What’s A Gambling Disorder And What Should Canadian Players Know About It?

It goes by many different names ranging from pathological gambling and compulsive gambling to gambling addiction. It is a disorder that can have negative effects on both the gambler and the people in that gambler’s life. It is a serious problem but there are ways to treat it. In this article, we will explore what gambling disorder (DSM-5) is, how to identify the probable signs of gambling addiction and what to do if you know someone who has the symptoms of this damaging problem.

The Definition of Gambling Disorder DSM-5

DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. It was published as an update to the existing manual in 2013. It is the taxonomic and diagnostic tool that is published by the American Psychiatric Association and is considered the principal authority for psychiatric diagnoses in the United States. The Fifth Edition includes several changes and additions compared to the previous publication which was published in 2000. One of the most interesting updates is in Section II: Diagnostic Criteria and Codes under the subsection titled Substance-Related and Addictive Disorders. New sections in this chapter of DSM-5 cover Gambling Disorder and Tobacco Use Disorder. Gambling Disorder DSM-5 is an urge to continuously gamble despite a desire to stop or negative consequences exist. It is now classified as an addictive disorder because those who suffer from it tend to display many of the same symptoms and behaviors related to substance addictions.

Gambling Disorder DSM-5 - The Symptoms

The reason why the DSM-5 lists gambling disorder under substance-related and addictive disorders instead of listing it as an impulse-control disorder is because of the symptomatology of the similarities of the problem to that of substance addiction. The definition goes on to outline the symptoms required to meet the criteria for gambling disorder. The gambler must exhibit at least four of these symptoms within a 12-month period to be diagnosed as having a gambling disorder.

- The need to have more money to gamble with to get the same amount of enjoyment from gambling as before

- Restlessness or irritability when trying to limit or stop gambling activity

- Has been unsuccessful in repeated attempts at reducing or stopping gambling activities

- Gambling is always on the gambler’s mind ranging from reviewing past sessions or planning future ones

- Will gamble when feeling anxious, guilty, or depressed

- Chases losses by trying to win back money lost during a previous session

- Lies about how much time and money they spend gambling

- Loses money, relationships, job opportunities all because of the distraction of gambling

- Seeks financial assistance from others to cover bills and other expenses caused by gambling

It is important to note that if you are just an occasional casino visitor or play the lottery regularly, you very likely do not have a gambling disorder. 

Gambling Disorder DSM-5 - The Difference Between Men and Women

Does gender play a role in how we develop a gambling disorder? According to a study conducted in 2013 that compared the problem gambling rates between the genders, there is a distinct difference. Although the number of men who like to gamble was fairly close to the number of women gamblers, the difference became apparent when the stats for problem gamblers were compared. A total of 2.9-percent of the female gamblers were considered to have a gambling disorder when stacked against the gambling disorder DSM-5 guidelines. Out of the male gamblers, a total of 4.2-percent were diagnosed as having a gambling problem. When you consider that there are about 6-million adults in the United States dealing with some form of gambling addiction, the study results mean that 59-percent of the male US population and 41-percent of the US female population has a gambling problem. The totals about 3.5-million men and 2.5-million women. 

But that’s not all. There was a bigger difference when the study examined the gambling habits of college students. That demographic happens to be the most active gamblers of all with 91-percent of all college males and 84-percent of all college-aged females engaged in some form of gambling activity. As for those who met the gambling disorder DSM-5 guidelines, 14-percent of the guys were considered to have a problem with gambling and just 3-percent of the gals were also problem gamblers. Why a difference in the first place? Well, men are more prone to develop a gambling addiction for a few reasons. Since men are typically sports fans, and sports are often mixed with betting, so the exposure rate will be high. Men also tend to spend social time at casinos and usually as groups of guys out on the town for some fun and games. And finally, when under stress, men have been proven to act more impulsively. Studies have concluded that men are just more likely to take risks under stress.

