Gambling Addiction (Compulsive or Pathological Gambling)

  • Medical Author:
    Roxanne Dryden-Edwards, MD

    Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Prescription Drug Abuse Statistics

Gambling addiction facts

  • Compulsive gambling affects 2%-3% of Americans, can involve a variety of ways and places to bet, and symptoms may differ somewhat between males and females, as well as teenagers versus adults.
  • Although men tend to develop a gambling addiction at a higher rate and at younger ages than women, women now make up more than one-quarter of all compulsive gamblers, and women's symptoms tend to worsen faster once compulsive gambling develops.
  • As opposed to pathological gambling, problem gambling involves more than one but less than five symptoms of compulsive gambling.
  • Although direct causes of compulsive gambling are unusual, the manic episodes associated with bipolar disorder and some medications that treat Parkinson's disease and restless leg syndrome have been associated with the development of this disorder.
  • Risk factors for pathological gambling include schizophrenia, mood problems, antisocial personality disorder, alcohol, or cocaine addiction.
  • The diagnosis of compulsive gambling involves identifying at least five symptoms that indicate poor impulse control when it comes to gambling, as well as ruling out other potential causes of the behaviors.
  • As with any mental-health condition, accurate diagnosis of gambling addiction requires a complete physical and psychological evaluation, including a mental-status examination and appropriate laboratory tests to rule out other possible causes of the symptoms that are being observed.
  • The treatment of compulsive gambling usually uses more than one approach, including psychotherapy, medication, financial counseling, support groups, 12-step programs, and self-help techniques.
  • The prognosis of recovery from compulsive gambling is encouraging with treatment.
  • Although pathological gambling may resolve with time on its own in many individuals, the devastating effects it usually has on the person's financial, family, legal, and mental-health status indicates that treatment should be attempted by anyone who is motivated to get help for this disorder.
  • Prevention of compulsive gambling usually involves addressing risk factors and educating the public about the warning signs of this disorder.

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Potential Causes of a Gambling Addiction

Bipolar Disorder

In order to qualify for the diagnosis of bipolar disorder, a person must experience at least one manic episode. Characteristics of mania must last at least a week (unless it is part of mixed features) and include

  • elevated, expansive, or irritable mood;
  • racing thoughts;
  • pressured speech (rapid, excessive, and frenzied speaking);
  • decreased need for sleep;
  • grandiose beliefs (for example, false beliefs of superiority or failures);
  • tangential speech (repeatedly changing conversational topics to topics that are hardly related);
  • restlessness/increased goal-directed activity;
  • impulsivity, poor judgment or engaging in risky behavior (like spending sprees, promiscuity, or excess desire for sex).

What is a gambling addiction?

Gambling addiction is a mental-health problem that is understood to be one of many kinds of impulse-control problems and having many similarities to obsessive compulsive disorder. However, it is now understood to be more similar to other addictive disorders. The types of gambling that people with this disorder might engage in are as variable as the games available. Betting on sports, buying lottery tickets, playing poker, slot machines, or roulette are only a few of the activities in which compulsive gamblers engage. The venue of choice for individuals with gambling addiction varies as well. While many prefer gambling in a casino, the rate of online/Internet gambling addiction continues to increase with increased use of the Internet. Alternatively, some compulsive gamblers may also engage in risky stock market investments. Gambling addiction is also called compulsive gambling or pathological gambling.

Estimates of the number of people who gamble socially and qualify for being diagnosed with a gambling addiction range from 2%-3%, thereby affecting millions of people in the United States alone. Other important statistics on problem gambling include that it tends to affect at least 1% of people internationally. Teens actually tend to suffer from this disorder at a rate that is twice that of adults.

Although more men than women are thought to suffer from pathological gambling, women are developing this disorder at higher rates, now making up as much as 25% of individuals with pathological gambling. Other facts about compulsive gambling are that men tend to develop this disorder during their early teenage years while women tend to develop it later. However, the disorder in women then tends to get worse at a much faster rate than in men. Other apparently gender-based differences in gambling addiction include the tendencies for men to become addicted to more interpersonal forms of gaming, like blackjack, craps, or poker, whereas women tend to engage in less interpersonally based betting, like slot machines or bingo. Men with pathological gambling tend to receive counseling about issues other than gambling less often than their female counterparts.

