Gambling Disorder - Rarely Diagnosed, Highly Prevalent

Gambling disorder may be the most under-diagnosed disorder in the DSM.  This is an exhaustive treatment of the neurobiological, psychological, and societal aspects of gambling addiction, featuring discussions on the brain's reward system, cognitive distortions, and the impact of advertising and the design of gambling products.

Please leave feedback at https://www.psydactic.com or send any comments to feedback@psydactic.com.

References and readings (when available) are posted at the end of each episode transcript, located at psydactic.buzzsprout.com. All opinions expressed in this podcast are exclusively those of the person speaking and should not be confused with the opinions of anyone else. We reserve the right to be wrong. Nothing in this podcast should be treated as individual medical advice.

Transcript

Gambling Disorder (Addiction)

Resources used for this episode:

“- YouTube.” n.d. Accessed March 25, 2025a. https://youtu.be/BdgrhO0IrlQ?si=LkhqEcbHqxbzj2jP.

“———.” n.d. Accessed March 25, 2025b. https://youtu.be/rMfcCBLAoeQ?si=uR90LE8eposPNJBo.

“———.” n.d. Accessed March 25, 2025c. https://youtu.be/5Am2R8BLugo?si=DrYf2aybPX9u64E2.

“———.” n.d. Accessed March 25, 2025d. https://youtu.be/6xNTmSSB22o?si=QeIItRtWhM1-n82l.

“———.” n.d. Accessed March 25, 2025e. https://youtu.be/iBakCqSvexE?si=F_NuIQTk87xgwOBo.

Alimoradi, Zainab, Aida Lotfi, Chung-Ying Lin, Mark D. Griffiths, and Amir H. Pakpour. 2022. “Estimation of Behavioral Addiction Prevalence during COVID-19 Pandemic: A Systematic Review and Meta-Analysis.” Current Addiction Reports 9 (4): 486–517.

American Psychiatric Association. 2023. “Understanding Mental Disorders: Your Guide to DSM-5-TR®,” October. https://doi.org/10.1176/appi.books.9781615375370.

Augner, Christoph, Thomas Vlasak, Wolfgang Aichhorn, and Alfred Barth. 2022. “Psychological Online Interventions for Problem Gambling and Gambling Disorder - A Meta-Analytic Approach.” Journal of Psychiatric Research 151 (July): 86–94.

Biggar, Blair, David Zendle, and Heather Wardle. 2023. “Targeting the next Generation of Gamblers? Gambling Sponsorship of Esports Teams.” Journal of Public Health (Oxford, England) 45 (3): 636–44.

Cohen, Joshua P. 2024. “As Sports Betting Proliferates, Incidence Of Gambling Disorder Rises.” Forbes. May 7, 2024. https://www.forbes.com/sites/joshuacohen/2024/05/07/as-sports-betting-proliferates-incidence-of-gambling-disorder-rises/.

Eriksen, Jakob W., Anne Fiskaali, Robert Zachariae, Kaare B. Wellnitz, Eva Oernboel, Anna W. Stenbro, Thomas Marcussen, and Marie W. Petersen. 2023. “Psychological Intervention for Gambling Disorder: A Systematic Review and Meta-Analysis.” Journal of Behavioral Addictions 12 (3): 613–30.

Fischer, Kavita. 2025. “The Real Madness of March – Why Every Psychiatrist Should Be Screening for Gambling Disorder.” Psychiatric News, March. https://doi.org/10.1176/appi.pn.2025.04.4.50.

Gambling, Sports, and America’s Fastest. n.d. “BETTING ON OVERSIGHT: REPURPOSING REGULATIONS FOR CIGARETTE AND TOBACCO ADVERTISING TO ADDRESS.”

Hennessy, Grace. n.d. “Can Medications Help People With Gambling Disorder?” https://doi.org/10.1176/appi.pn.2016.PP4a1/format/epub/EPUB/xhtml/f1.xhtml.

Higueruela-Ahijado, Marina, Fidel López-Espuela, Pedro Ángel Caro-Alonso, Andre Novo, and Beatriz Rodríguez-Martín. 2023. “Efficacy of Cognitive-Behavioral Therapy in Improving the Quality of Life of People with Compulsive Gambling, a Systematic Review.” Archives of Psychiatric Nursing 43 (April): 127–42.

Mangat, Harshdeep S., Mark D. Griffiths, Shu M. Yu, Katalin Felvinczi, Ronald K. Ngetich, Zsolt Demetrovics, and Andrea Czakó. 2024. “Understanding Esports-Related Betting and Gambling: A Systematic Review of the Literature.” Journal of Gambling Studies 40 (2): 893–914.

