Excessive gambling can drain finances, ruin personal and professional relationships, and harm the gambler’s mental health. Gambling disorder affects about 1% of Americans who can’t stop, despite the consequences. Gambling covers more than a trip to the casino or an illicit poker game – it includes lotteries, online poker, and sports betting, and there's a debate over whether it also includes daily fantasy sports leagues.
Yale Medicine is a leader in gambling disorder treatment research, with one of two Centers of Excellence in gambling research in the nation financed by the National Center for Responsible Gaming located at Yale. We take a multidisciplinary approach, including brain imaging, pharmacology, and genetics, to investigate the neurobiology and treatment of gambling disorder.
What are the risk factors for gambling disorder?
Risk factors for gambling disorder may include:
- Sex. Men are more likely to have gambling problems than women, but the disparity seems to have narrowed in recent years. Men appear more drawn to such strategic forms of gambling as card games or sports betting, while women tend to prefer such non-strategic forms as bingo or slot machines.
- Age. Two to 7% of youths develop a gambling disorder, compared with about 1% of adults, and many gambling disorders begin in adolescence. College students also gamble at higher rates than the general population.
- Family. People who have a parent with a gambling problem are more likely to have problems too. Yale research is working to understand the connection between genetics and gambling disorders. It’s estimated that a gambling disorder’s development is 50 percent due to genetic factors and 50 percent due to environmental factors.
- Other behavior or mood disorders. People with gambling disorder often abuse alcohol, tobacco, or other drugs, have mood or personality disorders such as schizophrenia or antisocial personality disorder, or have attention deficit hyperactivity disorder (ADHD). A 2008 study showed that people with psychiatric disorders are 17 times more likely to develop gambling problems.
- Personality traits. People who tend to be restless, easily bored, extremely hard-working, or very competitive may be at greater risk of developing gambling disorder.
What’s the difference between enjoying gambling and gambling disorder?
Most adults who gamble do not have a gambling disorder, but those who do can face very serious problems. An afflicted gambler may deplete savings, borrow money, or liquidate retirement accounts to finance their gambling, damage personal relationships (especially with a spouse and family), and have troubles at work. People with a gambling disorder often feel guilt or shame and may experience such withdrawal symptoms as restlessness and irritability when attempting to stop gambling.
Many people may take gambling lightly, not realizing that it may be addictive in many of the same ways as drugs are. Gambling problems can be very harmful to affected individuals and their families.
How is gambling disorder diagnosed?
People who, over a 12-month period meet four of these nine criteria devised by the American Psychiatric Association, are considered to have a gambling disorder:
- Need to gamble with increasing amounts of money in order to achieve the desired excitement
- Are restless or irritable when attempting to cut down or stop gambling
- Have made repeated unsuccessful efforts to control, cut back, or stop gambling
- Are often preoccupied with gambling (e.g. having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)
- Often gamble when feeling distressed (e.g. helpless, guilty, anxious, depressed)
- After losing money gambling, often return another day to get even (“chasing” one’s losses)
- Lie to conceal the extent of involvement with gambling
- Have jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
- Rely on others to provide money to relieve desperate financial situations caused by gambling
What are the treatment options for gambling disorder?
There are three main forms of interventions:
- Psychotherapy. Individual and group approaches such as cognitive behavioral therapy, which helps to identify and modify damaging thinking and behavior, can help people overcome the problem. Another method is motivational interviewing, which helps to turn ambivalence about quitting into motivation to quit and can help patients combat urges to gamble.
- Medications. There are multiple potential pharmaceutical approaches to treatment, although no medication has an FDA indication for gambling disorder. Such opioid antagonists as naltrexone and nalmefene, which may reduce cravings for alcohol, have been found in randomized clinical trials to be superior to placebo in the treatment of gambling disorders. The antidepressant and antianxiety medication escitalopram may help decrease anxiety and problem-gambling severity in people with co-occurring anxiety and gambling disorders. The mood stabilizer lithium has been shown to reduce mania and problem-gambling severity in individuals with co-occurring bipolar-spectrum and gambling disorders. However, most medication trials have been relatively short-term and have involved small sample sizes.
- Support groups. Some people with gambling disorder find help with such groups as Gamblers Anonymous, a 12-step program dedicated to abstinence. Participants meet and share experiences, supporting each other in their efforts to abstain from gambling.
What makes Yale Medicine’s gambling disorder research unique?
Yale’s Center of Excellence in Gambling Research, one of two such centers in the nation, is supported by the National Center for Responsible Gaming and conducts groundbreaking research into gambling disorder.
The Center, directed by Yale Medicine psychiatrist Marc Potenza, MD, PhD, has conducted the first brain imaging studies on people with gambling problems. The functional imaging investigations, along with volumetric and neurochemical studies, have found that the brain acts similarly during monetary reward processing in individuals with gambling disorder as it does in people with binge-eating, alcohol-use and tobacco-use disorders. Yale Medicine research has made advances in understanding the effects of such opioid antagonist medications as naltrexone and nalmefene on gambling problems (including planning and participating in the largest multi-center, randomized clinical trial thus far to investigate pharmacotherapy for treating gambling disorder). The Yale Center has also investigated gender-related differences in gambling behaviors and disorders. Next for the Center is tracking the brain’s activity during effective behavioral and pharmacological treatments.
Dr. Potenza is also director of the Problem Gambling Clinic, a collaboration between the Yale Department of Psychiatry and the Connecticut Mental Health Center, which treats patients and conducts research into gambling disorder. He is also a consulting psychiatrist for and medical director of the New Haven component of the Bettor Choice program operated through The Connection.