Gambling is the risking of something of value on an event whose outcome is primarily determined by chance for the purpose of realizing a gain or profit. It has existed in virtually every society since prerecorded history and has been incorporated into many customs and rites of passage. Its popularity has ebbed and flowed through times of great wealth (such as the era of gambling on Mississippi riverboats) and periods of moral conservatism (such as the early 20th century when prohibition of gambling helped the mafia flourish).
Most individuals gamble without causing any problems, and even a small percentage of those who develop problems can be recovered from pathological gambling, an addiction recognized in the Diagnostic and Statistical Manual of Mental Disorders. But, for a very large subset of individuals, gambling is an uncontrollable behavior with devastating personal, family, and financial consequences. It is estimated that about 4% of people receiving treatment for substance use disorder also meet criteria for pathological gambling and 7% of psychiatric inpatients have a diagnosis of pathological gambling. It is therefore important that physicians evaluate their patients for this potentially harmful behavior.
A growing body of evidence supports that the behavior of gambling is best viewed as an addictive disorder rather than a simple vice or leisure activity, and this change in perspective has had significant clinical implications. Currently, the evaluation of patients’ gambling behaviors within a general medical setting is becoming increasingly important because it is a prevalent and legalized activity with potentially addictive potential.
It is thought that a combination of psychological and biological factors makes some individuals more susceptible to developing gambling problems than others. These include a tendency to engage in risk-taking activities, a genetic predisposition toward addictive behaviors, and the presence of other psychological or psychiatric disorders. In addition, there appears to be a significant interaction between gambling and the environment in which it occurs. For example, a person may be more likely to develop gambling problems in a culture that values winning at all costs and where there are few social constraints on gambling.
The most common form of gambling is lotteries, which are available in nearly all countries. However, sports betting, fantasy leagues, and online poker are also forms of gambling. The amount of money that is legally wagered on these and other forms of gambling is enormous, possibly in the range of $10 trillion worldwide.
There are some skills that can be used to improve a person’s chances of winning in a gambling game, such as knowledge of betting strategies for a particular card game or training a horse in a race. But, in the end, a winner is determined by chance alone, and a loser is destined to be a loser.
The behavior of gambling can be influenced by reward-seeking responses and reinforcement, such as the positive feelings experienced with winning and the relief associated with losing. The size of these rewards may be a factor in determining whether or not an individual is addicted to gambling. For instance, individuals who are highly rewarded by a win will continue to gamble for longer periods than those who do not receive as much reinforcement from the game.