Masaeli, Nassim, and Hadi Farhadi. 2021. “Prevalence of Internet-Based Addictive Behaviors during COVID-19 Pandemic: A Systematic Review.” Journal of Addictive Diseases 39 (4): 468–88.

McGrane, E., H. Wardle, M. Clowes, L. Blank, R. Pryce, M. Field, C. Sharpe, and E. Goyder. 2023. “What Is the Evidence That Advertising Policies Could Have an Impact on Gambling-Related Harms? A Systematic Umbrella Review of the Literature.” Public Health 215 (February): 124–30.

Montiel, Irene, Jéssica Ortega-Barón, Arantxa Basterra-González, Joaquín González-Cabrera, and Juan Manuel Machimbarrena. 2021. “Problematic Online Gambling among Adolescents: A Systematic Review about Prevalence and Related Measurement Issues.” Journal of Behavioral Addictions 10 (3): 566–86.

Raybould, Jodie N., Michael Larkin, and Richard J. Tunney. 2021. “Is There a Health Inequality in Gambling Related Harms? A Systematic Review.” BMC Public Health 21 (1): 305.

Richard, Jérémie, and Serena M. King. 2023. “Annual Research Review: Emergence of Problem Gambling from Childhood to Emerging Adulthood: A Systematic Review.” Journal of Child Psychology and Psychiatry, and Allied Disciplines 64 (4): 645–88.

Thomas, Samantha, May C. I. van Schalkwyk, Mike Daube, Hannah Pitt, Darragh McGee, and Martin McKee. 2023. “Protecting Children and Young People from Contemporary Marketing for Gambling.” Health Promotion International 38 (2). https://doi.org/10.1093/heapro/daac194.

Tran, Lucy T., Heather Wardle, Samantha Colledge-Frisby, Sophia Taylor, Michelle Lynch, Jürgen Rehm, Rachel Volberg, et al. 2024. “The Prevalence of Gambling and Problematic Gambling: A Systematic Review and Meta-Analysis.” The Lancet. Public Health 9 (8): e594–613.

Valenciano-Mendoza, Eduardo, Bernat Mora-Maltas, Gemma Mestre-Bach, Lucero Munguía, Jérémie Richard, Jeffrey L. Derevensky, Marc N. Potenza, and Susana Jiménez-Murcia. 2023. “Clinical Correlates of Sports Betting: A Systematic Review.” Journal of Gambling Studies 39 (2): 579–624.

Wardle, Heather, Louisa Degenhardt, Virve Marionneau, Gerda Reith, Charles Livingstone, Malcolm Sparrow, Lucy T. Tran, et al. 2024. “The Lancet Public Health Commission on Gambling.” The Lancet. Public Health 9 (11): e950–94.

Welcome to PsyDactic.  Today is Tuesday, March 25, 2025.  I am your host, Dr. O'Leary, a child and adolescent psychiatry fellow in the national capital region.  This is a podcast I designed to help myself and other Child and Adolescent Psychiatry fellows study for their boards.  Anyone interested in human development and mental health will likely also get something out of it.  I am using AI to assist me with the content creation.  The tool that I used to create this episode allows me to do a literature search on a topic and pick peer reviewed and reputable sources to feed into the AI.  Then I create a prompt to guide the discussion.  I usually have to create 2-3 different prompts and explore the output of each, then pick the best parts, edit out problem parts, and paste it all together.  Even though I am using AI, all the content in the podcast should be considered my opinion and no one else's.  At the very least, it is compiled by me and released to you, so I take responsibility for that. If you find errors in the content or have suggestions for improvement, I would love it if you could go to PsyDactic.Com and fill out a form there to let me know.  You can also email me at feedback@psydactic.com.

I am going to release this episode in both my PsyDactic and PsyDactic Child and Adolescent Psychiatry Editions because the topic has so much overlap with adult psychiatry and reflects a global crisis.