Problem gambling generally means gambling that involves more than one symptom but fewer than the at least five symptoms required to qualify for the diagnosis of compulsive or pathological gambling. Binge gambling is a subtype of compulsive gambling that involves problem gambling but only during discrete periods of time. That is different from a general gambling addiction, which tends to involve excessive gambling behavior on an ongoing basis and to include persistent thoughts (preoccupation) about gambling even during times when the person is not engaged in gambling.

What are causes and risk factors for gambling addiction?

When contemplating why people gamble, it is important to understand that there is usually no one specific cause for pathological gambling. Some potential exceptions include the observation that some individuals who are given medications that treat Parkinson's disease or restless leg syndrome (including pramipexole [Mirapex]) have been observed to develop impulse-control disorders like compulsive gambling, shopping, or compulsive sexual behaviors. The theory about that connection involves the increased activity of the chemical messenger dopamine in the brain. Another example where compulsive gambling may have a single cause is in bipolar disorder since exorbitant spending, including compulsive gambling, may be a symptom of the mania that is part of bipolar disorder.

Much more commonly, gambling addiction, like most other emotional conditions, is understood to be the result of a combination of biological vulnerabilities, ways of thinking, and social stressors (biopsychosocial model). There are, however, elements that increase the likelihood that the individual will develop a gambling addiction. Risk factors for developing pathological gambling include schizophrenia, mood problems, antisocial personality disorder, and alcohol or cocaine addiction. Individuals who have a low level of serotonin in the brain are also thought to be at higher risk for developing pathological gambling compared to others.

People who suffer from compulsive gambling have a tendency to be novelty seekers, feel disconnected (dissociated), relaxed, or aroused while gambling or playing video games. Research also shows that individuals who have money problems, win a large amount of money early into gambling, suffer a recent loss (like divorce, job loss), or are lonely increases the risk of developing compulsive gambling. Easy access to gambling (for example, living near towns with many gambling resources, such as Las Vegas or Atlantic City), belief that they’ve discovered a system to winning at gambling and failing to keep track of money won and lost gambling are more risk factors for engaging in compulsive gambling.

What are symptoms and signs of a gambling addiction?

Pathological gambling involves persistent and recurring problem gambling that includes several of the following symptoms that are not the result of another mental-health problem, like during a manic episode:

  • A preoccupation with gambling, either by reliving past gambling, planning for future gambling experiences, and/or thinking of ways to secure money to finance gambling
  • Needing more and more money for gambling in order to achieve the desired level of gambling enjoyment
  • Repeated unsuccessful attempts to stop or reduce betting behaviors
  • Becoming uneasy or easily irritated when trying to reduce or stop gambling
  • Gambling for the purpose of escaping problems or to relieve depression or anxiety
  • Returning to gambling after losing money in an effort to recoup losses
  • Lying to family or other loved ones, mental-health professionals, or others in an effort to hide the extent of the gambling behavior
  • Committing crimes (for example, stealing, fraud, or forgery) or securing illegal loans to finance gambling
  • Risking important relationships, employment, or other opportunities due to gambling
  • Depending on others for money to resolve dire financial situations that are the result of gambling

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How do health-care professionals diagnose a gambling addiction? What specialists diagnose and treat this illness?

The first step to obtaining appropriate treatment is accurate diagnosis, which requires a complete physical and psychological evaluation to determine whether the person may have a gambling addiction. Since some medical conditions can cause an individual to develop erratic, impulsive behaviors, including problem gambling, the examining physician should rule out (exclude) these possibilities through an interview, physical examination, and applicable laboratory tests, as well as implementing a full mental-health evaluation. A thorough diagnostic evaluation includes a complete history of the patient's symptoms, during which time the practitioner might ask the following questions:

  1. How old were you when you gambled for the first time?
  2. How much time (how often and for how long each time) do you spend gambling or thinking about gambling?
  3. How much money do you lose/spend gambling?
  4. What kinds of things do you do to finance gambling?
  5. Do you have irresistible urges to gamble?

