The Harmfulness of Gambling Addiction 1.1 - A Comparative Analysis with Substance and Behavioral Addictions

Our research involved an extensive review of the latest available literature, including peer-reviewed articles, meta-analyses, and personal stories from recovering addicts. We specifically focused on comparative studies that highlight the neurobiological, psychological, and social impacts of gambling addiction in relation to other addictions. This study will serve as an overview, laying the groundwork for the subsequent studies in this six-part series that will detail individual addiction comparisons. 

Behavioral Addictions

Behavioral addictions (BA) are compulsive behaviors that do not involve the ingestion of a psychoactive substance but produce short-term rewards leading to persistent behavior despite adverse consequences. These disorders are characterized by impaired control over the behavior, preoccupation, and continued engagement despite significant problems in various areas of life.

Substance Addiction

Substance addiction (SA), or substance use disorder (SUD), is a chronic, relapsing brain disorder characterized by the compulsive seeking and use of substances, despite harmful consequences. It often leads to tolerance, dependence, and withdrawal symptoms. Substance addiction affects brain function and behavior, making it difficult for individuals to control their use of substances.

Gambling Addiction

Gambling addiction (GA), or gambling disorder (GD), is characterized by compulsive gambling behaviors despite adverse consequences, similar to the diagnostic criteria for substance use disorders.

• "Gambling disorder is identified by a pattern of repeated and ongoing betting and wagering that continues despite creating multiple problems in several areas of an individual’s life." (Mestre-Bach & Potenza, 2023).

Drug Addiction

Drug addiction, a subset of substance use disorder, involves the compulsive use of illegal or prescription drugs. It is characterized by the development of tolerance, dependence, and withdrawal symptoms, significantly impacting the user's physical and mental health.

• "Drug addiction involves the compulsive use of substances like opioids, stimulants, and depressants, leading to tolerance, dependence, and withdrawal symptoms." (Maldonado et al., 2021).

Alcohol Addiction

Both gambling addiction and alcohol addiction involve compulsive behaviors and impaired control. However, alcohol addiction is characterized by the physical effects of chronic alcohol consumption and withdrawal, which differ from the primarily behavioral nature of gambling addiction.

• "Gambling addiction and alcohol addiction both involve compulsive behaviors, but alcohol addiction includes the physical effects of chronic consumption and withdrawal." (Poisson et al., 2021).

Internet Gaming Disorder

GD and internet gaming disorder (IGD) both show deficits in decision-making and impulsivity. Gamblers consistently performed worse in decision-making tasks, while IGD patients improved over time, indicating potential differences in cognitive flexibility.

• "Gamblers consistently performed worse in decision-making tasks compared to internet gamers, highlighting differences in cognitive flexibility." (Becirovic & Pajević, 2020).

Sex Addiction

Both GD and sex addiction (SA) share psychopathological traits such as impulsivity and novelty-seeking. However, individuals with SA tend to have higher education levels and lower scores in harm avoidance compared to those with GD.

• "While both gambling and sex addiction share traits like impulsivity, sex addiction is associated with higher education levels and lower harm avoidance scores." (Sharma & Mahapatra, 2021).

Food Addiction

Characterized by the compulsive consumption of food, especially high-fat and high-sugar foods, despite negative health consequences. It shares similarities with substance use disorders, including cravings and loss of control.

• "Food addiction involves the compulsive eating of certain foods, leading to health issues and impaired control over eating habits." (Becirovic & Pajević, 2020).

"People with substance use disorders are at an increased risk of developing gambling disorder, indicating significant overlap between these addictions." (Costa, N. Cunha E., S. Cruz, and G. Sobreira. 2022)

1. Prevalence

There are ~2,500,000 documented individuals currently suffering from gambling addiction in the United States as reported by the National Council on Problem Gambling. This number is surely low as millions go undiagnosed.

Do you know how to diagnose gambling addiction? Discover the steps to self-diagnose and take control of your well-being here.

2. Statistical Data

Statistical data on the prevalence of gambling addiction and other addictions show significant overlap and high comorbidity rates. For example, people with substance use disorders are at an increased risk of developing gambling addiction.

