Questions and Answers

How similar is gambling addiction to drug/alcohol addiction?

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the
American Psychiatric Association recategorized gambling disorder from the "Impulse Control
Disorder'' section to the newly expanded "Substance-related and Addictive Disorders'' section.
With this move, gambling disorder has become the first recognized nonsubstance behavioral
addiction, reflecting the many shared features between gambling disorder and substance use
disorders.

In a 2016 review article, Carla Rash and colleagues compare gambling and substance-related
disorders. Similarities relate to evidence of heritability of risk, demographics of who is most
affected, and the development of tolerance, withdrawal, loss of control, and negative
consequences. The authors conclude that evidence suggests " significant overlap and common
risk factors" between gambling and substance-related disorders, and recommend screening
people with one set of disorders for the other (Document 1).

How common is gambling addiction?

In the United States, the National Council on Problem Gambling estimates that 2 million U.S.
adults have a gambling disorder, with another 4 to 6 million having mild to moderate gambling
problems, but not meeting the threshold of a gambling disorder diagnosis (Document 2, see:
https://www.ncpgambling.org/help-treatment/faq/).

In their 2016 article, Carla Rash and colleagues cite several studies to estimate that about 1-2%
of Americans have had gambling addiction in their lifetime, including about 0.5-1% in the past
year. These are generally similar to rates found in global studies. With the changes to the legal
status of gambling in recent years and in diagnostic criteria, there is a need for new national
prevalence studies (Document 1).

What is the recommended treatment for gambling addiction?

The treatment of gambling addiction most commonly includes psychological interventions, such
as cognitive-behavioral therapy or motivational interviewing. The evidence for their
effectiveness is still emerging. There is an absence of well-designed evaluation studies and a
compelling need for more research in this field. There are no FDA-approved medications for
gambling addiction.

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A 2021 review by Davor Bodor and colleagues found: "A substantial body of literature has
shown that the most successful therapeutic protocols are psychological interventions,
especially based on cognitive-behavioral therapy/methods and/or motivational interviewing.
Other interventions with promising results include different self-help interventions and
mindfulness. Interventions such as couples therapy and support groups, may have positive
effects in terms of increasing therapeutic adherence and retention, while pharmacotherapy is
especially useful in patients with comorbidities" (Document 3).

A 2017 study by Nancy Petry and colleagues concluded, "Although most studies found some
benefits … only a handful of studies demonstrated any long-term benefits" (Document 4).

Gamblers Anonymous, founded in 1957, is a self-help group that can provide for people with
gambling use disorder.

Given the high rates of co-occurring substance use disorders and psychiatric disorders, it is
important for individuals with gambling addiction to receive a comprehensive evaluation.

What is the societal cost of treating gambling addiction?

The National Center for Problem Gambling estimates the social cost of problem gambling in the
United States is $7 billion per year including structural and personal factors such as the
spending on gambling-related criminal justice and healthcare as well as job loss and bankruptcy
(Document 2). This estimate is based on the 1999 National Gambling Impact Study Commission
and has been adjusted to account for inflation and current rates of problem gambling.

Are young adults particularly likely to engage in gambling and to suffer from gambling-related
disorders?

There are several studies that suggest young adults, specifically young men, are at higher risk
for gambling in general, and sports gambling in particular. This evidence dates back as far as
2001, when Howard Shaffer, Matthew Hall, and Joni Bilt reviewed 146 studies and found that
younger age was associated with gambling-related disorders (Document 5).

In 2008, Ronald Kessler and colleagues found that people with problem gambling reported
starting at the age of 16 to 17, while people who gambled without problems started at about
24 years old (Document 6). In that same year, John Welte and colleagues published the results
of a random survey of more than two thousand 14 to 21 year olds in the United States. More

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than two-thirds of respondents reported gambling in the past year, with a rate of problem
gambling of 2% (Document 7).

More recently, in 2022, Jonathan Noel and colleagues published a cross-sectional prevalence
study of problem gambling among young adults aged 18 to 25 who lived in Rhode Island for at
least part of 2020. The study found that 22.4% engaged in one or more gambling activities and
11.5% of participants had any gambling problems, five times the national estimate. The odds of
gambling activities in this group were higher among those who identify as Black, Indigenous and
People of Color. In this study, individuals who engaged with sports betting had 2.4 times the
odds of having problems with gambling (Document 8).

In a separate paper in 2022, Jonathan Noel and colleagues concluded: "Gambling is a common
and ubiquitous activity among Rhode Island young adults, and participants engaged in a variety
of different gambling behaviors, which ranged from buying scratch tickets to casino gambling to
sports betting. Problem gambling was also prevalent in nearly all identified socio-demographic
groups." The authors noted, "The high prevalence of gambling and gambling problems in
Rhode Island’s young adults may be, at least partially, due to the state’s lax gambling
regulations (ex. 18 years minimum gambling age, allowing online sports betting)" (Document 9).

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This document was prepared by John Poulos, candidate for MSPH in Health Policy and Dr.
Joshua Sharfstein, Professor of the Practice in Health Policy and Management at the Johns
Hopkins Bloomberg School of Public Health. It does not necessarily reflect the view of the Johns
Hopkins Bloomberg School of Public Health or of Johns Hopkins University.

References

1. Rash, C. J., Weinstock, J., & Van Patten, R. (2016). A review of gambling disorder and
substance use disorders. Substance abuse and rehabilitation, 7, 3–13.
https://doi.org/10.2147/SAR.S83460
2. National Council on Problem Gambling. (2021, September 28). FAQ. National Council on
Problem Gambling. Retrieved March 16, 2023, from https://www.ncpgambling.org/help-
treatment/faq/
3. Bodor, D., Ricijaš, N., & Filipčić, I. (2021). Treatment of gambling disorder: review of
evidence-based aspects for best practice. Current opinion in psychiatry, 34(5), 508–513.
https://doi.org/10.1097/YCO.0000000000000728

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4. Petry, N. M., Ginley, M. K., & Rash, C. J. (2017). A systematic review of treatments for
problem gambling. Psychology of addictive behaviors : journal of the Society of Psychologists
in Addictive Behaviors, 31(8), 951–961. https://doi.org/10.1037/adb0000290
5. Shaffer, H. J., Hall, M. N., & Vander Bilt, J. (1999). Estimating the prevalence of disordered
gambling behavior in the United States and Canada: a research synthesis. American journal
of public health, 89(9), 1369–1376. https://doi.org/10.2105/ajph.89.9.1369
6. Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer,
H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication.
Psychological medicine, 38(9), 1351–1360. https://doi.org/10.1017/S0033291708002900
7. Welte JW, Barnes GM, Tidwell MC, Hoffman JH. The prevalence of problem gambling among
U.S. adolescents and young adults: results from a national survey. J Gambl Stud. 2008
Jun;24(2):119-33. doi: 10.1007/s10899-007-9086-0. Epub 2007 Dec 21. PMID: 18097737;
PMCID: PMC4405098.
8. Noel, J. K., Rosenthal, S. R., & Sammartino, C. J. (2022). Correlates of gambling and gambling
problems among Rhode Island young adults: a cross-sectional study. Journal of public health
(Oxford, England), fdac023. Advance online publication.
https://doi.org/10.1093/pubmed/fdac023
9. Noel, J. K., Tudela, S. E., Jacob, S., & Rosenthal, S. R. (2022). Gambling: A Ubiquitous
Behavior Among Rhode Island's Young Adults. Rhode Island medical journal (2013), 105(3),
46–50.