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Pathological gambling is the inability to resist impulses to gamble, leading to severe personal or social consequences.

Gambling - compulsive; Compulsive gambling; Addictive gambling

Pathological gambling affects 1-2% of adults, and up to 4% of adults living within 50 miles of a casino. It typically begins in early adolescence in men and between ages 20 and 40 in women.

Pathological gambling is a brain disease that seems to be similar to disorders such as alcoholism and drug addiction. These disorders likely involve problems with the part of the brain associated with behaviors such as eating and sex. This part of the brain is sometimes called the "pleasure center" or dopamine reward pathway.

In people who develop pathological gambling, occasional gambling leads to habitual gambling. Stressful situations can make gambling problems more severe.

People with pathological gambling often feel ashamed and try to avoid letting others know of their problem. The American Psychiatric Association defines pathological gambling as consisting of five or more of the following symptoms:

• Preoccupation with gambling (spending much of the time thinking about gambling, such as past experiences, or ways to get more money to gamble with)
• Needing to gamble larger amounts of money in order to feel excitement
• Repeated unsuccessful attempts to cut back or quit gambling
• Restlessness or irritability when trying to cut back or quit gambling
• Gambling to escape problems or feelings of sadness or anxiety
• Chasing losses (gambling larger amounts of money to try to make back previous losses)
• Lying about the amount of time or money spent gambling
• Committing crimes to get money to gamble
• Loss of job, significant relationship, or educational or career opportunity due to gambling
• Need to borrow money for survival due to gambling losses

A psychiatric evaluation and history can be used to diagnose pathological gambling. Screening tools such as the Gamblers Anonymous 20 Questions may also be used to assist in diagnosis.

Treatment for people with pathological gambling begins with the recognition of the problem. Since pathological gambling is often associated with denial, people with the illness often refuse to accept that they are ill or need treatment. Most people with pathological gambling enter treatment under pressure from others, rather than voluntarily accepting the need for treatment.

Treatment options include individual and group psychotherapy, medications, and self-help support groups such as Gamblers Anonymous. Gamblers Anonymous is a 12-step program similar to Alcoholics Anonymous. Abstinence principles that apply to other types of addiction, such as substance abuse and alcohol dependence, can also be helpful in the treatment of pathological gambling.

A few studies have been done on medications for the treatment of pathological gambling. Early results suggest that antidepressants, opioid antagonists, and mood stabilizers may help treat the symptoms of pathological gambling.

Like alcohol or drug addiction, pathological gambling is a chronic disorder that tends to get worse without treatment. Even with treatment, relapses are common. Nevertheless, people with pathological gambling can do very well with appropriate treatment.

People with pathological gambling often have problems with substance abuse, depression, and anxiety. For example, up to half of people with pathological gambling also have alcohol and drug abuse problems. People with pathological gambling frequently consider suicide, and 15-20% of them attempt it.

People with pathological gambling tend to experience financial, social, and legal problems. These can include bankruptcy, divorce, job loss, and incarceration. The stress and excitement of gambling may lead to heart attacks in vulnerable people. Many of these complications can be prevented with appropriate treatment.

Call your health care provider or mental health professional if you believe you have symptoms of pathological gambling.

Exposure to gambling may increase the risk of developing pathological gambling. Minimizing exposure may be helpful for vulnerable people. Public exposure to gambling, however, continues to increase in the form of lotteries, electronic and Internet gambling, and casinos. Intervention at the earliest signs of pathological gambling may prevent worsening of the disorder.