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Gambling addiction - Cause, outcome and a way out

1. Introduction

From Dr. Thorsten Heedt, medical specialist for psychotherapy with an emphasis on the treatment of post-traumatic illnesses.

All addictions have one thing in common whether you are addicted to alcohol, heroin and nicotine or to gambling:

  • The addictive "drug" is consumed obsessively in the course of the addiction even though the feeling of joy might not be achieved by consuming the "drug".
  • The loss of control increases steadily.
  • The addictive drug is used to flee from reality.
  • The addiction continues even though it has caused several negative consequences or health damage.

The following article deals with addiction to gambling, its origin and how to determine whether you are suffering from a gambling addiction and where you can find help.

2. What is gambling addiction?

Pathological playing is listed under "abnormal behavior or flaw in the control of the impulses" in the ICD-10 of the established international illnesses classification and is defined as follows:

"The malfunction consists of frequent and repeated gambling, which controls the life of the patient and leads to the breakup of social, occupational and family values and commitments."

Excessive playing by manic patients is defined as: A mania is a discrete disease which goes along with strong arousal, inner agitated melancholia, positive changes in mood without reason, and a ceaselessly agitated melancholy.

Also deferred from the gambling addiction is playing with a social personality disorder characterized by a disregard for social obligations and heartless disregard for feelings of others. This type of behavior can be found quite frequently in prisons.

Pathological playing is characterized by persistent, recurrent and often increased gambling behavior despite negative personal and social consequences such as debt, disruption of family relationships and effects on one's professional development.

Before one can be said to suffer from pathological playing, there have to be two or more episodes of pathological playing over a period of at least one year.

The distorted thinking patterns of gamblers are also mentioned in another widespread disease classification, the "DSM-IV":

  • The special importance of money for gamblers.
  • Thinking patterns concerning competition.
  • The restlessness of a gambler.
  • Their exaggerated need for social recognition.
  • A tendency for work mania.
  • The frequent occurrence of psychosomatic stress disorders.

3. How does a gambling addiction develop?

3.1. The basic problem

The development of a gambling addiction is a complex process affected by several factors. The most important factors are the following:

  • A profound disturbance of one's self-worth ("narcissistic" disorder).
  • A relationship disorder.
  • Irregular arousal.

Self-esteem disorder
The serious underlying self-esteem disorder is of particular importance where the self is described as an emptiness or as nothing. Several deep-rooted feelings of inferiority, originated from the childhood, are compensated for by delusions of megalomania.


The initial winnings strengthen the ego and confirm that we are indeed something special. In the beginning, there is often a "big win", an apparent rapid and easy profit which marks the start for taking off into a fantasy world.


Bonding disorder
The British child psychiatrist John Bowlby created the bonding theory in the 60s. He noted that depending on the sensitivity of the mother to the baby various bonding types are created:

In the "uncertain-avoiding" bonding type, children are unsure whether their bonding person or loyalty person is available to them. They expect that their wishes will be rejected in principle; this is often the case with children who have frequently been rejected. Children with such a bonding type are generally more prone to mental disorders than children with a "safe" bonding type. Players also frequently show this type of uncertain bonding type. You'll often find gambling addicts who are in a "broken-home"-situation with a terrible relationship to their fathers. Abuse experiences can often be found in gambling addicts too.


Unregulated arousal
The inability to adequately regulate the internal tension and excitement results in the particular restlessness of a gambler. The motivation for playing in the beginning is often the quest for success and profits, the reduction of boredom or managing negative emotions such as occur after a separation. The player gradually falls into a vicious circle, which all other areas of his life fall victim to.

The player gets into a state of pleasure and excitement when he is playing and tries to find a logical explanation for his uncontrolled gambling. Superstitious behavior and magical thinking can occur. He increasingly joins the fantasy world marked by power and profit fantasies. He alienates himself from his environment and slowly grows lonely. Distorted thinking patterns start to arise. Ultimately playing becomes the main activity in life. This development leads to physical, personal and social decline.

