Harvard Mental Health Letter

Pathological gambling

Problem gambling behavior was first mentioned in the medical literature in the early 1800s, but the American Psychiatric Association did not classify pathological gambling as a psychiatric disorder until 1980, in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). An ongoing discussion in the mental health community is whether gambling is an impulse control disorder — as it is currently classified in the DSM-IV — or whether it is better understood as an addiction, as the DSM-V proposes (see "Symptoms of pathological gambling"). Epidemiological studies have found that pathological gambling often occurs in conjunction with dependence on a chemical substance. While roughly 1% to 3% of people in the general population develop a pathological gambling disorder at some point in their lives, as many as 5% to 33% of people with substance use disorders will do so. One national survey found that pathological gamblers were five times as likely as those in the general population to be dependent on alcohol, and nearly seven times as likely to be dependent on nicotine. The DSM-V work group cited other evidence to support its proposal that pathological gambling be considered an addiction. Genetic studies suggest that people who develop pathological gambling or a substance use disorder are more likely than those in the general population to have particular gene types (alleles) associated with impulsive behavior. Brain imaging studies have reported that both substance use disorders and pathological gambling create similar types of dysfunctions in a neural circuit involved in reward processing and decision making. Regardless of how pathological gambling is eventually classified, however, many of the strategies for treating it are based on those used for substance use disorders. Although there is no consensus yet about which therapies are best, several have emerged as the most promising.
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