The Diagnostic and Statistical Manual of Mental Disorders (DSM) only just classified pathological gambling as an addiction; in the 1980s, it was considered an impulse-control disorder, an umbrella group that included kleptomania, pyromania, and compulsive hair pulling. Scientific American reports that the decision to officially change gambling disorder to an addiction in the DSM is a landmark move, resulting from 15 years of deliberation and a new understanding of the biology of the disease. Addiction itself has undergone a redefinition, now viewed as “repeatedly pursuing a rewarding experience despite serious repercussions.”
Those who suffer from a gambling addiction experience an uncontrollable urge to keep gambling despite its negative impact on his/her life, according to the Mayo Clinic. Symptoms include: getting a high from taking big gambling risks; needing to take increasingly greater risks; an obsession or preoccupation with gambling; reliving past experiences associated with gambling; using gambling to escape or avoid problems and feelings such as depression, helplessness, or guilt; neglecting work and family life to gamble; concealing or lying about gambling habits; guilty or remorseful feelings following gambling; borrowing or stealing money to make bets; and failure to limit or eliminate gambling.
Frequently, an addiction to gambling develops or many months or years of social betting. Periods of stress can dramatically increase the urge to gamble; like many addictions, compulsive gambling occurs more often in conjunction with other mental disorders like anxiety and depression. The addictive behaviors serve as an unhealthy escape from difficult times. In this way, for those with compulsive gambling disorder, betting is not about the money, but rather the elevated feelings associated with the risks — much like the high users get from drugs or alcohol. And just as drug addicts develop a tolerance and require more of the substance to get the same high, compulsive gamblers pursue ever-riskier bets.
What all addictions have in common is a pathological pursuit of a reward or relief by some substance or behavior. On an oversimplified level, abused substances and behaviors are sought because they provide a reward in the form of pleasure. In the brain, pleasure manifests in the form of dopamine release, specifically in the nucleus accumbens. The nucleus accumbens is a cluster of nerve cells underneath the cerebral cortex, and is known as the brain’s pleasure center. In addition to controlling the brain’s reward and pleasure centers, the neurotransmitter also plays a role in movement and emotional responses. It is what enables us to both see rewards and to take steps to reach them.
Dopamine is not the only neurotransmitter released during gambling; so are endorphins. They are produced when we encounter certain stimuli, particularly stress, pain, or fear, and are most commonly received in the parts of the brain associated with blocking pain and controlling emotion. The limbic system is, among other things, responsible for processing all of our emotions and contains a large amount of opioid receptors. When these receptors are filled by endorphins, a sense of pleasure and satisfaction occurs and there is no need to continue whatever stimulus was being experienced. Because control and endorphins are so connected, it is possible that the neurotransmitter plays a significant role in compulsive disorders (including compulsive gambling). Someone with a lack of the neurotransmitters may require a longer exposure to a stimulus or more of a behavior to receive the chemical message to stop. Similarly, some believe that improper endorphin production or reception can cause serious emotional shifts or clinical depression. Disorders like depression, anxiety, and bipolar often have a strong positive correlation to addictions.
As is true of all addictions, compulsive gambling alters the neural circuitry of the brain, changing the ways that brain cells communicate with one another. Over time, because of the flood of endorphins and dopamine, a tolerance is developed. The brain becomes overwhelmed by the amount of the neurotransmitters and adapts by not releasing as much dopamine or eliminating dopamine receptors. Simultaneously, the neural pathways from the reward center to the frontal cortex — the part of the brain that deals with impulse control — are weakened, meaning that it becomes harder to stop the more an addict engages in the addictive behavior.
The renaming of gambling disorder as an addiction rather than a compulsive disorder has had a significant impact outside the DSM. Therapists have already seen a better response from compulsive gamblers using treatments typically associated with other addictions. This includes a form of therapy known as cognitive behavioral therapy (CBT). CBT focuses on viewing particular thoughts, feelings, and reactions in a more rational manner in the hopes of identifying inaccurate or negative thinking. In this way, the patient can develop clearer and more effective responses to stressful situations. In the case of gambling addicts, this may include learning that consecutive losses or a near miss on a bet does not indicate a coming win.
In conjunction with CBT, drug therapy has also been shown to prove helpful for compulsive gamblers. Specifically, drugs called narcotic antagonists, like naltrexone, that are used for substance abuse are also effective for gambling addictions because they inhibit the production of dopamine. This limits cravings and, subsequently, acting on those cravings. Therapists may prescribe antidepressants and mood stabilizers in addition to narcotic antagonists, as they help treat issues commonly associated with addiction (depression, compulsion, and ADHD).
It can be helpful to join Gamblers Anonymous and other self-help groups. These not only provide crucial support systems, structure, and accountability, but they also are a great source of information for members. Many of these groups are based on the same 12-step program founded by Alcoholics Anonymous.
Of course, the first step is acknowledging the problem and seeking treatment. Unfortunately, it is estimated that 80 percent of those suffering from a gambling addiction never pursue care, and around 75 percent that do end up relapsing. This makes preventative measures such as education and awareness so important. If you or a loved one are suffering from gambling addiction, be sure to consult your doctor or psychiatrist. Develop a plan, stick to it, and find a support system. These are great ways to start on the road to recovery.