Today I discuss gambling disorder and as your AI hosts will point out later, the rate of this disorder among adolescence has skyrocketed with the advent of online and mobile gambling platforms and the loosening of restrictions on sports betting in the United States. Let me start with the DSM5 criteria for gambling disorder. So the DSM5 defines gambling disorder as a persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress. And it's indicated by an individual exhibiting four or more of the following nine items in a 12-month period. One, needs to gamble with increased amounts of money. in order to achieve the desired excitement. Two, is restless or irritable when attempting to cut down or stop gambling. Three, has made repeated unsuccessful efforts to control, cut back, or stop gambling. Four, is often preoccupied with gambling. Five, often gamles when feeling distressed. Six, after losing money, gambling often returns another day to get even. is chasing one's losses. Seven, lies to conceal the extent of involvement with gambling. Eight, has jeopardized or lost a significant relationship, job or educational or career opportunity because of gambling. Nine, relies on others to provide money to relieve desperate financial situations caused by gambling. Basically, a financial b out. Now, a lot of people who are experiencing a manic episode may gamble and lose lots of money, but if this occurs within the mania and is not a problem outside of the manic episode, this would not be gambling disorder. Now, the DSM5 compared to the DSM4 has a few changes. First, the DSM4 included a criterion about committing illegal acts like forgery, fraud, or theft uh to finance the gambling, but it was removed in the DSM5 because it was found to be relatively rare and almost always occurring in conjunction with other criteria. And speaking of that criteria, I remember when I was younger driving to Kansas City with a friend of mine so that we could bail his father out of jail. His father was in jail for stealing a purse at a casino because he had run out of money. But this was also comorbid with a pretty severe drinking problem. I wonder why casinos serve alcohol. Another thing that's different between the DSM4 and the DSM5 uh is a reduction in the diagnostic threshold. So instead of meeting at least five out of 10 criteria for a diagnosis of gambling disorder, DSM5 reduced the threshold to four of nine. It also reflects a general trend in the DSM5 to conceptualize gambling disorder as a behavioral addiction with significant overlap with substance use disorders and in instead of as an impulse control disorder as people used to conceptualize. it. Now, there's something also called problem gambling. Uh, and this is a more loosely defined and term and not something I'm going to spend a lot of time on today, but in general, you could consider problem gambling as gambling that doesn't quite meet four out of those nine criteria, but there is still significant impact on the person's life. It's kind of like nient gambling disorder. In any case, now I'm going to turn you over to my AI co-hosts, Aiko and Aninsley. Or you could call them Aean and Ailen. Or you can call them whatever you want. They don't care. They're just the products of algorithms. Welcome back everyone to the deep dive. Today we are going to get into something well something that a lot of people have a relationship with in one way or another. Gambling. Um you know for some it's a bit of fun. Maybe a way to uh spice up a game or you know a quick lottery ticket here and there. But for others it can be a real struggle and we're not here to judge anyone but to really try to get a better understanding of what's going on um inside the brain.

Right? So for this deep dive we have uh pulled together as much research as possible. So that would be things like those really dense scientific articles with all the statistics and methodology.

Oh yeah.

And also uh some systematic reviews. So those take a look at a bunch of articles and give us a kind of zoomed out picture. Nice.

And then also meta analyses. Okay.

And we've also taken a look at what some experts are saying um on platforms like YouTube just to get a really well-rounded view.

Cool. So today's mission is to unpack why gambling can be so engaging and for some why it can be so hard to control. And we're going to really try to go beyond willpower,

right?

And understand what's actually happening in the brain. So things like the reward system, the neurochemicals involved, and even how the actual design of these gambling activities

um can kind of really mess with our brains. Yeah.

So by the end of this, we want going to give you more complete picture of how it all actually works. You know, the biological underpinnings of why people um get into trouble with gambling. So, let's start with the brain's reward system and dopamine, I guess.

Yeah. Dopamine is this uh this neurochemical that is involved in both pleasure and learning,

right?

So, when we do things that our brain finds rewarding, you know, like gambling, we get this surge of dopamine

and that feels good. Um it gives us pleasure. gives us excitement and then crucially it makes us want to repeat whatever behavior gave us that feeling.

So if I gamble and I win that dopamine is going to make me want to keep doing it. Okay. Now I was watching this TEDex talk by Carolyn Holly and she made a really interesting point. Um the anticipation of a win

she was saying actually plays a big part in that dopamine release.

Right.

It's not just the win. It's like even expecting something good to happen,

right? Yeah.

Like maybe the next hand is going to be the big one that can cause a dopamine release.

Yeah. It's like um almost like your brain is priming you for more rewards.

Yeah.

Yeah. But this is where it gets kind of tricky. She also explained that in people who develop a gambling addiction,

that dopamine response isn't only happening with wins anymore,

right? And that is um that's actually a really important point because it might seem kind of counterintuitive.

Yeah.

But in some people Yeah.

even losing can trigger a dopamine response.

Um kind of like what happens with winning. And this really explains why people chase losses. You know, that really powerful urge to keep gambling.

Oh, yeah.

