The pleasure of gambling has always been recognised, but the problem is that people can become addicted. When that happens, it has serious consequences for their family life and work. For some, it also leads to mental health problems and substance abuse. Despite this, gambling remains more acceptable and accessible than ever before. Many states offer casino gambling and the internet allows people to play from home. This makes it difficult for anyone to resist the urge to place a bet.

As a result, the number of people with gambling problems continues to increase. In fact, in 2013, pathological gambling was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an addiction akin to a substance such as alcohol or drugs. It is a problem caused by dramatic alterations in the brain’s chemical messages and genetic or psychological dispositions that make some people more prone to gambling than others.

People love to gamble because of the thrill it brings, but that isn’t the only reason. Gambling stimulates the reward pathway in the brain, which produces dopamine whenever a positive outcome is achieved. This response is similar to the feeling you get when a skillful player hits a basketball into the net or pulls a rabbit out of the hat. But as you continue to gamble, your chances of winning decrease and you may even start to lose money.

This can trigger a vicious cycle because, as you lose more, the dopamine production becomes less intense. This is why gamblers often invest more time and money in trying to ‘win back’ losses, or avoid the feelings of loss and frustration by chasing wins. This is why it is important for those who treat gambling addiction to recognise and confront irrational beliefs, such as the idea that a certain pattern of losing will lead to a win.

Various groups such as research scientists, psychiatrists and other treatment care clinicians, and public policy makers have different paradigms or world views from which to consider gambling. These perspectives are influenced by their disciplinary training, experience and special interests. This can cause confusion because of the lack of agreed nomenclature to describe and understand the effects of gambling.

When assessing the impact of gambling, it is crucial that all impacts are considered and not just economic ones. It is essential to recognise that social, family and community impacts exist as well. These can be at the individual, interpersonal or society/community level and can be either internal or external. For instance, the personal level involves effects such as financial strain or the stress of gambling on relationships with family members. The community/society level includes costs such as escalating debt or homelessness. The external level involves costs that are incurred by those not involved in the gambling activity, such as the general public or local charities. This type of cost is not directly related to gambling activities and may be more difficult to measure.