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Top risk factors for developing/maintaining GD are being male; being young and single or married for less than 5 years; living alone; having a low level of education; and struggling financially.⁶ Like people with drug addiction, people with GD experience cravings and withdrawal symptoms and develop tolerance—needing to gamble with increasing amounts of money in order to achieve the desired excitement. Generally, a person with GD cannot control their gambling and experiences significant negative consequences, typically financial and relationship problems, because of it. The indebtedness and shame experienced by people who gamble can lead to self-harm and suicide or suicide attempts.⁷

People with GD often also have comorbid SUDs, other mental disorders,⁸ and/or compulsive behaviors like problematic shopping and gaming.⁹ GD is the model behavioral addiction: gambling is a classic experimental tool to measure risk-taking and bias in behavioral economics (ie, the gambling task),¹⁰ and it shares neurobiological substrates with SUDs, including dysregulation of mesocorticolimbic dopamine pathways, altered reward processing, and impaired cognitive control.¹¹ People with Parkinson’s disease treated with L-dopa or with dopamine agonist medications with high affinity for D3 receptors are at risk of developing compulsive gambling.¹²

Mobile technologies have transformed gambling over the past two decades in a manner analogous to how synthetic drugs have transformed the drug landscape over the same period of time. Just as new, cheap, high-potency synthetic opioids like fentanyl have created conditions for faster progression from initiation to disordered opioid use, gambling on high-speed, 24/7 mobile platforms exposes vulnerable people to a potent combination of continuous betting opportunities, data-driven promotions, and real-time micro-rewards. New markets are exposed to gambling, and compulsive use of these platforms is a predictable result. 

The legalization of online gambling is associated with larger increases in irresponsible or risky gambling, particularly among those with lower incomes who can least absorb losses. Adolescents, who may be exposed to online gambling influencers and “risk-free” promotions in sports media and social media feeds, are likely to be especially susceptible due to their heightened reward sensitivity and immature executive control and impulsivity. Prevalence estimates for problem gambling in teens vary across studies but there are clear associations with other risk behaviors like alcohol and illicit drug use.¹³

Recognizing and Treating Gambling Disorder

Health care providers must become cognizant of this new gambling landscape, if they aren’t already, and be prepared to provide or refer adults and youth with gambling problems to appropriate, evidence-based treatment.

Cognitive behavioral therapy (CBT) is generally the treatment of choice for problem gambling. Randomized controlled trials consistently show CBT to be effective at reducing gambling frequency, symptom severity, and financial loss, with gains often sustained for months after treatment.^14,15 Self-guided, online CBT-based interventions have shown some promise,¹⁶ and they may be augmented with human support.¹⁷

Motivational interviewing (MI) has also been shown to be effective, particularly as an engagement strategy and as a brief intervention in primary care, emergency departments, and telehealth settings.¹⁸ Adjunctive approaches—mindfulness-based relapse prevention, acceptance and commitment therapy (ACT), and structured self-help—are supported by less evidence but may be useful in stepped-care models or in contexts where high-intensity therapy is not immediately available. Couples therapy and support groups may positively affect treatment retention and adherence.

A recent 2-year longitudinal study in France found that gambling medium (physical vs online) did not influence middle- and long-term recovery prospects in a cohort of gamblers receiving regular counseling for their gambling (with an option of group CBT), but online gamblers had an earlier and shorter course of GD prior to treatment.¹⁹ A large majority of participants recovered after 1–2 years of treatment.

While youth-specific GD treatment research is limited, adaptations of CBT (with family involvement) and MI show promise.²⁰ Pediatricians working with transitional-age youth should include gambling when they talk to their patients about substance use and other risk behaviors and collaborate with families, school counselors, and addiction treatment specialists to intervene early.

No medications are FDA approved for GD, but opioid antagonists—particularly naltrexone and nalmafene—have the strongest evidence among pharmacological options, reducing gambling urges and behavior in some patients.²¹ In clinical practice, naltrexone may be most helpful for individuals with high craving intensity, those with alcohol or opioid use disorder, or when rapid reduction in urge is needed to stabilize finances or relationships. An area of needed research is GLP-1 agonists, which have been reported anecdotally (eg, on social media platforms like Reddit) to help people curb their gambling and other problem behaviors, not just substance use and overeating.²² If medications are used, they should be embedded in a broader psychosocial treatment plan that addresses comorbid mental disorders.

Currently, there is a lack of strong evidence supporting the diagnostic accuracy of available screening tools for problem gambling, especially brief tools used in general medical settings.²³ Thus, creating and validating such measures is another area where research is needed.

Closing the Treatment Gap

Mobile access has transformed the temporal, spatial, and psychological dynamics of gambling, compressing the cycle of urge, opportunity, and action into seconds and thereby amplifying risk for rapid escalation and in some instances catastrophic outcomes. Physicians have a unique role in recognizing and responding to this transformed landscape through more routine delivery of evidence-based care or referral to appropriate treatment by specialists.

Unfortunately, despite our available tools to treat problem gambling, they currently only reach a fraction of those who could benefit. Just 7–12% of people with GD seek help from treatment or even support groups,²⁴ and treatment infrastructure remains underdeveloped. Dedicated GD services are sparse in most states, and insurance coverage for GD treatment is inconsistent. State funding for addressing problem gambling through prevention and treatment is generally a small or even miniscule fraction of gambling-related revenues.^25,26

People seeking help can call or text 1-800-GAMBLER (the National Problem Gambling Helpline), and since 2022 that number routes nationally—a crucial modernization.²⁷ But the effectiveness of call centers and referral networks depends on there being professionals in a caller’s area who are trained in addressing GD, and this may not be the case. Physician training in GD is minimal even in most psychiatry residencies, and many treatment programs lack staff trained in gambling-specific CBT. Professional medical associations like 麻豆传媒在线 and other behavioral health organizations could help by facilitating training in addressing GD through continuing medical education and other means.

As with other addictions, prevention is also crucial. At least among adolescents and young people, prevention programs delivered in school settings and tailored to developmental stage have been shown to meaningfully reduce gambling behaviors.²⁸ More robust age verification is needed to prevent youth from gambling online. Other strategies that need study include AI-based algorithms that would identify problem play and intervene in some way.²⁹ Regulatory, technological, and policy levers will need to complement more targeted education and intervention to reduce gambling and its harms. People increasingly inhabit a world where sports books and casinos are right in their pocket—perhaps even alongside their own telepsychiatry app. In such a world, gambling addiction can be expected to become more and more prevalent. Attention from clinicians, researchers, and professional societies is needed to better understand, prevent, and treat this and other emerging addictions facilitated by digital technologies.