pathological gambling: a behavioral addiction. World psychiatry: official journal of the World Psychiatric Association (WPA), 15(3), 297-298.
- National Center for Responsible Gambling. (2015). Retrieved from: http://www.ncrg.org/discovery-project.
- National Council on Problem Gambling. Help and Treatment. Retrieved from: https://www.ncpgambling.org/help-treatment/
- Rennert, L., Denis, C., Peer, K., Lynch, K. G., Gelernter, J., & Kranzler, H. R. (2014). DSM-5 gambling disorder: prevalence and characteristics in a substance use disorder sample. Experimental and clinical psychopharmacology, 22(1), 50-6.