Gambling Disorder DSM-5 - Suicide

An online survey conducted in late 2020 by academics from the City University of London and University of Glasgow indicated a disturbing connection between suicide and problem gambling. The Emerging Adults Gambling Survey was for young adults between the ages of 16 and 24 and found that 37-percent of the male respondents who had attempted suicide in the previous year also had survey scores that were indicative of gambling disorder. By comparison, just 3.6% of the male respondents had either not attempted suicide in the previous year or had thoughts of suicide. As for the female respondents, 14.5% had attempted suicide in the previous year and had scores indicative of a gambling issue. Only 2-percent of the female respondents had not attempted suicide or thought of suicide in the previous year. The findings point to an association between problem gambling and attempted suicide in both young men and young women.

The interesting thing is, that once the survey results were adjusted to factor in alcohol use, anxiety, loneliness, impulsivity, video gaming, life satisfaction and other metrics, the association between suicide and gambling addiction was still obvious. In the United Kingdom, online gambling has exploded, much as it has in other parts of the world. COVID-19 and self-isolation are considered to be contributing factors. With online gambling being so easy to participate in, it has also become very easy to become addicted to and mount huge losses if players are not mindful of their playing habits. Although suicide is already the leading cause of death of young adults around the world, the suicide rate has increased due to the many different stresses that have developed in recent years. Social media, online bullying, lifestyle stress, feelings of insecurity, and gambling addiction are all responsible for the increased suicide risk for young adults.

How Big Is Gambling Disorder DSM-5 In Canada?

Studies indicate that in Canada, roughly 3-percent of the population has a gambling problem. That equals about 1-million Canadians. But how do they keep their gambling habits under control compared to their American neighbors? Well, that boils down to the access Canadians have to casinos and gambling venues. Each province and territory in Canada is responsible for the licensing and maintenance of gambling options within their provincial jurisdiction. Although there are regional and national lotteries, casinos and other games of chance are strictly monitored and limited to within the boundaries of the province they exist. Casinos and bingo halls are very popular but are typically only located in larger urban centers. The internet has connected Canadian residents in rural communities to other forms of gambling including online gaming platforms. Again, provincially-sponsored sites exist but the lure of offshore gambling sites has attracted many Canadian gamblers.

The issue with this is that technically, offshore gambling sites are considered illegal in Canada. If the site is not based in Canada and does not have a license to operate in Canada, it is illegal. However, offshore sites have gotten around this by simply accepting Canadian members and accepting Canadian currency. Since enforcement is light in Canada, there is little to stop Canadians from jumping into offshore online gambling. Yes, provincial lottery corporations have online gaming sites as well, but by comparison, the offshore offerings are far more attractive. Not only do they provide greater game selection, but the prizes are bigger, there are more bonuses and special features and offshore gambling sites provide incentives that the provincial government gaming sites could not match if they tried. For the average Canadian who spends most of their Winter holed up in a cabin in the woods, having internet access to offshore gambling is far more interesting than listening to CBC Radio.

Plus, Canadians tend to be a responsible bunch when it comes to gambling. Land-based casinos are a draw, but for the most part, Canadians use them for entertainment purposes as opposed to feeding an addiction. This may be due in part because of the emphasis the individual provincial government lottery corporations put on being responsible gamblers. Slogans such as “Know your limit, play within it” are commonplace in any gambling setting licensed by a Canadian provincial government. With the government earning a portion of all bets made, it is an interesting concept to keep releasing new games in the scratch ’n’ win lottery ticket variety but also reminding players to not spend so much so they can remain responsible gamblers. Canada may be onto something with their limiting gambling regulations, lack of enforcement for Canadian illegally participating at offshore gaming sites, and promoting safe gambling instead of clamping down on limiting ticket purchases.

The Complication of Gambling Disorder DSM-5

We’ve indicated that problem gambling is associated with suicide but other complications can develop when a gambler becomes addicted to the activity. Here are a few of the complications that may arise and tip you off that the person you know could have a gambling disorder DSM-5.

Complication #1 - Financial Difficulties

This is at the top of our list for a very good reason. Financial problems can be a huge issue resulting from compulsive gambling. Even for those who are in denial, you can expect to discover that they are hiding huge financial losses. The problems can cover the spectrum from large debts to outright poverty and even bankruptcy.

Complication #2 - Legal Problems

Not every gambler with experience legal problems. However, some gamblers may resort to getting involved in illegal activities, or stealing to finance their habit. Getting caught and facing legal consequences can negatively impact both the gambler, friends, family, and employment opportunities.

