Key takeaway
Gambling disorder often occurs with a substance use disorder. In a survey SAMHSA cites, 73.2 percent of people with pathological gambling had an alcohol use disorder and 38.1 percent had a drug use disorder. Other studies it cites found a gambling problem in 10 to 15 percent of people with a substance use disorder. A clinician diagnoses either one.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
The drinking is what got you through the door, and the bets are the part you have not said out loud. Gambling disorder and substance use disorders often travel together. SAMHSA's 2014 advisory for clinicians opens on that point: people who come in for an alcohol or drug problem may also have a gambling problem, and people with a gambling problem are more likely to have sought help for some other behavioral health condition than for the gambling itself. If treatment only names the substance, the gambling can keep feeding debt, shame, and a return to use.
The overlap is the level of detail here. A diagnosis still belongs with a clinician, and programs are not ranked below.
What the diagnosis is
SAMHSA defines gambling as risking something of value, usually money, on an outcome decided at least partly by chance. That includes lottery tickets, casino games, a poker night, an office pool, gambling websites, racing, and slot machines. Most adults have gambled at least once. SAMHSA cites a figure of more than 75 percent of Americans age 18 or older. Gambling once is not a disorder.
The disorder has a history inside the diagnostic manual. Pathological gambling was the older name. In DSM-5, SAMHSA says, it was renamed gambling disorder and moved out of the impulse-control section into Substance-Related and Addictive Disorders. The number of criteria required dropped from five to four, the behaviors have to occur within 12 months, and illegal acts to finance gambling were removed from the list. Research SAMHSA cites often still uses the older name or the broader phrase "problem gambling." The words below follow SAMHSA and use the study's own terms.
SAMHSA quotes the DSM-5 rule: a persistent, recurrent pattern that causes clinically significant impairment or distress, with four or more of nine behaviors in a year. Examples on that list include needing to gamble with more money to get the same excitement, restlessness or irritability when trying to cut down, repeated failed attempts to stop, preoccupation, gambling to escape distress, chasing losses, lying about the extent of it, risking a relationship or a job, and relying on other people for money to cover desperate losses. The pattern is not better explained by a manic episode. A clinician counts those items. Four checked boxes on a printout are not a diagnosis.
SAMHSA says there are no obvious physical signs. People often seek care for insomnia, stress, depression, anxiety, or conflict at home. Money trouble is the most common reason they finally ask for help with the gambling itself. Only about 10 percent of people with a gambling problem seek treatment for it, in the studies SAMHSA cites.
Surveys SAMHSA cites estimate that about 0.5 percent of Americans have had pathological gambling at some point, roughly 1.5 million people. Problem gambling, the milder description, may affect two to four times as many. Anyone can develop it. SAMHSA says men are more likely than women to have it. Those are survey patterns, not a screen for a neighbor.
How substance use fits
SAMHSA cites the National Epidemiologic Survey on Alcohol and Related Conditions. Among people diagnosed with pathological gambling, 73.2 percent had an alcohol use disorder, 38.1 percent had a drug use disorder, 60.4 percent had nicotine dependence, 49.6 percent had a mood disorder, 41.3 percent had an anxiety disorder, and 60.8 percent had a personality disorder. From the other direction, studies SAMHSA cites suggest that 10 to 15 percent of people with a substance use disorder may also have a gambling problem.
SAMHSA says the two problems resemble each other: loss of control, craving, withdrawal, and tolerance. For gambling, tolerance means needing to stake more money to get the same feeling. Imaging studies it cites suggest shared brain regions. Childhood impulsivity has been related to both later on. As gambling problems get more severe, SAMHSA says the number of high-risk situations tends to rise, including gambling when tense, when celebrating, when thinking about debts, or when other people are gambling.
None of that means a drink causes a bet, or that a bet causes a drink, in a straight line. It means a program that treats only one of them can miss the trigger for the other. Substance use plus a mental disorder is the dual-diagnosis guide. Gambling disorder is classified with addictive disorders, and mood and anxiety disorders are common in the same surveys. One of those overlaps is the depression guide. A clinician still has to decide what is present.
SAMHSA also ties pathological gambling to suicidal thoughts and suicide attempts. Financial loss and depression are among the risk factors it names. People who have both pathological gambling and a substance use disorder may be at greater risk of an attempt. If that risk is active, call or text 988. If you are in immediate danger, call 911. An assessment can wait until you are safe.
What care has evidence, at a high level
SAMHSA says a variety of approaches have been found useful, and that none has been clearly shown to be more effective than another. Much of the research tested combinations, which makes it hard to crown a single method.
