What Is Gambling Addiction?

The image of casinos that the gambling industry wants to give is one of excitement and fun, even glamour and, most of all, harmless entertainment.

Yet, as anyone who has been to a casino knows, you will see very few people who look like they are having fun.  There are very few smiles in a casino like SugarHouse - few smiles from patrons at least.

There is a reason for this, and it is not just that most people, most of the time are losing.  The existing evidence tells us that casinos rely on gambling addiction for profit, and there is nothing fun about gambling addiction.

But what is gambling addiction?

Sometimes referred to, as it is known clinically, as "pathological gambling," "gambling addiciton" is the more common term that refers to this particular illness. 

The American Psychiatric Association (APA), in the authoritative guide to mental illness, the Diagnostic and Statistical Manual (DSM), defines the disorder, Pathological Gambling, as "[p]ersistent and recurring maladaptive gambling behavior as indicated by five (or more)" of a set of ten symptoms.  Those symptoms include a preoccupation with gambling; chasing one's loses, gambling to escape problems or relieve feelings like depression or anxiety, and asking others to relieve a desperate financial situation.

Typically research will also designate levels below Pathological Gambling, where an individual has at least one symptom but fewer than five, as "problem gambling," or some other designation.[1] 

Currently gambling addiciton is classified as an Impulse Control Disorder rather than a Substance-Related Disorder like addiction or dependence on cocaine or alcohol.

But that is set to change.

The DSM V, the next version of the DSM set to come out in 2013, the category Substance-Related Disorders will have a new addition, Gambling Disorder, formerly Pathological Gambling. [2] 

Why the change?  Over the past twenty years a mountain of evidence has led the APA Working Group on Substance-Related Disorders to conclude

Pathological (disordered) gambling has commonalties in clinical expression, etiology, comorbidity, physiology and treatment with Substance Use Disorders.

In other words, in terms of brain pathways, the development of the disease, and co-occuring disorders, gambling addiction is like being addicted to heroin, cocaine, or nicotine.  Those with gambling addiction may even experience shaking or other signs of withdrawl if they stop gambling.

Nobody tells you that when you walk in to a casino.

The image they give is one of harmless entertainment.

What the evidence tells us is that calling frequent gambling "harmless entertainment" is like calling frequent cocaine or heroin use "harmless entertainment."   

[1]  See, for example, Timothy Fong; Addictive Disorders, in Psychiatric Times; September 2009, Vol. 26, Issue 9, p. 20-25.  For research referring to "levels" of gambling disorder, see, for example Andres Boudreau, Richard Labrie, Howard Shaeffer, Towards DSM V: 'Shadow Syndrome' symptom patterns among pathological gamblers, in Addiction Research & Theory; August 2009, Vol. 17, Issue 4, p. 406-419.

[2] The Working Group on Substance-Related Disorders has also "tentatively" changed the category "Substance-Related Disorders," to Substance Use and Addictive Disorders for the DSM V.