Complication #3 - Health Concerns

Gambling disorder DSM-5 can result in extreme stress which is not good for the body. The medical profession has pointed to stress as the cause of many different illnesses and conditions that impact our quality of life. A problem gambler can develop these including ulcers, digestive problems, sleeping issues, and headaches.

Complication #4 - Problems At Home

Families are usually impacted greatly by being related to a problem gambler. Those who are in the same family as a gambling addict are most likely to experience violence or verbal abuse from the gambler. Children born to habitual gamblers have a greater risk of developing mental health issues and drug problems.

The Role Of Dopamine In Gambling Disorder DSM-5

Dopamine is a chemical in the brain that acts as a neurotransmitter. It triggers feelings of pleasure, motivation, and reward. When we accomplish something that falls under these three main feelings, our brain naturally releases dopamine into our body. Any activity we engage in that benefits our longevity and survival triggers dopamine and money is one of those things we need to assist with both our longevity and survival. As a result, our brain will release a greater amount of dopamine each time we have an opportunity to enhance our lives in ways that are related to longevity and survival. A job promotion, winning a casino jackpot, and starting a family are examples of things that will help our brain to inject some extra dopamine into our system. Dopamine also plays a role in gambling disorder DSM-5, and here is what it does.

Each time a gambler hits a jackpot or spins a win at the slots, they are releasing dopamine into their body. It feels good but after a while, the effects wear off and the gambler gets used to the amount of dopamine being released. The gambler now requires greater stimulation which equates to larger amounts of dopamine. This is only made possible by hitting bigger jackpots and to do this, the gambler has to spend more time and money gambling. Do you see how this can develop into a problem? It also is why a problem gambler just can’t quit cold turkey because they have become reliant on the risk and reward of betting to keep releasing dopamine. It can take weeks to years for a problem gambler to restore their dopamine system and this makes quitting even more difficult and why relapses are common.

Gambling Disorder DSM-5 - The Causes

The DSM-5 goes into great detail on what causes problem gambling. The disorder can begin to develop as early as adolescence or early adulthood however, in other individuals, the disorder does not develop until later in life. Regardless of when it starts, the disorder takes several years but it seems to progress faster in females than in males. The development of a gambling disorder follows a pattern of gradual increases in frequency and amount wagered with mild forms capable of developing into severe cases. Two very distinct types of gambling can be problematic to Canadians. One is buying scratch ’n’ win tickets daily and the other is playing blackjack or slot machines weekly at a casino. Although the frequency is related to the development of gambling disorder DSM-5, it is related more to the type of gambling rather than the severity of gambling. For example, buying scratch ’n’ win tickets daily may not be a problem overall. The same thing applies to spending the same amount of money gambling each week at a casino. However, both of these patterns can develop into something far more serious than casual gaming activities.

Speaking of gambling patterns, they can be episodic or regular. Plus, the gambling disorder DSM-5 can be either in remission or persistent. Confusing, right? Well, gambling activity can increase when the gambler is depressed or stressed and can also increase when the gambler is either using substances or not. Add to all of this the fact that at times the gambling activity can be extremely heavy while at other times it can be light. There are also times when problem gambling is associated with spontaneous, long periods of abstinence. But this is where it can be most dangerous as some gamblers will underestimate their level of vulnerability and develop a gambling disorder or fall back into a gambling disorder following a lengthy break from the activity. This happens when the gambler is in remission and incorrectly assumes that it will be easy for them to control the amount of gambling they do. And, in some cases this is possible but then for other individuals, they succeed at gambling without an issue for some time and then fall back into a gambling disorder. To say it can be hit or miss is a fairly accurate description of the pattern this issue follows.

It appears more common for males to show signs of gambling disorder DSM-5 earlier than females. It is also common for individuals to start gambling early in life as a family activity or something shared with friends. The development of problem gambling early in life appears to be connected to impulsivity and substance abuse. As noted above, high school and college-aged students fall victim to gambling issues but tend to grow out of it over time. But for some, gambling will end up becoming a lifelong problem. The development of gambling problems is more common in females than males when looking at midlife and later in life demographics. This means that gambling disorder DSM-5 has variations related to gender and age. In simple terms, it is common in young, middle-aged, and older people. It is more common in males in adolescence and high school or college ages. Sports betting is preferred by younger gamblers and adults tend to lean towards slot machines and bingo. As for treatment, the number of problem gamblers seeking help is low in all demographics with young adults less likely to look for help compared to all other age groups.

