The International Classification of Diseases (ICD) is the text produced by the World Health Organization that summarises all the medical issues they recognise.
When the latest version, the ICD-11, was produced, the section concerning addictive disorders included a category for addictive behaviours. It’s now medically recognised that people can become addicted to specific actions and not just substances. Chief among these behaviours is gambling.
Gambling addiction is undoubtedly a real thing and a big problem. Hence the UK government bringing in measures to hopefully curb, or at least reduce, the harm it does.
But how do people end up addicted to gambling? And why is it often so difficult to treat compared to more ‘typical’ substance-based addictions?
The ‘how’ is relatively straightforward. The primary appeal of gambling is essentially obtaining large amounts of money for next-to-no effort.
When it comes to making decisions, the human brain is constantly weighing up effort against potential reward. If something ends up being heavily skewed towards the latter (for example, paying a small amount of money to receive a large amount in return), we tend to really approve of it.
There’s also the fact that the human brain is complex enough to recognise money as significant, in the biological sense, even though it’s technically an abstract concept. Our brains also prioritise novelty and unpredictability.
All this together means that gambling can, and does, have the same effect on the brain’s reward system as certain drugs and substances. An addiction develops, with all the subsequent consequences for the individual.
This doesn’t happen for everyone who gambles, of course. A lot of people don’t gamble at all. Many people are instinctively averse to risk or loss, which are unavoidable aspects of gambling. But other people aren’t sensitive in this way and are far more willing to embrace gambling as a pastime.
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But while the similarities between our brains’ responses to gambling and drugs can explain why gambling is so often addictive, it’s the differences between them that can make a gambling addiction particularly difficult to treat.
As a gambling addiction lacks any biological substance, it’s easier to miss or hide. As a result, some evidence suggests that 90 per cent of gambling addictions go unreported and untreated.
Also, the lack of any specific substance underpinning gambling addiction means there’s nothing to ‘take away’, so to speak. Even for long-term, chronic drug addictions, there’s the option of removing the drug (going ‘cold turkey’) and allowing people’s brains and bodies to adjust to the absence. Granted, this is often a deeply unpleasant – even dangerous – option. But it’s still an option.
That isn’t the case with gambling. It’s an action, not a substance. As long as someone has money and autonomy, it’s extremely difficult to deny them access to gambling. Even if you could, that still may not make any difference, thanks to how gambling is experienced.
The nature of gambling means it isn’t experienced as a direct ‘stimulation = reward’ process, the sort that applies to drug taking and underlies the fundamental learning processes of classical conditioning (a key aspect of how addictions take hold in the first place).
Such relatively simple processes can also be simple to unlearn. If the stimulation stops producing a reward, then the association undergoes ‘extinction’ in the brain. Do this with the source of an addiction and it loses its power over you. Due to the profound complexity of the human brain, achieving this is rather difficult, but it at least provides something to work toward.
Consider this, however. If an alcoholic found that only one random drink in 20 contained any alcohol, while others made them nauseous, it would presumably become a lot easier to kick the habit. But that doesn’t work with gambling, because that’s already how gambling is experienced.
The rewards of gambling occur via a variable reinforcement schedule. You never know when you’re going to win and losing is unavoidable. But as long as you win often enough, you keep at it. And an addiction to the behaviour occurs.
Knowing the negative outcomes of gambling is already a part of the process. It’s like trying to treat an alcoholic by making them pay for their own drinks; they invariably already are.
These are just some of the reasons gambling addictions are such thorny problems to tackle, medically. That means it’s imperative to work on reducing exposure to gambling and the occurrence of addictions in the first place. We’ve got to even the odds somehow.
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