Gambling: the addiction with no smell that stays invisible

“I never noticed. He didn’t smell of anything, he didn’t stumble, he went to work every day.” That was told to me by a woman who found out about her husband’s betting from a letter from the bank. Fifteen years together, two children, nothing in his behaviour she could have read as a sign. If he had been drinking, she would have known. But a phone looks the same whatever is happening on it.

That is the first thing to say about gambling: it has no smell. There is no breath, no dilated pupils, no morning shaking. Which is why it is discovered late – usually at the point where financial damage sets the deadline instead of the person.

The one behavioural addiction nobody disputes

In 2013, gambling disorder was moved in DSM-5 into the addictions chapter, out of the section on impulse-control disorders. That was an important shift, because the field thereby recognised that an addiction does not require a substance. ICD-11 likewise classifies it among disorders due to addictive behaviours.

It does not depend on whether someone plays machines, bets on sport, or sits at an online table. The criterion is not the sum. The criterion is the pattern: loss of control, abandoning other things, continuing despite consequences.

That shift has a practical consequence that is still too rarely heard. If something is an addiction, then it is not a matter of character and not a matter of upbringing – it is a health condition with a treatment. Someone who is repeatedly told he is “greedy” or “irresponsible” rarely seeks help. Someone who hears that this is a recognised disorder with a known course and known treatment options seeks it considerably sooner.

The game is not neutral: it is built to teach

This is the part people most underestimate. A slot machine is not a lottery ticket with glitter. It is a device designed on learning principles known from the laboratory.

The key is the variable ratio schedule of reinforcement. The reward does not arrive every time and does not arrive by rule – it arrives unpredictably. Skinner showed back in the 1950s that such a schedule produces the most persistent behaviour and the one that is slowest to extinguish. When a reward ought to come every time, an animal abandons the behaviour quickly. When it is unpredictable, the behaviour persists long after the rewards have stopped.

The second is the near miss. When two symbols line up and the third misses by one position, what happens in the brain is not what you would expect. Luke Clark and colleagues showed in 2009 that near misses activate the same network as actual wins and increase the desire to continue – even though the outcome is a loss. The proportion of near misses is not accidental; it can be set.

A loss that looks like a win

The third element is especially cunning. Modern games often return less than was staked, but accompany that with the light, sound and animation of a genuine win. The player experiences the loss as a small victory. Mike Dixon’s research group showed that the body responds to such events with physiological arousal as though they were wins, and that people later do not remember those outcomes as losses.

Which is why the question “how much have you lost” is almost always answered wrongly. Not because the person is lying, but because his memory genuinely holds a different balance sheet.

Why a phone is not the same as a casino

When betting was tied to a place, there were built-in pauses. You had to go out, drive, pay for parking, run into acquaintances, wait for the match. Every one of those fragments was an interruption, and interruptions are what allow an urge to fall.

Now the pauses have been removed. A bet is three taps away, available at night, during a break at work, in bed beside a sleeping partner. In-play betting shortens the gap between action and outcome to a few seconds – exactly the interval at which learning consolidates fastest. Add to that the fact that money is no longer physical: it is counted in units on a screen, which the brain treats differently from notes in the hand.

So I find it misleading to talk about “poor self-discipline”. The environment has changed more in fifteen years than people have. Someone with a mild inclination used to carry it into occasions that were rare. Today the occasions are continuous, and the inclination meets a different fate.

Chasing losses

If anything separates gambling from gambling disorder, it is chasing: returning to the game to recover what you lost. In every other activity, a loss inhibits the behaviour. Here it drives it.

The logic makes sense. If you stopped now, the loss would be final and you would have to admit it. As long as you keep playing, it is still open. At exactly that moment, playing turns from entertainment into the regulation of an unbearable feeling – and from there it is no longer about money but about escape from your own state. I described a similar logic in the piece on what a symptom is actually for.

What happens over time

The path differs between people and it is not inevitable. It still recurs often enough to be worth knowing – not as a prediction, but as a map on which you might locate yourself earlier than on a bank statement.

