Is There a Relationship Between Alcohol Abuse and Gambling?

Drinking and gambling are activities that are often connected, but they also have links in brain regions that can lead to risky behaviors and, consequently, serious mental health problems.

Alcohol consumption and involvement in gambling are constantly intertwined, especially in entertainment contexts like casinos, bars, sports events, and social gatherings. However, these risky behaviors can lead to significant mental health issues.

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders – 5th Edition) (1) mentions compulsive gambling (or pathological gambling) as a mental disorder and points to a connection with substance use and compulsive behaviors. Frequently, gambling disorder is related to alcohol abuse, as players under the influence of alcohol may engage more in gambling, spend money carelessly, and consequently develop this problematic behavior (2).

This occurs because the brains of compulsive gamblers and individuals who abuse alcohol are affected by changes in specific brain circuits involving processes in the reward system, impulse control, decision-making, and emotional regulation (2).

A review study (3) showed that the activation of brain areas related to memory, reward, and executive functions may be the underlying mechanism for this behavior. Specifically, the brain regions of the nucleus accumbens and striatum (ventral and dorsal), parahippocampal regions, amygdala, and various areas of the prefrontal cortex appeared more active in individuals exposed to gambling (3) . Additionally, the insula may play a crucial role in connecting these three systems in a highly integrated neural network with various implications for the modulation of reward processing, associative learning, and attentional regulation that seemingly "enhance" addiction-related signals. These findings are consistent with previous discoveries related to substance use such as alcohol, tobacco, marijuana, or cocaine (3) .

Thus, in the brains of compulsive gamblers who engage in alcohol abuse, there is a complex interaction between the intense desire for immediate reward, the inability to inhibit risky behaviors, and increased sensitivity to stress and environmental factors. By gambling and drinking, these individuals experience immediate pleasure at the cost of long-term negative consequences.

Drinking and gambling are mutually connected activities, and the comorbidity of alcoholism and pathological gambling has been more the rule than the exception (2). Besides the fact that one disorder may precede the other, and vice versa, they also share genetic vulnerability and risk factors (2).

The comorbidity of alcoholism and compulsive gambling is a clinical and social problem. However, this issue is stigmatized and often accompanied by a lack of cooperation from the individual suffering from it regarding treatment, making it challenging. Therefore, more research should be conducted to find appropriate treatments for these patients. Dysregulation of the reward and inhibitory control brain systems can result in a vicious cycle that is difficult to break without proper intervention.

Scientific evidence shows that alcohol and pathological gambling share common neurobiological mechanisms, reinforcing the importance of integrated preventive and therapeutic approaches. Prevention should focus on educating the population about the risks associated with these behaviors, especially in vulnerable groups. Regarding treatment, the combination of psychological therapies, such as cognitive-behavioral therapy (4), with pharmacological (5) and social support approaches shows promise. Furthermore, demystifying and reducing the stigma associated with these disorders are crucial for encouraging help-seeking and facilitating access to health services.

References: 

Referências:

1. American Psychiatric Association. (2014). DSM-5: Manual diagnóstico e estatístico de transtornos mentais. Artmed Editora.
2. Martinac, M., Karlović, D., & Babić, D. (2019). Alcohol and gambling addiction. In Neuroscience of alcohol (pp. 529-535). Academic Press.
3. García-Castro, J., Cancela, A., & Cárdaba, M. A. (2023). Neural cue-reactivity in pathological gambling as evidence for behavioral addiction: a systematic review. Current Psychology, 42(32), 28026-28037.
4. Pfund RA, Ginley MK, Kim HS, Boness CL, Horn TL, Whelan JP. Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis. Clin Psychol Rev. 2023 Nov;105:102336.
5. Dowling N, Merkouris S, Lubman D, Thomas S, Bowden-Jones H, Cowlishaw S. Pharmacological interventions for the treatment of disordered and problem gambling. Cochrane Database Syst Rev. 2022 Sep 22;9(9):CD008936.