Symptoms

Signs and symptoms of compulsive (pathologic) gambling include:

• Gaining a thrill from taking big gambling risks
• Taking increasingly bigger gambling risks
• A preoccupation with gambling
• Reliving past gambling experiences
• Gambling as a way to escape problems or feelings of helplessness, guilt or depression
• Taking time from work or family life to gamble
• Concealing gambling
• Feeling guilt or remorse after gambling
• Borrowing money or stealing to gamble
• Failed efforts to cut back on gambling
• Lying to hide gambling

Compulsive gambling typically begins in the late teen years. On rare occasions, gambling becomes a problem with the very first wager. But more often, a gambling problem progresses over time. In fact, many people spend years enjoying social gambling without any problems. But more frequent gambling or life stresses can turn casual gambling into something much more serious. During periods of stress or depression, the urge to gamble may be especially overpowering. Eventually, a person with a gambling problem becomes almost completely preoccupied with gambling and getting money to gamble.

For most compulsive gamblers, betting isn't as much about money as it is about the excitement. Sustaining the thrill gambling provides usually involves taking increasingly bigger risks and placing larger bets. Those bets may involve sums you can't afford to lose. Unlike most casual gamblers, compulsive gamblers are compelled to keep playing to recoup their money — a pattern that becomes increasingly destructive over time.

When to see a doctor or mental health provider Have family members, friends or co-workers expressed concern about your gambling? If so, listen to their worries. Because denial is almost always a characteristic of compulsive or addictive behavior, it may be difficult for you to recognize that you have a problem and seek treatment.

Gambling is out of control if:

• It's affecting your relationships, your finances or your work life
• You're devoting more and more time and energy to gambling pursuits
• You've unsuccessfully tried to stop or cut back on your gambling
• You try to conceal your gambling from family or health professionals
• You resort to theft or fraud to get gambling money
• You ask others to bail you out of financial woes because you've gambled money away

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

Compulsive gambling affects both men and women and cuts across cultural and socio-economic lines. Although most people who play cards or wager never develop a gambling problem, certain factors are more often associated with compulsive gamblers:

• Other behavior or mood disorders. People who seem to gamble compulsively often have substance abuse problems, mood and personality disorders, as well as attention-deficit/hyperactivity disorder (ADHD). Many compulsive gamblers abuse alcohol, and many compulsive gamblers experience major depression.
• Age. Compulsive gambling is more common in younger people.
• Sex. Compulsive gambling is more common in men than women. Women who do gamble typically start later in life, are more apt to have depression and gamble as a way of escape from problems, and may become addicted more quickly.But in recent years, gambling patterns among men and women have become more similar.
• Family influence. If your parents had a gambling problem, the chances are greater that you will too.
• Medications used to treat Parkinson's disease. Medications called dopamine agonists have a rare side effect that results in compulsive behavior in some people.
• Certain personality characteristics. Being highly competitive, a workaholic, restless or easily bored may increase your risk.

Complications

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

• Relationship problems
• Financial problems, including bankruptcy
• Legal problems or incarceration
• Job loss or professional stigma
• Development of associated problems, such as alcohol or drug abuse
• Suicide

Appointment

If you've made the choice to seek help for your gambling, you've taken an important first step. Start by talking to your primary care doctor. If it seems that you have a serious problem, you'll likely be referred to a mental health provider for further evaluation and treatment. These suggestions can help you get the most from your appointments:

• Write down all the feelings you're experiencing, even if they seem unrelated to your problem. Be sure to 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.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking. Better yet, take the original bottles and a written list of the dosages and directions.

Tests and diagnosis

To be diagnosed with compulsive gambling, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

DSM criteria for the diagnosis of compulsive gambling require that at least five of the following signs and symptoms must be present:

• Being preoccupied with gambling, such as reliving past gambling experiences or planning ways to get gambling money
• Needing to gamble with increasing amounts of money to become excited
• Trying to cut back on gambling, without success
• Getting restless or irritable when attempting to cut down on gambling
• Gambling as a way to escape problems or to relieve feelings of helplessness or sadness
• Chasing losses, or trying to get back lost money by gambling more
• Lying to family members, therapists or others to hide the extent of gambling
• Committing fraud, theft or other illegal acts for the sake of gambling
• Jeopardizing or losing an important relationship, job, or educational or career opportunity because of gambling
• Turning to others for money when the financial situation becomes desperate

Because excessive gambling can sometimes be a sign of bipolar disorder, mental health providers are careful to rule out this disorder before making a diagnosis.

Treatments and drugs

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

Treatment for compulsive gambling involves three main approaches:

• Psychotherapy. Psychological treatments, such as behavior therapy or cognitive behavioral therapy, may be beneficial for compulsive gambling. Behavior therapy uses systematic exposure to the behavior you want to unlearn (gambling) 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.
• Medications. Antidepressants and mood stabilizers may help problems that often go along with compulsive gambling — such as depression, obsessive compulsive disorder or ADHD — but not necessarily compulsive gambling itself. Medications called narcotic antagonists, which have been found useful in treating substance abuse, may help treat compulsive gambling.
• Self-help groups. Some people find self-help groups, such as Gamblers Anonymous, a helpful part of treatment.

Even with treatment, you may return to gambling, especially if you spend time with people who gamble or in gambling environments. If you feel that you'll start gambling again, contact your care provider or sponsor right away to head off a full-blown relapse.

Coping and support

The appeal of gambling is hard to overcome if you keep thinking that you'll win the next time you gamble. Here are some recovery skills that may help you remain focused on resisting the urges of compulsive gambling:

• Tell yourself that it's too risky to gamble at all. One bet typically leads to another and another.
• Give yourself permission to ask for help, as part of realizing that sheer willpower isn't enough to overcome compulsive gambling.
• Stay focused on your No. 1 goal: not to gamble. Coping skills to better manage the other issues in your life can be initiated only when you aren't gambling.
• Recognize and then avoid situations that trigger your urge to bet.

Family members of compulsive gamblers can get counseling, even if the gambler is unwilling to participate in therapy.

Prevention

There's no proven way to prevent a gambling problem from occurring or recurring. But if you have risk factors for compulsive gambling, avoiding gambling in any form, people who gamble and places where gambling occurs may help. Getting treatment at the earliest sign of a problem may help prevent a gambling disorder from becoming worse.