Gambling involves risking something of value on an event that is largely unpredictable, with the intention of winning an equivalent value. It is considered to be a form of entertainment and recreation, and some people are able to control their gambling behaviours while others cannot. It is also seen as a socially unacceptable activity, and it can lead to severe consequences for the gambler. For example, it may cause financial loss and debt, as well as the alienation of friends and family. In some cases, gambling can become a disorder known as pathological gambling.
In the past, psychiatry has considered gambling to be less of an addiction than a compulsion or an impulse-control disorder such as kleptomania (stealing) and pyromania (setting fires). However, in a landmark decision in 1987, the APA moved pathological gambling from the “impulse control disorders” section to the “substance use disorders” section of the Diagnostic and Statistical Manual of Mental Disorders. This change reflected the growing consensus that gambling is an addictive behaviour and that it is similar to other substance addictions.
There are two broad questions that research into gambling can address: First, what does the fact that gamblers sometimes have difficulty controlling their behaviour tell us about the nature of human decision-making? Second, from a clinical perspective, how does this common recreational behaviour develop into a problem?
Many theories of gambling behaviour have emerged from the scientific literature. Some have focused on the role of cognitive and emotional factors in gambling. Others have highlighted the importance of a desire to win and the distorted appraisal of control that often occurs during gambling. Psychobiological studies have also emphasized the involvement of the ventromedial prefrontal cortex, and have identified changes in dopamine neurotransmission.
The reason that some people engage in gambling behaviour while others do not is a subject of debate and continues to be investigated. One suggestion is that the underlying causes include a genetic propensity for impulsiveness, a tendency to engage in sensation-and novelty-seeking, and an increased tolerance to negative emotions. Other factors that have been linked to gambling are the presence of a spouse or other person with a history of gambling, and social or familial pressures to gamble.
It is also possible that a number of medical conditions can be associated with gambling behaviour, including depression, schizophrenia and anxiety. In addition, there are several different forms of psychotherapy that can help people with a gambling problem. These therapies focus on changing unhealthy thoughts, emotions and behaviors, and involve working with a licensed mental health professional. Some of these therapies include group and individual therapy, psychoeducation, and family and marriage counseling. The U.S. Food and Drug Administration does not currently approve any medications to treat gambling disorder, but there are a number of psychotherapies that have been shown to be effective. These therapies are sometimes combined with pharmacotherapy. In some cases, inpatient or residential treatment and rehabilitation programs are available to those who are unable to control their gambling habits without round-the-clock support.