What is the Connection Between Gambling Addiction and Substance Abuse?

Gambling disorder and substance use disorder co-occur far above chance rates, because both conditions recruit the same dopamine reward circuitry. Many people who gamble compulsively begin drinking or using drugs to blunt the stress of mounting losses.

The National Epidemiologic Survey on Alcohol and Related Conditions found that a majority of adults meeting criteria for pathological gambling also met lifetime criteria for an alcohol use disorder (Petry, Stinson, & Grant, 2005).

That overlap is not coincidental. Shared genetic vulnerability, trait impulsivity, and blunted striatal reward response make each disorder a measurable risk factor for the other.

The DSM-5-TR classifies gambling disorder under Substance-Related and Addictive Disorders, the only behavioral addiction placed in that category.

Which condition tends to come first, and does the order change how clinicians sequence care?

How Does Gambling Lead to Substance Use?

Gambling losses generate acute financial stress, and that stress drives self-medication with alcohol, cannabis, or stimulants. The swing between near-miss arousal and post-loss shame creates the window in which substance use begins.

Stimulants extend play by delaying fatigue, while alcohol blunts loss aversion and increases average bet size. Each substance serves a different function inside the gambling session.

Nicotine dependence appears in 60.4% of adults with pathological gambling, and 38.1% meet criteria for a drug use disorder (Petry, Stinson, & Grant, 2005). Tobacco and stimulants extend gambling sessions by delaying fatigue.

Onset order matters clinically. Adults with pathological gambling placed their first bet at a mean age of 16.7 years, compared with 23.9 years among gamblers without problems (Kessler et al., 2008).

What are the Common Risk Factors Between Gambling Addiction and Substance Abuse?

The common risk factors between gambling addiction and substance abuse are genetics, mental health issues, and environmental factors.

These risk factors are listed below.

• Genetics: Genetics play a significant role in the development of addictive behaviors. Individuals with a family history of addiction are at a higher risk of developing both gambling and substance use disorders, according to a study by the National Institute of Health. People vulnerable to one type of addiction may be prone to others.
• Mental Health: Mental health conditions, such as depression, anxiety, and personality disorders, are common risk factors for both gambling addiction and substance abuse. Individuals with untreated mental health issues may turn to gambling or substances as a way to self-medicate and manage their symptoms. NESARC recorded a mood disorder in 49.6% of adults with pathological gambling, an anxiety disorder in 41.3%, and a personality disorder in 60.8% (Petry, Stinson, & Grant, 2005).
• Environmental Factors: Environmental influences, such as exposure to gambling and substance use at a young age, social circles that engage in these behaviors, and high-stress environments, can also increase the risk. Being exposed to these behaviors can normalize addictive actions, making it easier for individuals to fall into patterns of gambling and substance abuse.

What Neurobiological Pathways Do Gambling Disorder and Substance Use Disorder Share?

Both gambling addiction and substance abuse affect the brain’s neurobiology in similar ways, particularly in how they influence dopamine levels. When a person engages in gambling or uses substances, it triggers the brain’s reward system, leading to a release of dopamine, the neurotransmitter that creates feelings of pleasure and reinforcement. 

This surge in dopamine reinforces the behavior, making individuals feel compelled to repeat it, despite potential negative consequences. Over time, continuous stimulation from gambling or substances leads to changes in brain chemistry, such as tolerance, where more intense gambling or higher substance doses are required to achieve the same dopamine effect.

A study Pathological Choice: The Neuroscience of Gambling and Gambling Addiction indicates that the neural pathways activated during gambling are similar to those activated by drug addiction, particularly in areas of the brain associated with reward, motivation, and impulse control, like the prefrontal cortex and ventral striatum. Shared circuitry explains why abstinence from one behavior often increases the other. Removing gambling without addressing the substance leaves the dopamine deficit unfilled.

Why Does Integrated Care Work Better Than Treating One Disorder First?

Integrated care treats gambling disorder and substance use disorder in the same clinical episode, rather than sequencing one after the other. Sequential models leave the untreated disorder free to trigger relapse in the one being addressed.

A clinician who stabilizes alcohol use without addressing betting behavior leaves the financial stressor intact, and that stressor reactivates drinking within months. Concurrent treatment removes both reinforcement loops at once.

Four components appear in most integrated plans:

• A single treatment team holds responsibility for both diagnoses, which prevents the contradictory instructions that split care produces.
• Cognitive behavioral therapy targets the distorted cognitions common to both conditions, including the near-miss effect and the illusion of control.
• Naltrexone reduces craving intensity in gambling disorder and alcohol use disorder through the same opioid receptor mechanism.
• Financial counseling runs alongside clinical work, because unresolved debt remains the strongest predictor of return to gambling.

Adults carrying both diagnoses need a single clinical team rather than two parallel providers. Right Choice Recovery’s compulsive gambling services are structured that way.

References

1. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). American Psychiatric Publishing.
2. Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66(5), 564–574.
3. Kessler, R. C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N. A., Winters, K. C., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351–1360.
4. Ladouceur, R., Sylvain, C., Boutin, C., Lachance, S., Doucet, C., Leblond, J., & Jacques, C. (2001). Cognitive treatment of pathological gambling. Journal of Consulting and Clinical Psychology, 69(5), 774–780.
5. Substance Abuse and Mental Health Services Administration. (2020). Substance use disorder treatment for people with co-occurring disorders (Treatment Improvement Protocol Series, No. 42). SAMHSA.
6. National Institute on Drug Abuse. (2024). Common comorbidities with substance use disorders research report. National Institutes of Health.
7. Clark, L., Averbeck, B., Payer, D., Sescousse, G., Winstanley, C. A., & Xue, G. (2013). Pathological choice: The neuroscience of gambling and gambling addiction. Journal of Neuroscience, 33(45), 17617–17623.