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href="#Factors_that_lead_to_gambling_addiction"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Factors that lead to gambling addiction</span> </div> </a> <button aria-controls="toc-Factors_that_lead_to_gambling_addiction-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Factors that lead to gambling addiction subsection</span> </button> <ul id="toc-Factors_that_lead_to_gambling_addiction-sublist" class="vector-toc-list"> <li id="toc-Suicide_rates" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Suicide_rates"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Suicide rates</span> </div> </a> <ul id="toc-Suicide_rates-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mechanisms" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Mechanisms"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Mechanisms</span> </div> </a> <button aria-controls="toc-Mechanisms-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Mechanisms subsection</span> </button> <ul id="toc-Mechanisms-sublist" class="vector-toc-list"> <li id="toc-Biology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Biology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Biology</span> </div> </a> <ul id="toc-Biology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Psychological" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Psychological"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Psychological</span> </div> </a> <ul id="toc-Psychological-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Step-based_programs" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Step-based_programs"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Step-based programs</span> </div> </a> <ul id="toc-Step-based_programs-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Motivational_interviewing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Motivational_interviewing"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Motivational interviewing</span> </div> </a> <ul id="toc-Motivational_interviewing-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Peer_support" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Peer_support"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Peer support</span> </div> </a> <ul id="toc-Peer_support-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Self-help" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Self-help"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Self-help</span> </div> </a> <ul id="toc-Self-help-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pharmaceutical_treatments" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pharmaceutical_treatments"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.5</span> <span>Pharmaceutical treatments</span> </div> </a> <ul id="toc-Pharmaceutical_treatments-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Self-exclusion" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Self-exclusion"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.6</span> <span>Self-exclusion</span> </div> </a> <ul id="toc-Self-exclusion-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Impact_(Australia)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Impact_(Australia)"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.7</span> <span>Impact (Australia)</span> </div> </a> <ul id="toc-Impact_(Australia)-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevalence" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prevalence"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Prevalence</span> </div> </a> <button aria-controls="toc-Prevalence-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Prevalence subsection</span> </button> <ul id="toc-Prevalence-sublist" class="vector-toc-list"> <li id="toc-Europe" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Europe"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Europe</span> </div> </a> <ul id="toc-Europe-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-North_America" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#North_America"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>North America</span> </div> </a> <ul id="toc-North_America-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-South_America" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#South_America"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>South America</span> </div> </a> <ul id="toc-South_America-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Oceania_(Australia)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Oceania_(Australia)"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.4</span> <span>Oceania (Australia)</span> </div> </a> <ul id="toc-Oceania_(Australia)-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Problem gambling</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 41 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-41" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">41 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A5%D8%AF%D9%85%D8%A7%D9%86_%D8%A7%D9%84%D9%82%D9%85%D8%A7%D8%B1" title="إدمان القمار – Arabic" lang="ar" hreflang="ar" data-title="إدمان القمار" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A5%D0%B0%D0%B7%D0%B0%D1%80%D1%82%D0%BD%D0%B0_%D0%B7%D0%B0%D0%B2%D0%B8%D1%81%D0%B8%D0%BC%D0%BE%D1%81%D1%82" title="Хазартна