Gambling Pain

Gambling, for some people, is a leisure activity that offers a night out on the town enjoying time with friends and family, with a distant possibility of winning money. For other people, the stakes are higher. After all, gambling is a $40 billion dollar industry in the United States. In Las Vegas alone—the unofficial gambling capital of the world—the casinos bring in over 10 billion dollars from people placing bets. Though many of those people only gamble once in awhile, there are people who make gambling the center of their universe. In other words, they are addicted to gambling.

The temptations to gamble are everywhere and you don’t need to be in a casino to try your luck. Every state in America, with the exception of Utah and Hawaii, offer some type of legalized gambling—from old-school slot machines to sports-betting apps and everything in between. The accessibility to gambling has only amplified with the Internet. Based on various surveys in recent years, it is estimated that two million people in the US are addicted to gambling. But that figure has the potential to increase at anytime, because those same surveys revealed as many as 20 million people noting that their gambling habit had begun to interfere with their work and social life. That type of behavior falls into the category of “compulsive gambling,” which is the stage before gambling addiction.

In a positive step, warnings on packs of antidepressants now state that there is a risk of developing a gambling addiction when taking the medication. This was previous simply labelled as.

Gambling disorder involves repeated problematic gambling behavior that causes significant problems or distress. It is also called gambling addiction or compulsive gambling. For some people gambling becomes an addiction — the effects they get from gambling are similar to effects someone with alcoholism gets from alcohol. People hypnotized for pain relief may show activity in brain areas that receive pain sensations but not in brain areas that make us consciously aware of the pain. This most directly supports the theory that hypnosis involves a. Paradoxical sleep. Social influences.

What is Compulsive Gambling?

“The shortest version is that compulsive gambling is, as its name implies, a compulsion,” says Lance Dodes, MD, author of THE HEART OF ADDICTION: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors. “Compulsive gambling leads to an addiction, which is a psychological symptom that is well-understood and treatable with psychotherapy oriented toward that understanding. It is not a biological, genetic or moral issue, and it is not fundamentally different from other compulsive behaviors or addictions.”

Gambling PainArticle continues below

Worried you or a loved one may be suffering from a gambling addiction?

Take our 2-minute gambling addiction quiz to see if you may benefit from further diagnosis and treatment.

Usually, people start out gambling for fun, and then they lose money they didn’t mean to, and they end up chasing that loss until all their money is gone. And in many cases, people are gambling because they have faced emotional and financial losses and they are trying to console themselves.

There is a misconception among many people that problem gambling, another term for gambling addiction, is not a big deal. “Most people don’t realize that problem gambling is a real disorder, just like alcohol or drug addiction,” says Shelia Moran, director of communications and marketing at First Choice Services, a nonprofit agency in West Virginia dedicated to mental health issues and problems. “They think it’s just a bad habit that can be easily ended. The good news is that we find most people who get treatment are able to successfully stop gambling.”

Gambling and Co-Existing Mental Health Conditions

Sadly, it is estimated that over 80% of people who suffer from some type of gambling addiction never seek treatment, no matter how bad their problem is. Other statistics reveal that while there are people who do seek treatment for their gambling addiction, over 70% end up returning to the world of betting. People with this type of disorder are more likely to suffer from other types of mental health and substance abuse issues. Many gamblers also have an alcohol disorder or addiction, and over half were nicotine dependent.

The emotional toll it takes on people is devastating, and in many cases a gambling addiction can also bring bouts of depression, and in extreme situations may lead to suicidal thoughts or tendencies. People with a gambling addiction are also prone to anxiety, high stress and extreme sadness. When a gambler loses everything, their life will suddenly become hopeless and they fear what the future might bring.

Gambling Addiction Symptoms and Signs

As with other addictions, there are warning signs to look out for. These include:

  • Keeping gambling habits a secret
  • Having trouble controlling their gambling habit
  • Continuing to be involved with a gambling habit when they cannot financially afford to do so.
  • Resorting to illegal activities to pay for their gambling habit

Physical symptoms of excessive gambling include problems sleeping, weight gain or loss, dark circles under the eyes and extreme headaches.