To try and win back the money they've lost even though it seems like a bad idea.

Yeah.

Their brain is essentially telling them that,

you know, the next bet could be the one that brings back that rewarding feeling.

Okay. And she also mentioned, if I remember correctly, that those dopamine responses, so those surges, they can actually be higher

whether they are happening during wins or losses

in people. who have a gambling problem

compared to people who are just casual gamblers.

Right. So, their brain's reward system is basically becoming super sensitized.

Yeah. Yeah.

To anything gambling related.

So, that's scary. Okay. Let's talk about how gambling can kind of blur the lines between winning and losing, especially when it comes to near misses.

I hate those. Yeah.

Like when you're so close on the slot machine, you have two of the symbols lined up perfectly and that third one is just like a hair off.

Yeah. So frustrating.

You know, you can't help but think, "Oh, I was so close. Next time." But that's the thing. It was a loss,

right?

Objectively.

Yeah.

But the brain interprets it as being almost a win, which um triggers some of the same reward pathways as an actual win,

right?

And that just makes you want to keep playing.

It's like our brains are trying to trick us into thinking that we almost won, so we should just keep going.

Right. Exactly.

Right.

And when you think about how fast some of these modern gambling games are, like online slots.

Oh, yeah.

You can rack losses so quickly,

right?

And those near misses just kind of sprinkle in there and keep you hooked.

Like a constant barrage of losing and almost winning.

Yeah. And Holly pointed out that because dopamine is so important in learning, all this repetition of losses um with these near misses mixed in can actually make changes in the brain, right,

that make you even more susceptible to becoming addicted.

So you're training your brain in a way to chase that high, right,

even when it keeps failing.

Exactly.

Okay. Um, what about this idea of dark flow? I think Holly mentioned that as well. What is that?

Yeah, dark flow is when you get so absorbed in playing. Usually, it's these really fast-paced online games

that you totally lose track of time, where you are, and how much money you're spending.

Oh, wow.

And that becomes a really big problem when you're losing a lot.

Oh, yeah.

But you're just so focused on the game that you don't even realize how much damage you're doing.

So, let me ask you this. As you keep gambling, even when you are losing more and more, more. Does your brain keep reacting the same way or does it change over time?

Well, this is where we get into the concept of tolerance.

Okay.

Just like with drugs, people can develop a tolerance to gambling.

Really?

Yeah. So, over time, they might find that they need to gamble more money or they need to gamble more often to get that same feeling of excitement.

Okay.

That they used to get.

So, it's like they need a bigger and bigger hit to get the same rush.

Right. Exactly.

That makes sense. I remember Tim Fong from the Nevada Council on Problem Gambling, he said something like uh I want more to get more response, which is kind of sums it up perfectly,

right? So this adaptation in the brain is um a big part of what happens with addiction.

Okay?

So your brain gets used to a certain level of stimulation

and it needs more and more to get the same effect.

Okay?

And this uh developing tolerance is something that you really see with addictive behaviors and it's usually not as prominent in people who just gamble. So you know.

Yeah. Yeah.

For fun.

Okay. So, we've talked about how the reward system gets kind of rewired, but what about stress? I mean,

yeah.

Doesn't stress play a role in a lot of these addictive behaviors.

Definitely. Cortisol, which is like the main stress hormone,

it has a huge impact on the brain,

right?

And when someone is chronically stressed, which can be both a cause and an effect of gambling problems,

it can actually change the physical structure of the brain.

Wow.

And how it functions. Dr. Fong even described it as like potentially leading to a uh frightened brain.

Frightened brain. That's uh kind of an unsettling thought.

Yeah.

What does he mean by that?

Well, it means that the brain is uh kind of in a constant state of high alert.

Okay.

Maybe more sensitive to triggers, right?

And less able to um

you know control impulsive behaviors.

Okay. Okay. And it's not just about cortisol either. Right. Right.

Dr. Fong was saying that this overuse of the brain's neurochemical systems you know, from all that gambling can be really tough on the brain over time,

right?

So, it's like if you keep running your car engine at max RPMs, eventually it's going to burn out.

Yeah.

It's pretty complicated stuff, but it is starting to make sense. You know, it's not just about someone being weak willed or anything. There are actual physical changes happening in the brain,

right?

Okay. Let's switch gears a bit and talk about this idea of addiction by design.

I've seen that phrase in some of the research, particularly in this report from the the Lancet Public Health Commission. What's that all about?

Addiction by design is basically this idea that a lot of the gambling products out there are made in a way that encourages you to keep playing,

okay?

To keep engaging with them,

right?

