Whether it’s buying a lottery ticket, playing poker, or picking the best players for your fantasy sports team, gambling involves risking something of value (typically money) on an activity that is largely determined by chance in hopes of winning. This activity has existed in nearly every society since prerecorded history and has often been incorporated into local customs and rites of passage. Most people who gamble do so without problems, but a small percentage develop a more serious problem known as pathological gambling, which is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) as an addiction that causes distress or impairment.
Most forms of gambling are recreational in nature, and many involve social interaction. Typical examples include card games like poker and blackjack in a private setting with friends, or placing bets on events such as horse races and football matches among coworkers or friends. People may also place bets on scratchcard games that contain a combination of skill and luck, or on the outcome of a specific event such as a dice game or an election.
The underlying motivations for gambling vary widely, but the most common are the desire to win money and/or material possessions and the excitement and anticipation that come with the possibility of success. A growing body of research suggests that gambling can also trigger feelings of euphoria that are associated with the brain’s reward system. Some people who gamble do so for the challenge, the social rewards, or to relieve stress and tension.
Gambling is a very common activity, and almost all adults and adolescents have placed some kind of bet. Most do so without problem, but a subset of individuals go on to develop gambling disorder, described in the Diagnostic and Statistical Manual of Mental Disorders as an addiction that causes distress or impairment.
Understanding gambling disorders and their treatment is a complex matter, primarily because it is a relatively new area of study. Early investigators of pathological gambling, often working without institutional support, laid the foundation for current research, and the discipline is now at a critical stage. Contemporary scientists are building upon these achievements, but it is important to remember that, as the French biologist Jean Rostand wrote, “nothing leads the scientist so astray as a premature truth.”
The current conceptualization and definition of pathological gambling has its roots in the DSM-III (1980). While the DSM-III-R revised the terminology from “substance abuse” to “dependence,” it did not change the fact that the criteria for pathological gambling are identical to those for substance dependence (see Goldstein & Simpson 1995). Despite this, several studies have questioned the validity of DSM nomenclature, suggesting that reliance on the external consequences of behavior and the assumption that gambling is similar to substance use are flawed. Consequently, it is important to explore empirical studies that can provide validation of the current conceptualization and definition of gambling disorders. These studies are needed to support the application of clinical practice guidelines and to inform the development of future treatments for this important public health issue.