Gambling involves putting something of value on an activity that is primarily based on chance with the hope of winning a prize. It is a form of risk-taking that has been part of every culture since prerecorded history and is often incorporated into local customs and rites of passage.

While most adults and adolescents have gambled at some point in their lives, a small percentage develop problems with gambling that can be extremely distressing and interfere with everyday functioning. This subset of people is diagnosed with a disorder called pathological gambling, which is classified as an impulse control disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Understanding how and why some people become addicted to gambling may help us identify better strategies for prevention and treatment.

The first step toward a diagnosis of pathological gambling is to determine whether or not someone meets the 10 DSM-IV criteria for this disorder: (1) damage or disruption, (2) loss of control, (3) dependence. Criteria for this include: a) repeated unsuccessful attempts to control, cut back or stop gambling; b) lying to family members, therapists or others about the extent of one’s involvement with gambling; c) losing more money than can be afforded and then returning another day in order to get even (“chasing losses”); d) having feelings of helplessness, guilt, anxiety or depression because of gambling; e) committing illegal acts such as forgery, fraud or theft in order to finance gambling; and f) jeopardizing a significant relationship, job or educational or career opportunity because of gambling.

Several factors contribute to the development of gambling disorder, including a desire for an early big win, boredom susceptibility, impulsivity, poor understanding of random events, use of escape coping and stressful life experiences. These factors can lead to an increase in the amount and frequency of gambling as well as an escalation in the types of bets placed. While these underlying mechanisms are complex, they have the potential to help explain how and why some people become addicted to gambling.

It is important to note that, while the DSM-IV criteria for gambling disorder are influenced by these factors, these disorders are not considered to be caused by them. The underlying mechanisms are similar to those that cause other disorders with impulsive features, such as attention-deficit/hyperactivity disorder or substance misuse. Therefore, it is possible that these disorders share a common biological basis and should be treated as the same. It is also important to remember that, like all addictions, gambling disorders are a complex problem that requires an individualized approach for assessment and treatment. Attempts to treat these disorders with general approaches aimed at treating impulsive behaviors may be ineffective and are likely to result in resistance to treatment. In fact, treating these conditions with a “tough love” approach is likely to result in a worsening of the gambling behavior and an increased likelihood of developing more serious and lasting problems.