So, the main goal, at least from the perspective of the gambling companies, is to make sure you spend as much time and money as possible on their products.

Yeah.

The Lancet report even used this phrase, play to extinction.

Wow.

Which is kind of a scary thought. Yeah,

but it basically means they want you to keep playing until you're broke.

Wow. What kind of features are we talking about here? What are they doing to achieve that?

Well, you see it a lot in those uh continuous forms of gambling like slot machines.

Okay.

You know, both the physical ones in casinos and the online versions, right?

It's that speed of play. There's always something happening.

New bets, flashing lights, sounds, and the way they show you the wins and near misses.

Yeah.

Just keeps you thinking that big win is right around the corner. And the Lancet Commission Alo pointed out that even those uh less intense forms of gambling like you know lotteryies and bingo. Yeah.

They've been redesigned to be more engaging. Really?

Yeah. They have more frequent draws.

Okay.

And now there's online versions with slot machine elements like uh you know Swingingo.

Okay.

So it's all designed to make it faster and potentially more addictive.

Yeah.

Yeah. And I've also noticed with sports betting there's been a huge increase in these personalized betting options and this whole inplay betting thing where you can bet on every little detail of the game as it's happening. Oh, yeah.

It's like non-stop.

It's really dynamic and it keeps you really engaged.

But like the Lancer Report said, that's kind of the point, right? The bookmakers want to keep you hooked.

Yeah. And speaking of being hooked, we can't ignore the sheer amount of gambling advertising that's everywhere. Oh, yeah.

I mean, it's on TV, it's online, it's on our phones. What does the research say about the impact of all that advertising?

Well, based on what we found, including this really good review, by McGrain and her colleagues which was published in public health. Um there's a clear link between seeing gambling ads and having more positive attitudes towards gambling.

Okay.

And also people report that they're more likely to gamble.

So the more we see these ads, the more we want to gamble

basically. Yeah. And not only that, they found something called a dose response effect.

Okay. What's that?

So it means that the more you're exposed to gambling advertising,

okay,

the more likely you are to gamble more frequently. right?

And engage in riskier gambling behavior.

And this is especially true for people who are already at risk of having gambling problems.

That's concerning. So it's like these ads are almost targeting the people who are most vulnerable.

Yeah.

What about kids? I know there's been a lot of talk about how these ads are affecting young people.

Yeah. That's a big concern.

Kids and teenagers are seeing these ads all the time,

right?

And they're very aware of them. And the problem is that both parents and kids often see these ads as making gambling seem normal.

Oh, yeah.

Like It's just a harmless everyday activity. And that can be really dangerous because it can shape how young people view gambling.

Yeah. It's like those old cigarette ads that tried to make smoking seem cool and normal.

Right. Exactly.

And I know the Lancet Commission mentioned that gambling companies are using some of those same tactics now, like with social media influencers.

Yeah. They're using social media and these online personalities to reach people, especially younger audiences,

right?

Who are, you know, more influenced by what they see online.

It's scary how how good they are at marketing. Okay.

Yeah.

So, we've got this reward system in our brain that can get hijacked. The games are designed to keep us playing and we're surrounded by advertising that makes it all seem okay,

right?

But what about these cognitive distortions? I've heard that term before. What exactly are those?

So, this is where the psychology of gambling comes in. It's not just about changes in the brain. It's also about these unhealthy thinking patterns,

okay,

that people develop that them stuck in that cycle of gambling.

Can you give me some examples? What kinds of things are we talking about?

Yeah. So, one example is something called attributional bias.

Okay.

And that's where people overestimate their skills.

Okay.

And underestimate the role of luck when it comes to gambling.

So, they think they're winning because they're good at it, right? Not just because they got lucky.

Exactly.

Okay.

Another one is the gamblers's fallacy.

Oh, yeah. I've heard of that one.

Yeah. That's the belief that, you know, something hasn't happened for a while, it's bound to happen soon. Right? So if you've been losing a lot, you start thinking, "Okay, this next one has to be a win."

Right. And so they keep gambling trying to recoup those losses,

right?

Based on this faulty logic.

It seems so logical when you say it out loud.

Yeah.

But I guess in the moment it can be pretty convincing.

Yeah, absolutely.

What other kinds of cognitive distortions are there?

Um well, there's a lot actually. Like um people might have inaccurate belief beliefs about randomness.

So they might think they can somehow influence a random event,

right?

Like uh you know blowing on the dice or something.

And they're also superstitious beliefs. Oh yeah.

Like having a lucky charm or a ritual that they think will help them win.

