Authored by Pin Ng

Edited by Hugh Soames

Reviewed by Dr Ruth Arenas

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Understanding Ludopathy


Ludopathy, sometimes known ludomania, is an addiction to gambling. Unlike many addictions there is no substance involved, instead the addiction is to the act of gambling itself, which has an effect on the brain’s reward centers. However, Ludopathy does often occur in conjunction with substance misuse.


Gambling addiction has become a bigger problem as gambling itself has been normalized and made legal in more areas. Once heavily regulated and restricted some form of gambling is now legal in every state except Hawaii and Utah.


The American Gambling Association states that the industry, employing over 1.8 million people, is worth over $260 billion a year. The internet also means that gamblers can often access betting and gambling sites, regardless of what federal or state regulations might apply.


Ludopathy Definition


Ludopathy is a process addiction, one in which the addiction is to the addictive act, rather than a drug or substance. The addiction, however, is formed in much the same way as any other addiction. The behavior, in this case gambling, results in the production of dopamine activating the brain’s reward centers.


Although dopamine has an important role to play in the body, and everyone will recognize the ‘hit’ of dopamine, with addicts the brain’s pathways get rewritten, increasing the need for dopamine and resulting in pathological gambling11.L. Clark, B. Averbeck, D. Payer, G. Sescousse, C. A. Winstanley and G. Xue, Pathological Choice: The Neuroscience of Gambling and Gambling Addiction – PMC, PubMed Central (PMC).; Retrieved September 23, 2022, from


Exactly why some people can gamble without forming an addiction while others develop problems is unclear. It’s estimated that at least 80-85% of the general population can, and in many cases do, gamble without becoming addicted, sometimes despite gambling regularly. The remaining 15-20% of the population either have, or are at risk of developing, a gambling problem.


While the research, and precise definitions, vary, it’s estimated that between 3-6% of the population have a gambling problem. The magnitude of these problems varies, dividing that group into problem gamblers and pathological gamblers.


According to Philippa Gold, one of the Worlds leading authorities on Behavior disorder and Dual Diagnosis


“while Ludomania may present in isolation it is usually combined with a number of co-occurring issues such as underlying mental heath conditions and of course other behavior and substance misuse addictions. Many pathological gamblers are drawn to different substances and its likely that slots players will choose opiate related substance while more engaging casino games such as Blackjack and Poker attract more stimulant types drug users such as Cocaine and Meth.”


Philippa Gold and the team at Remedy Wellbeing have created an award winning program of recovery from all kinds of behavior addictions and substance misuse disorders.


Problem gamblers, approximately 2-3% of people, have a gambling problem which has not quite reached the level of being a gambling addiction. These can exhibit a range of behaviors that suggest they do not have full control of their habit but are likely to have enough control that it has no, or no significant, impact on their general life22.T. W. Fong, The Biopsychosocial Consequences of Pathological Gambling – PMC, PubMed Central (PMC).; Retrieved September 23, 2022, from


They might exhibit behaviors like finding it hard to stop gambling once they have started or gambling more than they budgeted. However, at other times gambling does not affect them, they might not have the compulsion to gamble at inappropriate times, for example, so their work is unaffected. However, they are at a significantly higher risk of developing Ludopathy.


Pathological gamblers make up about 1-3% of the population. In these cases, their ludopathy will often have a significant negative impact on their lives. A pathological gambler will have significantly less, or perhaps even no, control over their gambling.


They might find themselves thinking about gambling when they should be focused elsewhere, or even avoiding their responsibilities to gamble. In such cases their ability to control their gambling behavior will either be extremely limited or simply non-existent.

Risks of Ludopathy


Despite not being a physical addiction, gambling addiction does carry with it significant risks. These risks can include negative outcomes to their physical and mental health as well as having significant social and economic impacts.


Those with gambling problems are at a higher risk of developing mental health problems. The most frequent are common mental health problems like depression or anxiety. There is also some evidence showing a connection between ludopathy and substance abuse, possibly because the addictive pathways in the brain have been formed.


However, more generally, there is a correlation between gambling and higher rates of alcohol and nicotine use. There is also a link between ludomania and lower levels of impulse control, although no clear evidence of the direction of causation. More generally, problem gamblers often experience negative emotions like shame and guilt because of their addiction, leading to lower levels of self-esteem.


Gambling has also been linked to several physical health problems. Some of these may be linked to the effects of poorer mental health, but some are more directly linked to gambling. One common problem are the adverse health effects of poor sleep.


With gambling available 24 hours a day many gamblers report getting less sleep than usual because of their habit. Those who use casinos may suffer because they are designed to remove the usual time cues, like windows or visible clocks. Problem gamblers will also tend to have higher rates of hypertension and cardiovascular illnesses.


Finally, problem and pathological gambling can result in severe social and economic consequences. Like any addiction, ludopathy can lead to the addict neglecting their usual duties and responsibilities. Estrangement from family and friends is a common consequence of gambling addiction.


Problem gamblers have higher rates of divorce and emotional absenteeism, possibly creating mental health problems for their loved ones.


The need to feed the habit can result in financial difficulties, getting into debt to continue gambling or having job difficulties because they are missing work. Some gamblers will also experience legal difficulties because they turn to crime to fund their addiction.


Many recovered gamblers will report having stolen to gamble, while some have turned to other illegal behavior like fraud, use of loan sharks and even prostitution to earn money for gambling.

Getting Diagnosed with Ludopathy


Ludopathy, or pathological gambling, is listed in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). As a mental health condition it is diagnosed based on whether the possible addict meets enough of the criteria for addiction, with a diagnosis requiring meeting five of the ten criteria.


While intended for medical professionals, the criteria can be used by people who are concerned about their own gambling / ludopathy, or a loved one’s gambling, to help them decide if they need to seek help.


