Gambling involves putting something of value, usually money, on an event with an uncertain outcome. The outcome is determined by chance or a game of chance, and the gambler hopes to gain something of value in return (see Figure below). Most people who gamble do so without serious problems. However, a small proportion of people develop pathological gambling. Pathological gambling is considered an addiction and may have a number of negative personal, social, work, and financial consequences.
Gambling is a common pastime for many individuals and can take place in a variety of settings, including casinos, racetracks, online gambling sites, home games with friends, and in other private activities. Most gambling occurs in the form of playing card games such as poker, blackjack, and spades with other family members or friends for enjoyment and competitiveness. Occasionally, bets on football matches or other sporting events will be placed within social circles and the winners of those bets are determined by random chance. Other examples include lottery tickets, bingo, and casino games such as slot machines and video poker.
The amount of time and money invested in gambling varies among individuals, with some people becoming very involved and causing significant problems for themselves and their families. Gambling can also cause a range of emotional and behavioral problems, such as guilt, shame, anxiety, and depression. Some people even become apathetic or suicidal. These problems can be difficult to recognize and treat, because of the stigma associated with gambling disorder.
Although the underlying factors of pathological gambling are not well understood, a number of risk and protective factors have been identified. These include age, family and peer relationships, employment, education, and socioeconomic status. A high degree of genetic vulnerability is also present. In addition, some individuals are more prone to erroneous beliefs and cognitive errors that lead them to be more likely to gamble.
Psychiatrists and other health care professionals often assess their patients’ gambling behaviors and make recommendations for treatment. These evaluations can be important in identifying those at risk for problem gambling and can help guide treatment.
In recent years, the understanding of the adverse effects of gambling has undergone a profound change. It is now widely accepted that such adverse consequences are a manifestation of an underlying psychological problem rather than the result of a specific substance or activity. This change has been reflected in the various editions of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, published by the American Psychiatric Association.
A growing role exists for assessing patients’ gambling behavior in primary care settings, and a range of effective treatments are available for people with gambling disorders. These treatments include family therapy, marriage counseling, and career or credit counseling. Family therapy is particularly helpful in dealing with the effects of gambling on a relationship, as it can help the spouses or partners of those with a gambling problem to set boundaries in managing household finances and to better understand their loved one’s impulsive impulses.