The gambler is finally distinguishable through his reduced impulse control, which is the impulse to play that cannot be resisted. This behavior is similar to alcoholics who can't resist drinking again straight after being released. Despite the many negative consequences, the desire to relieve tension by playing is strengthened.

It has a neurological basis as well. The reward system of the brain is chronically overstressed which leads to a counter-regulation of the brain. In order to protect against harmful agitation of the brain, it starts to react less to the reward stimulus. A neurological adaptation starts to set in. In order to get the desired kick, buy-ins or the volume of play have to be increased. By the way, the most conductive situation to this addiction is the showdown.

3.2. Distorted thinking patterns

Typical for gamblers are many distorted irrational attitudes:


  • The illusion of control

    This is shaped by the assumption that gambling has more personal influence than is the case objectively.
    They say that profits are due to their ability and losses due to unfortunate circumstances.

  • The Monte-Carlo effect ("gamblers fallacy")

    The frequency of past events suggest what the probability of future events is going to be (e.g. at roulette: There were 3 black numbers in a row, this must mean that the probability of red is increasing.)

  • Misinterpretation of the probability of winning

    The player over estimates his profit prospects unrealistically. For example, 98% of all raffle buy-ins are lost.

  • The near-hits ("cognitive regret and near miss")

    This occurs in gambling machines where three of the same symbols have to appear in order to receive a payoff but you only get 2 of the same symbols. The result: "I just missed winning, so I have to continue playing!"

  • The capture ("entrapment")

    This is the adherence to wrong decisions to justify the investments already made - "Ok, I'm probably beat, but since I called until the turn I am going to look at the river as well."

There is evidence that a very high percentage of faulty thought patterns are created while gambling.

4. Who is at risk?

The people most affected are males who live alone in a large city around the age of 30. The onset of addiction usually occurs in adolescence, however, women tend to become addicted in the middle stages of their lives. If they enter treatment, they are usually already deeply in debt, in danger of suicide and usually have committed crimes in order to raise funds for playing. A large proportion (approximately one third) of the addicts also suffer from physical dependencies, i.e. alcohol or heroin.

About 2-3 % of the population has a gambling problem and roughly 1 % suffer from what is called abnormal gambling behavior. There is a correlation between the availability of gambling on offer (for example, measured as slot machines per 1000 inhabitants) and the frequency of pathological gamblers.

Triggers for addiction could be experiences of winning a lot ("a big win") or debilitating life experiences such as partnership problems, separation, pregnancy of one's partner or professional upheavals.

The high morbidity (parallel existence of other diseases) is very noticeable. For example, up to 50% of all gambling addicts have depressive disorders, which are driven by compulsive disorders, depressed mood and loss of general interest.

25% of all gamblers who have sought treatment have already tried to commit suicide once. Particularly striking is the frequent occurrence of personality disorders which over 90% of treated gamblers have.

A personality disorder is characterized by a persistent distorted behavior pattern which begins in childhood and adolescence causing serious problems in social relations. The narcissistic personality disorder occurs especially often which is where one develops an overblown sense of one's own importance. For example many patients exaggerate their own achievements and talents, are self-absorbed about their fantasies, unlimited success, power, glamor, beauty or ideal love. They think of themselves as being very unique and they continually strive for excessive admiration.

This narcissistic personality disorder is difficult to treat because the patient tends to devalue the therapist or stop the treatment if he doesn't confirm his fantasized greatness.

5. What are the effects of a gambling addiction?

A dynamic develops, typical to this addiction, which affects all areas of life. Eventually these people have limited possibilities to regulate their actions.

The dynamic of the addiction shows, for example, when people try to offset their losses by increasing their buy-ins, so-called chasing. In poker, this is referred to as going on tilt.

Social isolation gradually increases. Feelings of shame and guilt start to set in and people start to conceal their gambling. Players increasingly integrate themselves into a specific environment with a lifestyle typical to gamblers, a lifestyle based on the immediate gratification of the player's needs. This can lead to criminal acts in order to obtain funds for gambling.

Finally, players can get ruined financially, lose the support of their families or lose their jobs. Psychiatry visits due to suicide attempts may follow, some gambling addicts go on to become criminals.