Treatment Options

The upside here is that problem gambling is treatable. However, it will be challenging. That’s mainly because it is difficult for the problem gambler to admit they have a problem. However, one of the most important steps to recovery happens to be coming to grips with the fact that there is a gambling problem. So, how do you treat it?

What Not To Do - Push Or Pressure

If you have a family member, friend, or employee that you suspect has gambling disorder DSM-5, the last thing you should do is pressure them to seek help. An intervention is a good idea, but it has to have a loving, caring, and compassionate tone. By pushing someone to seek treatment, you may find the gambler resisting help and that just defeats the purpose of the intervention in the first place. Gently nudge the person to seek help and be supportive throughout the entire process.

What Not To Do - Bail Them Out

Another mistake family and friends make when trying to help a loved one with a gambling problem to seek help is to offer to cover debts. While this is usually considered an act of generosity, it is far better for the gambler to take full responsibility for the losses incurred. While it may take a long time to recover, meeting with a financial advisor will provide a better idea of programs and processes to follow that will resolve the debts effectively and efficiently.

What To Do - Therapy

Behavior therapy may be beneficial to some with gambling disorder DSM-5. That’s because this form of therapy helps to unlearn the habitual habits and teach skills that can be used to resist the urge to gamble. Cognitive behavioral therapy concentrates on identifying unhealthy and irrational beliefs and replaces them with healthy and positive ones. In other words, you can retrain your brain to seek pleasure and entertainment from other activities not related to gambling.

What To Do - Stop Gambling

Problem gamblers who promise to reduce their time spent online or in casinos have a low success rate. That is because even small exposure to gambling seems to result in a relapse for many problem gamblers. The only way to break the cycle is to eliminate the source of activity. This means a problem gambler has to quit visiting the places that offer gambling opportunities. Family and friends can assist with this by providing alternate activities for the gambler to focus attention on.

What To Do - Medications

With the support of your medical professional, prescription drugs may prove to be an effective form of treatment. Since some problems that are associated with problem gambling can be treated with medications, combating such things as depression, OCD, or ADHD behavioral problems may also treat gambling addiction. Medications identified as narcotic antagonists are used in treating substance abuse and may have positive effects in treating compulsive gambling activity.

What To Do - Self-Help Groups

There is no shortage of self-help groups out there who can assist. In Canada, each province and territory has a toll-free gambling helpline where resources can be accessed to help both the gambler and those around the gambler. The helpline numbers are listed below.

Toll-Free Gambling Helplines:

Alberta Problem Gambling Resources Network - 1-866-461-1259

British Columbia Problem Gambling Help Line - 1-888-795-6111

Manitoba Addictions Help Line – Problem Gambling - 1-800-463-1554

New Brunswick Gambling Information Line - 1-800-461-1234

Newfoundland Problem Gambling Help Line - 1-888-899-4357

Northwest Territories General Help Line - 1-800-661-0844

Nova Scotia Problem Gambling Help Line - 1-888-347-8888

Nunavut Kamatsiaqtut Help Line - 1-800-265-3333

Ontario ConnexOntario Help Line - 1-866-531-2600

Prince Edward Island Problem Gambling Help Line - 1-855-255-4255

Quebec Gambling: Help and Referral - 1-800-461-0140

Saskatchewan Problem Gambling Helpline - 1-800-306-6789

Yukon Mental Wellness and Substance Use Services - 1-866-456-3838

In Conclusion

Gambling disorder DSM-5 can be the ruin of many a gambler. It can develop at an early age, in middle age, or later in life. Gambling addiction impacts both men and women and isn’t always easy to identify as sometimes it is obvious and other times it is not. However, the gambler will eventually exhibit behavior patterns that may point to a gambling issue. There are treatments available, but for success to occur, the problem gambler has to eliminate all forms of gambling from their lives. By removing the stimulus, then behavior therapy, medications, and support groups can have an impact on the recovery. While relapses do occur, former gamblers can remain former gamblers for the rest of their lives provided they do not expose themselves to any type of gambling. For more information, contact the toll-free gambling hotline in your province.