The Neuroscience of Disordered Gambling: It Really Is an Addiction
The functional interconnectivity between differing brain circuitry is what governs all complex cognitive functioning and addictive behavior. We know that this circuitry is both genetically determined and can be modified by environment and experience (phenotypical changes). Pathological gambling is associated with several cognitive impairments, including diminished reward sensitivity that is similar to the neuroadaptive changes that result from abusing alcohol or other drugs. Gambling problems are also associated with reduced ability to delay reward or to learn corrective behavior from negative consequences. Like all addiction, problem gamblers experience strong anticipatory rewards resulting from increased synaptic Dopamine in the midbrain in response to environmental stimulus, near wins and poor error monitoring. These cognitive deficits can complicate treatment and recovery.
Symptoms of Disordered Gambling
The American Psychiatric Association’s diagnostic manual (4th edition) classifies compulsive gambling as an impulse-control disorder. To meet the diagnostic criteria for compulsive gambling, a person must show persistent gambling behavior as indicated by at least five of the following criteria:
- Is preoccupied with gambling (for example, reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)
- Needs to gamble with increasing amounts of money to achieve desired excitement
- Makes repeated, unsuccessful efforts to cut back or stop gambling
- Is restless or irritable when attempting to cut down or stop gambling
- Uses gambling as a way to escape problems or to relieve a dysphoric mood (feelings of helplessness, guilt, anxiety, depression)
- After losing money gambling, often returns another day to get even (“chasing” one’s losses)
- Lies to family members, therapists or others to conceal extent of involvement with gambling
- Has committed illegal acts such as forgery, fraud, theft or embezzlement to finance gambling
- Has jeopardized or lost an important relationship, job, or educational or career opportunity because of gambling
- Relies on others to provide money to relieve a desperate financial situation caused by gambling
Why Does This Matter?
Insights from neuroscience help clinicians and their patients understand the underlying psychopathology and process of addictive gambling. Once adequate motivation and desire to change occurs, therapy focuses on learning and practicing strategies to reduce craving, thwart anticipatory reward and actively engage in their recovery. Unfortunately, empirically derived, peer reviewed evidence is scarce. More research is needed to examine the neurobiology of gambling disorder, understand relationships to other addictions, and develop novel and effective new approaches to treatment.