As you read at the beginning of this chapter, DSM-5 lists gambling disorder as an addictive disorder alongside the substance use disorders. This represents a significant broadening of the concept of addiction, which in previous editions of the DSM referred only to the misuse of substances. In essence, DSM-5 is suggesting that people may become addicted to behaviors and activities beyond substance use.

It is estimated that as many as 4 percent of adults and 3 to 10 percent of teenagers and college students suffer from gambling disorder (Nowak & Aloe, 2013; Black et al., 2012; Splevins et al., 2010). Clinicians are careful to distinguish between this disorder and social gambling (APA, 2013). Gambling disorder is defined less by the amount of time or money spent gambling than by the addictive nature of the behavior (Carragher & McWilliams, 2011). People with gambling disorder are preoccupied with gambling and typically cannot walk away from a bet. When they lose money repeatedly, they often gamble more in an effort to win the money back, and continue gambling even in the face of financial, social, occupational, educational, and health problems (see Table 12-5). They usually gamble more when feeling distressed, and often lie to cover up the extent of their gambling. Many people with gambling disorder need to gamble with ever-larger amounts of money to reach the desired excitement, and they feel restless or irritable when they try to reduce or stop gambling—symptoms that are similar to the tolerance and withdrawal reactions often associated with substance use disorder (APA, 2013).

420

The explanations proposed for gambling disorder often parallel those for substance use disorders. Some studies suggest, for example, that people with gambling disorder may: (1) inherit a genetic predisposition to develop the disorder (Vitaro et al., 2014; Jabr, 2013); (2) experience heightened dopamine activity and operation of the brain’s reward center when they gamble (Jabr, 2013); (3) have impulsive, novelty-seeking, and other personality styles that leave them prone to gambling disorder (Leeman et al., 2014); and (4) make repeated and cognitive mistakes such as inaccurate expectations and misinterpretations of their emotions and bodily states (Fortune & Goodie, 2012; Williams et al., 2012). However, the research on these theories has been limited thus far, leaving such explanations tentative for now.

Several of the leading treatments for substance use disorders have been adapted for use with gambling disorder. These treatments include cognitive-behavioral approaches like relapse-prevention training, and biological approaches such as narcotic antagonists (Jabr, 2013; Bosco et al., 2012; Larimer et al., 2012). In addition, the self-help group program Gamblers Anonymous, a network modeled after Alcoholics Anonymous, is available to the many thousands of people with gambling disorder (Marceaux & Melville, 2011). People who attend such groups seem to have a better recovery rate.

As people increasingly turn to the Internet for activities that used to take place in the “real world”—communicating, networking, shopping, playing games, and participating in a community—a new psychological problem has emerged: an uncontrollable need to be online (Hsu et al., 2014; Young, 2011). This pattern has been called Internet use disorder, Internet addiction, and problematic Internet use, among other names (Acier & Kern, 2011).

For people who have this pattern—at least 1 percent of all people—the Internet has become a black hole. They spend all or most of their waking hours texting, tweeting, networking, gaming, Internet browsing, e-mailing, blogging, visiting virtual worlds, shopping online, or viewing online pornography (Yoo et al., 2014; Young & de Abreu, 2011). Specific symptoms of this pattern parallel those found in substance use disorders and gambling disorder, extending from the loss of outside interests to possible withdrawal reactions when Internet use is not possible (APA, 2013).

Although clinicians, the media, and the public have shown enormous interest in this problem, it is not included as a disorder in DSM-5. Rather, the DSM work-group has recommended that one version of the pattern, which it calls Internet gaming disorder, receive further study for possible inclusion in future editions (APA, 2013). Time—and research—will tell whether this pattern reaches the status of a formal clinical disorder.