Behavioral approaches try to change the behavior, identify cues, and build activities that compete with gambling. Cognitive therapy targets distorted beliefs about odds, such as the idea that a machine is "due" or that a lucky object changes the chance of winning. Cognitive behavioral therapy combines those. A meta-analysis SAMHSA cites found various forms of cognitive behavioral therapy effective in reducing pathological gambling. Motivational interviewing, which works with ambivalence about change, has been studied less, and some studies have been promising. Brief motivational work has helped some people. SAMHSA says it is often combined with cognitive behavioral therapy.
Gamblers Anonymous is a mutual-help group modeled on Alcoholics Anonymous. SAMHSA says mutual-help groups are not treatment or counseling, and that they can still be an important support. Family members are often dealing with broken trust and debt. SAMHSA points them toward Gam-Anon and toward family or couples counseling. Debt is common enough that SAMHSA says addressing money should be part of treatment, including help with food and housing if those are at risk. That is case management, not a budget you can download.
Medicines have been studied. SAMHSA says the FDA has not approved any medication for gambling disorder. If an alcohol or drug use disorder is also present, the medicines and therapies that have evidence for that disorder still apply. Do not stop a prescribed medicine for depression, alcohol use disorder, or opioid use disorder because a gambling resource did not mention it. Alcohol care is described on the alcohol page and the treatment guides linked from it. Those pages do not describe a gambling protocol.
SAMHSA says treating gambling disorder is within the scope of licensed mental health counselors, clinical social workers, psychologists, psychiatrists, and other professionals licensed to treat mental disorders. It points providers to the National Council on Problem Gambling and to its own problem-gambling toolkit. It does not publish a national list of endorsed clinics.
Screening matters because people rarely lead with the gambling. SAMHSA describes the Lie/Bet questions: have you ever felt the need to bet more and more money, and have you ever had to lie to people important to you about how much you gambled? A yes to one of them is a reason for a longer tool, such as the South Oaks Gambling Screen, and then a clinical assessment. It is not a result you should act on by yourself beyond asking for that assessment.
A stimulant treatment handbook lists gambling as one behavior people sometimes swap in after stopping a drug. That swap is not the diagnosis above. The swap is the compulsive behaviors guide. Substance use and mental health treatment are listed on FindTreatment.gov. SAMHSA's helpline, 1-800-662-HELP (4357), refers people to local care and is not a gambling clinic. How that locator works is the guide to finding treatment. Say both problems when you call. A program that can treat the substance use disorder and will also address the gambling, or will refer to someone who can, is the practical ask.
Call or text (800) 653-9376 if you want help finding care and both gambling and substance use are part of the story.
Additional Resources
Sources cited on this page:
- SAMHSA Advisory: Gambling Problems: An Introduction for Behavioral Health Services Providers (SMA 14-4851)
- SAMHSA National Helpline
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
Is gambling disorder the same thing as a substance use disorder?
No, but SAMHSA says DSM-5 placed gambling disorder in the same chapter as substance-related and addictive disorders. It was previously called pathological gambling and sat with impulse-control disorders. The move did not make gambling a drug. It did change how clinicians are supposed to notice it.
How often do gambling and substance use problems show up together?
SAMHSA cites the National Epidemiologic Survey on Alcohol and Related Conditions. Among people with pathological gambling, 73.2 percent had an alcohol use disorder, 38.1 percent a drug use disorder, and 60.4 percent nicotine dependence. Other studies SAMHSA cites suggest that 10 to 15 percent of people with a substance use disorder also have a gambling problem. Those are study figures, not a diagnosis.
Can I tell from a two-question quiz that I have a gambling disorder?
No. SAMHSA describes a two-question screen, about needing to bet more money and lying about gambling. A yes to either one is a reason for a longer assessment, not a diagnosis. DSM-5, as SAMHSA quotes it, requires four or more of nine behaviors in a year, and the gambling must not be better explained by a manic episode. A clinician applies that list.
Is there a medicine for gambling disorder?
SAMHSA says several medicines have been studied and that the FDA has not approved any medication to treat the condition. Cognitive behavioral therapy and motivational interviewing have been studied. SAMHSA also says no single approach has been shown to be clearly more effective than the others. Treatment of a co-occurring substance use disorder still follows the evidence for that disorder.
What if gambling and drinking come with thoughts of suicide?
SAMHSA says pathological gambling is associated with suicidal thoughts and attempts, and that a substance use disorder may raise the risk of an attempt. If you are thinking about suicide, call or text 988, or call 911 if you are in immediate danger. Do not wait for a gambling assessment.