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Problem gambling, ludopathy, 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. Pathological gambling was long considered by the American Psychiatric Association to be an impulse-control disorder rather than an addiction. 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-medication" 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.
Problem gambling is an addictive behavior with a high comorbidity with alcohol problems. A common tendency shared by people who have a gambling addiction is impulsivity.
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. 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. To be diagnosed, an individual must have at least four of the following symptoms in 12 months:
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. Dopamine dysregulation syndrome has been observed in the aforementioned theory in people with regard to such activities as gambling. 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. (source: Mick I, et al. Endogenous opioid release in pathological gamblers after an oral amphetamine challenge. At The European College of Neuropsychopharmacology Congress. 2014.)
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. 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 , , and Online gambling 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.
There have also been studies that showcase factors like gender and age can affect how a person is affected by gambling. Where the probability of addiction can be 11% stronger in men than in women, and the age range of 19-29 has the highest risk of developing problem gambling or pathological gambling habits.Potenza, Dr. Mark, (2003), The Psychology of Gambling, Yale.edu
Spain's gambling watchdog has updated its 2019–2020 Responsible Gaming Program, classifying problem gambling as a mental disorder.
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. 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.
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. In this framework, personality traits favoring present-oriented decision-making increase susceptibility to gambling addiction, mirroring risk-taking behaviors seen in other species.
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. 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.
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. 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.
As to behavioral treatment, some recent research supports the use of both activity scheduling and desensitization in the treatment of gambling problems. In general, behavior analytic research in this area is growing There is evidence that the SSRI paroxetine is efficacious in the treatment of pathological gambling. Additionally, for patients with both pathological gambling and a comorbid bipolar spectrum condition, sustained-release lithium has shown efficacy in a preliminary trial. The opioid antagonist drug nalmefene has also been trialled quite successfully for the treatment of compulsive gambling. Group concepts based on CBT, such as the metacognitive training for problem gambling have also proven effective.
A series of anti-depressant studies were conducted to determine their efficacy in treating problematic gambling. These studies produced three critical findings:
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. 'Nobody stopped me' at the casino: Ontario self-exclusion program fails to keep gambling addicts out
There is also a question as to the effectiveness of such programs, which can be difficult to enforce. Casino Industry in Asia Pacific: Development, Operation, and Impact, page 153 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".
With gambling addiction on the rise worldwide and across Europe in particular, those calling gambling a disease have been gaining grounds. The UK Gambling Commission announced a significant shift in their approach to gambling 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).
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. Studies commissioned by the National Gambling Impact Study Commission Act has shown the prevalence rate ranges from 0.1 percent to 0.6 percent. 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.
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. A 1996 study estimated 1.2 to 1.9 percent of adults in Canada were pathological. In Ontario, a 2006 report showed 2.6 percent of residents experienced "moderate gambling problems" and 0.8 percent had "severe gambling problems". In Quebec, an estimated 0.8 percent of the adult population were pathological gamblers in 2002. Although most who gamble do so without harm, approximately 6 million American adults are addicted to gambling.
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.
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.
Signs of a gambling problem include:
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. Gambling in West Africa is linked with problems with law enforcement and other authorities, substance use, and reckless financial spending. 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.
Gambling is also closely associated with gaming behaviors, specifically the prevalence of loot boxes. 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.
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 metres of any gambling venue, and was over 50% higher than among those living ten kilometres from a venue. The study's data stated:
According to the Productivity Commission's 2016 report into gambling, 0.5% to 1% (80,000 to 160,000) 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. Estimates show that problem gamblers account for an average of 41% of the total gaming machine spending. Productivity Commission Inquiry Report, Gambling, Vol 1, 2010, p. 203
Early onset of problem gambling may increase the lifetime risk of suicide. Both comorbid substance use and comorbid mental disorders increase the risk of suicide in people with problem gambling. A 2010 Australian hospital study found that 17% of suicidal patients admitted to the Alfred Hospital's emergency department were problem gamblers.
South America
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.
Africa
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. 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. Regarding youths who gamble, almost 50% of them report some form of gambling severe enough to be classified as problematic by the DSM.
Asia
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. 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. Among those who live in poverty and experience homelessness, 43.7% of individuals reported as lifetime gamblers. 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.
Oceania (Australia)
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.
Specifically, people who lived 100 metres from their favourite 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 kilometre away, and 2.2 times per month for people living ten kilometres away.
Long-term health impacts
If not treated, problem gambling may cause severe and lasting effects on an individual's life:
Suicide rates
A gambler who does not receive treatment for pathological gambling when in a desperation phase may contemplate suicide. Problem gambling is often associated with increased suicidal ideation and attempts compared to the general population.
See also
Further reading
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