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Diagnosis: The Signs and Symptoms of Gambling Addiction

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

According to our definition of addiction, people can develop addictions to activities as well as substances. Professionals refer to gambling addiction as gambling disorder. .  Gambling disorder is included in the category of disorders called, "Substance Related and Addictive Disorders." The rationale behind this change in classification stems from substantial research that shows the neurological similarities between gambling addiction and drug addiction. Paradoxically, research suggests that it is the "near-misses" (not wins) that lead to increased levels of dopamine during gambling (Chase & Clark, 2010).

It may be difficult to understand how someone might become addicted to an activity in the same way that people become addicted to drugs.   It is helpful to recognize that people do not actually become "addicted" to drugs or activities themselves.  Instead, people become "addicted" to the effect of those drugs and activities on the brain.  From this more accurate perspective, it becomes easier to understand how activities can become addictive. This is because certain activities have the same chemical effect in the brain as drugs. Therefore, some addictions occur because drugs are added to the body.  These drugs alter the brain's functioning.  Certain activities can achieve a similar effect.  These activities alter brain chemistry in a manner that is similar to alcohol or other drugs.  

Activities such as gambling, eating, and sex increase levels of dopamine in the brain in the same way that using cocaine or nicotine does. Dopamine is a neurotransmitter that causes pleasurable feelings. Due to the brain's reward system, people are more likely to repeat behaviors that result in the pleasurable release of Dopamine.

Of course, it is sensible to wonder, "When does a healthy activity like eating or sex become an addiction?" A simple way to distinguish between ordinary pleasurable activities and addiction is to review the definition of addiction. When a person continues to engage in a pleasurable activity even thought the negative consequences outweigh the benefits, we can begin to speak of an activity addiction. When an activity takes on a compulsive quality, we can speak of an activity addiction. However, professionals can best determine these sorts of distinctions.

Regardless of the specific form of activity addiction, the pleasures of addictive activity are short-lived. As momentary pleasure subsides, the pursuit begins again. This is similar to the pattern seen in drug and alcohol addictions. Pleasure eventually gives way to compulsions in an effort to reduce the tension associated with cravings.

Gambling activity resembles addiction to alcohol or other drugs when it becomes the primary source of pleasure in life, or replaces other healthy interests (work, relationships, recreation, etc.). Gambling addiction is indicated when someone experiences a reduced control over their behavior despite negative consequences. Examples of these consequences include: arguments with a partner over financial problems due to gambling; losing a job because of using a company computer for gambling; becoming a victim of assault because of failing to pay unconventional loans; and many other health, legal, and financial problems. Gambling addiction is also indicated when gambling activities become compulsive. For more detailed information about the diagnosis of gambling addiction please refer to our topic center on addiction.

If you wonder whether you or someone you love has a gambling addiction, get a professional evaluation. It is best to choose someone who specializes in addictive disorders. Some professionals are highly specialized. Their practice may be limited to certain types of addictions such as gambling addiction or sex addiction. Recovery from gambling can be more complicated than with drugs or alcohol. With alcohol and other drug addictions, complete abstinence is an achievable, clearly defined recovery goal. With gambling, abstinence is certainly achievable, but defining what represents abstinence may not be as clear-cut.

The severity of gambling addiction

The DSM-5 uses a dimensional scale to estimate the severity of addiction.  This scale based upon the total number of symptoms matching the diagnostic criteria.   The scale ranges from mild-to moderate-to severe.  Clinicians include this severity code as part of the diagnosis.