Gambling Addiction Treatment
What is Gambling Addiction?
While addiction is most frequently associated with substance abuse, drugs and alcohol are only some of the many objects and behaviors with which people can develop unhealthy relationships. A wide variety of impulse control disorders exist, ranging from sex addiction to internet addiction. These behaviors are generally pursued for pleasure by the majority of people. However, in cases where people develop addictions, they may be unable to resist cravings or control the extent of their behavior. This can lead to severe negative consequences.
Gambling addiction is often defined as a process addiction, sometimes known as a behavioral addiction. Unlike substance addictions, which occur when a person feels obligated to stimulate themselves using a particular psychoactive substance, process addictions involve compulsive relationships with stimulating behaviors. These behaviors can range from passive behaviors (eg, watching television) to active behaviors (eg, playing video games, pathological working). Gambling is a particularly stimulating activity, given its potential for extreme ups and downs. The activity also leads to very profound consequences, ranging from the fortunate to the disastrous, which further increase its addictive potential.
In order to understand what gambling addiction is, it is necessary first to define healthy gambling. Gambling, in essence, involves wagering something of value (most commonly money). These wagers occur in the context of an event or game with an outcome that is uncertain to a greater or lesser degree. The objective of gambling is to win a prize that is greater in value than the object that was wagered. When an individual places a bet, they are exposing themselves to the whims of chance. Given the uncertainty of the outcome, they place themselves at risk of significant loss, but they also stand to gain. Healthy gambling is an activity that is pursued willingly; when an individual engages in healthy gambling, they are generally able to stop when they decide to do so. Addictive or compulsive gambling, however, is an activity that a person cannot control.
People may gamble for many reasons. Those who gamble for recreational reasons do so for the fun of it, because they enjoy the activity for its own sake. The vast majority of people gamble to pursue monetary gain. Professional gamblers make their living from gambling, and often utilize complex strategies to maximize the chances of a favorable outcome. Both recreational and professional gambling can be either healthy or unhealthy.
Individuals who suffer from gambling addiction are unable to manage or regulate their gambling. Whereas non-addicts can engage in the activity for a short period and then easily let go, people who suffer from gambling addiction may feel unable to stop once they begin. Gambling addicts frequently experience cravings or strong desires to gamble throughout the day. These cravings may interfere with their ability to function normally in their everyday lives, whether the cravings are acted upon or not. Further, the behavior of gambling itself can have extreme and inherently unpredictable consequences for their lives — and for the lives of their family members. Individuals suffering from gambling addiction may recognize these negative consequences, and they may exert effort to curb their gambling behaviors or stop entirely, but the nature of addiction itself prevents them from doing so successfully, at least for long. Without outside help, individuals suffering from gambling addiction generally continue to experience the destructive effects of their compulsive behaviors, with often devastating consequences.
Causes of Gambling Addiction
Gambling addiction is relatively poorly understood, though a growing body of research is beginning to illuminate the underlying nature of the condition. When gambling addiction was initially recognized by psychiatrists, they understood it as an impulse control disorder rather than an addiction. Many psychologists and medical practitioners treated it as an obsessive-compulsive condition akin to obsessive-compulsive disorder (OCD). However, in recent years this conceptual model has been abandoned. Researchers now understand that gambling addiction, as a behavioral addiction, shares many traits with substance use disorder. The obsessions and compulsions that occur in OCD and other related disorders arise due to misplaced signals from the brain’s fear mechanisms. With gambling addiction as well as substance use disorders, the problematic compulsions and obsessions stem from the brain’s reward centers.
How do the brain’s reward centers lead to problematic gambling? The primary culprit is a neurotransmitter called dopamine. Dopamine is an essential neurotransmitter for proper brain functioning. It is released during healthy activities such as sex, shooting basketball hoops, and even while eating a delicious meal. Dopamine is the brain’s way of rewarding itself for a job well done. When the brain experiences a dopamine boost, whatever behavior led to dopamine’s release becomes reinforced and a person is more likely to repeat said behavior. In the case of substance abuse, drugs such as heroin and cocaine release such high levels of dopamine that it is difficult to say no to repeated doses. However, the brain responds to gambling in different ways. When a person loses, they are likely to experience crushing despair. When a person wins, however, the brain releases enormous quantities of dopamine. By flooding the brain with dopamine, the brain becomes hardwired to try to continually place bets, even if the rational decision would be to walk away with the winnings or to cut ones losses before too late.
