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Gambling Addiction & Substance Abuse: How They Are Linked & What to Do

Claire Wilcox, MD profile image
Medically Reviewed By Claire Wilcox, MD • Updated Jun 2, 2022 • 14 cited sources

A person chooses to take that first sip of alcohol or hit of drugs. They feel euphoric. A person also decides to roll the dice or bet on cards for the first time. They win, and also feel a high. But what happens when they lose the bet, or the alcohol or drug is no longer available after they have come to rely on it?  

Cravings set in. And the behavior becomes compulsive.

The fact that substance use disorders and gambling use disorders operate through similar brain circuits is also manifest in the epidemiological studies: they often travel together in populations.  A study of people with gambling disorders, almost 23% also had substance use disorders (SUDs).[1] For people with both problems, it’s even harder to get well. 

Gambling Disorder & Substance Use Disorder: Overlapping Signs & Symptoms

The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5), includes entries for both substance use disorder and gambling disorder.[2] Medical and mental health providers can diagnose their patients with one or both of these conditions depending on whether or not they meet specific criteria. Several criteria are listed under the headings of both disorders, highlighting their overlap.

Below are the criteria that are seen in the descriptions of both gambling disorder and substance use disorder:

  • Tolerance: Over time, the person must use more of the substance to feel the same effect. A person with gambling disorder bets more often or larger amounts. A person with a substance ue disorder consumes larger and larger quantities of their drug of choice over time. 
  • Loss of control: The person no longer feels they have the power of choice in cutting back or quitting.. A person with gambling disorder can’t drive by a casino without stopping in. A person with a substance use disorder can’t resist the power of a craving. 
  • Withdrawal: The person feels uncomfortable when trying to quit and experiences a set of specific physical and psychological symptoms, usually unique to each drug. The person with a gambling disorder feels irritable and jumpy. The person with a substance use disorder  feels different symptoms depending on the drug, but usually irritability and unpleasant emotions are part of withdrawal from all drugs. 
  • Continued use: The person sticks with the habit despite having experienced negative consequences that significantly impact their livelihood. The person with gambling disorder keeps betting even though family members notice heavy financial losses. The person with a substance use disorder keeps using even after landing in the hospital due to an overdose. 
  • Fixation: The person is preoccupied with the habit. The person with gambling disorder skips work to bet during the day. The person with a substance use disorder spends an inordinate amount of time getting or using substances. 

Differences between the two conditions exist within the DSM-5.

  • Compulsive gambling: Chasing losses, lying about gambling, and asking for financial bailouts to cover losses are characteristics of a gambling disorder that don’t relate to substance use disorder.
  • Substance misuse: Drug or alcohol use in hazardous situations, such as while one is driving, is a symptom that isn’t listed in the description of a gambling disorder.. 

The conditions are remarkably similar, however, and how people behave when impacted are much the same. 

Compulsive Disorders & Your Brain 

Why are gambling and substance use disorders similar? Researchers say the answers lie within the cells of your brain. 

Your brain releases dopamine in response to a positive, rewarding activity. Bite into a ripe apple? You’ll get a dopamine burst. Hug someone you love? You’ll feel more dopamine. 

We’ve known for decades that addictive drugs cause dopamine surges. Each hit floods your brain with feelings of reward, security, and happiness. Over time, with continued use or engagement in a behavior like gambling, your brain  produces less dopamine and reductions in the sensitivity to dopamine through reductions in the number of dopamine receptors on the neurons.  This leads people to use more and more. In addition, dopamine release plays an important role in conditioning and the  reward learning process: the more dopamine is released, the more likely they are to go back to the behavior that caused its release in the first place. 

In time, people with SUDs rewire their brain circuits. They require addictive substances and certain behaviors to feel normal. They have a hard time resisting urges to go back to these substances or behaviors. And they need large amounts to feel anything approaching happiness. 

Researchers say that gambling works on these same pathways.[3] A big win releases dopamine, and users chase that high by betting more often and larger amounts. 

Brain circuit vulnerabilities could be responsible in cases of people with both gambling disorder and SUDs.[4] Impaired functioning of the prefrontal cortex, the part of the brain responsible for behavioral control and decision-making to start renders people less able to assess risks and suppress their impulses. 

Someone with a preexisting susceptibility who experiences a dopamine surge after engaging in a particular behavior might find it particularly hard to walk away from future opportunities. And the more often they repeat the behavior, the more they damage their brain cells. 

Are Gambling Disorder & Substance Use Disorders Existing Conditions? 