The effects of constant ceaseless gambling can manifest physically. For example, through symptoms like peptic ulcers, headaches or heart attacks.

6. How do I know whether I am addicted?

There are a number of questionnaires and testing procedures to test whether a gambling addiction is present and to delineate pathological gambling from other forms of gambling like social gambling, professional gambling, gambling in a manic episode, gambling with an antisocial personality or pathological pc-usage (gaming, chatting, surfing).

The world's most widespread scale is the SOGS (South Oaks Gambling Screen). There are many other testing procedures as well though. Finally, they all basically test the same thing, namely whether you have the ability to control your urge to play and to quit playing if there are negative consequences to playing, i.e. exhaustion. They also test whether the narcissistic problems mentioned in the chapters above, are present, whether problems such as debt are present and whether the player is willing to carry out criminal acts in order to obtain funds.

7. Self-test

To assess whether you might be addicted to gambling, you can take the following test. It is a questionnaire with 19 questions that you either answer with yes or no. If you answer more than 7 questions with yes, gambling addiction might be a problem for you.

1. Have you ever played until all your money was gone?

2. Have you ever borrowed funds for gambling?

3. Have you ever taken a loan because of or for gambling?

4. Do you regularly go over the time or financial limit which you set for yourself, gambling?

5. Have you ever thought about obtaining money by doing illegal things?

6. Do you think a lot about gambling?

7. Have you ever stolen money for gambling?

8. Do you have a hard time focusing on other things except gambling?

9. Are you anxious or aggressive if you can't play?

10. Does your normal life seem boring compared to the gambling?

11. Does your interest for your social life decrease?

12. Do you play to recoup losses?

13. Do you hide how much you are playing and how much you have lost from your family?

14. Do you often have a guilty conscience after you've played?

15. Has it happened that you continued playing even though you knew that you would hurt yourself or others?

16. Have you ever played in order to improve your mood and to avoid problems?

17. Has the gambling caused fights or disputes in your family?

18. Have you ever missed school or work in order to play?

19. Have you ever thought about or actually tried to commit suicide due to your gambling problem?

8. What to do about gambling?

We have to determine at first whether we are dealing with a gambling pattern that has a pathological value. You should turn to a specialized advisory board (see also: search on this website)

Then you have to decide between outpatient and inpatient treatment. If the patient is still well integrated socially, when the addiction hasn't had a chance to develop that much yet, a visit to an addiction counseling center or outpatient psychotherapy with an established psychological or medical psychotherapist is advisable.

If the addiction has advanced pretty far, one must decide whether the patient should be taken to a psychosomatic specialist clinic or an addiction clinic. If the psychosocial consequences aren't that serious yet or if the gambling behavior was only caused by acute stress situations (such as separation, loss of the job etc.) it would be advisable to make use of a psychosomatic specialist clinic for treatment.

In an advanced addiction dynamic, a specialist clinic for addiction should be chosen. If there is also a physical addiction to some drugs, i.e. alcoholism or drug abuse, the person should be weaned from the drugs in a psychiatric clinic.

In general, this is the part of therapy where both parties make a contractual agreement on compliance with gambling abstinence. A simple reduction of gambling is usually not enough. In particular, complete abstinence from the drug usually reveals the underlying problem that usually manifests itself quite clearly, which is the actual cause of the patient needing the addictive drug in the first place.

It is important in any case, to find the real reason behind the gambling behavior, and then to talk about making changes in the typically distorted thinking patterns and to work out a plan for relapse prevention with the patient in the treatment. All of the problems of the gambler have to be worked on i.e. the disturbance of self-regulation, emotional regulation, and the relationship patterns. Distortions in these relationship patterns can be worked on quite well in group therapy.

It is of particular importance to highlight the debt problem in order to create a debt management program for the patient rather than to ignore this problem. The relatives should normally be involved, as they usually end up support the patient with his pathological problem by accepting the debt.

9. Where can I find help?

On this website there are detailed descriptions of problem gambling which might help you with your problem. There are lots of other websites listed in the references which might also be of interest. Furthermore you could call the following hotline to get some professional advice:


You'll be anonymous. Relatives can also call this number.

