The Biology and Treatment of Pathological Gambling

Most adults gamble recreationally. However, a subset suffers from pathological gambling. Although pathological gambling is classified as an impulse control disorder, it shares many features with substance dependence and is sometimes referred to as a “behavioral” addiction. Pathological gamblers may demonstrate cognitive distortions such as probability errors and superstitious beliefs, and they often chase gambling losses. Studies examining the neurobiology of pathological gambling suggest influences of the neurotransmitters norepinephrine, serotonin, dopamine, opioids, and other systems in pathological gambling. Neuropsychological studies also suggest executive functioning impairments that are independent of intellectual differences as assessed by intelligence quotient testing. These findings are consistent with neuroimaging studies demonstrating differences in brain areas implicated in mood regulation and risk/reward decision-making. Emerging behavioral and pharmacological treatments have demonstrated some benefit. However, treatment efficacy represents a significant challenge in part due to the relatively low number of individuals seeking treatment and the high frequency of co-occurring psychiatric disorders.