The doctor usually asks about alcohol and drug use and whether the patient has had thoughts about death or suicide. Further, the history often includes questions about whether other family members have had a gambling problem or other mental-health problems, and if treated, what treatments they received and which were effective versus ineffective.

A diagnostic evaluation also includes a mental-status examination to determine if the patient's speech, thought pattern, mood, or memory has been affected, as often happens in the case of a many forms of mental illness. As of today, there is no laboratory test, blood test, or X-ray that can diagnose this mental disorder.

What is the treatment for gambling addiction?

Although there is no standardized treatment for pathological gambling, many people participate in Gamblers' Anonymous (GA) or learn how to stop engaging in gambling behaviors. The approximately 8% one-year abstinence rate that intervention tends to produce is often improved when GA is combined with psychotherapy that is administered by a trained professional. That seems to be particularly true when cognitive behavioral treatment is the psychotherapy approach that is used by the practitioner. Medications that have been found to be helpful in decreasing either the urge to gamble or the thrill involved in doing so include antiseizure medications like carbamazepine (Tegretol) and topiramate (Topamax), mood stabilizers like lithium (Eskalith, Lithobid), medications used to address addictions like naltrexone (ReVia), and antidepressants like clomipramine (Anafranil) and fluvoxamine (Luvox). Psychotherapy appears to be more effective than any of the medications used to treat this disorder so far. Financial/debt counseling and self-help interventions may also be important aspects of the care provided to individuals with gambling addiction.

Individuals who engaged in illegal behavior in the year prior to treatment tend to have more severe symptoms of this disorder, have more gambling-related debt compared to people who have not engaged in illegal activity during that time period. It is therefore thought that people who engage in breaking laws in the year before treatment begins need more intensive treatment for a longer period of time, sometimes even requiring inpatient or residential treatment, often referred to as rehab. Another important fact to consider in treatment for a gambling addiction is that up to 70% of people with this disorder also have another psychiatric problem. Therefore, it is not enough to just treat the gambling problem but any coexisting mental-health condition (such as alcoholism or other substance abuse problem, mood disorder, or personality disorder) should be addressed as well in order to give the person with a gambling addiction his or her best chance for recovery from both conditions. There is also a need for research about how a person's culture can play a role in the development and treatment of problem gambling.

Some studies have explored the possibility that so-called home remedies may help treat gambling addiction. Some remedies being explored to address this disorder include glutamate, diet, and aromatherapies.

What is the prognosis for gambling addiction?

With treatment, the prognosis of compulsive gambling can be quite encouraging. More than two-thirds of people with this disorder tend to abstain from problem gambling a year after receiving six weeks of treatment. After treatment has ended, less than one-fifth of those who receive follow-up for relapse prevention tend to relapse into gambling addiction behavior after one year compared to half of those who do not receive follow-up.

What are complications and negative effects of gambling addiction?

Although as many as one-third of individuals who suffer from pathological gambling may recover from the disease without receiving any treatment, the potential devastation that compulsive gambling can wreak on the life of the suffer and those around him or her clearly indicate that the potential positive aspects outweigh the possible complications that result from an intervention. As much as $5 billion is spent on gambling in the United States every year, with people who are addicted to gambling accruing tens to hundreds of thousands of dollars in debt. Harmful effects that compulsive gambling can have on the individual include financial problems ranging from high debt, bankruptcy or poverty, to legal problems resulting from theft to prostitution, to wanting, attempting, or completing suicide. Many compulsive gambling sufferers experience stress-associated medical problems like insomnia, stomach ulcers and other gastrointestinal problems, headaches, and muscle aches. Gambling addiction can have a multitude of negative effects on the family. Statistics indicate that families of people with compulsive gambling are more likely to experience domestic violence and child abuse. Children of problem gamblers are at significantly higher risk of suffering from depression, behavior problems, and substance abuse. One of the challenges of treatment of compulsive gambling is that as many as two-thirds of people who begin treatment for this disorder discontinue treatment prematurely, whether treatment involves medication, therapy, or both.