Comments (30)

#1 mouse89, 10 Nov 08 16:15


#2 jp2570, 09 Jan 09 11:30

Good article, I'm pritty sure i'm not addicted but it highlighted some concepts that are restricting my poker development

#3 SPeedFANat1c, 13 Jan 09 17:57

I didnt like few questions:

Do you have a hard time focusing on other things except gambling?
Yes, I do have a hard time, but I do other things if I need to do them. So do I need to answer YES?

Does your normal life seem boring compared to the gambling? My asnswer is - a little borring, but if I could not play poker, maybe I would play other computer games or watch movies. Playing poker is the best entertainment at the moment, so I play it.

Has the gambling caused fights or disputes in your family? There wasn't fights, but there was some disputes. I can't do anything about it, just not gamble. I remember when I liked playing tennis, there were disputes, when I liked playing computer games, there were disputes, now when I like playing poker there is also disputes. So what should I do to make this answer NO :) ?

Also I didn't like questions with EVER, because if I ever have done that thing(lend money e.g.), the answer is YES for all my life.

And I agree with #2 comment.

#4 vitchque, 24 Feb 09 18:41

The guy who asked the questions have never probably played poker that's why i think some of the questions shouldn't be there :) but in general a good article :)

#5 SadStory, 11 Mar 09 10:41

Very good article

#6 cyzo, 30 Jun 09 03:35

Hm. I answered yes to 9 of the questions but am quite bored with poker, would never play even 1 hand/roll/whatever of an against-the-house (-EV) game, play few hours out of the day on average, earn all my money from this game, and maintain high grades in college at the same time. This makes me question how applicable this article is to poker in comparison to -EV (idiot) gambling.

#7 theboydave, 22 Jul 09 16:15

good read highlighting the potential dangers.

#8 jethrothefox, 29 Aug 09 13:17

Refering to #7 cyzo..
i answered yes/no to 2 questions but, i agree with you that these questions are more aimed at gambling in general and most likely adapted from drug addiction questions i think. Although 9 Yes' is kinda worrying. Enless you're a pro, i would worry about your social life and put some more restrictions on your poker play.

#9 thepowerplay, 03 Nov 09 00:52

I answered yes to 4 questions, but I don't worry at all about my own well being in regards to compulsive gambling. I limit myself to about an hour a day on work days, and 1-4 hours on weekends. Probably 2-3 days of the week, I don't play at all.

Having said that, any addiction is a real and significant threat to vulnerable personalities. I've had a few relatives go through the ringer with drug addiction. Nasty stuff. The psychology of gambling addiction is probably strikingly similar. Unfortunately, the people most likely to be affected are the least likely to be aware of it until they are knee deep in shit!

#10 KevinC42, 13 Nov 09 00:57

I answered yes to all of those except #19, I have not committed suicide hence me posting this message.

#11 SPTHARRY, 13 Jan 10 11:36

I answered yes to suprisingly more questions than i would have liked ,however my main gauge for keeping tabs on how much of a problem my poker is, is my family and the relationship between them and me in respect of poker

#12 HansTheGreat, 10 Mar 10 10:24

Well,I answered 9 questions with yes,but all of them are linked to my,hmmm....,"high" past.I am on college and I started to live without parents and my poker hours increased from 1 hour till about at least 12 hours a day.I played poker 24 hours without stopping once just,my roommate 46or 47 I dont remember exactly.But my opinion is that you can become a gambler if you are mental weak person or you re life is too boring(you dont have any other interest in your life,e.g.watching any sport match) or you were on drugs to much(e.g.marijuana).

#13 ilovem0ney22, 19 May 10 17:03

i agree with Sikac, poker has helped me stop smoking alot of weed =)

I answer yes to most of the appropriate ones, but my defending question is addiction and passion is just borderline, if you don't have passion how can you succed in poker ?

