Gambling involves risking something of value, such as money or property, on an event whose outcome is uncertain. This can include activities such as playing card games or fruit machines, betting on horse or greyhound races, football accumulators and lottery tickets. It can also involve more formal types of gambling such as casinos, scratch cards and’skin gambling’ in video games (where virtual items with different rarities are traded for real money).
Most gamblers do not consider themselves to be problem gamblers but research shows that two million people in the US have a gambling problem that significantly interferes with their lives. It can have a detrimental effect on their relationships, work or school performance and their finances. It can also lead to depression, anxiety and suicidal ideation in advanced cases of pathological gambling.
Many factors contribute to gambling addiction, including a lack of control, the illusion of learning and improvement and reward schedules that are optimized to keep players engaged in their favourite games. There are also a number of psychological features of gambling, such as the Gambler’s Fallacy – the incorrect belief that because an event or outcome has not happened recently it is more likely to happen in future. For example, if you roll the same die five times and don’t get four, you will believe that it is more likely to land on four the next time. However, the probability of rolling a four remains the same regardless of previous outcomes.
For adolescents, the ability to participate in social and simulated gambling is increased by their peer group’s participation and by access to mobile devices such as phones and tablets. It can also be facilitated by ‘gaming influencers’ who promote third-party sites and games in which users gamble for virtual items. These’skins’, or items that modify the appearance of the user’s avatar/character and weapons, are obtained through in-game purchases or loot boxes and are valued based on their rarity.
In the past, the psychiatric community regarded pathological gambling as a compulsive disorder rather than an addiction. However, in the latest version of its Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychiatric Association has moved it to the section on addictions. This change means that the term ‘gambling addiction’ is now more widely used. It is important to frame gambling as a health issue when talking to patients about their behaviour, as it may reduce resistance to help and prevent the development of more serious problems such as alcohol misuse and suicidal thoughts. It is also a good way to identify those who may be at high risk of harm.