February 13th, 2015

Rolling The Dice: Problem Gambling And Substance Use Disorder Recovery

Editor’s Note: Gambling Disorder was moved from the “Impulse” to the “Addiction” chapter of the most recent edition of the Diagnostic and Statistical Manual (DSM-5). It is the first of the “process addictions” to be included with the substance use disorders. In addition to meeting in itself the criteria for being an addictive disorder, problem gambling is a co-morbid complication for many people with substance use disorders. Our guest blogger this month, Dr. Lori Rugle, is eminently qualified to address this difficult issue. For those of you wanting to know more, I invite you to attend Lori’s Kolmac School presentation in our Columbia office on February 20.

 Lori Rugle

By Loreen Rugle, PhD

Among those with substance use disorders, the prevalence estimates of lifetime gambling disorder are substantially higher than in the general adult population and range from 7 percent to 39 percent, and for those in methadone maintenance treatment up to 52.7 percent.  Additionally, research has shown that untreated gambling problems among those in treatment for a substance use disorder may contribute to decreased treatment effectiveness and increased treatment costs.

A recent study completed in Maryland found that 40.5 percent of clients in outpatient treatment for a substance use disorder met DSM-5 criteria for a gambling disorder.  However, the majority of these clients never addressed the impact of gambling on their recovery as part of their treatment.1 These findings have led us to ask some important questions.

In what ways can gambling and problem gambling affect substance use disorder recovery?

  • Gambling can be a sequential addiction.
  • Gambling can be a relapse trigger.
  • Research has found that winning is a more significant relapse precipitator than losing.
  • Gambling can involve people, places, and things that are associated with substance use and other risky behaviors.
  • Initial effect of gambling may be to decrease symptoms (depression, anxiety, distressing thoughts, etc.) versus long-term effect of making symptoms worse.
  • Gambling can seem like something “safe” to do with money and time that had previously been spent on substance use.
  • Family members’ gambling can create stress that contributes to relapse.

How do staff and clients perceive the impact of gambling and problem gambling on substance use disorder treatment?

Comments from Staff:

  • “I never thought much about gambling and my clients, but as soon as we started talking about it, I noticed all the scratch-off tickets in the hallway wastebaskets.”
  • “I always just rushed over the one gambling question in our intake. Now that I know how to ask about gambling in different ways, I’m finding out a lot more information about my clients’ gambling.”
  • “It’s not just my clients’ gambling that is coming up, but they are talking about how their family members’ gambling is affecting them.”

Comments from Clients:

  • Gambling gives me the same kind of rush cocaine did.”
  • “I never made the connection, but when I won gambling, I always went out and got high.”
  • “When I was first sober, I went to the casino. I won a jackpot and before I knew it, I was drinking and celebrating.”
  • “I never talked about this, but my husband has a real gambling problem and when he loses, he gets mean and abusive.”

What can counselors do?

  • Be aware that clients are not likely to acknowledge gambling problems during brief screening on initial interviews.
  • Be informed about problem gambling and how to talk about it with your clients in a non-judgmental and non-labeling manner.
  • Help clients understand the costs as well as benefits of gambling to their recovery.
  • Help clients identify high risk versus low-risk gambling.
  • Help clients know their personal warning signs for gambling problems.

For more information and resources to address problem gambling, visit the Maryland Center of Excellence in Problem Gambling.


  1. Himelhoch, S., Miles-McLean, H., Medoff, D., Kreyenbuhl, J., Rugle, L., Brownley, J., Bailey Kloch, M., Potts, W., & Welsh, C. (in press). Twelve month prevalence of DSM-5 Gambling Disorder and associated gambling behaviors among those attending methadone maintenance. Journal of Gambling Studies.

Loreen Rugle, PhD, brings 30 years of experience in the treatment, prevention and research of problem gambling to her position as Program Director of the Maryland Center of Excellence in Problem Gambling within the University of Maryland, School of Medicine. Dr. Rugle has managed problem gambling programs within the Veterans Administration, in the private sector and within state systems.

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