Gambling Disorder and SUD commonly co-exist. Researchers say problem gambling rates are four to 10 times higher in those with SUDs when compared to the general population.[5] Pre-existing vulnerabilities in brain function, such as in the prefrontal cortex, could be partially to blame. People with high impulsivity scores tend to make rash decisions about both substances and gambling putting them at higher risk of developing a difficult-to-break habit.

In addition, gambling and substance use often go hand in hand. While some gamblers complain that casinos serve fewer free drinks than they did in the past, most casinos will provide at least some sips to big spenders.[6] 

People who drink tend to stay on the gambling floor longer, so this small expense seems worthwhile to the Casinos. This continual flow of alcoholic beverages solidifies the link between drinking and gambling.

Risk Factors You Should Know About 

What can you do to avoid compulsive gambling? Some risk factors are within your control, while others are not. 

4 Risk Factors You Can’t Change

Some people are at higher risk of developing a gambling disorder due to factors  outside of their control. These might include:

  • Your upbringing: Growing up in a home that recognized superstition, luck, or other forms of magical thinking can make gambling more attractive.[7] If you believe that you can beat the house because you’re having a lucky day or someone is interceding on your behalf, you’re less likely to see the facts clearly: for example that the deck is stacked against you. 
  • Your genetic makeup: Problem gambling runs in families, as do most substance use disorders.[8] You can’t change the influence of your genes.
  • Early, big wins: The first time you gamble, you walk away with an entire pot of money. Your sense of euphoria is massive, and it could set you up for a lifetime of chasing that high. 
  • Low economic status: People who have less to spend are more likely to feel a bigger sense of euphoria when they win, even if the jackpot is relatively small. 

4 Risk Factors You Can Change

Say you don’t want to develop a problem with gambling and want to know how to prevent it. Try altering these risk factors:

  • Support circle: People with poor connections to others become more quickly dependent on the high from gamblingto reduce stress and boost a low mood. Find people you trust and nurture those relationships so you have good support in your life. 
  • Time spent gambling: The more you bet, the more you change your brain. Step away as soon as you can. Better yet, don’t gamble at all. 
  • Gambling habits: Mixing chemicals and gambling can overwhelm your brain, and make it hard to make rational grounded decisions. Don’t take drugs or drink while you gamble. 
  • Knowledge of gambling: Learn all about how casinos, card games, and online gaming work. Understand that the deck is always stacked against you. 

How Can Gambling & SUDs Hurt You?

Bank accounts can take a hit when gambling and substance use is combined. Alcohol and drugs are expensive, and money goes fast in the casino. 

Your mental health also can suffer. Repeated losses while gambling leads to brain changes and psychological strain with regret and symptoms of depression and anxiety. Regular use of all habit-forming drugs is also damaging to brain chemistry, and leads to low mood through biochemical effects and through effects on life functioning. You will be compelled to stick to your substance use and gambling, and your thoughts will be consumed by the bets you didn’t take and the drugs you couldn’t get. Even if you manage to pay off your debts, your problems will remain.[9]

Your family can also be negatively effected and both can temporarily or permanently damage important relationships in your lives. Teens with gambling parents often develop depression, conduct disorders, and their own gambling problems.[10] too. So you may be adversely affecting your loved ones in ways you haven’t even thought of.

What Treatment Options Are Available?

The best treatments are tailored. There is no form of therapy that works best for all people all the time. But researchers say some forms of treatment have a good track record of helping people stop gambling. 

Cognitive Behavioral Therapy (CBT)

Work with a counselor on four components of healing:[11]

  • Identify and counteract harmful, untrue thoughts about gambling, and magical thinking
  • Develop problem-solving skills 
  • Improve social skills 
  • Learn to avoid relapse 

Meet in one-on-one sessions with a counselor, or join group sessions with others who want to stop gambling.

Medication for Addiction Treatment (MAT)

No medications are approved to help people with gambling addictions uncomplicated by substance use. But some doctors use buprenorphine to help people avoid gambling relapse.[12] There are many medication-based options for substance use disorders, especially alcohol and opioid use disorders, and whether or not you have a  gambling disorder talking with your medical and mental health provider about whether MAT is right for you is always a good idea.. 

Support Groups 

Meeting with other people in recovery from gambling problems can promote recovery. No therapists guide your sessions in self-help groups, such as 12-step based groups, but peers will set an agenda and keep the meeting on track. 

