Understanding the Intersection of Gambling and Co-occurring Disorders

By Bobbe McGinley, Provider for the Division of Problem Gambling
Founder of ACT—Counseling & Education
Clinical Director, Recovery in the Pines and Birches Health


May marks Mental Health Awareness Month, a time dedicated to raising awareness about the importance of mental health and breaking down the stigma surrounding mental illness. During this month, it’s crucial to shed light on the complex interplay between mental health disorders and addictive behaviors, such as gambling disorder, compulsive sexual behaviors, video gaming disorder, and internet and online addiction. As with mental health disorders regardless of age, community, or socio-economic status, gambling can transform into a debilitating struggle for individuals and close community members, especially when co-occurring with other mental health disorders.


Depression and Gambling

The relationship between depression and gambling is notably significant, given the shared neurobiological pathways and psychological profiles associated with both conditions. Depression is often characterized by persistent sadness, lack of interest in enjoyable activities, and a variety of cognitive and physical symptoms. For some individuals, gambling becomes a way to escape these depressive symptoms, providing temporary relief and excitement. Unfortunately, this can lead to a vicious cycle where the individual’s gambling losses lead to increased depression, which in turn may drive more gambling as a form of self-medication.

Research indicates that the prevalence of major depressive disorder is significantly higher among pathological gamblers than in the general population. The impulsivity associated with depression can exacerbate gambling behaviors, leading to more severe gambling problems. Treatment for individuals who are dealing with both depression and problematic gambling often involves cognitive-behavioral therapy (CBT), which aims to address distorted beliefs about gambling, improve emotional regulation, and develop healthier coping mechanisms.

Personalized, integrated treatment plans like those offered by licensed specialized counselors that also address depression through pharmacotherapy and psychotherapy can be effective in breaking the cycle between these co-occurring disorders.


Substance Use Disorder and Gambling

The link between substance use disorders (SUDs) and gambling is well-documented, with studies showing that many individuals who suffer from problematic gambling also struggle with alcohol or drug use. This comorbidity can be partly explained by the similar ways in which gambling and substance use activate the brain’s reward system, producing feelings of pleasure and euphoria. For someone with a SUD, the stimulating environment of gambling can enhance the psychoactive effects of substances, making both behaviors more appealing.

Moreover, both substance use and gambling disorders involve repeated behaviors in spite of negative consequences, and both require increasingly larger amounts of the activity to achieve the desired effect, a phenomenon known as tolerance. Treatment for individuals grappling with both gambling and a substance use disorder typically involves an integrated approach that addresses both issues simultaneously. This may include residential treatment programs, 12 step support groups like Gamblers Anonymous and Alcoholics Anonymous, and therapies that focus on harm reduction, impulse control, and relapse prevention.


Bipolar Disorder and Gambling

Bipolar disorder, characterized by extreme mood swings ranging from manic highs to depressive lows, has a complex relationship with gambling. During manic phases, individuals may exhibit heightened impulsivity, grandiosity, and poor judgment, which can lead to excessive gambling. The thrill and risk associated with gambling match the heightened reward sensitivity and impulsivity seen in manic episodes, making gambling particularly enticing.

During depressive episodes, individuals with bipolar disorder might turn to gambling as a way to alleviate their symptoms, similar to the pattern seen in unipolar depression. The management of co-occurring bipolar disorder and gambling addiction requires careful psychiatric treatment, including mood stabilizers and psychotherapy, to address both the emotional swings and the compulsive behavior. Behavioral therapies that focus on impulse control, such as CBT, are also essential components of treatment. Moreover, ongoing monitoring and support are critical given the cyclical nature of bipolar disorder and its impact on gambling behaviors.


What To Be Aware of During Mental Health Month

The co-occurrence of gambling with depression, substance use disorders, and bipolar disorder presents significant challenges for treatment and recovery. Understanding the intricate relationships between these disorders is crucial for developing effective intervention strategies.

By focusing on integrated treatment approaches that address both the psychological and behavioral aspects of these conditions, healthcare providers can better support individuals struggling with these complex co-occurring issues. Importantly, enhancing awareness about these co-occurring disorders can also help reduce stigma and promote earlier intervention, leading to better overall outcomes for affected individuals, their families, and their loved ones.


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Bobbe works in private practice, where she is Clinical Director, Counselor and Consultant at her agency ACT – Counseling & Education. For information call 602-569-4328 and visit http://www.actcounseling.com