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Is it possible to prevent gambling addiction?

In addition to alleviating risk factors for compulsive gambling, educating the public about the warning signs for this disorder are key components to prevention. Some warning signs include often talking about gambling, bragging about gambling wins, poor performance and unexplained absences from work or school, mood swings, stealing, or excessive borrowing.

Where can people get support for gambling addiction?

Compulsive Gamblers Hub
http://www.cghub.homestead.com

Compulsive Gambling Center
924 East Baltimore St.
Baltimore, MD 21202
1-800-LOST-BET (1-800-567-8238)
http://www.lostbet.com

Debtors Anonymous
General Service Office
P.O. Box 920888
Needham, MA 02492-0009
Phone: 781-453-2743
Fax: 781-453-2745
http://www.debtorsanonymous.org

Gam-Anon International Service Office, Inc.
P.O. Box 157
Whitestone, NY 11357
718-352-1671

Gamblers Anonymous (GA) International Service Office
P.O. Box 17173
Los Angeles, CA 90017
213-386-8789
isomain@gamblersanonymous.org

GamBlock
http://www.gamblock.com

Problem Gambling.com
24 Hours a Day
7 Days a Week
U.S. Gambling Hotline: 1-800-522-4700
Canadian Gambling Hotline: 1-888-391-1111

United States National Gambling Help Line
1-800-522-4700

Where can people find more information about how to overcome gambling addiction?

NAADAC - The Association for Addiction Professionals
1001 N. Fairfax St., Suite 201
Alexandria, VA 22314
Phone: 1-800-548-0497
Fax: 1-800-377-1136

UCLA Gambling Studies Program
http://www.uclagamblingprogram.org

Massachusetts Council on Compulsive Gambling
1-800-426-1234
http://www.masscompulsivegambling.org

REFERENCES:

Abler, B., R. Hahlbrock, A. Unrath, et al. "At Risk for Pathological Gambling: Imaging Neural Reward Processing Under Chronic Dopamine Agonists." Brain 132.9 (2009): 2396-2402.

Alegria, A., S. Bernardi, and C. Blanco. "Pathological gambling: obsessive-compulsive disorder or behavioral addiction?" Columbian Psychiatry Review 39(suppl) (2010): 133-142.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Treatment Revision. American Psychiatric Publishing: Washington, D.C., 2000.

Centre for Addiction and Mental Health (CAMH). Problem Gambling: The Issues, the Options 2012, Ontario, Canada.

Cunningham-Williams, R.M., R.A. Grucza, L.B. Cottler, et al. "Prevalence and Predictors of Pathological Gambling: Results From the St. Louis Personality, Health and Lifestyle (SLPHL) Study." Journal of Psychiatric Research 39.4 July 2005: 377-390.

Dodd, M.L., K.J. Klos, J.H. Bower, Y.E. Geda, et al. "Pathological Gambling Caused by Drugs Used to Treat Parkinson Disease." Archives of Neurology 62 (2005).

Fong, T.W. "Pathological Gambling: Update on Assessment and Treatment." Addictive Disorders 27 Aug. 2009.

George, S., and V. Murali. "Pathological Gambling: An Overview of Assessment and Treatment." Advances in Psychiatric Treatment 11 (2005): 450-456.

Grant, J.E., and S.W. Kim. "Medication Management of Pathological Gambling." Minnesota Medicine 89.9 Sept. 2006: 44-48.

Hall, G.W., N.J. Carriero, R.Y. Takushi, et al. "Pathological Gambling Among Cocaine-Dependent Outpatients." American Journal of Psychiatry 157 July 2000: 1127-1133.

Korn, D.A., and H.J. Shaffer. "Practice Guidelines for Treating Gambling-Related Problems: An Evidence-Based Treatment Guide for Clinicians." Massachusetts Council on Compulsive Gambling Jan. 2004.

Ledgerwood, D.M., J. Weinstock, B.J. Morasco, and N.M. Petry. "Clinical Features and Treatment Prognosis of Pathological Gamblers With and Without Recent Gambling-Related Illegal Behavior." Journal of the American Academy of Psychiatry and the Law 35.3 (2007): 294-301.

