Problem gambling affects an estimated 23% of the adult population, with a larger proportion experiencing subclinical levels of gamblingrelated harm. Unlike alcohol or drug use disorders, gambling disorder leaves no physical trace, no smell, no visible intoxication, no withdrawal syndrome that demands attention. The concealment that many people with gambling disorder maintain, often successfully for years, contributes to its underdetection and the associated delays in accessing help.
The neurobiological overlap with substance use disorders is substantial. Gambling activates the same mesolimbic dopamine reward pathways as addictive substances, produces similar tolerance phenomena (the need for larger bets to produce the same excitement), and is characterized by the same core features of addiction: loss of control, continued use despite harm, and craving.
Assessment in clinical settings
The South Oaks Gambling Screen and the NODS (NORC Diagnostic Screen for Gambling Problems) are the most commonly used validated screening instruments. Brief screening in primary care and behavioral health settings is warranted given the prevalence and the consistent finding that most people with gambling disorder never present with gambling as their primary concern, they present with depression, anxiety, financial crisis, or relationship problems.
Treatment approaches with evidence support include cognitivebehavioral therapy (addressing cognitive distortions about gambling, particularly illusions of control and gamblers' fallacy thinking), motivational interviewing, and peer support through Gamblers Anonymous. The comorbidity profile, most people with gambling disorder have at least one cooccurring mental health or substance use condition, means that integrated treatment is almost always more appropriate than gamblingspecific intervention alone.