Criteria for Ludopathy Diagnosis:


  • Preoccupation with gambling
  • A need to gamble more and more to enjoy the same level of excitement
  • Repeated unsuccessful attempts to control gambling
  • Being restless or irritable when trying to cut down or stop
  • Using gambling as an escape from problems
  • Gambling in an attempt to recover previous gambling losses
  • Lying to others to conceal their ludopathy
  • Breaking the law to get money for gambling
  • Damaging their relationship, job, or other life opportunities because of their gambling
  • Relying on others to help them out of problems caused by ludomania


Gambling Addiction Self Test


Gambling disorder is officially recognized by the American Psychiatric Association as a real mental health condition, and it’s defined by a repeated pattern of gambling behavior, that’s causing significant stress or harm in your life.


The following test is the self assessment version of the North diagnostic screening for gambling disorders, and it’s based on the DSM five diagnostic criteria for pathological gambling. It asks 10 questions to help you discern if you have a gambling problem, as we go through each question mark it as a yes or no. And for every yes that you have, that’s a score of one, and at the end we’ll go through what each score means.


  1. Have there ever been periods lasting two weeks or longer, when you spend a lot of time thinking about your gambling experiences, planning out future gambling ventures or bets, or thinking about ways of getting money to gamble with?
  2. Have there ever been periods when you needed to gamble with increasing amounts of money or with larger bets than before, in order to get the same feeling of excitement?
  3. Have you ever felt restless, or irritable when trying to stop, cut down or control your gambling?
  4. have you tried and not succeeded in stopping cutting down or controlling your gambling, three or more times in your life?
  5. Have you ever gambled to escape from personal problems or to relieve uncomfortable feelings such as guilt, anxiety, helplessness or depression?
  6. Has there ever been a period when if you lost money gambling one day, you would often return another day?
  7. Have you lied to family members, friends, or others about how much you gamble and or about how much money you lost on gambling on at least three occasions?
  8. Have you ever written a bad check or taken money that didn’t belong to you from family members, friends, or anyone else in order to pay for your gambling?
  9. Has your gambling ever caused serious or repeated problems in your relationships with any of your family members or friend?
  10. Has your gambling ever caused you problems at work, or your studies?


So now just take a moment and compile your score, how many answers did you answer ‘yes’, and for each ‘yes’, mark that as a score of one and add up your score.


  • Score of zero indicates that results are not consistent with problematic levels of gambling
  • Score of one or two means that results are consistent with mild but subclinical risk for gambling problems.
  • Score of three or four indicates results are consistent with moderate but subclinical gambling problems
  • Score of five or higher means that results are consistent with a likely diagnosis of pathological gambling, consistent with the diagnostic criteria of the DSM five, up to the highest possible score of 10

Treatment for Ludopathy


Ludopathy, Ludomania and Gambling addictions are treatable and because there is no physiological need to gamble, the aim of treatment is to stop gambling entirely. When considering treatment options other problems should also be considered, if gambling becomes an escape, for example, or to relieve depression, then treating gambling addiction alongside those conditions is more likely to be successful.


Perhaps the most important way to deal with ludopathy is to make lifestyle changes. These might be changing things that trigger gambling, like avoiding locations with casinos or old gambling buddies, or identifying and avoiding other triggers, like stressful situations that would prompt lifestyle changes.


Therapy for Gambling Addiction


Cognitive Behavioral Therapy, or CBT, is often successfully used to treat gambling addiction. In some ways this is akin to making lifestyle changes, but the starting point will be the patient’s own thought processes. A simplistic explanation is that CBT will help the patient understand the processes that lead to gambling, for example a stressful situation might result in tension, which is relieved by gambling. CBT helps the patient identify this and break the link by taking different actions, like finding an alternative way to relax.


Medication can be used in some cases, but this is usually only effective where there are other problems, such as bad mental health, that is associated with the gambling. In these situations, medication can be effective in recovery, but on its own is unlikely to address a gambling addiction.


There are also many groups and outpatient programs that can help. 12-step programs, like Gamblers Anonymous, can help people that have suffered from gambling problems where they can find mutual support to help them recover and stay free from gambling problems. Many charities and private providers also run support groups, not always as 12-step programs, with some supplementing the peer support of the group with professional addiction guidance.


Inpatient treatment is an option for people with severe gambling addiction33.A. B. Chairman & CEO Remedy Wellbeing, REMEDY Wellbeing® – The Most Unique & Exclusive Rehab in the World, Remedy Wellbeing.; Retrieved September 23, 2022, from Inpatient facilities can help by removing not only the temptation, but also the ability to gamble. The gambler can break the immediate habit and then start preparing to leave, so they can develop their tools they need to avoid, and if necessary resist, the desire to gamble after their inpatient treatment is finished.


Although the treatment required will vary from gambler to gambler, ludopathy is very treatable. Identifying the problem and seeking help is the important first step, and once that is done work can begin on identifying and avoiding or removing the triggers to start a gambling-free life.


Previous: Process Addiction

Next: Food Addiction

  • 1
    1.L. Clark, B. Averbeck, D. Payer, G. Sescousse, C. A. Winstanley and G. Xue, Pathological Choice: The Neuroscience of Gambling and Gambling Addiction – PMC, PubMed Central (PMC).; Retrieved September 23, 2022, from
  • 2
    2.T. W. Fong, The Biopsychosocial Consequences of Pathological Gambling – PMC, PubMed Central (PMC).; Retrieved September 23, 2022, from
  • 3
    3.A. B. Chairman & CEO Remedy Wellbeing, REMEDY Wellbeing® – The Most Unique & Exclusive Rehab in the World, Remedy Wellbeing.; Retrieved September 23, 2022, from
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