Right. Right.

And then there's also selective memory.

Okay.

Where they remember their wins really clearly.

Right.

But they kind of forget about all the times they lost.

Yeah.

And there's also something called the illusion of control.

Oh, okay.

Where they feel like they have more control over the outcome of the game than they actually do.

Okay? So, they think they can somehow outsmart the system,

right?

And then there's also um what we call illusory associations,

okay?

Where people see patterns that aren't really there,

okay?

And they use those patterns to try and predict what's going to happen next.

So, it's like our brains are trying to find order in chaos,

right?

Which with gambling is kind of impossible.

Yeah. Exactly.

And those wins, even if they're not that frequent, they must really reinforce those distorted beliefs.

They do because that's um what we call intermittent reinforcement.

Okay?

So the winds come on this unpredictable schedule,

right?

Which keeps your brain engaged,

keeps it seeking that reward,

okay?

And then there's also uh negative reinforcement,

okay?

Which is when gambling provides like a temporary escape from negative emotions like stress or anxiety, right?

So becomes a coping mechanism even though it's not a healthy one,

right? Right. Okay. So, all of this really paints a pretty comprehensive picture of how gambling can become such a huge problem for some people. Now, are there certain people who are more likely to develop these issues?

Yeah, there are definitely some risk factors that have been identified.

Okay. Like what?

Well, being younger is a risk factor.

Okay.

And also, um being male also socioeconomic factors play a role.

So, things like uh you know, growing up in a disadvantaged neighborhood or having a lower socioeconomic status, those can increase your risk.

Okay. Now, I'm curious about the CO 19 pandemic. Did that have any noticeable effect on gambling behavior?

It did. A metaanalysis that was published in current addiction reports, it looked at a lot of studies and found that um behavioral addictions overall,

okay,

including gambling addiction seemed to be a pretty significant problem during the pandemic.

Their estimate was that the rate of gambling addiction during that time was around 7 2%.

Wow, that's pretty high. Do we know why there was that increase during the pandemic?

Well, the study found a link between how much internet access a country had and the prevalence of gambling addiction.

Okay, that makes sense. You know, everyone was stuck at home,

right?

Online more.

Exactly.

So, it's kind of natural that online gambling would go up.

Yeah. And they also found that people who didn't gamble online before COVID, but started during lockdown,

they actually tended to have more severe gambling problems.

Oh, wow.

And lower incomes compared to people who were already gambling online before the pandemic.

It's like those lockdowns kind of pushed some people towards online gambling,

right? As a way to cope or for entertainment.

Yeah.

But for some it didn't end well,

right? Okay. Let's talk a bit about sports betting specifically, okay? Because that has become really popular in recent years.

What does the research tell us about sports betting?

Well, a recent review published in the Journal of Gambling Studies looked at a bunch of research on sports betting. M

and found that men who are more impulsive tend to be more drawn to sports betting.

That makes sense. You know, it's fast-paced. There's always something happening. You can get quick results.

Yeah. It's all about that instant gratification,

right?

And the thrill of potentially winning quickly.

Okay. What about mental health issues?

Is there a connection between sports betting and other mental health problems?

Yeah, actually research shows that sports betting often occurs alongside other mental health conditions.

Okay. especially substance use disorders and other types of addiction.

Okay.

So, it suggests that there might be some shared vulnerabilities in the brain

that make people more susceptible to both gambling and other addictive behaviors.

Interesting.

And there's also been research on daily fantasy sports or DFS.

Okay.

Which has found that playing DFS regularly is a strong predictor of gambling problems.

Really,

especially in college students.

That's surprising. I think a lot of people see DFS as more of a game of skill than traditional gambling.

Yeah, there is definitely a skill component to DFS,

right?

But the chance element and the potential to win money,

right,

can still trigger those same reward circuits in the brain.

Okay.

Especially in people who might already be vulnerable to gambling problems.

So, it's not just about luck versus skill. It's about how your brain reacts to the whole experience.

Right. Exactly.

Okay. Wow. This has been a really fascinating look at the neurobiology of gambling. It's amazing how many different factors are involved. You know, the brain's reward system, dopamine, the way these games are designed, all that advertising, and even our own thinking patterns.

Yeah, it's really complex.

So, just to recap some key takeaways, okay,

gambling really activates those specific pathways in the brain, especially the dopamine reward system, right?

And as we've discussed, it's not just winning that triggers that response.

Even the anticipation of winning and even losing, especially for people with gambling problem, s

can release dopamine and the way those gambling products are designed and all that advertising, it just makes it harder to resist.

