Compulsive gambling

Compulsive gambling most often begins in early adolescence in men, and between ages 20 and 40 in women.

People with compulsive gambling have a hard time resisting or controlling the impulse to gamble. The brain is reacting to this impulse in the same manner it reacts to a person addicted to alcohol or illegal drugs. Although it shares features of obsessive compulsive disorder (OCD), compulsive gambling is likely a different condition.

In people who develop compulsive gambling, occasional gambling leads to a gambling habit. Stressful situations can worsen gambling problems.

People with compulsive gambling often feel ashamed and try to avoid letting other people know about their problem. The American Psychiatric Association defines gambling disorder as having 4 or more of the following symptoms:

• Feeling restless or irritable when trying to cut back or quit gambling.
• Gambling to escape problems or feelings of sadness or anxiety.
• Gambling larger amounts of money to try to make back past losses.
• Losing a job, relationship, education, or career opportunity due to gambling.
• Lying about the amount of time or money spent on gambling.
• Making many unsuccessful attempts to cut back or quit gambling.
• Needing to borrow money due to gambling losses.
• Needing to gamble larger amounts of money in order to feel excitement.
• Spending a lot of time thinking about gambling, such as remembering past experiences or ways to get more money with which to gamble.

A psychiatric evaluation and history can be used to diagnose compulsive gambling. Screening tools such as the Gamblers Anonymous 20 Questions at www.gamblersanonymous.org/ga/content/20-questions can help with the diagnosis.

Treatment for people with compulsive gambling begins with recognizing the problem. Compulsive gamblers often deny they have a problem or need treatment.

Most people with compulsive gambling only get treated when other people pressure them.

Treatment options include:

• Cognitive behavioral therapy (CBT).
• Self-help support groups, such as Gamblers Anonymous. Gamblers Anonymous www.gamblersanonymous.org/ga/ is a 12-step program similar to Alcoholics Anonymous. Practices used to treat other types of addiction, such as substance use and alcohol use, can also be helpful in treating compulsive gambling.
• A few studies have been done on medicines for treating compulsive gambling. Early results suggest that antidepressants and opioid antagonists (naltrexone) may help treat the symptoms of compulsive gambling. However, it is not yet clear which people will respond to medicines.

Like alcohol or substance use disorder, compulsive gambling is a long-term disorder that tends to get worse without treatment. Even with treatment, it's common to start gambling again (relapse). However, people with compulsive gambling can do very well with the right treatment.

Complications may include:

• Alcohol and illegal drug use problems
• Anxiety
• Depression
• Financial, social, and legal problems (including bankruptcy, divorce, job loss, time in prison)
• Heart attacks (from the stress and excitement of gambling)
• Suicide attempts

Getting the right treatment can help prevent many of these problems.

Contact your health care provider or mental health professional if you believe you have symptoms of compulsive gambling.

If you or someone you know is thinking about suicide, call or text 988 or chat 988lifeline.org. You can also call 1-800-273-8255 (1-800-273-TALK). The 988 Suicide and Crisis Lifeline provides free and confidential support 24/7, anytime day or night.

You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.

If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.

Exposure to gambling may increase the risk of developing compulsive gambling. Limiting exposure may be helpful for people who are at risk. Intervention at the earliest signs of compulsive gambling may prevent the disorder from getting worse.

Gambling - compulsive; Pathological gambling; Addictive gambling; Gambling disorder

American Psychiatric Association website. Non-substance-related disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR), Washington, DC: American Psychiatric Association Publishing; 2022.

Balodis IM, Potenza MN. The biology and treatment of gambling disorder. In: Johnson BA, ed. Addiction Medicine: Science and Practice. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 33.

Bains A, Sanders KM. Disruptive, impulse-control, and conduct disorders. In: Stern TA, Wilens TE, Fava M, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 3rd ed. Philadelphia, PA: Elsevier; 2025:chap 23.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.