However, while everyone who gambles successfully experiences a dopamine rush, not everyone develops a gambling addiction. The true causes of gambling addiction are not well understood, though researchers recognize a variety of factors that are tightly bound to the condition. One major factor is alcohol use disorder. Gambling addiction is highly correlated with alcohol abuse. Individuals who consume alcohol abusively tend to gravitate toward recreational activities like gambling. They are also more likely to place irrational and unwise bets, due to the disinhibitory effects of alcohol consumption. The truth is that the causal relationship between alcohol abuse and gambling addiction goes both ways, with many gambling addicts turning to alcohol as a way of soothing their sorrows when gambling goes wrong, or when the negative consequences of gambling addiction damage their livelihood. As such, proper treatment for gambling addiction requires that comorbid conditions like alcohol use disorder receive treatment as well.
Other biological, genetic, and environmental factors that can influence the onset of gambling addiction include:
- Age and gender (gambling addiction is more commonly found among young and middle-aged people, and it is also more common among men than women)
- The presence of comorbid mental health disorders (such as substance abuse problems, personality disorders, mood disorders)
- Influence or peer pressure from friends and family members
- Drugs with rare side-effects (such as antipsychotic medications or dopamine agonists).
- Inherent personality traits
- Trauma, especially early childhood trauma
- A family history of addiction
- Persistent solitude and the subjective experience of loneliness
We base our assessment questions on the criteria laid out by the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Regardless to the results of the assessment, it is important to note that an impulse control disorder must be diagnosed by a trained medical professional.
Signs of Gambling Addiction
Gambling addiction is recognized by the American Psychiatric Association as a legitimate mental health condition. Known as gambling disorder among psychiatrists and other mental health professionals, the condition can be treated and managed by individuals who seek help. Receiving a legitimate diagnosis from a qualified mental health professional is essential, as they can properly assess whether a person does or does not suffer from a particular condition, evaluate the needs of the patient, and design an appropriate treatment plan. Getting officially diagnosed with gambling disorder is also essential for individuals who hope to pay for their addiction treatment using health insurance. Psychiatrists use a book called The Diagnostic and Statistical Manual of Mental Disorders, or DSM-V, to make official diagnoses of mental health conditions. The DSM-V lists nine distinct symptoms that characterize gambling disorder. If an individual suffers from four or more of them, they will likely be diagnosed with the condition. The symptoms of gambling disorder are as follows:
A diagnosis of gambling disorder requires at least four of the following during the past year:
- Need to gamble with increasing amount of money to achieve the desired excitement
- Restless or irritable when trying to cut down 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
As a spectrum disorder, many different severity levels for gambling addiction are possible. Not everyone who suffers from a gambling addiction experiences all of these symptoms. Individuals who experience four or more of them can receive a basic diagnosis of gambling disorder and can access treatment options. Those with significantly more symptoms are at the highest risk. It is important to understand, however, that symptoms generally wax and wane throughout the years. That means that even individuals with fewer symptoms can rapidly enter a period of increased severity, and individuals with more severe gambling disorders may sometimes avoid treatment because they feel like their condition is sometimes more manageable. Over time, however, most people’s gambling addictions get worse, never better. Gambling addiction is a progressive disorder that requires treatment as soon as it is recognized.
Long-Term Risks of Gambling Addiction
Over time, what begins as a recreational hobby can rapidly turn into an activity that controls — and ruins — almost every aspect of a person’s life. The long term risks for professional gamblers are as serious as those for recreational gamblers. On the most basic personal level, anyone suffering from addiction, including gambling addiction, shares one common experience: a feeling of losing control of oneself and ones life. Gambling addiction can make people feel helpless, as they time and time again return to a behavior that they have promised themselves to stay away from. When the consequences of gambling addiction manifest themselves in more severe ways, repeatedly engaging in this self-destructive behavior against ones own will can make people feel despondent.