• A study on the prevalence and clinical significance of psychiatric comorbidities with gambling disorder found that 58.3% of patients with gambling disorder had comorbidities, including tobacco use disorder (20.9%), alcohol use disorder (13.9%), and behavioral disorders (13.1%) (Yamada et al., 2022).
• Research on the prevalence of comorbid pathological gambling in substance use disorders highlighted that gambling disorders affect 0.2–5.3% of adults worldwide and are highly comorbid with other substance use and mental health disorders (Čargonja et al., 2023).

A study investigating comorbidity between gambling disorder and substance use disorders revealed that over half of problem gamblers experience a substance use disorder, with shared clinical and personality factors explaining the high rate of comorbidity (A Håkansson, A Karlsson, 2020). These factors include:

• Clinical Factors: Both disorders share similar presentations and often co-occur. Pathological gamblers frequently have high rates of substance use, mood, anxiety, and personality disorders.
• Personality Factors: Traits like high impulsivity, low conscientiousness, and high neuroticism are common in individuals with both disorders, predisposing them to these conditions.
• Psychiatric Comorbidities: Depression, anxiety, and other mood disorders are prevalent in both gambling and substance use disorders, suggesting these conditions contribute to their co-occurrence.
• Genetic and Neurobiological Factors: There is genetic and physiological overlap between the disorders. Similar neurobiological pathways increase the risk for both conditions.
• Environmental and Social Factors: Stressful life events, socioeconomic factors, and familial influences contribute to both disorders. Shared environmental risk factors significantly impact their comorbidity rates.

• Research indicated that gambling disorder frequently co-occurs with other behavioral addictions, such as food binging (8.1%) and compulsive buying (3.6%), further demonstrating the high comorbidity rates among various addictions (Tang et al., 2020). 

3. Demographic Factors

Demographic factors influencing each addiction include age, gender, socioeconomic status, and education levels. For instance, individuals with SA tend to have higher education levels compared to those with GD (Farré et al., 2015). Understanding these demographic influences is crucial, as they can shed light on how different groups are affected by gambling addiction. For a more detailed exploration of this issue, see our research on gambling as a hidden epidemic. 

In our research into the complexities of addiction, we have observed that certain psychological traits are commonly shared among various types of addictions, including gambling disorder and substance use disorders. What we have found is that while there are significant overlaps, each addiction also possesses unique characteristics that influence coping mechanisms and social impacts differently:

1. Common Psychological Traits: Addictions share common traits like high impulsivity and neuroticism. However, specific personality profiles vary: those with gambling disorder (GD) exhibit profiles similar to controls, while those with substance addictions show distinct traits such as lower agreeableness.
   1. "Those with gambling disorder exhibit personality profiles similar to controls, whereas substance addictions are marked by distinct traits like lower agreeableness." (Jacobs et al., 2022).
2. Differences in Coping Mechanisms: While both GD and internet addiction involve significant impulsivity, internet addiction patients exhibited greater interpersonal disengagement and coping issues compared to pathological gamblers.
   1. "Internet addiction patients exhibited greater interpersonal disengagement and coping issues compared to pathological gamblers." (Tonioni et al., 2020).

Financial Consequences

Both gambling and substance addictions often lead to severe financial problems and strained relationships. The social consequences of these addictions are profound, affecting not just the individual but also their families and communities. Walter's experience, where he lost friends and relationships and ended up homeless, illustrates the social devastation caused by gambling addiction. He describes how the addiction's euphoria and high mirrored his experiences with drugs, leading to significant personal and social distress.

• "Gambling is associated with higher financial distress and lower financial inclusion and planning, and with negative lifestyle, health, well-being, and leisure outcomes" (Muggleton et al., 2021).
• "Debt stress is a robust indicator of financial problems and may indicate underlying problem gambling and mental health issues" (Swanton & Gainsbury, 2020).
• "The financial consequences associated with harmful gambling create significant health and social stressors for individuals, their families, and communities".

Gambling addiction often leads to specific social issues such as financial instability and legal problems, while substance use disorders may also result in health-related consequences and social stigma.

• Gambling addiction is associated with severe financial problems and legal issues. In total, 14% to 30 % of individuals with gambling disorder engage in illegal acts to finance such behavior, and the financial distress is substantial (Gorsane et al., 2020).
• The economic cost along with the physical and mental health problems associated with problem gambling necessitates studying how problem gambling can be reduced. In the United States, financial literacy could potentially reduce gambling frequency, albeit males, older people, people with higher household income, and people who have easy access to gambling are likely to be frequent gamblers. (Watanapongvanich et al., 2021).

