Gambling Therapy

What is Problem Gambling?

For most people, placing a bet here or there while visiting a casino or local bar isn’t a big deal, and doesn’t cause any major problems. However, there are some people who find these small bets escalate quickly, causing them to lose control. People who struggle with problem gambling often describe that their addiction has cost them greatly. Some report losing their savings, their homes, their jobs, and even cause irreparable damage to some of their most important relationships.

Many who struggle with this issue have Gambling Disorder, a psychological disorder that affects 1% of adults in the U.S., which is about 2 million Americans. An additional 4-6 million Americans display some signs and symptoms of gambling disorder, including experiencing negative consequences as a result of gambling too much. According to research, certain individuals are more likely to develop gambling disorder. People who are at higher risk for gambling disorder include:

• Males
• Ethnic and racial minorities
• Teenagers and younger adults
• People with existing mental health conditions
• People with existing substance use issues (especially alcohol use)
• People with a family history of addiction or problem gambling
• People without a lot of social support or stability
• People in areas where gambling has recently become available
• People who play fast-paced games like slots, poker or Blackjack
• People who are naturally impulsive, competitive or like taking risks

Having many of the risk factors above can increase the likelihood of problem gambling, but it’s important to know that most people who gamble do not have or develop a gambling disorder. Also, it’s possible for anyone to develop gambling disorder, even if they don’t fit into one of the categories listed above. 

Signs & Symptoms of Gambling Disorder

Gambling Disorder (GD) is characterized by a pattern of compulsive gambling that becomes problematic and negatively impacts an individual’s life. In order to be diagnosed with gambling disorder, a person has to experience four or more of the following symptoms:

• A need to gamble with larger amounts of money to feel the same level of excitement
• Restlessness or irritability when trying to cut back or stop gambling
• Repeated unsuccessful efforts to stop or cut back on gambling
• Persistent preoccupation, or having frequent thoughts about gambling
• A pattern of gambling when feeling distressed 
• Returning to gamble after losing to “recover” or “chase” their  losses
• Lying or downplaying the extent of the gambling to other people
• Having risked or lost a significant relationship, job, or opportunity because of gambling
• Relying on money from others to relieve financial strain caused by gambling

Some additional signs that can indicate someone has a Gambling Disorder or is at risk include:

• Spending more time or money gambling than you originally intended
• Feelings of regret, remorse, or guilt after gambling
• Gambling money that you cannot afford to lose
• Intending, planning, or attempting to stop gambling but not following through
• Feeling unable to control yourself when you start gambling

If you notice these signs or symptoms, it may mean that you are struggling with a Gambling Disorder, or that you are at risk of developing one. If you are concerned about your gambling habits, take the NODS-SA ten-question problem gambling self assessment.

Gambling: A Form of Addiction?

Some people with gambling disorders are able to avoid gambling or gamble in moderation for periods of time, only losing control occasionally. Others with the disorder describe that their gambling patterns are consistently problematic. Regardless of whether problem gambling is periodic or consistent in nature, it can cause serious consequences in a person’s life.

Most people with gambling disorder don’t feel fully in control of their gambling, similar to the experiences of people who struggle with addictions to drugs or alcohol. Interestingly, research supports these similarities, suggesting that it is possible to be addicted to gambling. For example, brain imaging studies have shown that gambling can cause the brain to release dopamine, a powerful neurotransmitter that is largely responsible for the ‘high’ people feel when they take illicit drugs. 

Over time, gambling can cause “addiction pathways” to form in the brain. Once these addiction pathways are formed in the brain, a person experiences strong urges to repeat the behavior. This makes it much more difficult for a person to control or stop their behavior, even after they know it is causing problems for them. For these reasons, gambling disorder is considered an addictive disorder, and shares many of the same features and symptoms as a drug or alcohol use disorder.

For example, many problem gamblers develop a “tolerance” and need to place larger bets to feel the same rush, similar to the experiences of a chronic substance user. Having made multiple attempts to cut back or stop gambling and feeling restless or agitated when they’re unable to gamble are also similar to the experiences of people struggling with an addiction to drugs or alcohol. In fact, a 2021 meta-analysis of risk factors concluded that continuous-play format gambling products are associated with the highest rates of problem gambling. This is particularly relevant as the prevalence of online gambling continues to grow, and is projected to be a hundred billion dollar market worldwide by 2024.

