What Counselors Need to Know About Gambling Disorder
Counseling Schools Search
When you click on a sponsoring school or program advertised on our site, or fill out a form to request information from a sponsoring school, we may earn a commission. View our advertising disclosure for more details.
As a child growing up near a major racetrack in southern California, I was always saddened to see beat-up cars with hungry-looking children in the back seat turning into the racetrack parking lot. I couldn’t imagine why the parents weren’t using their money to feed their families instead of watching horses run. While many people enjoy betting on horse races and other sports without experiencing hardship, others are not so fortunate.
Gambling disorder is the only behavioral disorder included in the Diagnostic and Statistical Manual (DSM-5). It appears alongside substance use disorders and is formally considered to be a type of addiction. Like other addictions, gambling disorder represents persistent, recurrent behavior that continues despite significant harmful consequences. Gambling disorder involves the same brain networks supporting excitement and anticipation that underlie substance use disorders.
Why is gambling addictive? You might think back to that discussion of B.F. Skinner and operant conditioning in your introductory psychology course. Skinner noted that one of the most compelling reinforcement schedules was the variable ratio schedule. In the simple world of the Skinner box, this means that the experimenter sets an average number of bar presses required for a food pellet during a session, but the exact number of required presses varies from trial to trial. This means that the rat (or person) cannot anticipate when the next reward will appear, leading to a very high, steady rate of responding.
I remind my students that the lavish casinos with their world-class entertainment are not built because most people win. Gaming is quite scientific. Casino owners understand B.F. Skinner. Slot machines are essentially Skinner boxes for people. The casino sets the amount of payoff they’re willing to give each day. This number is higher in areas where return customers are expected, such as a casino, and lower in areas where they are not, such as the Las Vegas airport. If a room of slot machines is full, the machines are programmed to pay out at different locations in the room, one after the other, leading to the false impression that your machine is “next.”
It is no surprise that many people fall victim to this sophisticated form of manipulation. When you add cheap, readily available alcoholic beverages to the mix, along with ATMs conveniently located nearby, the results are unsurprising.
Identifying Gambling Disorder
Counselors might be unaware that gambling disorder is as common as it is, which makes it easy to overlook. It is difficult to estimate how many people are affected by gambling disorder, as the reported numbers are likely to be an underestimate. At least 1 percent of the U.S. adult population meets DSM-5 criteria, and another 2 to 3 percent show problem gambling behaviors that do not quite meet full criteria.
These percentages equate to millions of Americans affected by problem gambling. Men, young adults, and people already diagnosed with substance use disorders, depression, anxiety, and impulse control problems are at higher risk. The ready availability of online betting has contributed to the expansion of gambling disorder. Smartphone apps make gambling easy around the clock, anywhere.
Gambling progresses to problem gambling as the person begins to gamble with larger and larger amounts of money. Attempts to cut back or quit gambling altogether are unsuccessful. Gambling becomes a preoccupation, identifying more and more of the person’s time and energy. Lying about gambling to friends and family members becomes routine. The person begins to experience trouble in educational or employment settings due to gambling.
Gambling disorder is often a “hidden” condition. Unlike substance use disorders, gambling disorder might remain hidden in its early stages. Shame and financial fears might lead people to hide their problems until it is no longer possible to do so. Some interpret their gambling as entertainment and do not identify as “gamblers.” In particular, young adults might think of stereotypical older adults sitting at slot machines in Las Vegas, an image with which they do not identify, as the definition of a gambler. Many clients who do seek help focus on other problems, such as relationship conflicts or suicidal ideation.
Counselors might suspect gambling disorder when clients have a family or personal history of substance use disorders, evidence of impulsivity and sensation seeking, financial stress, or relationship difficulties. Brief screening questions could include gambling frequency, the amount of money spent, financial consequences, and family impacts.
If a gambling disorder is suspected, special care should also be taken to assess risk of suicide, which is elevated by this condition.
Treating Gambling Disorder
Cognitive behavioral training has the best record for improving cases of gambling disorder. In addition, relapse prevention strategies used routinely in the treatment of substance use disorders can also help clients identify high-risk situations and triggers for gambling.
Because of the common relationship problems associated with a family member’s gambling disorder, couples or family counseling can be quite useful.
Finally, peer support groups such as Gamblers Anonymous can provide a helpful adjunct approach for some clients.
Conclusions
Given the frequency of gambling disorder, counselors should expect to see clients who meet this condition’s criteria. Knowing the risk factors and warning signs, routinely screening clients at risk, and providing evidence-based interventions such as cognitive behavioral therapy should help counselors identify and effectively treat this disorder.
Laura Freberg, PhD
Writer & Contributing ExpertLaura Freberg serves as professor of psychology at Cal Poly, San Luis Obispo, where she teaches introductory psychology and behavioral neuroscience.
Dr. Freberg is the author or co-author of several textbooks, including Discovering Psychology: The Science of Mind, Discovering Behavioral Neuroscience, Applied Behavioral Neuroscience, and Research Methods in Psychological Science. She served as President of the Western Psychological Association (WPA) in 2018-2019.