Is Gambling Addiction a Mental Illness?

The short answer

Yes, and it has been officially since 2013.

That date matters more than it sounds. Gambling has been recognized as a disorder since 1980, but for thirty-three years the diagnostic manual filed it under impulse-control disorders, alongside kleptomania, pyromania, and compulsive hair-pulling. The framing was that a person had a problem controlling an impulse.

When the APA published the DSM-5 in May 2013, it moved gambling disorder into the chapter called "Substance-Related and Addictive Disorders." Same chapter as alcohol use disorder. Same chapter as opioid use disorder. It remains the only non-substance condition the manual treats that way.

That wasn't a relabeling exercise. The APA also changed how the diagnosis works, which tells you the reclassification was substantive rather than cosmetic.

What the diagnosis actually requires

Under the DSM-5, gambling disorder means persistent, recurring gambling that causes clinically significant impairment or distress, shown by four or more of these in a twelve month window:

1. Needing to gamble with increasing amounts of money to get the same excitement.
2. Restlessness or irritability when trying to cut down or stop.
3. Repeated unsuccessful efforts to control, cut back, or stop.
4. Frequent preoccupation with gambling.
5. Often gambling when feeling distressed, whether helpless, guilty, anxious, or depressed.
6. Returning another day to get even after losing, which is chasing.
7. Lying to conceal how deep the involvement goes.
8. Jeopardizing or losing a relationship, job, or opportunity because of gambling.
9. Relying on others for money to relieve desperate financial situations gambling caused.

Severity is graded. Four or five criteria is mild, six or seven is moderate, eight or nine is severe. There are also remission specifiers, since this is treated as a condition people recover from: early remission means no criteria met for three to twelve months, sustained remission means twelve months or more.

Two details from the 2013 revision are worth knowing. The APA dropped the criterion about committing illegal acts to finance gambling, because it turned out to add little diagnostic value. And it lowered the threshold from five of ten criteria to four of nine, which means the DSM-5 identifies the condition somewhat earlier than the DSM-IV did.

If you read that list and recognized yourself at four or more, that isn't a verdict on your character. It's a description of a condition with a name.

The codes, and why two systems disagreed for years

Two classification systems matter in practice, because they're what appears on paperwork.

ICD-10, still widely used for billing in the United States, lists this as F63.0, pathological gambling, filed under "Habit and Impulse Disorders." Note what that means: ICD-10 kept the older impulse-control framing even after the DSM moved on in 2013. For years the two authorities were describing the same condition in incompatible terms.

ICD-11 closed that gap. The WHO adopted it in 2019 and it took effect for member state reporting on January 1, 2022. Gambling disorder now sits in a grouping called "Disorders due to substance use or addictive behaviours", the WHO's version of the same move the APA made nine years earlier.

So as of now, both major diagnostic authorities in the world classify gambling as an addiction rather than an impulse-control problem. It took the field roughly a decade to converge.

Why they moved it

The APA's stated rationale was that gambling disorder resembles substance use disorders across clinical expression, brain origin, comorbidity, physiology, and treatment response.

The research that supports this framing centers on the brain's reward circuitry. Functional imaging studies find dysregulation in the ventral striatum and medial prefrontal cortex, the same anticipation-and-reward circuitry implicated in drug addiction. PET studies find amplified dopamine release during gambling cues and anticipation.

The picture isn't identical to substance addiction, and it's worth being honest about that. Baseline dopamine D2 receptor binding shows little difference in gambling disorder, whereas it's typically reduced in substance addictions. Structural MRI shows only modest gray-matter changes, where substance use disorders show more pronounced ones. In the words of one integrative review, these are related conditions rather than the same condition.

A note on the sequence: some of this imaging literature was published after 2013, so it's more accurate to describe it as evidence that supports the reclassification than as the evidence the APA voted on.

What all of this means practically is simple. This isn't a willpower failure that happens to be expensive. It's a condition involving the brain's reward system, which is why "just stop" works about as well here as it does for any other addiction.

It rarely travels alone

Most people with gambling disorder are dealing with something else at the same time. That's one of the strongest and most consistent findings in the literature.

A 2025 systematic review and meta-analysis in European Psychiatry, pooling population-based surveys, found 82.2% of people with gambling disorder had at least one other mental disorder, and estimated they were 10.7 times more likely to have any mental disorder than the general population. It reported any substance use disorder at 34.2%, any mood disorder at 30.9%, any anxiety disorder at 29.9%, and major depression at 20.3%.

An earlier and widely cited 2011 meta-analysis in Addiction found higher rates: nicotine dependence 60.1%, any substance use disorder 57.5%, any mood disorder 37.9%, any anxiety disorder 37.4%.

Those two sets of numbers disagree, and I'd rather show you that than pick the more dramatic one. They're fourteen years apart, use different study inclusion criteria, and span a change in diagnostic definitions. The honest summary is that comorbidity is the norm rather than the exception, and the precise figure depends on which survey you read.

The 2025 review also found women with gambling disorder show higher comorbidity for mood, anxiety, and suicidality specifically.

If you're reading this because of the gambling, it's worth asking what else is going on. Treating gambling while an untreated depression sits underneath it is a harder road than treating both.

How many people

This is where the numbers get shakier than most articles admit.

The figure you'll see quoted everywhere is 2.5 million US adults, about 1%, meeting criteria for a severe gambling problem in a given year, with another 5 to 8 million (2 to 3%) having mild or moderate problems. That comes from the National Council on Problem Gambling.

