Snapshot A 27-year-old male presents to the general medical clinic with his wife who complains that he has lost all of their savings gambling. She reports that her husband was a successful trader on Wall Street but has been laid off after missing work to place bets. He has tried multiple times to quit but repeatedly relapses. Introduction Sub-categorized under substance-related disorder (DSM-V) similar neurochemistry as other drug addictions Epidemiology Prevalence 1-3% of adults peak prevalence in adolescence and young adulthood, less common in older adults men account for two thirds of cases increased incidence of mood disorders, anxiety disorders, OCD predisposed in patients who have lost a parent during childhood, experienced inappropriate parental discipline, have a diagnosis of ADHD, or lack a family emphasis on saving money Presentation Symptoms preoccupation with gambling need to gamble with increasing amount spent to achieve enjoyment repeated unsuccessful attempts to cut down irritability with attempts at stopping gambling using gambling to avoid facing problems or to relieve dysphoria returning to reclaim losses after gambling lying to therapist, family, and friends about intensity of gambling committing illegal acts to finance gambling activities jeopardizing interpersonal relationships or professional work because of gambling relying on others to financially support gambling Diagnosis Persistent and recurrent maladaptive gambling behavior as evidenced by five of the symptoms listed above Treatment Participation in Gamblers Anonymous 12-step program the most effective treatment Insight-oriented psychotherapy may be initiated after 3 months of abstinence from gambling SSRIs, mood stabilizers, or opioid antagonists important to treat comorbid mood, anxiety, or substance abuse disorders SSRI's are a common therapy for diseases associated with impulse control Prevention Limiting lifetime exposure to gambling may be helpful to people at risk Prognosis Like other addictive disorders, pathological gambling is a long-term problem that tends to get worse without treatment However, one-third of patients may improve without treatment Even with treatment, patients often relapse The prognosis is often quite good with appropriate therapy