Leung, K.S., and L.B. Cottler. "Treatment of Pathological Gambling." Current Opinion in Psychiatry 22.1 Jan. 2009: 69-74.

Moreyra, P., A. Ibanez, J. Saiz-Ruiz, et al. "Review of the Phenomenology, Etiology and Treatment of Pathological Gambling." German Journal of Psychiatry 3 (2000): 37-52.

Nower, L., and A. Blaszcznski. "Binge Gambling: A Neglected Concept." International Gambling Studies 3.1 (2003): 23-35.

Okuda, M., I. Balan, N.M. Petry, et al. "Cognitive-Behavioral Therapy for Pathological Gambling: Cultural Considerations." American Journal of Psychiatry 166 Dec. 2009: 1325-1330.

Park, S. "An overview of pathological gambling: methods of treatment and prevention." National Gambling Impact Study Commission Sept. 1998; Biloxi, Mississippi, and New Orleans, Louisiana.

Petry, N.M. "Internet Gambling: An Emerging Concern in Family Practice Medicine?" Family Practice 23.4 (2006): 421-426.

Petry, N.M, and C. Armentano. "Prevalence, Assessment and Treatment of Pathological Gambling: A Review." Psychiatric Services 50 Aug. 1999: 1021-1027.

Pettorruso, M., L. De Risio, G. Martinotti, et al. "Targeting the glutamatergic system to treat pathological gambling: current evidence and future perspectives." Biomedical Research International 2014.

Potenza, M.N., M.A. Steinberg, S.D. McLaughlin, et al. "Gender-Related Differences in the Characteristics of Problem Gamblers Using a Gambling Helpline." American Journal of Psychiatry 158 Sept. 200: 1500-1505.

Raylu, N., and T.P. Oei. "Role of culture in gambling and problem gambling." Clinical Psychology Review 23 (2004): 1087-1114.

Slutske, W.S. "Natural Recovery and Treatment-Seeking in Pathological Gambling: Results of Two U.S. National Surveys." American Journal of Psychiatry 163 Feb. 2006: 297-302.

Tsoi, S. "Academics Discuss Issues Concerning Gambling and Asian American Community Health." Sampan 19 Mar. 2009: 40.

Weintraub, D., A.D. Siderowf, M.N. Potenza, et al. "Association of dopamine agonist use with impulse control disorders in Parkinson Disease." Archives of Neurology 63 (2006): 969-973.

Westermeyer, J., J. Canive, J. Garrard, et al. "Lifetime Prevalence of Pathological Gambling Among American Indian and Hispanic American Veterans." American Journal of Public Health 95.5 May 2005: 860-866.

Wood, R.T.A., R. Gupta, J.L. Derevensky, and M. Griffiths. "Video game playing and gambling in adolescents: common risk factors." Journal of Child and Adolescent Substance Abuse 14.1 (2004): 77-100.

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References
REFERENCES:

Abler, B., R. Hahlbrock, A. Unrath, et al. "At Risk for Pathological Gambling: Imaging Neural Reward Processing Under Chronic Dopamine Agonists." Brain 132.9 (2009): 2396-2402.

Alegria, A., S. Bernardi, and C. Blanco. "Pathological gambling: obsessive-compulsive disorder or behavioral addiction?" Columbian Psychiatry Review 39(suppl) (2010): 133-142.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Treatment Revision. American Psychiatric Publishing: Washington, D.C., 2000.

Centre for Addiction and Mental Health (CAMH). Problem Gambling: The Issues, the Options 2012, Ontario, Canada.

Cunningham-Williams, R.M., R.A. Grucza, L.B. Cottler, et al. "Prevalence and Predictors of Pathological Gambling: Results From the St. Louis Personality, Health and Lifestyle (SLPHL) Study." Journal of Psychiatric Research 39.4 July 2005: 377-390.

Dodd, M.L., K.J. Klos, J.H. Bower, Y.E. Geda, et al. "Pathological Gambling Caused by Drugs Used to Treat Parkinson Disease." Archives of Neurology 62 (2005).