Yeah.

And we can't forget about those cognitive distortions, you know, those faulty thinking patterns that kind of keep people trapped,

right?

But it's important to remember that all this brain stuff is just one part of the story.

Yeah.

Social factors, economic factors, psychological factors, all of those play a role, too.

So, if someone's gambling is becoming a problem, how do clinicians actually figure that out? seems like it's something people might try to hide.

Yeah, gambling disorder can be really sneaky. It's often hidden. And it's estimated that less than 15% of people who actually have the disorder ever get treatment. That just shows you how important screening is. It needs to be a standard part of healthcare because right now it's not something that's routinely checked during regular checkups.

So, what are the tools clinicians use to screen for gambling disorder? Are there specific questionnaires or something?

There are there are a few. There's the SCIPG, the South Oaks Gambling screen or SOGS, the diagnostic interview for gambling severity, DIGS. Even the 20 questions used by Gamblers Anonymous, those can be helpful for screening. And then there are shorter ones like the Massachusetts gambling screen and the gambling assessment module. One that I find particularly useful is the lie bet questionnaire. It's just two questions, but they're really powerful. Have you ever felt the need to lie to people you care about about how much you gambled? And have you ever felt the need to bet more and more money to get the same feeling? It's simple, but it's very effective at identifying potential problems.

The lie bet questionnaire, that's pretty straightforward. Why isn't something like that used more often?

It's a good question. Honestly, sometimes it's just a lack of awareness. A lot of healthcare providers don't realize how common and how serious gambling disorder is. They may also feel pressed for time. And then there's the stigma. Addiction in general carries a lot of stigma, and gambling disorder is no different. We even came across a case where a patient was really upset because a diagnosis of gaming disorder was put in their medical record. It shows you how sensitive people can be about these labels and it really highlights how important it is to communicate clearly and compassionately.

Yeah, it makes sense. So, let's say someone is diagnosed with gambling disorder. What kinds of treatments actually work?

Well, cognitive behavioral therapy, CBT, that's really the gold standard for treating gambling disorder. The idea behind it is that the disorder stems from, you know, messed up learning processes and distorted thinking patterns. Things like the illusion of control, where someone thinks they can control random events, or the gamblers's fallacy, where they think past events will affect future ones, like if they've lost a few times, they believe a win is due.

So CBT helps them change those thoughts and behaviors.

Exactly. CBT helps people recognize those distorted beliefs and the harmful behaviors that come with them, and it helps them challenge those thoughts. Studies show that CBT can help people gamble less often and reduce the amount of money they're wagering. And there are even benefits that have been seen months and even years after treatment. And when you combine CBT with support groups like Gamblers Anonymous, the results are even better. People are more likely to stay away from gambling altogether after 12 months.

I noticed some debate in the research about how long those therapy sessions should last to be most effective.

Yeah, there's some back and forth about that. Some studies say short-term CBT is enough. Others say you need longer term therapy to really make those changes stick and prevent relapse. It's something to keep in mind. And another important point is that therapy like CBT can help with other mental health issues, too. A lot of people with gambling disorder also have depression or anxiety, and CBT can help with those symptoms as well.

What about medication? Does that have a role in treating gambling disorder?

So, right now, there's no FDA approved medication specifically for gambling disorder. However, medication can be really helpful for treating other conditions that often go along with it, like ADHD, depression, or bipolar. disorder. These conditions can sometimes make gambling behaviors worse. And some medications show promise in reducing cravings and the urge to gamble. It's not a magic bullet, but it can be part of a comprehensive treatment plan. And we can't forget about sleep. Getting enough sleep is crucial for the brain to heal and for people to be able to focus on their recovery.

So, it's not just about therapy and medication. It's about a whole lifestyle change. Are there other things that are important for a good treatment plan?

Absolutely. Motivational interviewing is a really helpful technique. It helps people explore their feelings about change. You know, work through that back and forth of wanting to change but also being hesitant. And family therapy can be huge. Gambling disorder affects everyone in the family, not just the person with the disorder. And of course, self-help programs like Gamblers Anonymous and Smart Recovery offer incredible peer support and a structured approach to recovery. In the end, the most successful treatment plans often involve a combination of all these approaches, and it takes real commitment from the person with the disorder. They have to be willing to stick with it and be honest about their gambling.

This is all great information for people who are struggling, but what about parents who are worried about their teenagers? What can they do to help and maybe prevent problems from starting in the first place?

