Compulsive gambling

Overview

Compulsive gambling, also called gambling disorder, is the uncontrollable urge to keep gambling despite the toll it takes on your life. Gambling means that you're willing to risk something you value in the hope of getting something of even greater value.

Gambling can stimulate the brain's reward system much like drugs or alcohol can, leading to addiction. If you have a problem with compulsive gambling, you may continually chase bets that lead to losses, use up savings and create debt. You may hide your behavior and even turn 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 people who struggle with compulsive gambling have found help through professional treatment.

Symptoms

Signs and symptoms of compulsive gambling (gambling disorder) can include:

• Being preoccupied with gambling, such as constantly planning gambling activities and how to get more gambling money
• Needing to gamble with increasing amounts of money to get the same thrill
• Trying to control, cut back or stop gambling, without success
• Feeling restless or irritable when you try to cut down on gambling
• Gambling to escape problems or relieve feelings of helplessness, guilt, anxiety or depression
• Trying to get back lost money by gambling more (chasing losses)
• Lying to family members or others to hide the extent of your gambling
• Risking or losing important relationships, a job, or school or work opportunities because of gambling
• Asking others to bail you out of financial trouble because you gambled money away

Most casual gamblers stop when losing or set a limit on how much they're willing to lose. But people with a compulsive gambling problem are compelled to keep playing to recover their money — a pattern that becomes increasingly destructive over time. Some people may turn to theft or fraud to get gambling money.

Some people with a compulsive gambling problem may have periods of remission — a length of time where they gamble less or not at all. But without treatment, the remission usually isn't permanent.

When to see a doctor or mental health professional

Have family members, friends or co-workers expressed concern about your gambling? If so, listen to their worries. Because denial is almost always a feature of compulsive or addictive behavior, it may be difficult for you to realize that you have a problem.

Causes

Exactly what causes someone to gamble compulsively isn't well understood. Like many problems, compulsive gambling may result from a combination of biological, genetic and environmental factors.

Risk factors

Although most people who play cards or wager never develop a gambling problem, certain factors are more often associated with compulsive gambling:

• Mental health issues. People who gamble compulsively often have substance misuse problems, personality disorders, depression or anxiety. Compulsive gambling may also be associated with bipolar disorder, obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).
• Age. Compulsive gambling is more common in younger and middle-aged people. Gambling during childhood or the teenage years increases the risk of developing compulsive gambling. But compulsive gambling in the older adult population can also be a problem.
• Sex. Compulsive gambling is more common in men than women. Women who gamble typically start later in life and may become addicted more quickly. But gambling patterns among men and women have become increasingly similar.
• Family or friend influence. If your family members or friends have a gambling problem, the chances are greater that you will, too.
• Medications used to treat Parkinson's disease and restless legs syndrome. Drugs called dopamine agonists have a rare side effect that may result in compulsive behaviors, including gambling, in some people.
• Certain personality characteristics. Being highly competitive, a workaholic, impulsive, restless or easily bored may increase your risk of compulsive gambling.

Complications

Compulsive gambling can have profound and long-lasting consequences for your life, such as:

• Relationship problems
• Financial problems, including bankruptcy
• Legal problems or imprisonment
• Poor work performance or job loss
• Poor general health
• Suicide, suicide attempts or suicidal thoughts

Prevention

Although there's no proven way to prevent a gambling problem, educational programs that target individuals and groups at increased risk may be helpful.

If you have risk factors for compulsive gambling, consider avoiding gambling in any form, people who gamble and places where gambling occurs. Get treatment at the earliest sign of a problem to help prevent gambling from becoming worse.

Diagnosis

If you recognize that you may have a problem with gambling, talk with your health care provider about an evaluation or seek help from a mental health professional.