Fong, T.W. "Pathological Gambling: Update on Assessment and Treatment." Addictive Disorders 27 Aug. 2009.

George, S., and V. Murali. "Pathological Gambling: An Overview of Assessment and Treatment." Advances in Psychiatric Treatment 11 (2005): 450-456.

Grant, J.E., and S.W. Kim. "Medication Management of Pathological Gambling." Minnesota Medicine 89.9 Sept. 2006: 44-48.

Hall, G.W., N.J. Carriero, R.Y. Takushi, et al. "Pathological Gambling Among Cocaine-Dependent Outpatients." American Journal of Psychiatry 157 July 2000: 1127-1133.

Korn, D.A., and H.J. Shaffer. "Practice Guidelines for Treating Gambling-Related Problems: An Evidence-Based Treatment Guide for Clinicians." Massachusetts Council on Compulsive Gambling Jan. 2004.

Ledgerwood, D.M., J. Weinstock, B.J. Morasco, and N.M. Petry. "Clinical Features and Treatment Prognosis of Pathological Gamblers With and Without Recent Gambling-Related Illegal Behavior." Journal of the American Academy of Psychiatry and the Law 35.3 (2007): 294-301.

Leung, K.S., and L.B. Cottler. "Treatment of Pathological Gambling." Current Opinion in Psychiatry 22.1 Jan. 2009: 69-74.

Moreyra, P., A. Ibanez, J. Saiz-Ruiz, et al. "Review of the Phenomenology, Etiology and Treatment of Pathological Gambling." German Journal of Psychiatry 3 (2000): 37-52.

Nower, L., and A. Blaszcznski. "Binge Gambling: A Neglected Concept." International Gambling Studies 3.1 (2003): 23-35.

Okuda, M., I. Balan, N.M. Petry, et al. "Cognitive-Behavioral Therapy for Pathological Gambling: Cultural Considerations." American Journal of Psychiatry 166 Dec. 2009: 1325-1330.

Park, S. "An overview of pathological gambling: methods of treatment and prevention." National Gambling Impact Study Commission Sept. 1998; Biloxi, Mississippi, and New Orleans, Louisiana.

Petry, N.M. "Internet Gambling: An Emerging Concern in Family Practice Medicine?" Family Practice 23.4 (2006): 421-426.

Petry, N.M, and C. Armentano. "Prevalence, Assessment and Treatment of Pathological Gambling: A Review." Psychiatric Services 50 Aug. 1999: 1021-1027.

Pettorruso, M., L. De Risio, G. Martinotti, et al. "Targeting the glutamatergic system to treat pathological gambling: current evidence and future perspectives." Biomedical Research International 2014.

Potenza, M.N., M.A. Steinberg, S.D. McLaughlin, et al. "Gender-Related Differences in the Characteristics of Problem Gamblers Using a Gambling Helpline." American Journal of Psychiatry 158 Sept. 200: 1500-1505.

Raylu, N., and T.P. Oei. "Role of culture in gambling and problem gambling." Clinical Psychology Review 23 (2004): 1087-1114.

Slutske, W.S. "Natural Recovery and Treatment-Seeking in Pathological Gambling: Results of Two U.S. National Surveys." American Journal of Psychiatry 163 Feb. 2006: 297-302.

Tsoi, S. "Academics Discuss Issues Concerning Gambling and Asian American Community Health." Sampan 19 Mar. 2009: 40.

Weintraub, D., A.D. Siderowf, M.N. Potenza, et al. "Association of dopamine agonist use with impulse control disorders in Parkinson Disease." Archives of Neurology 63 (2006): 969-973.

Westermeyer, J., J. Canive, J. Garrard, et al. "Lifetime Prevalence of Pathological Gambling Among American Indian and Hispanic American Veterans." American Journal of Public Health 95.5 May 2005: 860-866.

Wood, R.T.A., R. Gupta, J.L. Derevensky, and M. Griffiths. "Video game playing and gambling in adolescents: common risk factors." Journal of Child and Adolescent Substance Abuse 14.1 (2004): 77-100.

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