Evidence-Based Reviews

More adolescents are gambling—with addiction

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When does social betting become problem behavior?


 

References

Matt, age 17, grew up in a household of gamblers. He learned to play poker from his father at age 8 and bet on sports with his friends in the 5th grade. For 2 years he has been playing poker three to four nights per week and watching a lot of televised poker. His parents worry he might be “addicted” to gambling and bring him for evaluation.

Easy access to gambling through casinos, lotteries, and Internet games has affected many social groups, particularly adolescents.1 Teens such as Matt are more likely than adults to become pathological gamblers,2 and they often have psychiatric disorders and antisocial behavior patterns that interfere with normal development. This article:

  • suggests screening tools to identify problem teen gambling
  • discusses how to use psychotherapy, medications, and other options to help gambling-obsessed adolescents change their high-risk behavior.

Why adolescents gamble

Gambling activates the same neural reward pathways affected by cocaine and amphetamines.3 Even so, many adolescents view gambling as less harmful than drugs4 and consider it a rite of passage:

  • 90% report having gambled for money
  • 75% have gambled at home for money
  • 85% of parents do not object to gambling behaviors, teens say.4,5
Adolescents gamble to win money and for excitement and entertainment, social acceptance, as a coping mechanism, or to feel a “rush.” Gambling is particularly attractive to adolescents who enjoy competing with peers. Being in a group that gambles offers a sense of community and shared experience.6

Adolescent gambling behavior. For approximately 85% of adolescents, gambling becomes no more than a social activity. For others, it can become problematic or even pathological (Table 1).5,7 Approximately 4 to 8% of adolescents meet criteria for pathological gambling, compared with 1% of adults.

Adolescents’ higher rate might reflect pathological gambling’s natural course—peaking during adolescence, then tapering during adulthood. Some adolescents may adapt their gambling behavior over time. Problem gambling tends to be more transient and episodic than pathological gambling, remitting when adolescents take on new responsibilities (such as with college, marriage, employment, or death of parents).8

Table 1

Adolescent gambling: From entertainment to mental illness

BehaviorPrevalence in U.S. teens (%)Definition
Social gambling80 to 85Gambling socially for a limited amount of time with predetermined, acceptable losses
Problem gambling10 to 14Gambling for recreation at the expense of other developmental activities; may interfere with time management, productivity, and relationships
Pathological gambling4 to 8Persistent and recurrent gambling that disrupts personal, family, or vocational pursuits
Source: References 3, 10.

Case continued: ‘Up big-time’

Matt says he loves to gamble and believes he is more gifted at poker than his peers. He also recognizes his behavior could be addictive and admits lying to his parents about his gambling. He plays Internet poker 3 to 4 hours per day and claims he wins more often than he loses. “I’m up big time,” he boasts.

Matt denies going to casinos or using bookies. He says he is managing school and home responsibilities without difficulty. He denies mood or anxiety symptoms but admits using methylphenidate while gambling. He obtains the stimulant from friends at school and usually snorts it to get “a bigger rush.”

Matt is clearly at risk for problem gambling. He was exposed to gambling early, is becoming preoccupied with it, lies about how much he gambles, and combines gambling with substance abuse. progress more rapidly and can become problem gamblers within 12 to 14 months.2

Neurobiologic differences between adolescent and adult pathological gamblers are not well-defined. Adults show evidence of dysregulated dopamine, norepinephrine, and serotonin neuro-transmission.9 Neuroimaging in adult pathological gamblers shows perturbations in reward processing centers and frontal lobe structures that control inhibition. These factors have been examined little in adolescents.

Identifying problem gambling in teens

Diagnostic “red flags” for problem gambling in adolescents include declining school performance, sleep disturbance, generalized anxiety or irritability, or possibly lack of response to general psychiatric treatment. Three tools can be useful for screening adolescents:

The Lie-Bet Questionnaire10 is a 2-question screen for problem gambling:

  • Have you ever lied to anyone important about how often you gamble?
  • Have you ever had to increase your bet to get the same excitement from gambling?
Explore at-risk gambling with patients who respond positively to either question.

The South-Oaks Gambling Screen11 is the standard pathological gambling screen for adults. Like the (SOGS-RA) is based and validated using DSM-III criteria (see Related resources). A score of 2 to 5 indicates at-risk gambling behaviors, and ≥6 indicate need for treatment.

The Gamblers Anonymous questionnaire12 comprises 20 questions that identify negative social, physical, and emotional consequences of gambling behaviors (Box). Seven or more positive responses indicate probable pathological gambling. This screen has shown reliability in adolescents.

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