зависимост – Bulgarian" lang="bg" hreflang="bg" data-title="Хазартна зависимост" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Ludopatia" title="Ludopatia – Catalan" lang="ca" hreflang="ca" data-title="Ludopatia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Gamblerstv%C3%AD" title="Gamblerství – Czech" lang="cs" hreflang="cs" data-title="Gamblerství" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Ludomani" title="Ludomani – Danish" lang="da" hreflang="da" data-title="Ludomani" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Pathologisches_Spielen" title="Pathologisches Spielen – German" lang="de" hreflang="de" data-title="Pathologisches Spielen" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%95%CE%B8%CE%B9%CF%83%CE%BC%CF%8C%CF%82_%CF%83%CF%84%CE%B1_%CF%84%CF%85%CF%87%CE%B5%CF%81%CE%AC_%CF%80%CE%B1%CE%B9%CF%87%CE%BD%CE%AF%CE%B4%CE%B9%CE%B1" title="Εθισμός στα τυχερά παιχνίδια – Greek" lang="el" hreflang="el" data-title="Εθισμός στα τυχερά παιχνίδια" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Ludopat%C3%ADa" title="Ludopatía – Spanish" lang="es" hreflang="es" data-title="Ludopatía" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Ludopatio" title="Ludopatio – Esperanto" lang="eo" hreflang="eo" data-title="Ludopatio" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Ludopatia" title="Ludopatia – Basque" lang="eu" hreflang="eu" data-title="Ludopatia" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A7%D8%AE%D8%AA%D9%84%D8%A7%D9%84_%D9%82%D9%85%D8%A7%D8%B1%D8%A8%D8%A7%D8%B2%DB%8C" title="اختلال قماربازی – Persian" lang="fa" hreflang="fa" data-title="اختلال قماربازی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Jeu_pathologique" title="Jeu pathologique – French" lang="fr" hreflang="fr" data-title="Jeu pathologique" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Ludoman%C3%ADa" title="Ludomanía – Galician" lang="gl" hreflang="gl" data-title="Ludomanía" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%B3%91%EC%A0%81_%EB%8F%84%EB%B0%95" title="병적 도박 – Korean" lang="ko" hreflang="ko" data-title="병적 도박" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Ovisnost_o_igrama_na_sre%C4%87u" title="Ovisnost o igrama na sreću – Croatian" lang="hr" hreflang="hr" data-title="Ovisnost o igrama na sreću" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Gangguan_Judi" title="Gangguan Judi – Indonesian" lang="id" hreflang="id" data-title="Gangguan Judi" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/Spilaf%C3%ADkn" title="Spilafíkn – Icelandic" lang="is" hreflang="is" data-title="Spilafíkn" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Disturbo_da_gioco_d%27azzardo" title="Disturbo da gioco d'azzardo – Italian" lang="it" hreflang="it" data-title="Disturbo da gioco d'azzardo" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%99%D7%9E%D7%95%D7%A8_%D7%A4%D7%AA%D7%95%D7%9C%D7%95%D7%92%D7%99" title="הימור פתולוגי – Hebrew" lang="he" hreflang="he" data-title="הימור פתולוגי" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%9A%E1%83%A3%E1%83%93%E1%83%9D%E1%83%9B%E1%83%90%E1%83%9C%E1%83%98%E1%83%90" title="ლუდომანია – Georgian" lang="ka" hreflang="ka" data-title="ლუდომანია" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Azartsp%C4%93%C4%BCu_atkar%C4%ABba" title="Azartspēļu atkarība – Latvian" lang="lv" hreflang="lv" data-title="Azartspēļu atkarība" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-li mw-list-item"><a href="https://li.wikipedia.org/wiki/Gokversjlaving" title="Gokversjlaving – Limburgish" lang="li" hreflang="li" data-title="Gokversjlaving" data-language-autonym="Limburgs" data-language-local-name="Limburgish" class="interlanguage-link-target"><span>Limburgs</span></a></li><li class="interlanguage-link interwiki-xmf mw-list-item"><a href="https://xmf.wikipedia.org/wiki/%E1%83%9A%E1%83%A3%E1%83%93%E1%83%9D%E1%83%9B%E1%83%90%E1%83%9C%E1%83%98%E1%83%90" title="ლუდომანია – Mingrelian" lang="xmf" hreflang="xmf" data-title="ლუდომანია" data-language-autonym="მარგალური" data-language-local-name="Mingrelian" class="interlanguage-link-target"><span>მარგალური</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Ketagihan_judi" title="Ketagihan judi – Malay" lang="ms" hreflang="ms" data-title="Ketagihan judi" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Pathologisch_gokken" title="Pathologisch gokken – Dutch" lang="nl" hreflang="nl" data-title="Pathologisch gokken" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://ja.wikipedia.org/wiki/%E3%82%AE%E3%83%A3%E3%83%B3%E3%83%96%E3%83%AB%E4%BE%9D%E5%AD%98%E7%97%87" title="ギャンブル依存症 – Japanese" lang="ja" hreflang="ja" data-title="ギャンブル依存症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Spilleavhengighet" title="Spilleavhengighet – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Spilleavhengighet" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Spelavhengnad" title="Spelavhengnad – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Spelavhengnad" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Problem_hazardu" title="Problem hazardu – Polish" lang="pl" hreflang="pl" data-title="Problem hazardu" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Jogo_patol%C3%B3gico" title="Jogo patológico – Portuguese" lang="pt" hreflang="pt" data-title="Jogo patológico" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9B%D1%83%D0%B4%D0%BE%D0%BC%D0%B0%D0%BD%D0%B8%D1%8F" title="Лудомания – Russian" lang="ru" hreflang="ru" data-title="Лудомания" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Gambling_addiction" title="Gambling addiction – Simple English" 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tabindex="0"></div><div class="cdx-dialog cdx-dialog--horizontal-actions"><header class="cdx-dialog__header cdx-dialog__header--default"><div class="cdx-dialog__header__title-group"><h2 class="cdx-dialog__header__title">Page version status</h2><p class="cdx-dialog__header__subtitle">This is an accepted version of this page</p></div><button class="cdx-button cdx-button--action-default cdx-button--weight-quiet
