Understanding Gambling Addiction: Why Gambling Disorder Treatment Must Evolve

According to the American Psychiatric Association, a diagnosis of gambling disorder requires persistent and recurrent problematic gambling behavior that results in significant distress or impairment. An individual must exhibit four or more of the following criteria within a 12-month period:

• Needing to gamble with increasingly larger amounts of money to achieve excitement
• Feeling restless or irritable when attempting to cut back or stop gambling
• Repeated unsuccessful efforts to control or stop gambling
• Frequent preoccupation with gambling
• Gambling to escape negative emotions
• Returning to gamble to recover losses
• Lying to conceal gambling behavior
• Jeopardizing important relationships, employment or opportunities because of gambling
• Relying on others for financial assistance due to gambling-related losses

The severity of gambling disorder is determined by the number of criteria met: mild (4-5), moderate (6-7) or severe (8-9).

If it seems like gambling is everywhere these days, especially if you're a sports fan, you're not alone. What was once largely confined to casinos in select states has become nearly as common and accessible as alcohol. The lure of revenue proved too great for most jurisdictions to resist. Today, most U.S. states permit some form of gambling, whether through sports betting, lotteries, casinos, horse racing or a combination of options. Two factors, however, have played particularly significant roles in the rapid growth of gambling and the increasing prevalence of gambling addiction: the internet and smartphones.

What once required a trip to a casino, racetrack or local bookmaker can now be accomplished in seconds from a mobile device. Alongside that convenience has come increased participation from younger generations. With smartphones and digital payment systems readily available, gambling opportunities now reach adolescents and young adults in ways that were previously unimaginable.

Technology and Unlimited Access to Money

But greater access to gambling alone does not fully explain the growth of problem gambling. Access to money has also fueled the trend.

Years ago, gamblers were often limited by the amount of cash they carried. Over time, the gaming industry introduced credit, ATMs and credit card transactions, allowing individuals to continue gambling even after reaching a predetermined spending limit.

Today, many gambling apps allow users to link directly to bank accounts, debit cards and credit cards. In practical terms, that means there may be few barriers between an impulse to gamble and the ability to place another bet.

The Rise of Micro-Betting and 24/7 Gambling Opportunities

The nature of gambling itself has changed as well.

Gone are the days when betting was largely limited to predicting the winner of a football, baseball, basketball, or hockey game. Today's bettors can wager on college sports, international competitions, and even highly specific "micro-bets" such as the outcome of a single pitch, play or point. In some cases, individuals can place bets on sporting events occurring virtually anywhere in the world at any time of day.

Beyond sports, betting markets now extend to everything from economic trends to political events and other real-world outcomes.

As a result, gambling is now available 24 hours a day, 365 days a year, often through a device that people carry with them everywhere they go.

Clinical resource

For individuals experiencing gambling-related problems, immediate support is available through the National Problem Gambling Helpline (1-800-GAMBLER), a confidential nationwide resource that connects callers with local treatment providers, support groups, and recovery resources. For clinicians, the helpline can also serve as a referral option when working with clients who need specialized gambling addiction treatment services.

What This Means for Gambling Addiction Treatment

This is the new reality, and gambling addiction treatment must evolve accordingly. While awareness of gambling disorder has increased, relatively few providers in the United States possess specialized expertise in the assessment and treatment of problem gambling. As gambling opportunities expand and become increasingly integrated into everyday life, the behavioral health field must continue building capacity to identify, assess and treat gambling-related harms.

For many clinicians, gambling disorder remains an under-recognized condition despite its significant impact on financial stability, relationships, mental health, and overall quality of life. Expanding access to effective problem gambling treatment will require not only increased public awareness but also greater investment in workforce development, training and research.

Key Questions Facing the Future of Treatment

Important questions remain:

• What is the appropriate level of care for gambling disorder?
• What training and competencies are necessary for providers?
• How should treatment outcomes be measured?
• Will insurers cover the cost of treatment?
• How can treatment remain accessible when severe financial hardship is often part of the disorder?
• What role should the gambling industry play in prevention and treatment efforts?
• How should elevated suicide risk be addressed within emerging treatment models?
• What role should families and loved ones play in recovery?

An Emerging Need for Trained Clinicians

These are only some of the issues that clinicians, researchers, and healthcare organizations must address as gambling disorder treatment continues to develop. The growing prevalence of gambling addiction demands a coordinated response that includes prevention, early intervention, specialized treatment and long-term recovery support.

As access to gambling expands and the profile of affected individuals continues to change, so too must the workforce prepared to treat them. More addiction counselors, therapists, social workers, psychologists and other behavioral health professionals will need training in the assessment and treatment of gambling disorder. Effective gambling addiction treatment will depend on a stronger clinical infrastructure, a growing evidence base and a commitment to meeting the needs of individuals and families affected by problem gambling.

There is much work to be done, and the field needs more clinicians willing to take on this important challenge.