As an activity that requires wagering valuable items, most commonly money, gambling first and foremost poses extreme risks to a person’s financial well-being. It is common for people who suffer from gambling addiction to bet beyond their means. This can mean dipping into savings accounts, childrens’ college funds, or money allocated for rent payments. While gambling addicts can periodically win, the nature of the game entails that they will more frequently lose — and their impulsivity in gambling further increases the chances of a financial loss. As a result, people with gambling addictions generally suffer from acute financial distress. They may struggle to pay for rent, food, or other basic necessities. They may go into bankruptcy. It is also common for people with this condition to go into considerable debt. As financial crises pile up, a person suffering from gambling addiction may be all the more tempted to place a bet in the hopes that a lucky result will erase all their problems.
Few people experience financial problems alone. While individuals who suffer alone are in some ways the most vulnerable, exposing themselves to the risks of homelessness and starvation, among other ills of destitution, people with strong social support systems face a variety of other consequences. The debts and other financial problems that accumulate around gambling often drive gambling addicts to turn to friends, family members, or other more dubious individuals to borrow money. As the money is unlikely to be paid back, this habitual activity can put a significant strain on interpersonal relations. The situation is far worse when a gambling addict has people who depend on him or her. Suffering from a gambling addiction makes it all but impossible to support a family. When a person’s addictive gambling behavior puts their family at risk of poverty, homelessness, and general instability, family life can suffer considerably. Gambling addiction can destroy relationships with friends and family, end in divorce, and even result in loss of child custody.
The financial problems that result from gambling addiction can also drive people to pursue criminal means of funding their addiction. When family members and friends are unable or no longer willing to loan out money, it may be tempting to steal, engage in fraud, or borrow money from criminal organizations. These activities put a person and their family at considerable risk. Furthermore, they expose them to significant legal risks. Defending oneself in court and the necessity of hiring a lawyer to do so can add to financial stress. Should that go wrong, criminal consequences, such as imprisonment, are a very real possibility.
Gambling addiction can also lead to a wide variety of health complications. Research has shown that gambling addiction actually leads to long-lasting changes in the brain on a neurological level, altering how a person metabolizes dopamine, serotonin, and adrenaline. The gambling sessions themselves also affect health. Gambling sessions among addicts often last up to two or three days straight, often without food, water, or sleep. Ignoring the biological needs of the body during a gambling session can have deleterious effects on health, but the prolonged physical and emotional stress associated with such gambling sessions makes the impact even more severe. Gambling addiction can cause or exacerbate dangerous physical health conditions, including hypertension, peptic ulcer disease, and cardiovascular disease. It should come therefore as no surprise that deaths of “natural causes” inside casinos are commonplace.
The activities and consequences associated with gambling addiction also frequently lead to mental illness. The interpersonal, financial, and criminal consequences of gambling addiction naturally result in a great deal of stress, which can manifest itself via a variety of mental health conditions, including anxiety disorder, major depression, and other mood disorders. The accumulated guilt, shame, hopelessness, and despair that accompanies gambling addiction tends to worsen these symptoms. Substance use disorders are a particular risk. Gambling addiction is highly correlated with alcohol use disorder, especially among men (who constitute the majority of gambling addicts). Comorbid substance use disorders not only complicate the process of treating a gambling addiction, they significantly increase health problems, and they can even be fatal in the case of a drug or alcohol overdose.
The most life-threatening problem that long-term gambling addicts face is suicide. Individuals suffering from gambling addiction have high rates of suicidal ideation. In fact, one study found that among problem gamblers, 20% had attempted suicide and 77% regularly experienced sucidal thoughts. A follow-up study found that among suicide attempts, 12% to 24% could be attributed to pathological gambling. Given that only 8% of people with gambling addiction ever seek help for their disorder, these individuals are gambling with more than just their financial assets — they are putting their lives at stake.
Treating Gambling Addiction
Gambling addiction is a treatable medical condition. Unfortunately, the stigma and shame that many people associate with gambling, and especially compulsive gambling, makes many people reluctant to discuss their problems. Most gambling addicts recognize the problematic nature of their behavior, especially when consequences become severe, but very few reach out for help. While it may be tempting to try to control and manage ones gambling addiction on ones own, the nature of addiction makes this very difficult. Given that gambling addicts suffer from a disorder located in their brain’s motivation and decision-making centers, trying to treat gambling addiction using individual willpower is like trying to cure a broken leg by going for a jog. While gambling addiction can be treated and successfully managed, doing so is contingent upon seeking outside help. Most outpatient treatment centers utilize a variety of treatment methods to manage gambling addiction, including psychotherapy, support groups, and sometimes medication. The nature of a person’s treatment plan depends in large part on their individual circumstances and needs.