Dogs gambling painting

How can you tell if someone has a gambling disorder? The American Psychiatric Association has developed guidelines and says that a person requires at least four of the following issues to take place during the past year:

  1. A person feels the need to gamble with an increasing amount of money in order to achieve the desired excitement.
  2. A person becomes angry, restless or irritable when someone tells them to cut back on their gambling, or to stop it altogether.
  3. A person will have unsuccessfully tried to cut back or stop gambling on their own.
  4. A person has frequent thoughts about gambling, including reliving past gambling adventures, planning their next gambling outing, and thinking of ways to get money to gamble with.
  5. A person will often gamble when they are feeling distressed.
  6. After a person loses money, they return to try and “get even” (referred to as “chasing” one’s losses)
  7. A person will not hesitate to lie to hide their gambling activity.
  8. A person will jeopardize or lose a significant relationship, job or educational/career opportunity because of gambling.
  9. A person will begin relying on others to help with money problems caused by their gambling habits.

Treatment Options for Gambling Addicts

If you suspect that someone in your life is addicted to gambling or a compulsive gambler, you should know that there is help. Here are treatment options to consider:

  • “Behavior therapy and cognitive behavior therapy are recommended for compulsive gamblers,” says Katie Hurley, LCSW. “Behavioral therapy uses systematic exposure to the behavior to teach skills to reduce the urges, while cognitive behavioral therapy focuses on identifying unhealthy and irrational thoughts and replacing them with positive/adaptive ones. Family therapy is another option,” Hurley explains.
  • Apps can help instill healthy habits and encourage consideration of events and emotions that lead to compulsive behaviors. Addiction AVERT app can help curb cravings. BreakFree can help people who use their smartphones to gamble spend less time on their phone.
  • Adaptive coping strategies like exercise, deep breathing, progressive muscle relaxation, mindfulness, and meditation are all positive options. There are even meditation apps that can help anyone who doesn’t know where to start.

According to the American Psychiatric Association, as of 2016, there are no FDA-approved medications for the treatment of gambling disorder. There is, however, emerging scientific research that has shown that medications can be effective in reducing the intensity of urges and cravings for gambling.

Finally, Gamblers Anonymous has been beneficial in the lives of people who have an addiction; however, they must first admit they have a problem, which is often times the most difficult thing to do. If someone is unable to find an accessible chapter of Gamblers Anonymous, Alcoholics Anonymous addresses many of the same behaviors.

Just as anyone can become addicted to gambling, anyone can stop.

You may also like:

By Colin Hodgen, Ph.D.

Gambling Disorder is recognized in the U.S. as an addictive disorder. Indeed, it is currently the only Addictive Disorder listed in the Diagnostic and Statistical Manual, 5th edition (DSM-5, 2013) published by the American Psychiatric Association (APA).

But, what is gambling disorder exactly? What drives a gambling behavior in problem gamblers? Expert Colin Hodgen explores more here in this article. Then, we invite your questions at the end. In fact, we try to respond to all questions personally and promptly.

What is a gambling disorder?

Previously classified as an Impulse Control Disorder, “Gambling Disorders” are now seen as a behavioral or process addiction with 4 core features. As explained by Dr. Jon Grant of the University of Chicago, these core features are:

  1. repetitive or compulsive engagement in a behavior despite adverse consequences;
  2. diminished control over the problematic behavior;
  3. an appetitive urge or craving state prior to engagement in the problematic behavior; and
  4. hedonic [pleasurable] quality during the performance of the problematic behavior.