A risk that has to be said out loud

In gambling disorder, suicidal thoughts are more common than in most other mental disorders. A Swedish study by Anna Karlsson and Anders Håkansson, which followed people with a diagnosis of gambling disorder, found markedly increased suicide mortality compared with the general population, most sharply among younger adults. Reviews find that roughly one in five people with a serious gambling problem reports suicidal thoughts.

There are several reasons and none of them is mysterious: sudden, enormous debt; shame; the sense of having ruined people who trusted you; and the belief that there is only one way out. That last sentence is the most dangerous and the most false – debt is solvable in instalments, through personal insolvency, through negotiated arrangements. None of that is pleasant, but all of it is feasible.

If someone is in that state, the order is clear: safety first, and only then the conversation about debt and pattern. The numbers in the box above are there for a reason.

What actually helps

The good news is that gambling disorder is among the better researched. Cognitive behavioural therapy has the strongest support – it works on beliefs about chance, on triggers, and on what a person does instead of playing. Motivational interviewing helps those who are still wavering. For some, a group is useful.

Very practical and underrated: self-exclusion with operators, blocking gambling transactions on a bank card, deleting the apps, handing over management of the money to someone else for an agreed period. This is not a sign of helplessness – it is the same as moving food out of your line of sight. It reduces the number of opportunities, and with behaviour that is triggered in seconds, the number of opportunities matters more than resolve.

Where depression or anxiety are also present, a conversation with a doctor makes sense; I have written separately about when a psychiatrist is the first step.

Family, and money

What I most often say to relatives who come to me is this: do not pay off the debt in secret to save the marriage. Repayment without an agreement about control of money most often buys a few months of quiet and one new debt.

It is more useful to separate three things: the family’s safety (income, roof, children), the debt (a repayment plan, ideally with an adviser), and the addiction (treatment). Each has its own address and its own timeline. Fuse them into one conversation at midnight and none of them moves. I have written more about where support ends and taking over begins in the piece on setting boundaries.

Where my explanation creaks

Now the section that contradicts everything so far. All of the above sounds as though the game were a teaching machine and the person a helpless victim of design. That is not true, and such a picture has a cost. Most people who gamble do not develop a problem; most play occasionally, lose a little and go home. If you treat every player as a future addict you do not help – you only manufacture the shame that keeps people from talking.

The second difficulty: the reward-system explanation is attractive but incomplete. It does not explain why the same game does nothing to one person and everything to another. The risk lies not only in the device but in what the person brings – impulsivity, poverty, loneliness, another mental disorder, a period of transition. What I wrote about why therapy is harder to research applies here too: averages say little about an individual.

And third: with gambling, harm reduction is a serious option, not a compromise for those unwilling to stop. For many people an agreement about time limits, a separate account and self-exclusion is more useful than a vow of final abstinence that will be broken and then kept quiet.

Questions that tell you more than the amount

Do not ask how much. Ask: have you ever gone back to play in order to recover a loss? Have you lied to anyone about your gambling? Have you ever borrowed or sold something in order to play? Has anyone close to you already been worried about it? Are you restless when you try to stop?

No single “yes” is a diagnosis. It is an invitation to speak to someone about it before the answers get longer.

If you are asking on your own behalf, add one more, the most uncomfortable: what would happen if I did not play for a month? People without a problem usually shrug at that question. Anyone who immediately hears an objection inside – that now is not the right time, that it is the season, that he has to make up ground first – has just been given the answer he was looking for.

What to remember

Gambling stays invisible for a long time because it has no bodily signs – the first visible sign is often money, and by then the pattern is old. The game is not neutral: unpredictable rewards, near misses, losses with the sound of a win, and speed are built in because they work. The dividing line is not the sum but chasing losses and continuing despite consequences. The risk of suicidal thoughts in this disorder is real and should not be underestimated – debt is solvable, even when it does not look that way in the moment. Treatment works, and self-exclusion and separated money do more than they appear to. And at the same time: most people who gamble never develop a problem, so a frightened tone helps nobody.