Parents have such a vital role to play here. Teaching kids about finances, working that into family life, maybe even getting the church or community groups involved can really make a difference. It's about giving teenagers the tools to manage their money responsibly, having open conversations about the risk of gambling, you know, making sure they understand the dangers. And churches and youth organizations can provide healthy alternatives, you know, fun activities, positive mentorships, things like that.

You know, you mentioned a story earlier about a mother who took really decisive action when her son was struggling.

Oh, yeah. The mother who got her son into residential treatment for his gambling problem. That's a perfect example of how important it is for parents to be aware, to step in early, and to get professional help if they need it. And parents need to realize that just blocking gambling apps on their kids' phone isn't enough. Teenagers are resourceful. They'll find ways around that. What they really need is a strong support system and honest communication.

So, taking a step back, what about on a larger scale? What common sense regulations and laws could help reduce how many people are dealing with gambling disorder, especially young people?

This is where policy really comes in. Right now, we are just bombarded with gambling ads everywhere we look, all over the media. And while it's hard to prove that seeing these ads directly causes gambling disorder. There is more and more evidence that there's a link between being exposed to those ads and how people think and act about gambling. People who are already at risk, they definitely notice these ads more and they're more likely to say that the ads made them gamble more, especially when it comes to sports betting.

And seeing all those ads, it almost makes it seem normal, like gambling is just a harmless activity, especially for kids and teenagers.

Exactly. Kids and teens see those ads and they start to think gambling is just a normal risk-free part of life. And the way sports betting is being marketed these days, it's very similar to how tobacco companies used to market cigarettes. And that's a big red flag. It suggests that we need to take a page from how we regulate tobacco advertising.

You're talking about things like restricting where and how gambling can be advertised, maybe even running counter advertising campaigns.

Exactly. Think back to how we dealt with tobacco ads. There was the fairness doctrine, which forced broadcasters to present both sides of cont. controversial issues. So alongside those cigarette commercials, you'd also see antismoking messages. And eventually we banned tobacco ads on TV and radio altogether. We need to consider similar strategies for gambling ads, especially on platforms where a lot of young people are watching. The Federal Trade Commission also needs to do something about these social media influencers who are basically promoting gambling under the guise of entertainment.

We also have to remember that the gambling industry, they have a vested interest in influencing ing the debate around regulation.

Oh, absolutely. Like a lot of industries that profit from potentially harmful products, the gambling industry is very strategic. They try to sway research, policy decisions, and public opinion to protect their bottom line. We need to be aware of these tactics.

So, if we're talking about research into gambling disorder and developing effective treatments, who should be footing the bill for that?

That's a good question. We need to move away from relying so heavily on the gambling industry to fund research and treatment programs. We need more independent funding from government agencies or charitable foundations to avoid conflicts of interest and make sure that public health is the top priority, not profit. We also need to remember the precautionary principle. If there's a reasonable suspicion that something is harmful, we need to take action to prevent harm, even if we don't have absolute proof. And the burden of proof should be on the people who are profiting from potentially harmful activities like commercial gambling.

What about specific regulatory measures? What would make the biggest In protecting people,

we need mandatory measures that actually limit how much people can gamble. This means setting and enforcing deposit limits, limits on how much people can bet, tailoring those limits to individuals. We also need universal pre-commitment systems. Pre-commitment lets people set limits on their spending and time before they even start gambling, which is a really important safeguard. It's interesting, jurisdictions that have specifically said, "We're changing our gambling policies to protect public health," they've been more likely to adopt these kinds of preventative measures. Just rely on ing on the gambling industry to regulate itself. That's not going to work. Their main goal is profit, which clashes with harm reduction. So, governments have to step up and put public health first. And this isn't just a local issue. It's a global one. We need urgent, coordinated action at the international level to tackle the harms of gambling.

Wow, we covered a lot of ground today. This was an incredibly insightful deep dive into gambling disorder. We talked about how common it is in different groups, the alarming trends we're seeing in young people, the huge impact of technology, the science behind addiction, the best ways to diagnose and treat it, how parents can help, and what kinds of regulations we need to make things safer.

Yeah, I hope this discussion gave everyone listening a much clearer understanding of this issue and why it's so important.

So, one last thing for everyone to think about. We've seen how addictive gambling can be. The brain science makes that very clear. And we've talked about how much advertising we're all exposed to. So, thinking about all of that, what are our responsibilities as individuals, as tech companies that provide these platforms, and as government, governments to create an environment that reduces harm while still respecting people's freedom of choice. It's a complicated ethical question as gambling becomes more accessible and the marketing becomes more sophisticated. Thanks for joining us for this deep dive.