Boom in Sports Betting Spurs New Guidance on Gambling Disorder

Pauline Anderson

December 03, 2021

Amid growing concerns about the impact of increased legalized online sports gambling, the American Psychiatric Association has issued an updated guide on gambling disorder.

The guide provides expert guidance based on current research and provides information on the etiology, psychopathology, neurobiology, and treatment of the disorder.

"For doctors who might think of gambling as either innocuous behavior or simply equivalent to, say, an alcohol problem, this guide not only shows the complexity and seriousness of gambling disorder but also evidence-based treatments that may help people actually get better," the guide's co-editor, Jon E. Grant, MD, MPH, JD, professor of psychiatry at the University of Chicago, told Medscape Medical News.

Online sports betting is booming. "It has really taken off" in recent years and is now a multibillion dollar industry worldwide, Grant added.

A recent CBS News report highlights a record volume of legally placed online sports bets during the first week of this year's NFL season. All told, 26 states now have legalized sports betting.

The COVID-19 pandemic has played a large role in boosting online gambling; as in-person casinos shut down, customers shifted to online betting, said Grant. "They realized they could stay home, stay safe, and still gamble, so there was an uptick in that movement."

However, the popularity of online gambling is also a sign of the times. "A whole generation of young adults have been raised on the internet. A lot of companies realize this is not a market that would ever go to a land-based casino, so they essentially took their product to the young people," said Grant.

Gambling Meets Technology

In addition to football, online gamblers can bet on other sports, including horse racing, or participate in "fantasy" sports where users assemble virtual teams of stand-ins for real professional players. There are also online casinos where users can play such things as blackjack and roulette.

The new guide devotes a chapter to online gambling and the complex interplay between gambling and technology. It highlights the growth of interactive platforms, the role of new player experiences and reward structures, and the integration into other online activities, such as social media.

Other chapters explore the interface between gambling and the legal system and differences in gender and between age groups.

There is also information on advances in treatments. Although there are no FDA-approved drugs for gambling disorder, new evidence supports the use of certain agents for this disorder, said Grant.

These include naltrexone, which has long been used for alcohol and drug addiction, and over-the-counter N-acetylcysteine (NAC), an amino acid that affects the reward system in the brain and has been used for cocaine and marijuana addiction.

Research also suggests that brief-format cognitive-behavioral therapy may be effective for gambling disorder, said Grant.

An estimated 1% of the population has such a disorder, which involves repeated, problem gambling with sufferers struggling to control their gambling behavior. Gambling disorder is associated with decreased self-esteem, comorbid substance abuse disorders, financial and legal difficulties, relationship and family stress, and suicidality.

Early Intervention Is Key

Most gamblers don't have a diagnosable disorder and can participate in the pastime without any long-term harm. However, some will show signs of problem gambling, Grant noted.

"We believe that's where interventions may have an even bigger impact," said Grant. "We want to get people early on in the illness." He added that gambling "runs along a continuum" from simply dabbling to serious addiction.

Whereas previous versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) put gambling in an impulse control category, the latest version ― DSM-5 ― recognizes gambling as an addiction alongside substances.

"That shows greater awareness of the biological connection to substance addiction," said Grant. "It's important for clinicians who are screening substance use disorder folks to make sure they include gambling in that screening."

The guide includes information on available screening and assessment instruments for diagnosing gambling disorder and for monitoring symptom changes.

Many clinicians may be unaware of the personal and social consequences of gambling disorder and its implications for public health. The new guide provides a detailed look at the effects of gambling on society and families, as well as on individual health and well-being.

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