Takeaway
Gambling disorder frequently goes unrecognized in clinical settings despite its significant impact on mental and physical health. Clinicians can routinely screen for it using validated tools and refer at-risk patients to resources.
Lifelong Learning in Clinical Excellence | September 2, 2025 | 3 min read
By Christopher Welsh, MD, University of Maryland
Gambling, the act of wagering something of value in games of chance for personal gain, encompasses a wide variety of activities ranging from Bingo and traditional lotteries, to slot machines, casino table games, online sports and casino gambling, and even extending to some stock market and cryptocurrency activities. With the introduction of the internet, venues for gambling have expanded greatly. Today, in the United States, 48 states have some form of legalized gambling (up from two in 1978).
Negative consequences related to gambling, both personal and societal, have accompanied gambling for as long as gambling behaviors have existed. Significant comorbidity has been identified with other psychiatric disorders, multiple substance use disorders, and stress-related health conditions such as hypertension, obesity, gastrointestinal disorders, headaches, and disrupted sleep. It’s associated with significant increased rates of domestic violence, bankruptcy, and suicide. Various terms have been used to describe excessive gambling including “problem gambling,” “at-risk gambling,” “risk gambling,” “compulsive gambling,” and “gambling addiction.” “Pathological Gambling” was first included as a psychiatric diagnosis in 1980 with the Diagnostic and Statistical Manual of Mental Disorders-3rd Edition (DSM-III) and was classified as an impulse control disorder along with kleptomania and trichotillomania. In 2013, the DSM-5 included “Gambling Disorder” in the category of “Substance-Related and Addictive Disorders” along with alcohol and other substance use disorders.
A recent national survey found that 8% of American adults (almost 20 million people) reported experiencing at least one indicator of problematic gambling behavior “many times” in the past year. National and international lifetime prevalence of disordered gambling is reported to range from 0.4 to 5.8% of the adult population.
Problematic gambling can be more difficult to identify than other forms of addiction because of the varied types of behavior it can involve and the fact that many individuals don’t recognize the behaviors as gambling. In addition, there’s no objective test (such as a urine drug test) for the behavior and no obvious, dramatic syndrome, such as overdose, that may draw attention to the problem.
Although it hasn’t been studied as extensively with problematic gambling, the use of screening and Brief Intervention and Referral to Treatment (SBIRT) for problematic substance use in primary care and mental health settings should be extended to screen and refer patients for problematic gambling. Longer (10 to 20 items) screening instruments such as the NODS (National Opinion Research Center DSM-IV Screen for Gambling Problems), SOGS (South Oaks Gambling Screen), the Problem Gambling Severity Index, and the GA20 (Gamblers Anonymous Twenty Questions), and brief (three to five items) instruments such as the NODS-CLiP, NODS-PERC, Brief Problem Gambling Screen (BPGS), and BBGS (Brief Biosocial Gambling Screen) can be useful in identifying individuals with problems related to their gambling.
If a potential problem is identified, providers can give patients the number for the National Problem Gambling Helpline (1-800-GAMBLER) which can help locate resources in the specific state. Clinicians can also make patients aware of Gamblers Anonymous which is a mutual-help group similar to Alcoholics Anonymous. Patients can also be instructed on ways to help limit harms from gambling such as setting limits on the time or dollar amount. Another resource is Voluntary Exclusion Programs (VEP) that are programs available in most states and casino companies (MGM, Caesars, etc.) that allow individuals to place themselves on a list that blocks them (theoretically) from gambling. Similarly, there are tools (BetBlocker, Gamban, etc.) that can be used to limit or block online sports gambling.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.