Authored by Pin Ng PhD

Edited by Hugh Soames

Reviewed by Michael Por, MD


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.

What is Ludopathy?

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 gambling.1


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 Dr Ruth Arenas, 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.”


Dr Ruth Arenas and the team at Remedy Wellbeing Rehab in Spain 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 life. 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 population2 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.

What are the risks of Ludomania?

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.

How is pathological gambling or Ludopathy diagnosed?

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.


The criteria consider the behaviors and actions that might have taken place because of Ludopathy and include:


  • A 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.

What gambling addiction treatment is available?

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.


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 addictions. 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.

Inside the brain of a gambling addict - BBC News

References: Ludopathy and Ludomania

  1. Ayton P, Fischer I. The hot hand fallacy and the gambler’s fallacy: two faces of subjective randomness? Mem Cognit. 2004;32:1369–1378. doi: 10.3758/BF03206327. []
  2. Balodis IM, Kober H, Worhunsky PD, Stevens MC, Pearlson GD, Potenza MN. Diminished frontostriatal activity during processing of monetary rewards and losses in pathological gambling. Biol Psychiatry. 2012;71:749–757. doi: 10.1016/j.biopsych.2012.01.006. [PMC free article] []
  3. Clark L, Lawrence AJ, Astley-Jones F, Gray N. Luopathy near-misses enhance motivation to gamble and recruit win-related brain circuitry. Neuron. 2009;61:481–490. doi: 10.1016/j.neuron.2008.12.031. []
  4. Ladouceur R, Walker M. A cognitive perspective on ludomania. In: Salkovskis PM, editor. Trends in cognitive and behavioural therapies. Chichester, United Kingdom: Wiley; 1996. pp. 89–120. []
  5. Potenza MN, Steinberg MA, Skudlarski P, et al. Gambling urges in pathological gambling: a functional magnetic resonance imaging study. Arch Gen Psychiatry. 2003;60(8):828–36. []
  6. Crockford DN, el-Guebaly N. Psychiatric comorbidity in pathological ludopathy: A critical review. Can J Psychiatry. 1998;43(1):43–50. []
  7. Grinols E. Gambling in America: Costs and Benefits. Cambridge, UK: Cambridge University Press; 2004. pp. 111–28. []
  8. Walters GD. Behavior genetic research on gambling and problem ludomania: A preliminary meta-analysis of available data. J Gambl Stud. 2001;17(4):255–71. []
  9. Ibanez A, Blanco C, de Castro IP, et al. Genetics of pathological gambling. J Gambl Stud. 2003;19(1):11–22. [PubMed] []

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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.
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