Treating Gambling Addiction Through Therapy
Most outpatient treatment centers for gambling addiction offer talk therapy, sometimes known as psychotherapy. Talk therapy can be highly beneficial for individuals suffering from gambling addiction. It allows them to deeply reflect on the underlying causes of their gambling addiction. By providing support during the course of such introspection, psychotherapists can help addicts address these underlying issues, which can range from early childhood trauma to untreated mental health disorders. Psychotherapy can also be a valuable tool for developing new coping strategies and tools for avoiding a gambling relapse. Certain therapeutic modalities are especially beneficial for gambling addiction.
- Cognitive-behavioral therapy (CBT) is generally the first type of psychotherapy recommended for gambling addicts. Cognitive-behavioral therapy involves recognizing maladaptive thought and behavior patterns and systematically working to replace them with more rational, beneficial thoughts and behaviors. Cognitive-behavioral therapy is a highly structured, goal-based therapy that often has a finite duration. Individuals with gambling addiction can use CBT to reduce their cravings and obsessions and gain the mental fortitude to avoid returning to old unhealthy behaviors.
- Couples therapy is a valuable tool for gambling addicts whose addictions have wreaked havoc on their family life. Spouses and significant others are often severely affected by the behavior of a gambling addict, which can drain shared financial resources and cause interpersonal conflict. While a gambling works to recover from their condition, addressing these interpersonal issues is an important part of the healing process.
- Group therapy is a great way of individuals suffering from gambling addiction to come together and share their experiences. By addressing personal challenges on a group level, individuals suffering from gambling addiction can feel less alone in their struggles.
Gambling Addiction Support Groups
Outpatient programs understand that an essential aspect of recovery from any addiction, from a substance use disorder to a gambling disorder, is developing a strong social support system. In fact, a large body of research exists backing up the idea that individuals with strong sober social support systems have better recovery outcomes. As such, one of the main benefits of enrolling in an outpatient treatment center is that a person gains access to a network of other like-minded individuals. Gambling addiction can be lonely and isolating, and being understood by other people with the same disorder can be a profoundly healing experience in and of itself. Furthermore, these support systems are likely to remain strong in the years subsequent to formal addiction treatment, providing recovering gambling addicts with a long-term resource that is likely to discourage relapse. Beyond merely discouraging relapse, however, involvement in a social support group is an inherently enriching experience that offers a source of joy in people’s newfound sober lives.
Other Support Groups
Many individuals who suffer from gambling addiction suffer from other comorbid mental health conditions. Since substance use disorders, especially alcohol use disorder, are by far the most common comorbid mental illness, it is often recommended that individuals with gambling problems make use of other kinds of support groups. By treating their other conditions, they can ensure that a relapse of their alcohol use disorder, for instance, doesn’t trigger a relapse of compulsive gambling as well. While individuals suffering from gambling addiction should primarily attend Gamblers Anonymous, a variety of other 12-step based programs are often recommended, depending on which additional conditions a person suffers from. These programs include:
- Alcoholics Anonymous
- Narcotics Anonymous
- Cocaine Anonymous
- Sex Addicts Anonymous
- Debtors Anonymous
- Al-Anon
Non 12-step-based programs and support groups are also popular options for people suffering from gambling addiction. The most prominent of these is SMART Recovery. SMART Recovery is a program that addresses all forms of addiction, ranging from substance use disorders to behavioral addictions like gambling. SMART Recovery, unlike 12-step programs, is entirely secular and is not rooted in spiritual principles. The program is designed with the concepts of cognitive-behavioral therapy (CBT) in mind. SMART Recovery helps members manage their cravings, emotions, obsessions, and compulsions. It does so by encouraging members to recognize and evaluate their maladaptive thought patterns and behaviors and then work to systematically replace them with healthier ones. SMART Recovery is convenient for people who live in remote areas, since the program is mostly online. However, while in-person SMART Recovery meetings do exist, they are less ubiquitous than 12-step meetings, and therefore 12-step-based programs are still recommended for individuals aiming to build a solid social support system in recovery.