Read NCPG's own footnote, though. That estimate is a formula derived from 1999 national survey data, adjusted for inflation and current population, most recently updated in December 2023. It is not a fresh clinical epidemiological study. I looked for a current, nationally representative, peer-reviewed prevalence study using DSM-5 criteria and could not find one.

A more current data point comes from NCPG's NGAGE 3.0 survey, fielded by Ipsos in early 2024 with about 3,000 respondents: roughly 8% of US adults, around 20 million people, reported experiencing at least one indicator of problematic gambling many times in the past year. That's down from 11% in 2021 and up from 7% in 2018. But it measures behavioral indicators, not clinical diagnoses, so it isn't the same thing as a prevalence rate.

The takeaway isn't that nobody knows. It's that the United States has been legalizing phone-based sports betting at speed while its best national prevalence data still traces back to a survey run before smartphones existed.

What treatment actually looks like

Cognitive behavioral therapy has the strongest evidence and is first-line. The UK's National Institute for Health and Care Excellence published guidance in January 2025 recommending group CBT of eight to ten sessions as the first-line treatment, with individual CBT of six to eight sessions where group isn't available. NICE found CBT both effective and cost-effective, delivered by practitioners with gambling-specific CBT training.

Motivational interviewing helps people engage, but isn't sufficient alone. The same guidance found it reduces gambling frequency and is cost-effective for engagement, while noting it's unlikely on its own to produce the behavioral change needed to reduce severity. It works best building commitment before or alongside CBT.

No medication is FDA-approved for gambling disorder. Naltrexone, an opioid antagonist approved for alcohol and opioid use disorders, is sometimes prescribed off-label. The evidence is modest: of four randomized controlled trials, two showed significant improvement over placebo, and a meta-analysis of opioid antagonists found a small but significant benefit. NICE positions it as an option for people who haven't responded adequately to psychological therapy or who relapse repeatedly, alongside therapy rather than instead of it, with liver and kidney monitoring and specialist supervision.

The practical version: therapy is the treatment, medication is a second-line adjunct for some people, and any provider who leads with a pill for this is ahead of the evidence.

The insurance problem nobody mentions

Here's the part that surprises people, and it's the most useful thing in this article if you're trying to get treatment paid for.

The Mental Health Parity and Addiction Equity Act of 2008 does not require your insurance to cover gambling disorder. What parity law does is narrower: if a plan covers mental health and substance use disorder benefits, it can't impose harsher financial requirements or treatment limits on those than on medical and surgical benefits. It doesn't force any plan to cover any particular condition.

Which conditions get covered is largely determined by each state's Essential Health Benefits benchmark plan under the ACA. Few states name gambling disorder explicitly. The result is that many private plans exclude gambling disorder treatment outright while covering substance use disorder treatment in the same policy, for a condition the DSM files in the same chapter.

So parity protects gambling disorder coverage once it exists, but doesn't create it.

There is a workaround worth knowing about, and it's often better than fighting your insurer. Several states fund gambling treatment directly out of gambling tax revenue, entirely outside the insurance system. Oregon funds roughly 46 state-contracted agencies that provide gambling disorder treatment free to the client. New York began covering gambling disorder treatment through Medicaid fee-for-service and Managed Care at certified programs in January 2023.

If you're looking for treatment, check two things: what your plan actually covers, and what your state's problem gambling council or health authority funds. The second is frequently faster and cheaper than the first.

Why the framing matters

There's a practical reason to care whether this counts as a mental illness, beyond being technically correct.

When someone is drowning in gambling, the questions they get asked are almost always financial. How much did you lose. Can you make rent. Have you told your partner. Those questions treat the money as the problem.

The money is a symptom. Nobody asks how long they've been awake, or what they were feeling at eleven at night when they opened the app, and those questions get closer to the condition being described in the DSM.

Calling it a mental health condition isn't softening it or making excuses. It's the opposite. It means there are diagnostic criteria you can be assessed against, clinicians trained to treat it, treatments with evidence behind them, and a documented path out. Character flaws don't have treatment protocols. Conditions do.

If you recognized four or more of those nine criteria in yourself, that's worth taking to someone who treats this specifically.

Sources

• American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013) and Text Revision (2022). Updates to DSM-5-TR Criteria and Text
• Gambling Disorder to Be Included in Addictions Chapter, Psychiatric News, American Psychiatric Association, 2013
• DSM-5 Diagnostic Criteria: Gambling Disorder, Connecticut Department of Mental Health and Addiction Services
• Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder, PMC, 2016
• An overview of gambling disorder: from treatment approaches to risk factors, Menchón et al., F1000Research, 2018
• ICD-10-CM F63.0, Pathological gambling
• The inclusion of gambling and other behavioral addictions in the addictions chapter of ICD-11, PMC
• Neuroimaging of reward mechanisms in gambling disorder: an integrative review, Clark, Boileau and Zack, Molecular Psychiatry, 2019
• Psychiatric morbidity and gambling disorder: a systematic review and meta-analysis of population-based surveys, European Psychiatry, 2025
• Prevalence of comorbid disorders in problem and pathological gambling, Lorains, Cowlishaw and Thomas, Addiction, 2011
• FAQs: What is Problem Gambling?, National Council on Problem Gambling
• NGAGE 3.0 survey, National Council on Problem Gambling and Ipsos, 2024
• Harmful gambling: identification, assessment and management, NG248, National Institute for Health and Care Excellence, January 2025
• Mental Health and Substance Use Disorder Parity, US Department of Labor
• Medicaid Reimbursement for Gambling Disorder Treatment, New York State OASAS, 2023
• Medicaid Coverage of Outpatient Gambling Disorder Treatment Services, Oregon Health Authority