Substance use disorders often lead to health-related consequences, including physical health deterioration and mental health issues. These disorders also carry a significant social stigma, impacting the individual's social and professional life (Vanderschuren & Ahmed, 2020).

The significant comorbidity between gambling disorder, mood disorders, and other addictive behaviors like alcohol use further complicates the individual's health and social standing (Tirlea et al., 2023).

Neurobiological Comparisons

Neurobiological comparisons reveal common vulnerabilities across different addictions. Individuals with gambling and cocaine-use disorders exhibit similar white-matter microstructural alterations, indicating shared neurobiological vulnerabilities (Rasgado-Toledo et al., 2020). Both gambling disorder and binge eating disorder patients show impairments in opioid and dopamine neurotransmission, pointing to specific neurochemical pathways involved in these addictions (Voon et al., 2020).

Integrated Treatment Strategies 

The treatment of gambling addiction, much like other behavioral and substance addiction treatments, requires a comprehensive approach that not only targets the specific behaviors associated with gambling but also considers the broader context of addictive behaviors themselves. Integrated treatment strategies are essential to address the complex interplay between different forms of addiction and the individual needs of patients.

1. Mayo Clinic: The Mayo Clinic offers TMS as a treatment for various conditions, including depression, and it is known for its comprehensive approach and research in neuromodulation therapies. They could provide insights into using TMS for treating gambling disorders​ (Mayo Clinic)​.
2. Amen Clinics: Amen Clinics are known for their comprehensive mental health and addiction treatments using various neuromodulation therapies, including TMS. They use SPECT imaging to guide the treatment, which enhances its effectiveness. They have locations in numerous cities across the US.
3. Brain Treatment Center: These centers focus on using advanced neuromodulation techniques, including TMS and tDCS, for treating various addictions, including gambling addiction. Brain Treatment Centers provide personalized care based on individual brain assessments. There are over 30 locations in the US and internationally. 

In concluding this initial study, the profound harm caused by gambling addiction becomes starkly evident. Through our research, we have seen that gambling addiction mirrors the intense grip of substance use disorders and the compulsive nature of other behavioral addictions. As one participant (Robert) poignantly shared,

These findings show the urgent need for integrated treatment strategies that address the unique and shared characteristics of various addictions. Cognitive-behavioral therapy has proven effective for many with gambling disorders, yet the complex nature of addiction calls for a holistic approach.

This research is the first installment of a six-part series aimed at presenting the nuances of gambling addiction compared to other addictions. The forthcoming studies will provide a more detailed analysis, offering further insights and recommendations for effective treatment and prevention.

Upcoming Papers in the Series

• Part 2: Gambling Addiction vs. Substance Use Disorders (cocaine, meth, heroin, etc.) - Examine the striking similarities and differences between gambling addiction and substance use disorders. Understand how both addictions hijack the brain's reward system, leading to devastating consequences. Explore the unique challenges and treatment approaches for those battling against the grip of gambling and substances like cocaine, meth, and heroin.
• Part 3: Gambling Addiction vs. Alcohol Addiction - Analyze the connections between gambling addiction and alcohol addiction, uncovering how they often co-occur and exacerbate each other. Learn about the shared psychological triggers, the impact on families and communities, and the comprehensive strategies needed for effective recovery from these pervasive addictions.
• Part 4: Gambling Addiction vs. Video Gaming Disorder - Discover the emerging world of behavioral addictions by comparing gambling addiction to video gaming disorder. Understand the similarities in compulsion, the escape from reality, and the digital hooks that keep individuals engaged. Gain insights into prevention and intervention methods tailored to these modern-day challenges.
• Part 5: Gambling Addiction vs. Sex Addiction - Investigate the intense and often hidden struggles between gambling addiction and sex addiction. Explore the psychological and emotional underpinnings that drive these behaviors, the shame and secrecy involved, and the innovative therapies that aim to bring healing and balance to those affected.
• Part 6: Gambling Addiction vs. Food Addiction - Learn about the complex relationship between gambling addiction and food addiction, two compulsive behaviors driven by reward-seeking and emotional regulation. Learn about the biological and environmental factors contributing to these addictions and the holistic approaches needed to address the underlying issues and promote long-term recovery.

Our goal with these studies is for our readers to be able to foster a deeper understanding of gambling addiction and its broader implications, paving the way for better support systems and therapeutic interventions for those affected.