Gambling disorder.

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 such as alcohol can, leading to addiction. If you're prone to compulsive gambling, you may continually chase bets, hide your behavior, deplete savings, accumulate debt, or even resort 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 compulsive gamblers have found help through professional treatment.

SYMPTOMS

Signs and symptoms of compulsive (pathologic) gambling include:

• Gaining a thrill from taking big gambling risks
• Taking increasingly bigger gambling risks
• 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 or lying about gambling
• Feeling guilt or remorse after gambling
• Borrowing money or stealing to gamble
• Failed efforts to cut back on gambling
  

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, serving as an unhealthy escape. Eventually, a person with a gambling problem becomes almost completely preoccupied with gambling and getting money to gamble.

For many compulsive gamblers, betting isn't as much about money as it is about the excitement. Sustaining the thrill that 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 who stop when losing or set a loss limit, compulsive gamblers are compelled to keep playing to recover their money — a pattern that becomes increasingly destructive over time.

Some compulsive gamblers may have remission where they gamble less or not at all for a period of time. However, without treatment, the remission usually isn't permanent.

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.

Gambling is out of control if:

• It's affecting your relationships, finances, or work or school life
• You're devoting more and more time and energy to gambling
• You've unsuccessfully tried to stop or cut back on your gambling
• You try to conceal your gambling from family or others
• 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 it cuts across cultural, social and 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 gamble compulsively often have substance abuse problems, mood or personality disorders, or attention-deficit/hyperactivity disorder (ADHD). Many compulsive gamblers abuse alcohol, and many experience major depression.
• Age. Compulsive gambling is more common in younger and middle-aged people.
• Sex. Compulsive gambling is more common in men than in women. Women who gamble typically start later in life, are more apt to have depression, anxiety or bipolar disorders, and may become addicted more quickly. But gambling patterns among men and women have become increasingly similar.
• Family influence. If one of your parents had a gambling problem, the chances are greater that you will, too.
• Medications used to treat Parkinson's disease and restless legs syndrome. Medications called dopamine agonists have a rare side effect that results in compulsive behaviors, including gambling, 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, such as:

• Relationship problems
• Financial problems, including bankruptcy
• Legal problems or imprisonment
• Job loss or professional stigma
• Associated alcohol or drug abuse
• Poor general health
• Mental health disorders, such as depression
• Suicide

PREPARING FOR YOUR 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 more evaluation and treatment.

What you can do

These suggestions can help you get the most from your appointments. Make a list of:

• 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.
• 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.

Make a list of questions to ask your doctor, such as:

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

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

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them so you'll have time to go over any points you want to focus on. Your doctor may ask:

• When did your gambling first start?
• How often do you gamble?
• 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?

TESTS AND DIAGNOSIS

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

DSM criteria for the diagnosis of gambling disorder require that a person have four or more of the following signs and symptoms present within one year:

• Is preoccupied with gambling, such as reliving past gambling experiences or planning ways to get gambling money
• Needs to gamble with increasing amounts of money to become excited
• Tries to control, cut back or stop gambling, without success
• Gets restless or irritable when attempting to cut down on gambling
• Gambles as a way to escape problems or to relieve feelings of helplessness or sadness
• Chases losses, or tries to get back lost money by gambling more
• Lies to family members, therapists or others to hide the extent of gambling
• Jeopardizes or loses an important relationship, job, or educational or career opportunity because of gambling
• Turns to others for money when the financial situation becomes desperate

Because excessive gambling can sometimes be a sign of bipolar disorder, mental health providers need 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 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 it may 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 treat 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 you're in gambling environments. If you feel that you'll start gambling again, contact your mental health provider or sponsor right away to head off a full-blown relapse.

LIFESTYLE AND HOME REMEDIES

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

COPING AND SUPPORT

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

• 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 part of realizing that sheer willpower isn't enough to overcome compulsive gambling. Ask a family member or friend to encourage you to follow your treatment plan.
• 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.