Compulsive Gambling

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By Tyrus Gardner & John Phillips, edited and reviewed by M. Williams, M.A.

What is Compulsive Gambling?

Pathological Gambling, also called Compulsive Gambling, is the most common type of impulse control disorder worldwide.

With the rapid expansion of legalized gambling avenues, such as casinos, lotteries, and online gambling, gambling behaviors are on the rise. Compulsive gambling is one of the most rapidly growing, but largely ignored, mental health problems in the United States.

This disorder can be defined as repeated maladaptive gambling that is associated with other problems, such as repeated, unsuccessful efforts to stop problem gambling, restlessness or irritability when trying to stop gambling, lying to family members and friends to conceal the extent of problem gambling, and committing crimes to finance gambling.

Prevalence of Compulsive Gambling

There is much concern over the growing problem of compulsive gambling. Two million (1%) of U.S. adults are estimated to meet criteria for pathological gambling in a given year. Another four to eight million (2-3%) would be considered problem gamblers; that is, they do not meet the full diagnostic criteria for pathological gambling, but meet one or more of the criteria and are experiencing problems due to their gambling behavior.

The spread of legalized gambling continues to increase these statistics. According to Gambler's Anonymous, approximately 85% of U.S. adults have gambled at least once in their lives and 60% in the past year. Some form of legalized gambling is available in 48 states plus the District of Columbia. (The only two without legalized gambling are Hawaii and Utah.) With the legalization of casinos nationwide in the last half-century, lotteries in almost every state, and now online Internet gambling, the prevalence rate for pathological gambling could experience exponential growth.

Compulsive gambling typically appears in early adolescence for males and later in life for females. Although some individuals become hooked with their very first bet, for most people the process is more insidious. There may be years of social gambling with friends followed by an abrupt onset that may be precipitated by more exposure to gambling or by stress.

There is usually a progression in the frequency of gambling, the amount wagered, and finding money with which to gamble. The desire to gamble generally increases during periods of stress or depression. Surprisingly enough, the people who usually become pathological gamblers tend to be intelligent, well-educated, competitive people who enjoy the challenges and risks involved in betting. When not gambling, pathological gamblers are frequently labeled as "workaholics" and they may be prone to developing medical conditions associated with stress, such as hypertension or migraines. Distortions in thinking are not uncommon, such as denial, superstitions, and overconfidence.

About one-third of pathological gamblers are women, but in different cultures, the gender ratio can vary. There are cultural variations in the prevalence and different types of gambling activities, from cards, to cockfights, or pai gow to horse racing. Prevalence rates in some areas such as Puerto Rico and Australia have been reported to be as high as 7%.

Causes of Compulsive Gambling

Evidence from twin studies suggests that impulsivity represents a common form of vulnerability and it is believed that this predisposition is influenced by genetic factors. Patients that were drug or alcohol dependent had rates of pathological gambling ranging from 13-33%, leading researchers to conclude that the co-occurrence of substance use disorders and compulsive gambling may be due to an underlying personality trait such as impulsivity. Impulsivity can be defined as the choice of a small, short term gain at the expense of a large, long term loss, which seems to describe both substance abuse and excessive gambling fairly well.

Other studies of men with compulsive gambling suggest that a history of inattentive and hyperactive symptoms in childhood may be a risk factor for developing this disorder. A variety of laboratory findings have been reported to be abnormal in males with pathological gambling compared with control subjects. These abnormalities are seen in a number of neurotransmitters, such as serotonin, norepinephrine, and dopamine. A family pattern can also be seen: pathological gambling and alcohol dependence are both more common among the parents of individuals with pathological gambling than among the general population. The gender and cultural differences may some day help explain the origin of pathological gambling.

Treatment for Compulsive Gambling

The main purpose of treatment is to prevent the relapse of gambling behavior. The specific type of psychotherapuetic treatment provided for pathological gambling will depend on the theoretical orientation and training of the clinician. Psychoanalytic, behaviorist, cognitive, and biological therapists will all provide treatments differently.

Psychoanalytic therapists help pathological gamblers find their underlying distress and understand it. Gambling may been as a means of satisfying some unconscious desire.

A behaviorist might help the client develop new skills and lifestyle patterns that promote positive patterns of behavior. They might also teach relaxation techniques to help the patient control their cravings. A behaviorist may take a patient to the casino to expose the person to a real life situation and teach them to control themselves there by not gambling or only gambling a small amount.

Cognitive therapists believe that teaching probability and randomness to patients would help decrease the participation in gambling activities, as "the house always wins."

Little research has been done on pharmacological treatments, but lithium carbonate and anti-convulsants are commonly used to help pathological gamblers. These drugs help the individual control their craving to gamble. Complete abstinence is not a highly regarded treatment, because it is too difficult to obtain. There are many self help groups, but only 8% of members in these groups remain completely abstinent from gambling.

As with any condition, prevention is the best medicine. It is crucial to educate the general public about the dangers of pathological gambling. Since the prevalence rate of pathological gambling is positively correlated with the availability of gambling, and the availability of gambling continues to increase, the public needs to understand the potential costs to society. Pathological gambling represents distress, a loss of control, and lost productivity for millions.

Related Reading


  • American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.) Arlington, VA: American Psychiatric Association.
  • Castellani, B. (2000). Pathological Gambling. Albany, NY: State University of New York Press.
  • Grant, J., & Kim, W. (2003). Comorbidity of impulse control disorders in pathological gambling. Acta Psychiatrica Scandinavica, 108, 203-210.
  • Morison, V., Orford, J., & Somers M. (1996). Drinking and gambling: a comparison with implications for theories of addiction. Drug Alcohol Rev, 1, 47-56.
  • National Research Council. (1999). Pathological Gambling: A Critical Review Washington: National Academies Press.
  • Petry, N. (2001). Substance abuse, pathological gambling, and impulsiveness. Drug and Alcohol Dependence, 63, 29-38.
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