It is important to note that the term “addiction” doesn’t mean that a person is physically addicted, and may just describe an unhealthy dependence or psychological addiction to something. Many people believe that cravings and withdrawals are the clearest sign of an addiction, but the hallmark symptom of all addictions is continuing the behavior even after it begins to cause serious problems for you. 

Getting Help for A Gambling Disorder

Addiction pathways in the brain make it more difficult to stop, but this does not mean that recovery is impossible for people who have gambling addictions. In fact, research suggests that most people who develop a gambling problem eventually stop, and one third do so without any professional help. 

Studies have demonstrated that by stopping a behavior or starting a new one, the human brain actually rewires certain connections. The old addiction pathways in the brain become less active and new, healthier pathways can be formed in their place. This is why over time, people in recovery usually find their cravings subside and it becomes easier to avoid falling back into their addictions.                     

While some people who have struggled with addiction find that they can control or moderate their behavior for a period of time, most eventually lose control. As addiction progresses, these honeymoon periods tend to become shorter and the consequences of gambling tend to become more serious. This is why most people who struggle with gambling addictions need to stop altogether, instead of trying to cut back or limit themselves.

Treatment Options for Gambling Disorders

For those who are interested in treatment, there are a range of different options available. Most of the time, therapy is a front line treatment for gambling disorder but in some instances, a combination of therapy and medication are used to help people recover. Many people benefit from having the structure that a treatment program provides, and find that it also helps them learn more effective coping skills, set goals for themselves, and stay accountable.  

Each program is a little different, and finding one that’s a good match for your needs is important. For example, some programs offer group therapy while others only offer individual or family counseling sessions. Some programs provide short-term inpatient treatment, while others offer outpatient programs that meet multiple times each week or 1:1 sessions one time a week. 

There is no “gold star” treatment approach for Gambling Disorder, but many programs use treatments which have been researched and found effective for addictive disorders. Cognitive Behavioral Therapy (CBT), is a commonly used treatment approach that has a lot of research to support its effectiveness in treating a variety of behavioral and mental health issues. In CBT sessions, people can learn how to manage impulses and regulate stress and emotions, think through choices more carefully, and build healthier behavior patterns over time. 

Another common treatment for gambling disorder is family therapy, which usually involves a blend of family and individual sessions with a therapist. This approach can be especially helpful for those who have damaged important relationships as a result of their problem gambling. Through the treatment process, the person is able to work on repairing damage to the relationship and rebuilding trust and the support person is provided with tools to be a positive support for the person in recovery. Search TherapyTribe therapist directory for an addiction specialist in your area.

When selecting treatment, there are a number of different factors to consider, including:

• Location: Where the program or facility is located and whether it’s convenient and accessible to the person’s home or office
• Finances: Whether a program is in-network, covered by insurance, offers payment plans, and is affordable
• Scheduling: The days and times the program is offered, and whether it’s possible to attend based on work schedules or other responsibilities
• Treatment needs: How serious or severe the addiction is, how urgent the need for treatment is, and whether there are other underlying health, mental health or addictive disorders that need to be treated
• Specialization: Whether the facility, clinic or provider specializes in addictive disorders, gambling disorders, and other issues that require treatment
• Personal preferences: Any personal preferences about the kind of treatment offered, the type of provider offering it, or other considerations that are important to the individual

How to Find Treatment For Gambling Disorder

If you have health insurance, it is likely that treatment will be at least partially covered by your insurance plan as long as you find an in-network provider. If you have health insurance, a good first step for finding treatment is to call the number on the back of your health insurance card and speak with a customer service representative. Ask the insurance representative the following questions to get more information about what treatments your plan covers:

• What types of addiction and mental health treatment are covered under my plan?
• What would the out-of-pocket costs be for each of these treatments?
• Is there a limit for how long or how often I can receive treatment under my plan?
• Do I need to get authorization or do anything to be eligible for this treatment?
• Can I receive a list of in-network treatment providers near me?

* Keep in mind that some plans separate mental health/addiction treatment from regular medical treatment, so if there is a specific number for mental or behavioral health, this would be the right number to call. 

Regardless of whether you are using insurance or not, it is important to be an informed customer when you are selecting a treatment provider. Having at least two or three different options and looking into each one is a good way to ensure you get the right treatment for you. Often, the preliminary information can be found online but it is also helpful to either call or visit a facility or provider before making a final decision. Some questions that may be helpful to ask include:

• What kind of treatments do you offer at this facility?
• How long does treatment normally last and how often would I need to come?
• What’s the cost of treatment and is it covered by my insurance?
• Are there sliding scale discounts or payment plan options available?
• Do you specialize in treating people with gambling disorder or behavioral addictions?
• Who would be involved in my treatment and what is their background/experience?

