In the 1968 film “Funny Girl,” Barbra Streisand’s character falls in love with Nick Arnstein, a dashing con artist whose reckless gambling causes them to lose their mansion, savings, and finally, their marriage.
When the movie first came out, Nick’s gambling problem was seen as just that — a problem. It wasn’t until 1980 that pathological gambling was identified as a mental disorder by the American Psychiatric Association. At the time, roughly 1.1 million Americans engaged in problematic or compulsive gambling; today, the National Council on Problem Gambling (NCPG) estimates that between 5.4 and 8.1 million adults meet the criteria for gambling addiction.
Heather Berlin, a neuroscientist at Mt. Sinai, says that like drug addicts, problem gamblers are unable to stop gambling even when the behavior becomes destructive. “They’ll do it at the cost of losing their job, destroying their relationships, or losing their money,” she says. “Gambling addicts just can’t seem to stop themselves from engaging in this negative or detrimental behavior.”
Problem gamblers aren’t only a danger to themselves — the NCPG estimates that the bankruptcies, burglaries, spouse abuse, child neglect, foreclosures, and even suicide associated with gambling addiction costs the U.S. $6 billion each year.
As with all addictions, the severity of the problem varies from person to person, and there’s no set pattern for when addicts gamble (daily vs. weekly) or the medium they use. Keith Whyte, executive director of the NCPG, says that men tend to prefer sports betting and competitive skill-based games, while women are more likely to play the slot machines or bingo.
What really matters, says Berlin, is how much you’re gambling and what happens when someone tries to stop you. “It’s a spectrum,” she says. “The depth of it is really what we have to gauge. There’s no clear black or white line whether it’s pathological or not. It’s just a matter of degree.”
Gambling your life savings, for example, or experiencing withdrawal symptoms, such as irritability and restlessness when prevented from betting, are good signs that you might have a problem, she says.
If you’re concerned about your own or a friend’s gambling habits, here are steps to overcoming a gambling addiction:
1. Admit you have a problem. As with all addictions, one of the first steps on the road to recovery is admitting there’s something wrong in the first place. The percentage of gambling addicts who seek out treatment is small (some estimates are as low as 3%), and Berlin says most addicts don’t get help until very late in the cycle. “In the beginning, they may be in denial,” she says, “but when it gets to a point where it’s clearly a problem, they stop trying to deny it.”
When they do seek help, many call 24-hour gambling hotlines, which are answered by trained mental health professionals. The NCPG hotline received 317,000 calls last year, says Whyte, and has received a 10% increase in calls each year for the past decade.
2. Join a support group. Along with individual therapy, many gamblers go to self-help groups like Gambler’s Anonymous (GA), a 12-step program modeled off of Alcoholics Anonymous that uses many of the same techniques, such as having a sponsor.
According to a GA spokesperson, there are just over 1,700 GA groups in the United States, all of which can be located by city and state on their website, and groups in 86 international cities. Spouses and family members of gambling addicts can go to Gam-Anon meetings(available in 40 U.S. states) to learn how to support their loved one without encouraging his or her problem.
3. Seek professional help. The standard treatment for gambling addiction, says Berlin, is cognitive behavioral therapy (CBT), in which a therapist and addict work one-on-one to change the gambler’s destructive behavior and thoughts. CBT helps addicts build coping skills and develop cognitive tools to help them resist the urge to gamble, such as practicing waiting for increasingly longer periods of time before giving in to the gambling urge.
“There’s a lot of relapse just like with drug addictions,” she says. “People stop for a while, and then something might trigger them, and they’ll go on a [gambling] binge and relapse.” CBT teaches gamblers how to deal with issues in their personal or financial lives rather than find an escape through gambling.
4. Consider medication. Like a drug addict who has become desensitized to small amounts of the drug, people who are prone to gambling addiction often have trouble feeling the same “high” that other people get when anticipating winning money, says Berlin. Rather than seeking out a high, she says, problem gamblers “need more just to get the normal high as someone who’s not a pathological gambler.”
To correct for this imbalance of dopamine, psychiatrists will often prescribe SSRIs, an antidepressant that affects the serotonin system. Other drugs that are also prescribed are lithium, often used in cases where the person also has bipolar disorder, and opiate antagonists like nalmefene, which reduces the positive feelings associated with winning.
5. Implement regulatory mechanisms. Some gamblers who don’t currently have a problem but worry about themselves in the future may try to put limits on how often they gamble and the amount of money they gamble with. This can include only bringing cash to a casino or gambling with designated money and not dipping into funds for other specified expenses (e.g., rent, mortgage, food).
Gamblers on the opposite end of the spectrum, who are clearly identified as pathological gamblers and are either not in treatment or are suffering from relapse, sometimes designate a trusted advisor to control their finances so that they’re literally prevented from accessing cash for gambling.
Written by Lydia Dallett