#14 IvanColakovac, 19 Oct 10 15:52

i had problems in my past, when i think about that time a few years ago my answers would be all yes, only 1 no - n that is that i never lost interest for social life - i like to party n womens :D nowdays yes would be my answer for maybe 5 questions... don't take adict things easily thats my advice, n search for help if u need help - thats no shame!!! shame is to steel or hurt or do other things like that!!!

#15 jimmyjames57, 23 Dec 10 20:05

I answered yes to 16 of the questions. I started playing play-money poker on my XBOX and won a couple matches. Well I figured I was ready to play real-money. I went to the casino one day after I got paid and lost $250 playing 1/2 NLHE. But that was the spark. I continued to frequent the cardroom, one weekend winning $280, but my losses exceeded far more than that. Within 2 months I was down $2000 (an entire paycheque for me)and the feelings of shame and guilt were so heavy that I considered stealing. I signed-up for online poker after that because they offered micro-stakes. I got my brother to lend me $50 on his VISA to play and figured I was ready. I lost a couple dollars one night and then tilted off the rest chasing my money. I then started to take more money off his VISA without asking, and almost always losing it all by chasing again, and again. I feel like I have to play because I feel great when I play, but in the end I'm just not disciplined enough to be ready to turn a profit. If this is you just do what I did and delete the software completely. After a week of no play you'll feel better and won't think of poker and gambling so much as you did. Its tough, but so is losing your money and feeling ashamed of yourself.

#16 Swinxas, 14 Apr 11 06:42

I am not addicted, i got 6 yes from test :D but its glad to have a guide lines, that i would in what spot i am. Great post.

#17 jozata, 18 Apr 11 14:05

I answered yes to 16 of the questions but I dont need a test to know that I am addicted to gambling.When I am waiting for the bus with friends we usually flip coins for all our money just for the sake of it.However,I am also addicted to many other things such as drugs,alchohol,sex,jacking off and football.Problem?6000 marki/Audi A6

#18 Adam667001, 20 Jul 11 00:10

yea for sure this was me for the first 6 months i started playing. I was drinking alot so the loses seemed almost fictional and you win a few tournaments and you get an ego that wont let you drop your buy in, so you end up losing your winnings and then going in the red.

The way i deal with it now is give someone else my account password, so i can login and play, but i cant change the buy-in restrictions we set when i gave her the password so giving into the temptation to bring your full stack is impossible

#19 PinkFairy, 24 Jul 11 04:20

well this is for sure something that made me see some mistakes in my poker play, hope i can change somethings and play my A

#20 spacedraptor, 29 Jul 11 22:06

Seems to me if your losing money @ gambling you have a problem. If your winning they give you a gold braclet.

to be good at anything like a footballer or a singer, dancer, or musician. You need that complusive nothing else matters personality. But hey they call that Drive & Determination, Celebrated! but in gambling slamed as addiction.

#21 Pouserly2, 12 Aug 11 09:02

I answered yes to 16

#22 Gunn56, 14 Aug 11 12:51

very scary ...

#23 SiennaC, 25 Oct 13 03:18

Gambling is just like other risky activities, in that when done in small amounts, for enjoyment, there's nothing too terrible about this. However, like other bad habits, it becomes harmful when a person becomes addicted and the economic impact of gambling craving exacts a heavy toll. Article resource: <a href="">have good way our site.</a>

#24 WpIoNker, 07 Jul 14 19:28


#25 spectrumm, 24 May 15 21:32

I sometimes wonder if losing at poker has it's own weird appeal, which sounds crazy, but I quite often find myself in the late stages of a tourney in a good position to hit the final table, sometimes top 3 chip lead. During the break I have a word with myself, all I have to do is continue to play solid poker and the time and money invested will pay off.

Then something strange happens... I make foolish or marginal calls, start taking missed hands to the river and putting myself in tight spots, destroying my usually pretty good table image.

Once recently all I had to do is fold one hand to cash and still be in a competitive place for top 3 or so, and I still hit the raise button, knowing a big bluff at this stage was highly unlikely from an experienced opponent. I love poker and this is something that I have to sort out! In a way perhaps it keeps me playing. Anyone found the same?

