Recently, scientists and mental health professionals decided to classify problem gambling as a behavioral addiction, the first of its kind, putting it in a category of disorders that also includes substance abuse. The reason for this change comes from neuroscience research, which has shown that gambling addicts have a lot in common with drug and alcohol addicts, including changes in behavior and brain activity.
A Behavioral Addiction
Gambling disorder refers to the uncontrollable urge to gamble, despite serious personal consequences. Problem gambling can impact a person's interpersonal relationships, financial situation, and physical and mental health. Yet it has only recently been
recognized as an addiction.
Problem gambling was first classified as a psychiatric disorder in 1980. In the third edition of the
Diagnostic and Statistical Manual, the American Psychiatric Association's guide to psychiatric disorders, the condition was termed "pathological gambling" and classified as an impulse control disorder, alongside disorders like kleptomania and pyromania. In 2013, it was renamed "gambling disorder" and moved to the Substance-Related and Addictive Disorders category, which includes
alcohol and drug addictions.
The decision to move gambling disorder alongside substance use disorders reflects a new understanding of the underlying commonalities between gambling and other addictions. There is a growing body of neuroscience and psychology research suggesting problem gambling is similar to drug addiction.
Many of the diagnostic criteria for gambling disorder share features with those for drug dependence, such as tolerance, withdrawal, repeated unsuccessful attempts to cut back or quit, and major interference in one's life. Problem gamblers also report cravings and highs in response to gambling.
"People will get inured to the high of gambling at a certain point and need to gamble with bigger bets and riskier betting options," says
Jon Grant, who studies addiction at the University of Chicago. "When people try to stop, they go through withdrawal, with insomnia, agitation, irritability, and a feeling of being ill at ease, similar to what we see in some substance abuse disorders."
Problem gambling also runs in families, alongside other addictions. "If you have family members with alcohol use disorders, you're at increased risk for gambling disorder," says
Nancy Petry, who studies addictive disorders at the University of Connecticut and served on the committee that led the reclassification of problem gambling as a behavioral addiction.
There may be some common genetic or brain differences in people who are more inclined to develop addictions, Petry says. For example, research shows that problem gamblers and drug addicts share many of the same genetic predispositions for impulsivity and reward-seeking behaviors.
This Is Your Brain on Gambling
Much of the research that supports classifying gambling disorder with other addictions comes from brain imaging studies and neurochemical tests. These have revealed commonalities in the way that gambling and drugs of abuse act on the brain, and the way the brains of addicts respond to such cues. The evidence indicates that gambling
activates the brain's reward system in much the same way that a drug does.
"Across many studies, the same brain areas come up time and time again — the ventral striatum and the prefrontal cortex," says
Luke Clark, a psychologist at the University of British Columbia.
The ventral striatum, located deep inside the brain, has been termed the brain's reward center, and it's been implicated in reward processing as well as substance abuse.
When people with gambling disorder watch gambling videos or participate in simulated gambling while their brains are being scanned, scientists can see changes in blood flow in specific brain areas, indicating which areas are more active. In one study, both problem gamblers and cocaine addicts watched videos related to their addictions while in a
functional magnetic resonance imaging (fMRI) scanner. Both groups showed diminished activation in the ventral striatum compared to healthy control participants. Problem gamblers also showed less ventral striatum activity during simulated gambling games and during the anticipation of monetary rewards than did people without gambling problems.