Most meetings follow a format developed by Alcoholics Anonymous, but Gamblers Anonymous also has additional resources to help you heal from financial trauma caused by gambling.[12]

Family Therapy

Bring your spouse, children, and other key people to group meetings or therapy sessions can be helpful. Discuss how your gambling started and what you’ll need to avoid a relapse. 

People say they are scared to discuss their habits in early sessions, but in time, they learn how to ask for help from their families.[13] A counselor supports your time together and ensures the conversation is constructive. These sessions can repair relationships that were damaged by substance use problems  and compulsive gambling.

3 Ways to Deal With Your Triggers

The urge to gamble may stay with you even when you’ve completed a treatment program. You’ll learn more about your triggers in your counseling sessions, and you’ll pick up tools you can deploy when your resolve begins to fade. These are three options you might use when the feeling arises. 

1. Set Up Safeguards 

Recognize when you’re vulnerable to gambling. Are you feeling stressed? Have you been sleeping? Did you just go through a breakup? 

When you’re not at your best, make it harder to return to gambling. Don’t drive past the casino. Ask your family to get the groceries, so you don’t pick up scratch-off tickets. Use electronic tools to block gambling sites from your phone.

2. Try the 6 Ds

You’re about to make a mistake, and you want to stop yourself cold. Use this approach:[15]

  • Delay: Tell yourself you won’t gamble right now. Hold out even for a few minutes. 
  • Deep breathing: Focus on your inhales and exhales. Feel your muscles soften and relax. 
  • Distract: Think about something else. See if you can recall the exact layout of your first bedroom, or try to recreate the sights, sounds, and smells of the last meal you ate. Get your mind off gambling for a few moments.
  • Discuss: Call someone you trust and explain that you’re in trouble. Talk it through with them. 
  • Do something else: Take a walk. Ride your bike. Throw the ball for your dog. 
  • Detour: Get away from the source of your temptation. Physically move your body somewhere else.

3. Choose Your Substitute

Think of an activity you once loved that you can take with you when you’re under stress. These are some common choices:

  • Knitting
  • Coloring
  • Crocheting
  • Whittling
  • Playing a harmonica 
  • Photography 
  • Crossword puzzles

When you feel the urge to use or gamble, try this distracting activity instead. Focus intently on what you’re doing right now. You may feel the urge fading as your concentration on something else grows. 

If you find you’re still tempted to gamble or use substances, despite your commitment and your hard work, talk with your treatment team. You may need an adjustment in your treatment approach to help you stay on track. 

Rest assured that there is hope in recovery from both gambling disorder and substance use disorder. With the right combination of treatments, you can enjoy a healthy future free from the stronghold of both substances and gambling.

Medically Reviewed By Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal ... Read More

  1. The Relationship Between Substance Use Disorder and Gambling Disorder: A Nationwide Longitudinal Health Registry Study. Scandinavian Journal of Public Health. September 2021. Accessed May 2022. 
  1. A Review of Gambling Disorder and Substance Use Disorders. Substance Abuse and Rehabilitation. March 2016. Accessed May 2022.
  1. Gambling Addiction Triggers the Same Brain Areas as Drug and Alcohol Cravings. ScienceDaily. January 2017. Accessed May 2022. 
  1. How the Brain Gets Addicted to Gambling. Scientific American. November 2013. Accessed May 2022. 
  1. Illicit Drug Use and Problem Gambling. International Scholarly Research Notes. August 2013. Accessed May 2022. 
  1. Understanding Complimentary Drinks in Casinos. Front Desk Tip. February 2019. Accessed May 2022. 
  1. Reviewing Two Types of Addiction: Pathological Gambling and Substance Use. Indian Journal of Psychological Medicine. January 2012. Accessed May 2022. 
  1. Gambling Addiction and the Brain. September 2015. Accessed May 2022. 
  1. FAQs. National Council on Problem Gambling. Accessed May 2022. 
  1. Problem Gambling. American Association for Marriage and Family Therapy. Accessed May 2022. 
  1. Treatment Recommendations for Gambling Disorders. Commonwealth of Massachusetts. Accessed May 2022. 
  1. Treatment Modalities for Patients with Gambling Disorder. Annals of General Psychiatry. April 2017. Accessed May 2022. 
  1. The Experience of Couples in the Process of Treatment of Pathological Gambling: Couple vs. Individual Therapy. Frontiers in Psychology. January 2018. Accessed May 2022.

  2. Learning About Triggers and Urges. Gambling Help Queensland. Accessed May 2022. 

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