#26 zzizek, 04 Aug 15 17:21

"The initial winnings strengthen the ego and confirm that we are indeed something special. "

That's interesting. People go to school to "achieve something", to strengthen their ego. Also, you need a job to strengthen your ego.

I mean, of course winning (money) will strengthen your ego, that's how it works. Trying leaving your job and see how well your ego will work. Ego must be strengthen, otherwise there are problems. As Maslow said, money + sex first. Basic job, basic sex. After you got this, you feel confident enough to go on.

Worse is always loosing, then winning.

#27 zzizek, 04 Aug 15 17:45

For me the only problem is motivation. Underlying depression always wants to show up. I can be up high in 3 tables, but loose motivation after like 1 or 1.5 hour. I lost motivation at work, too. It's not that simple. Poker is hard because you have to be SELF disciplined, that's the biggest problem for me.

Also, people don't support you. Neither mom, neither dad supports me, because socially betting and poker is looked as some kind of taboo. And if I don't gain mothers support, meaning I'll be criticized if I talk about poker/betting or she sees me doing it ... it is very hard.

I was showing my mom in a face a cashier where I made x20 from starting deposit in 2 weeks by playing tournaments. She DIDN'T SEE it. She isnt blind, but she didn't want to see it. I told her "C'mon, look closer, you might see then". No, she didn't want to see it. So, who's in denial then? It's basicly she doesn't want to confirm a success. And it's hard. It's hard doing something you're not supported doing it. This basicly mean you have noone to share this with. I mean, OK, you have, friends and stuff, but still, it's hard ...

... when you're still at home (because of fear of criticism and because of that fear of abandonement (no support) ...

So, however it is good to talk things trough, some things can not be talked trough or solved with emotional solving IMO, they can be solved with either cutting the contacts (getting on your own), being 100% indepenent and denying any help offered, etc. However this is very black and white, cause even buddhists says its good to take food if offered (though it's not always like that - food can be symbol of love, or of care, or it can just be for the sake of it (because it "must") - so again, I don't quite agree on first ball, it depends what does food sybolizes in family.

It's always very very much more colorful then "addiction" says. We're all addicted. Try even as a psychologist sitting down for the whole day doing nothing. Not even to entratain your emotions with music or work ... then you'll see how addicted you are. To your thoughts, emotions, feelings, ...

I also realized maybe we like to gamble a lot because we had fathers or mothers who demended perfectionism. Demended to finish school ... or to work hard like on the field or industrial or something. And this causes rebelion. Because we live in 21st century when after you succed to break trough some thousand of dollars of money, you can do wonders with it. You can resell, you can gamble by like 0.5% bankroll, you can basicly have fun + work very little to have like 1k monthly to live by yourself.

The problem is "it is never enough". This steams from parents that demeneded perfectionism. Whenever I cry, I cry because I realized IT FUCKING WAS ENOUGH, I SOMETIMES ACTUALY DID SOMETHING ENOUGH .... That's how sick this in built perfectionism is.

And to never give up is a gift. Try, sweat, have stress ... you have to work it trough. If you decide gambling is your job, then do it. Do it. Loose 10k and then win 20k back and then win conftorbaly 1k per month for example. What have you done if you stop? Nothing. You lost 10k. It's not fucking rullete. You can have edge. You know very well when you gamble. You know by experiences what is safe call and what is not. You can choose to either gamble or not.

It's mish-mash, a little of everything, it may help someone ... just don't let others guide you too much. You KNOW your life story.

#28 zzizek, 04 Aug 15 18:01

And it's fucking nonsense, anyway. I know no one who would look like a junkie roullete player playing poker. Poker is gambling depending on how you play it. Job doesn't do any good if you are always without money for the last week or more. Same sh1t.

Interesting is also that ego ALWAYS strengtens. I see if I work out for 5 days and go with my impulses there instead of clicking (well, I can't delete impulses, lol), I automaticly walk differently, have more confidence considering power issues, etc. That's how automaticly ego works basicly. When you improve, ego strenghtens ...

#29 medapkrgod, 06 May 17 15:44

Life is a gamble

#30 olorunshogo24, 16 Sep 18 14:04

good article pls