Gamblers Anonymous
Gamblers Anonymous (GA) is a program for individuals who are working to recover from gambling addiction. Gamblers Anonymous does not use the terms “problem gambling,” “gambling addiction,” or “gambling disorder,” preferring to address the issue in terms of “compulsive gambling” instead. At Gamblers Anonymous meetings, members who are trying to avoid a gambling relapse come together to share their experience, strength and hope. Gamblers Anonymous meetings are opportunities for people at varying stages of recovery to relate their experiences and challenges, receive advice and emotional support, and help others recover.
The program is 12-step-based and modeled after the principles of Alcoholics Anonymous (AA), the longest-running recovery group in the world. A large number of outpatient programs are also 12-step-based, and therefore many of them encourage individuals to attend GA meetings. The 12 steps of Gamblers Anonymous are spiritually-based, emphasizing the importance of developing a relationship with a “higher power.” This concept of a higher power is self-defined, meaning a person’s understanding of it can include anything from God to the community of GA itself. Ultimately, the 12 steps are about recovering from addiction by letting go of ones personal ego and self-will. Newer members are advised to work with a “sponsor,” who is a person who has completed the 12 steps and is amenable to guiding a newer member through them. Since GA’s program of recovery emphasizes helping others as a means to helping oneself, sponsors, as well as the rest of the GA community, are generally willing to bend over backwards to support newer members in their recovery efforts.
Gamblers Anonymous is available worldwide in almost every major city. The program has no costs for membership, and the only requirement for admittance is a desire to stop compulsively gambling.
Treating Gambling Addiction Through Medication
There isn’t a great deal of research being done at the moment on pharmacological approaches to treating gambling addiction. However, preliminary evidence has shown that individuals with gambling addiction can sometimes benefit from certain medications. The SSRi paroxetine, which is often sold under the brand name Paxil, has shown some promise in reducing the compulsions associated with gambling disorder. Additionally, the opioid antagonist nalmefene, which is most commonly used to treat alcohol dependence, has been shown in clinical trials to be effective at managing gambling disorder as well. While in severe cases these medications can be used to supplement treatment, it is highly recommended that individuals suffering from gambling addiction make use of psychosocial treatment programs that utilize talk therapy and support groups.
Gambling Addicts and Co-Occurring Mental Health Conditions
Gambling addiction is highly correlated with other mental health disorders. Many individuals turn to gambling in the first place as a self-medication tool to soothe the symptoms of undiagnosed and untreated mental illness. However, many people also develop mental health conditions as a consequence of compulsive gambling. Given that the causal relationship goes in both directions, gambling addiction and mental illness can rapidly become a vicious and self-perpetuating cycle. As such, successful treatment of a gambling addiction is dependent upon the accurate assessment of comorbid mental health conditions. When an individual suffers from other problems in addition to gambling disorder, medication can be a valuable tool that indirectly alleviates the symptoms of compulsive gambling.
Getting Help
Gambling addiction is not something a person can readily manage on their own. As with any addiction, compulsive gambling actually changes people’s brains on the neurological level, making it difficult for them to resist the temptations for long. While the stigma and shame associated with gambling disorder may make people reluctant to seek help, attempts to quit gambling without a strong support system are likely to be short-lived. When individuals have begun to experience the severe consequences of gambling addiction, it often becomes even more difficult to pull oneself out of the mire. It is essential to seek the help of professionals who have experience in treating gambling addiction.
Create Recovery Center outpatient rehab is the ideal place to pursue gambling addiction recovery. Given gambling disorder’s strong ties to alcohol use disorder and other substance use disorders, Create Recovery Center’s strong emphasis on sobriety propounds a strong foundation for gambling addiction recovery as well. The clients at Create Recovery Center come from a range of backgrounds and are seeking recovery from a variety of addictions, ranging from alcohol use disorder to compulsive gambling. In Create Recovery Center’s treatment program, people work daily to come to a better understanding of the underlying nature of their addictions and develop tools for dealing with them.
It is Create Recovery Center’s philosophy that recovery from addiction is not just about quitting a certain behavior. It’s about building a new life. Gambling addiction, like all addictions, tends to wreak havoc on a person’s life. Recovering from gambling disorder, therefore, entails a lengthy healing process. But the gift of recovery goes beyond healing past damage and feeling regret — it’s a positive experience of designing and building a new life.