To evaluate your problem with gambling, your health care provider or mental health provider will likely:

• Ask questions related to your gambling habits. Your provider may also ask for permission to speak with family members or friends. However, confidentiality laws prevent your provider from giving out any information about you without your consent.
• Review your medical information. Some drugs can have a rare side effect that results in compulsive behaviors, including gambling, in some people. A physical exam may identify problems with your health that are sometimes associated with compulsive gambling.
• Do a mental health assessment. This assessment includes questions about your symptoms, thoughts, feelings and behavior patterns related to your gambling. Depending on your signs and symptoms, you may be evaluated for mental health disorders that are sometimes related to excessive gambling.

Treatment

Treating compulsive gambling can be challenging. That's partly because most people have a hard time admitting they have a problem. Yet a major part 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 possibly help heal damaged relationships or finances.

Treatment for compulsive gambling may include these approaches:

• Therapy. Behavioral therapy or cognitive behavioral therapy may be helpful. Behavioral therapy uses a process of exposure to the behavior you want to unlearn and teaches you skills to reduce your urge to gamble. Cognitive behavioral therapy focuses on identifying unhealthy, irrational and negative beliefs and replacing them with healthy, positive ones. Family therapy also may be helpful.
• Medications. Antidepressants and mood stabilizers may help treat problems that often go along with compulsive gambling — such as bipolar disorder, depression or anxiety. Some antidepressants may be effective in reducing gambling behavior. Medications called narcotic antagonists, useful in treating substance misuse, may help treat compulsive gambling.
• Self-help groups. Some people find that talking with others who have a gambling problem may be a helpful part of treatment. Ask your health care provider or mental health provider for advice on self-help groups, such as Gamblers Anonymous and other resources.

Treatment for compulsive gambling may involve an outpatient program, inpatient program or a residential treatment program, depending on your needs and resources. Self-help treatments such as structured internet-based programs and telephone visits with a mental health professional may be an option for some people.

Treatment for substance misuse, depression, anxiety or any other mental health issue may be part of your treatment plan for compulsive gambling.

Relapse prevention

Even with treatment, you may return to gambling, especially if you spend time with people who gamble or you're in gambling settings. If you feel that you'll start gambling again, contact your mental health provider or sponsor right away to prevent a relapse.

Coping and support

These recovery skills may help you to resist the urges of compulsive gambling

• Stay focused on your No. 1 goal: Not to gamble.
• Tell yourself it's too risky to gamble at all. One bet typically leads to another and another.
• Give yourself permission to ask for help, as sheer willpower isn't enough to overcome compulsive gambling. Ask a family member or friend to encourage you to follow your treatment plan.
• Recognize and then avoid situations that trigger your urge to bet.

Family members of people with a compulsive gambling problem may benefit from counseling, even if the gambler is unwilling to participate in therapy.

Preparing for your appointment

If you've decided to seek help for compulsive gambling, you've taken an important first step.

What you can do

Before your appointment, make a list of:

• All the feelings you're experiencing, even if they seem unrelated to your problem. 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.
• Key personal information, including any major stresses or recent life changes.
• All medications, vitamins, herbs or other supplements that you're taking, including the dosages.
• Other physical or mental health problems that you have and any treatments.
• Questions to ask your provider to make the most of your appointment time.

Questions to ask may include:

• What's the best approach to my gambling problem?
• What are other options to the primary approach that you're suggesting?
• Should I see a psychiatrist, psychologist, addiction counselor or other mental health professional?
• Will my insurance cover seeing these professionals?
• Can I get help as an outpatient or would I need inpatient treatment?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your health care provider or mental health provider will likely ask you several questions, such as:

• When did your gambling first start?
• How often do you gamble?
• How has gambling affected your life?
• Are your friends or family members worried about your gambling?
• When you gamble, how much do you typically put on the line?
• Have you tried to quit on your own? What happened when you did?
• Have you ever been treated for a gambling problem?
• Are you ready to get the treatment needed for your gambling problem?

To make the most of your appointment time, be ready to answer these questions and to provide an accurate picture of your gambling issues.