Gambling Problems: Signs and Symptoms of a Disorder

The staggering expansion of sports betting after decades of casino expansion certainly gives any sane person reason to pause.

For most bettors, gambling is an occasional form of entertainment — Powerball tickets when the jackpot swells to $1 billion, Super Bowl squares with co-workers, a birthday trip to the casino.

But for other people, the possibility of developing a gambling disorder looms.

How worried should Americans be?

To play is to be human

A nuanced answer begins with the fact that gambling has been popular for a long, long time.

Evidence of gambling has been found in ancient cultures around the world. Archaeologists have unearthed dice marked with eyes, or dots, in Mesopotamia that date back to 1300 BC. go back. Historians have records of dice games in Greek and Indian cities before 400 BC. found

In North America, a Navajo myth tells the story of Noqoìlpi, or “the gambler”. Informal gambling and lotteries were common in the American colonies, including lotteries to fund the Continental Army.

In the US, sports and gambling have long been intertwined. In the decades following the Civil War, billiard halls were set up near Western Union stations so gamblers could easily place bets on horses. And sports like baseball and boxing became very popular in the 19th century, in part because they attracted competitors.

For as long as gambling has existed, there has also been problem gambling.

Several writers in ancient India highlighted the consequences of habitual gambling. Over 150 years ago, Dostoyevsky famously wrote Crime and Punishment to pay off gambling debts. And in the 20th century, sports betting imploded the careers of baseball legends “Shoeless” Joe Jackson and Pete Rose.

If problems occur

I’m telling this story because it shows that people always seem to have found a way to gamble, whether it’s legal or not. And inevitably, some bettors will suffer harm or experience gambling disorder.

I lead the Institute for Gambling Education and Research where we focus on treating gambling disorders and gambling problems.

Psychologists have only recently begun to view problem gamblers as a form of addictive behavior in which gambling, tolerance, and withdrawal are related to addictive development. Researchers have found that brain imaging data and symptom patterns of problem gamblers are similar to those of people who are addicted to drugs or alcohol. Players can build up tolerance, meaning they have to play more and bet higher amounts to maintain the same level of excitement. And attempts to cut back or quit can lead to emotional struggles.

There are also financial and social implications of gambling disorder.

Lack of money is the most commonly cited reason people start wondering if they have a problem. However, other symptoms include damage to relationships, deterioration in mood, and the physical cost of this strain. Problem gamblers often lie about or hide their gambling, which can make it difficult for loved ones to spot.

The best prevalence research shows that anywhere from 1% to 2% of the US adult population, or 2 to 4 million adults, will experience a gambling disorder in their lifetime. Another 3% to 5%, or 5 to 9 million people, will report a subclinical problem at some point in their lives, meaning some symptoms of a gambling disorder are present but the psychiatric diagnosis is not warranted.

Despite some hand-wringing over the expansion of sports betting, I believe any increase in the problem rate is likely to be temporary. A review of 30 years of research on the prevalence of problem gambling and gambling disorders reveals a pattern. Greater availability of gambling tends to increase the number of people reporting gambling problems in the short term. However, populations tend to adapt over time; the rate of gambling problems decreases accordingly.

It will be interesting to see if the same pattern applies to sports betting.

treatment obstacles

My team also runs an outpatient clinic where we treat people with gambling addiction. Our research and therapy sessions have pointed out some encouraging news, along with some obstacles.

The good news is that treatment, especially when it includes cognitive behavioral techniques, significantly reduces gambling disorder symptoms and psychological distress. While long-term treatment is recommended, an effective course of treatment is around eight to ten sessions.

However, there are still roadblocks. People are often reluctant to try treatment; those who drop out frequently.

People are often unaware that they have gambling problems, even when they report symptoms of gambling problems. We don’t know exactly why. However, the impact is significant. Only about 10% of people with a gambling problem ever seek treatment. For comparison, the rate of seeking help for people with substance use disorders ranges from 10% to 50%. It is significantly lower than in people with depression and anxiety, of whom 70% to 90% seek treatment.

We also know that gambling disorders are one of the most stigmatized mental health issues. We find that people tend to blame someone who has developed gaming problems and see them as dangerous or untrustworthy. In contrast, someone suffering from depression and anxiety is less likely to be blamed for their problems.

The other challenge is the frequency with which people discontinue treatment before completing the standard course of therapy. For most mental health problems, 20% of those who begin psychological treatment do not continue with that treatment. In comparison, the drop-out rate due to gambling damage is almost twice as high: 39%.

We believe that the dropout rate is not explained by people not wanting to put in the work to change. Instead, the relationship with the therapist and ambivalence about the progress made tends to derail the treatment process. Finances are also a real problem. Patients may not be able to afford their appointments or their insurance may not cover a gambling addiction diagnosis.

Knowledge and funding gaps

About a decade ago, an alcohol researcher friend noted that thinking and research about gambling lagged behind alcohol by about four decades. The knowledge gaps were obvious. We still don’t have good models for how a gambling problem develops or how to conceptualize an addiction without substance. We don’t know the long-term effects of gaming problems and gaming disruptions. And we don’t fully understand to what extent improvements from treatment are preserved.

As researchers around the world fill in these gaps in knowledge, major challenges remain – not the least of which is that gambling regulations are constantly changing and new forms of gambling are emerging.

More importantly, there are few resources available to learn more about gaming disruption — and almost no funding from the US government. In 2022, the National Institutes of Health invested over $570 million to study alcohol use problems.

The amount the NIH budgeted for the study of gambling?

Zero.

James P. Whelan is a Research Professor of Clinical Health at the University of Memphis

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