Gambling Disorder

Gambling Disorder

Gambling behaviors activate reward systems similar to those activated by drugs of abuse and produce some behavioral symptoms that appear comparable to those produced by the substance use disorders.1

Similarities Between Substance Use Disorder & Gambling Disorder 2

  • A state of euphoria resulting from engagement in the behavior. Thus, the behavior- at least early in the course of the chronic condition- is pleasurable (engagement in the behavior for purposes of reward);
  • Preoccupation when engaging in the activity;
  • Loss of control at times when engaging in the behavior;
  • Progression of problems and symptoms over time;
  • Stage of change, readiness to change, and interest in changing issues, usually manifesting as diminished recognition of problems associated with addictive behavior;
  • The behavior is continued in spite of adverse consequences;
  • Tolerance develops with repeated engagement in the behavior;
  • Urges and cravings develop regarding further engagement in the behavior;
  • There is enhanced cue responsiveness, which can trigger relapse to the behavior;
  • Withdrawal symptoms occur when the activity is unavailable;
  • Psychological drives of escape, self-medication, and avoidance exist (engagement in the behavior for purposes of relief);
  • Committing illegal acts to fund ongoing engagement with the behavior(substance use or gambling) can be episodic, chronic, or in remission.

Gambling Disorder Diagnostic Criteria 1

Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period:

  1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement.
  2. Is restless or irritable when attempting to cut down or stop gambling
  3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.
  4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble).
  5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).
  6. After losing money gambling, often returns another day to get even (“chasing” one’s losses).
  7. Lies to conceal the extent of involvement with gambling.
  8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling.
  9. Relies on others to provide money to relieve desperate financial situations caused by gambling

The gambling behavior is not better explained by a manic episode.

Current severity

  • Episodic
  • Persistent
  • In early remission
  • In sustained remission

Course Specifiers

  • Mild: 4-5 criteria met.
  • Moderate: 6-7 criteria met.
  • Severe: 8-9 criteria met.

Created by the North Dakota Problem Gambling Advisory Council
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1 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
2 Mee-Lee D, Shulman GD, Fishman MJ, Gastfriend DR, Miller MM, eds. The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd ed. Carson City, NV: The Change Companies ; 2013