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David Baxter PhD

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Compulsive gambling
By Mayo Clinic Staff
Jan. 20, 2009

Compulsive gambling is the uncontrollable urge to keep gambling despite the toll it takes on your life. If you're prone to compulsive gambling, you may continually chase bets, may lie or hide your behavior, and may resort to theft or fraud to support your addiction.

Compulsive gambling is a serious condition that can destroy lives. Although treating compulsive gambling can be challenging, many compulsive gamblers have found help through professional treatment.

On rare occasions, gambling becomes a problem with the very first wager. But more often, gambling progresses over time. In fact, you may spend years enjoying social gambling without any ill effects. But more frequent gambling or life stresses can turn casual gambling into something much more serious. During periods of stress or depression, the urge to gamble may be especially overpowering. Eventually, you become almost completely preoccupied with gambling and getting money to gamble.

For most compulsive gamblers, betting isn't as much about money as it is about excitement. Sustaining the thrill gambling provides usually involves taking increasingly bigger risks and placing larger bets. Those bets may involve sums you can't afford to lose. Unlike most casual gamblers, compulsive gamblers are compelled to keep playing to recoup their money ? a pattern that becomes increasingly destructive over time.

Signs of compulsive (pathologic) gambling include:

  • Gaining a thrill from taking big gambling risks
  • Taking increasingly bigger gambling risks
  • A preoccupation with gambling
  • Reliving past gambling experiences
  • Taking time from work or family life to gamble
  • Concealing gambling
  • Feeling guilt or remorse after gambling
  • Borrowing money or stealing to gamble
  • Failed efforts to cut back on gambling
  • Lying to hide gambling
  • In severe cases, financial ruin, legal trouble, loss of career and family, and even suicide
Compulsive gambling is an impulse-control disorder. This means that you're not able to resist engaging in behavior that's harmful to you or to someone else. People with impulse-control disorders usually feel a sense of emotional arousal or excitement before engaging in the behavior, followed by pleasure and gratification, and then guilt or remorse.

When to see a doctor or mental health provider
Have family members, friends or co-workers expressed concern about your gambling? If so, listen to their worries. Because denial is almost always a characteristic of compulsive or addictive behavior, it may be difficult for you to recognize that you have a problem and seek treatment.

Your gambling is out of control if:

  • It's affecting your relationships, your finances or your work life
  • You're devoting more and more time and energy to gambling pursuits
  • You've unsuccessfully tried to stop or cut back on your gambling
  • You try to conceal your gambling from family or health professionals
  • You resort to theft or fraud to get gambling money
  • You ask others to bail you out of financial woes because you've gambled money away
It's not known exactly what drives people to engage in compulsive gambling, but like many problems, it may result from a combination of genetic and environmental factors. Studies show that problems with certain naturally occurring chemicals in the brain may play a role, especially the neurotransmitters serotonin, norepinephrine (noradrenaline) and dopamine. Some of these problems may be genetically determined.

Neurotransmitters act as chemical messengers that enable nerve cells (neurons) to communicate. Neurotransmitters are released into the gaps (synapses) between nerve cells in the brain to help messages flow from one cell to another. If neurons don't produce enough of these chemicals, messages aren't communicated effectively. Serotonin is a chemical in the brain that plays a key role in regulating mood and behavior.

Role of the reward system
Norepinephrine, a hormone released in response to stress, has been linked to arousal and risk-taking in compulsive gamblers. Brain cells release dopamine as part of the reward system through which you learn to seek things that make you feel pleasure, such as food and sex. Dopamine plays a role in developing addiction. Together, these may set the stage for compulsive gambling.

Role of altered brain function
In some cases, certain medications or traumatic head injuries that alter brain function can contribute to compulsive gambling. This is especially true of injuries to the orbitofrontal cortex, a poorly understood part of the brain involved in decision making and in processing reward and punishment, including monetary gain and loss. Neuroimaging studies of the orbitofrontal cortex of compulsive gamblers support the idea that the disorder has a biological basis.

Risk factors
Compulsive gambling affects both men and women and cuts across cultural and socio-economic lines. Although most people who play cards or wager never develop a gambling problem, certain factors can increase your risk:

  • Other behavior or mood disorders. People who gamble often have substance abuse problems as well as mood and personality disorders. Many compulsive gamblers abuse alcohol, and close to three-fourths of compulsive gamblers experience major depression.
  • Your age. You may be more likely to develop an addiction to gambling if you begin to gamble at a young age.
  • Your sex. Compulsive gambling generally occurs in men ages 21 to 55, although the incidence is increasing among teenage boys. Far fewer women than men are compulsive gamblers, but women who do gamble may become addicted more quickly. Men tend to play blackjack and cards and to bet on sporting events and horse races. Women are more likely to play the slot machines and bingo.
  • Location. People who live close to a casino or betting facility are more likely to develop a gambling problem. Even more problematic is access to video lotteries, sometimes called the "crack cocaine" of gambling because of their highly addictive nature.
  • Family influence. If your parents had a gambling problem, the chances are greater that you will too.
  • Medications used to treat Parkinson's disease. Medications called dopamine agonists, and in particular pramipexole (Mirapex), have a rare side effect that results in compulsive behavior in some people.
  • Certain personality characteristics. Being highly competitive, a workaholic, restless or easily bored may increase your risk.
Compulsive gambling can have profound and long-lasting consequences for your life, including:

  • Estrangement of family and friends
  • Financial problems, including bankruptcy
  • Legal problems or incarceration ? nearly 90 percent of compulsive gamblers commit felonies
  • Job loss or professional stigma
  • Development of associated problems, such as alcohol or drug abuse
  • Suicide ? Gambling hotspots such as Las Vegas and Atlantic City, New Jersey, have some of the highest suicide rates in the country
Preparing for your appointment
If you've made the choice to seek help for your gambling, you've taken a huge first step. Start by talking to your primary care doctor. If it seems that you have a serious problem, you'll likely be referred to a mental health provider for further evaluation and treatment. These suggestions can help you get the most from your appointments:

  • Write down all the feelings you're experiencing, even if they seem unrelated to your problem. Be sure to note what triggers your gambling, whether you've tried to resist the urge to gamble, and the effect that gambling has had on your life.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, as well as any vitamins or supplements, that you're taking. Better yet, take the original bottles and a written list of the dosages and directions.
Tests and diagnosis
About 2 million Americans are classified as compulsive gamblers ? that is, they meet the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. Another 4 million to 6 million adults are considered "problem gamblers." They meet some, but not all, of the criteria for compulsive gambling.

DSM criteria for the diagnosis of compulsive gambling require that at least five of the following signs and symptoms must be present:

  • Being preoccupied with gambling, such as reliving past gambling experiences or planning ways to get gambling money
  • Needing to gamble with increasing amounts of money to become excited
  • Trying to cut back on gambling, without success
  • Getting restless or irritable when attempting to cut down on gambling
  • Gambling as a way to escape problems or to relieve feelings of helplessness or sadness
  • Chasing losses, or trying to gamble back lost money
  • Lying to family members, therapists or others to hide the extent of gambling
  • Committing fraud, theft or other illegal acts for the sake of gambling
  • Jeopardizing or losing an important relationship, job, or educational or career opportunity because of gambling
  • Turning to others for money when the financial situation becomes desperate
Because excessive gambling can sometimes be a sign of bipolar disorder, mental health providers are careful to rule out other reasons for this behavior.

Treatments and drugs
Treating compulsive gambling can be challenging. That's partly because most people have a hard time admitting they have a problem. Yet a major component of treatment is working on acknowledging that you're a compulsive gambler. If your family or your employer pressured you into therapy, you may find yourself resisting treatment. But treating a gambling problem can help you regain a sense of control ? and perhaps even help heal damaged relationships or finances.

Treatment for compulsive gambling involves three main approaches:

  • Psychotherapy. A form of psychotherapy called cognitive behavior therapy (CBT) may be especially beneficial for compulsive gambling. CBT focuses on identifying unhealthy, irrational and negative beliefs and replacing them with healthy, positive ones. Group therapy also may be helpful. In group therapy, you're able to tap into advice, feedback and support from people facing similar issues.
  • Medications. Antidepressants and mood stabilizers may help emotional issues that often go along with compulsive gambling, but not necessarily compulsive gambling itself. Medications called narcotic antagonists, which have been found useful in treating substance abuse, may help treat compulsive gambling.
  • Self-help groups. Some people find self-help groups such as Gamblers Anonymous a helpful part of treatment. Gamblers Anonymous doesn't have the track record of Alcoholics Anonymous, however.
Even with treatment, you may return to gambling, especially if you spend time with people who gamble or in gambling environments. If you feel that you'll start gambling again, contact your health care professional or sponsor right away to head off a full-blown relapse.

Coping and support
The appeal of gambling is hard to overcome if you keep thinking that you'll win next time. Here are some recovery skills that may help you remain focused on resisting the urges of compulsive gambling:

  • Tell yourself that it's too risky to gamble at all. One bet typically leads to another and another.
  • Give yourself permission to ask for help, as part of realizing that sheer will power isn't enough to overcome compulsive gambling.
  • Stay focused on your No. 1 goal: Not to gamble. Coping skills to better manage the other issues in your life can only be initiated when you aren't gambling.
  • Recognize and then avoid situations that trigger your urge to bet.
Family members of compulsive gamblers can get counseling and, in some cases, funding, even if the gambler is unwilling to participate in therapy.

There's no proven way to prevent a gambling problem from occurring or recurring. But if you have risk factors for compulsive gambling, avoiding gambling in any form, people who gamble, and places where gambling occurs may help. Getting treatment at the earliest sign of a problem may help prevent a gambling disorder from becoming worse.
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