Helping Yourself: Alternatives to Treatment

For a variety of reasons, some people struggling with Gambling Disorders may not feel that treatment is the right option for them. Time or money is a barrier for some people and others might feel confident in their ability to recover on their own. If you or a loved one isn’t interested in treatment, there are a variety of “middle ground” options between formal treatment and no treatment. Many of these programs are offered at no cost and include individual coaching or support groups that can help people during the recovery process.

Some of the free and low-cost resources available for problem gambling include:

• Self-help or support groups like Gamblers Anonymous
• Hotlines and helplines like The National Problem Gambling Helpline
• The National Council on Problem Gambling’s state-by-state guide to resources

In addition to seeking out help from a coach or support group, people who are working to stop their problem gambling may also benefit from making some lifestyle changes. Even small changes can help set you up for success, especially as you are in the beginning stages of making changes, which is often when people describe feeling the most vulnerable. 

Some lifestyle changes that may help you stay on track with your recovery include:

• Involve your friends, family, and supports: Letting people close to you know about your problem and asking for their involvement in your recovery is a good idea, and can help you stay motivated and accountable
• Set up financial safeguards: Asking someone to restrict or monitor your accounts or finances can also help to reduce the risk of gambling
• Plan ahead to avoid triggers and temptations: A little planning can go a long way early on in recovery, and may involve taking a different route home to avoid passing a casio, leaving your wallet or cash at home, or not hanging around people you usually gamble with
• Identify and healthy outlets and coping skills: Reduce the risk of giving into urges to gamble when stressed or upset by identifying hobbies, creative outlets, and healthy coping skills like exercise or journaling  
• Set up a daily routine or schedule: Setting up a daily schedule can help you get into a new, healthier routine that involves more time doing things you want or need to do, and less idle time that could be wasted gambling
• Build in rewards: Building some rewards into your plan can help you stay motivated and on track, and may include buying yourself something nice or treating yourself to a weekend away once you’ve gone a certain amount of time without gambling

Final thoughts 

When you notice the signs of problem gambling, it is important to take a first step in getting help or changing your behavior, regardless of what this first step is. Often, people who struggle with addictions also describe sometimes struggling with denial, minimizing their behavior or the impacts it has had or making other excuses about why “this time will be different”. Denial and excuses like these provide the chance for addictions to continue to grow, progressively becoming more destructive over time. As people with this issue know, there is more at stake than just money.

Resources for Problem Gambling

• National Problem Gambling Helpline: 1-800-522-4700 or online at ncpgambling.org
• Gamblers Anonymous at www.gamblersanonymous.com
• Search TherapyTribe therapist directory for an addiction specialist in your area.
• Free Online Support Group: AddictionTribe

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. Mann, K., Fauth-Bühler, M., Higuchi, S., Potenza, M. N., & Saunders, J. B. (2016). Pathological gambling: a behavioral addiction. World psychiatry: official journal of the World Psychiatric Association (WPA), 15(3), 297-298.
3. National Center for Responsible Gambling. (2015). Retrieved from: http://www.ncrg.org/discovery-project.
4. National Council on Problem Gambling. Help and Treatment. Retrieved from: https://www.ncpgambling.org/help-treatment/
5. Rennert, L., Denis, C., Peer, K., Lynch, K. G., Gelernter, J., & Kranzler, H. R. (2014). DSM-5 gambling disorder: prevalence and characteristics in a substance use disorder sample. Experimental and clinical psychopharmacology, 22(1), 50-6.
6. Kraus SW, et al. Current pharmacotherapy for gambling disorder: A systematic review. Expert Opinion on Pharmacotherapy. 2020; doi:10.1080/14656566.2019.1702969.
7. Hodgins, D. C., & Stevens, R. (2021). The impact of COVID-19 on gambling and gambling disorder: emerging data. Current opinion in psychiatry, 34(4), 332–343. https://doi.org/10.1097/YCO.0000000000000709
8. Youssef Allami, David C. Hodgins, Matthew Young, Natacha Brunelle, Shawn Currie, Magali Dufour, Marie-Claire Flores-Pajot, Louise Nadeau (2021). A meta-analysis of problem gambling risk factors in the general adult population. Retrieved from: https://doi.org/10.1111/add.15449