Background
American Society of Addiction Medicine (ASAM) president and National Institute on Drug Abuse (NIDA) director both recently delivered remarks about the rise in problem gaming, especially in the context of online sports betting that can now be done from a smartphone in 26 states
24/7 nature of mobile gambling platforms have resulted in a faster progression to disordered use
Heavily promoted in social media and sports media
Biology
Scientific literature shows that Gambling Disorder (GD) has the same underlying neurobiological mechanisms as SUDs and is the only behavioral addiction recognized in the DSM-5.
Involves mesocorticolimbic dopamine pathways, altered reward processing and impaired cognition
People have cravings, withdrawals, tolerance and generally experience negative consequences like financial and relationship problems
Gambling is the addiction most closely associated with suicidality (More than heroin, cocaine, or alcohol).
Risk Factors
Male, young, single or married < 5 years, living alone, low level of education, financial struggles.
Individuals with Parkinson disease treated with L-dopa or dopamine agonists have increased risk of compulsive gambling
Treatments
Cognitive Behavioral Therapy (CBT) is the mainstay, showing reduced gambling frequency, financial loss, symptom severity
Motivational Interviewing can be effective to increase engagement with treatment, particularly in primary care, emergency departments, and telehealth.
Naltrexone and nalmafene are opioid antagonists that have shown some evidence that they can reduce gambling urges and behavior.
GLP-1 agonists are being actively investigated
Persons seeking help can call or text 1-800-GAMBLER (National Problem Gambling Helpline).
References
Bodor D, Ricijaš N, Filipčić I. Treatment of gambling disorder: review of evidence-based aspects for best practice. Current Opinion in Psychiatry. 2021;34(5):508. doi:10.1097/YCO.0000000000000728
Ford M, Håkansson A. Problem gambling, associations with comorbid health conditions, substance use, and behavioural addictions: Opportunities for pathways to treatment. PLOS ONE. 2020;15(1):e0227644. doi:10.1371/journal.pone.0227644
Pfund RA, Ginley MK, Kim HS, Boness CL, Horn TL, Whelan JP. Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis. Clin Psychol Rev. 2023;105:102336. doi:10.1016/j.cpr.2023.102336
Wardle H, Degenhardt L, Marionneau V, et al. The Lancet Public Health Commission on gambling. The Lancet Public Health. 2024;9(11):e950-e994. doi:10.1016/S2468-2667(24)00167-1