The long term effects of gambling disorder are often observed as:

  1. Tolerance
  2. Withdrawal
  3. Repeated unsuccessful attempts to cut back or stop
  4. Impairment in major areas of life functioning

In other words, gambling is something we continue to do, over and over, even if it causes problems in our lives. We are no longer able to consistently decide when we will or will not gamble, and if we do gamble, we can’t consistently decide when we will or will not stop. Further, we experience sometimes overpowering urges or cravings to repeat the behavior, and that behavior provides a sense of pleasure, relief, or release in the moment, thereby reinforcing the behavior. This behavior must be repeated and completed to reduce chronic anxiety. Over time, we experience clinically significant impairment or distress in our daily lives at home, school, or work.

Why do people gamble?

Gambling behavior is often separated into two categories: action and escape.

a) Action – Some people seem to gamble for the excitement.
b) Escape – Others tend to gamble to “get away from it all.”

The American Society of Addiction Medicine (ASAM) terms these behavior syndromes as “reward” and “relief.” If we focus on the “escape” or “relief” conditions, it becomes apparent that many gamblers are seeking some sort of pain relief, some reduction in the stress, pain, or anxiety in their lives, whether past or present.

  • Numbing pain – Gambling activity becomes a way of “numbing” the acute/chronic pain and can lead into addiction. This numbed condition makes it very difficult for the individual or the treatment provider to connect with and/or resolve the underlying trauma and consequent pain.
  • Relieving anxiety – In general, many gamblers engage in the behavior to reduce or relieve a cumulative condition of anxiety. This anxiety state can arise from or lead to chronic psychic pain and cognitive dissonance. Chronic anxiety can be a result of earlier life trauma or persistent excitation of the “fight-or-flight” response within the limbic system of the brain. A brain in chronic pain will often go to desperate measures to reduce or avoid continued pain.
  • Coping with trauma – The brain pain is both acute and chronic. The acute state arises from the immediate circumstances of the gambler; the chronic state often is a residue of long-term, perhaps early childhood, trauma.

Over time, the gambler exhausts the repertoire of available coping responses, and is left with a dysfunctional, ineffective, and increasingly harmful set of behaviors and emotional responses. This history of trauma can lead to long-term effects on the brain and its function, through a process of adaptive learning or neuroplasticity.

The brain of gambling addicts

We need to understand brain function to address a gambler’s behavior and plan for recovery. Let’s take a brief look at what goes on in the brain, from the inside out, before taking a brief look at treatments that can be helpful in dealing with the immediate and long-term remediation of the effects of gambling disorder.

The brain is basically an electrochemical generator of the central nervous system and it regulates our thoughts, feelings, and actions. To do so, our brain generates and regulates various neurotransmitting chemicals. Here are five (5) primary neurotransmitters and their associated activities:

When the primary neurotransmitters Dopamine, Serotonin, and Norepinephrine are in balance, we see well-ordered mood and behavior:

Dogs Gambling Painting Meaning

Deficits in one or more of these chemicals (shown in italics) cause imbalances, and we see disordered mood and behavior:

Most of these mood states will be familiar to those with addictive behaviors.

A particular combination of neurotransmitter deficits contributes to the distress of the gambler, specifically combined deficits in Dopamine and Serotonin which contribute to the hybrid state of Depression and Craving experienced by most individuals with Gambling Disorder.

Impulsivity in the problem gambler

What may seem to be impulsivity in the compulsive gambling is often also a characteristic of both anxiety and a need for anxiety reduction. Problem gamblers will often present with symptoms of co-occurring Anxiety and/or Depression and will have concurrent difficulty with Impulse Control.

Glutamate and dopamine in the brain

Much of what we know about addictive behaviors relates to dopamine dysregulation, and is often associated with the effects of GABA and Glutamate on dopamine. Glutamate is an excitatory chemical and motivates behavior; GABA is an inhibitory chemical and deters or defers behavior.

Below we see two examples of the interaction of Glutamate and Dopamine, first where Glutamate from the PreFrontal Cortex motivates a pleasurable behavior associated with Dopamine. In the second example, Glutamate triggers GABA to inhibit disordered pleasurable behavior associated with Dopamine:

Psychotropics may not be the best gambling disorder treatment

Oftentimes, individuals, and the primary care physicians and mental health professionals who deal with them, attempt to diagnose and treat the mood/behavioral symptoms (anxiety, depression, sleep disturbance, etc.) without examining the underlying addictive conditions which produce these symptoms. Sadly, from a medication-based perspective, the use of psychotropics may cause more problems than they relieve.

Recently, in fact, the onset of troublesome compulsive behaviors such as compulsive gambling, compulsive shopping, and hypersexual behaviors have been associated with medications such as Mirapex and Abilify, side effects which were not anticipated or sometimes even associated with the medication. This is not to say that appropriate psychopharmacology cannot help reduce the distress of a problem gambler.

However, great care should be used when attempting to address addictive behaviors solely through use of psychotropic medications.
Well, then, what can we do?

Treatments for gambling problems

Cognitive Behavioral Therapy (CBT) – This type of therapy is associated with good outcomes in treatment of addictive disorders and is also associated with better outcomes in long-term recovery. Generally, CBT targets improving the gambler’s “executive functioning,” that is, planning, cognitive flexibility, and inhibition responses. It involves a Functional Analysis of an individual’s Antecedents or triggers, the subsequent Behaviors, and the resultant Consequences. Over time, the gambler is better able to choose more appropriate and effective behaviors and begins to experience more positive Consequences.

Neurolinguistic Programming (NLP) – Another useful and effective approach involves Neurolinguistic Programming (see Dr. Janice Walton’s April 26,2016 article, “NLP Strategies Counselors Can Use When Treating Addictive Behavior” on Addiction Blog. This therapeutic approach also addresses thinking, behavior, and executive functioning. In the absence of co-occurring mental health disorders, this approach can be quite effective with behavioral/process disorders as well as substance-related disorders.

Alternative gambling treatments – For additional information on treatment alternatives, please see an earlier Addiction Blog entry, Jaime Costello’s article, “How to quit gambling: Alternatives for recovery” .

Gambling Man Painting

For additional insights into Gambling Disorder, please see any of the other Bybee Initiative posts on Addiction Blog under the Compulsive Gambling category. For more extensive examination of the neurobiology of addictive disorders, see Neurobiology of Addiction (Koob & Le Moal, 2005).

Gambling Man Paint Horse


The nature of gambling disorder

Gambling Disorder, and similar process/behavioral disorders, can often resemble substance-related disorders. Many of the components of traditional substance-related disorders can be customized for use in treatment. After all, we’re dealing with the effects of chemicals on brain function. In the case of Gambling Disorder, these are Endogenous (internal source) chemicals (Dopamine, Serotonin, etc.) rather than Exogenous (external source) chemicals such as alcohol, opioids, or stimulants.

Whatever the source, and whatever the etiology of the disorder, individuals, families, and communities suffer the effects and consequences of Gambling Disorder. This disorder is uniquely insidious, a “hidden addiction,” since there are no immediate biochemical tests for the disorder. Oftentimes the disorder and the damage only become evident after some catastrophic event. Our challenge is to stay vigilant for early indicators and early intervention. Our task is Awareness, Education, and Advocacy.

Got any questions about the brain and gambling?

Do you have any additional questions and would like to ask questions regarding the diagnosis, nature, and treatment of gambling disorder? We welcome you to post them in the comments section below. We try to answer all legitimate inquiries personally and promptly, or refer you to someone who can help.

About the Author: Colin Hodgen, PhD, is the Director of RENEGADE Counseling in Reno, NV. He is a member of the Shannon Bybee Working Group.

Gambling Paintings

Authors contributing to this blog on Disordered Gambling are all recipients of the Shannon L. Bybee Award, presented by the Nevada Council on Problem Gambling in recognition of proactive commitment to problem gambling advocacy, education, and research. If you believe that you or a loved one may have a gambling problem, please call the 24-hour national Problem Gamblers Helpline at (800) 522-4700 FREE for confidential assistance.