							cdx-button--size-medium cdx-button--icon-only cdx-dialog__header__close-button" aria-label="Close" onclick="document.getElementById("mw-fr-revision-details").style.display = "none";" type="submit"><span class="cdx-icon cdx-icon--medium
							cdx-fr-css-icon--close"></span></button></header><div class="cdx-dialog__body">This is the <a href="/wiki/Wikipedia:Pending_changes" title="Wikipedia:Pending changes">latest accepted revision</a>, <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Special:Log&type=review&page=Special:Badtitle/Message">reviewed</a> on <i>17 November 2024</i>.</div></div><div tabindex="0"></div></div></div></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Repetitive gambling despite demonstrable harm and adverse consequences</div> <p class="mw-empty-elt"> </p> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Problem gambling</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Ludopathy, ludomania, degenerate gambling, gambling addiction, compulsive gambling, gambling disorder</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Gambling_chips.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Gambling_chips.jpg/220px-Gambling_chips.jpg" decoding="async" width="220" height="147" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Gambling_chips.jpg/330px-Gambling_chips.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/53/Gambling_chips.jpg/440px-Gambling_chips.jpg 2x" data-file-width="750" data-file-height="500" /></a></span></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a>, <a href="/wiki/Clinical_psychology" title="Clinical psychology">clinical psychology</a> <span class="penicon autoconfirmed-show"><span class="mw-valign-text-top" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q748309?uselang=en#P1995" title="Edit this on Wikidata"><img alt="Edit this on Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></span></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Spending a lot of money and time in casino/sports betting, <a href="/wiki/Video_game_addiction" title="Video game addiction">Video game addiction</a><sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1257001546"><table class="infobox" style="width:{{{width}}}; ; border-collapse:collapse;"><tbody><tr><th colspan="2" class="infobox-above" style="font-size:100%; background:#FFCC66; box-shadow: inset 3px 3px 0 #fafafa, inset -3px -3px 0 #fafafa;; padding:5px;">Addiction and dependence glossary<sup id="cite_ref-Cellular_basis_2-0" class="reference"><a href="#cite_note-Cellular_basis-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Addiction_glossary_3-0" class="reference"><a href="#cite_note-Addiction_glossary-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Brain_disease_4-0" class="reference"><a href="#cite_note-Brain_disease-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></th></tr><tr><td colspan="2" class="infobox-full-data" style="text-align:left; padding-left:0;"> <ul><li><b><a href="/wiki/Addiction" title="Addiction">addiction</a></b> – a <a href="/wiki/Biopsychosocial" class="mw-redirect" title="Biopsychosocial">biopsychosocial</a> disorder characterized by persistent use of drugs (including <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a>) despite substantial harm and adverse consequences</li> <li><b><a href="/wiki/Addiction" title="Addiction">addictive drug</a></b> – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug's effect on brain <a href="/wiki/Reward_system" title="Reward system">reward systems</a></li> <li><b><a href="/wiki/Substance_dependence" title="Substance dependence">dependence</a></b> – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake)</li> <li><b><a href="/wiki/Reverse_tolerance" title="Reverse tolerance">drug sensitization</a></b> or <b>reverse tolerance</b> – the escalating effect of a drug resulting from repeated administration at a given dose</li> <li><b><a href="/wiki/Drug_withdrawal" title="Drug withdrawal">drug withdrawal</a></b> – symptoms that occur upon cessation of repeated drug use</li> <li><b><a href="/wiki/Physical_dependence" title="Physical dependence">physical dependence</a></b> – dependence that involves persistent physical–<a href="https://en.wiktionary.org/wiki/somatic" class="extiw" title="wikt:somatic">somatic</a> withdrawal symptoms (e.g., fatigue and <a href="/wiki/Delirium_tremens" title="Delirium tremens">delirium tremens</a>)</li> <li><b><a href="/wiki/Psychological_dependence" title="Psychological dependence">psychological dependence</a></b> – dependence socially seen as being extremely mild compared to physical dependence (e.g., with enough willpower it could be overcome)</li> <li><b><a href="/wiki/Reinforcement" title="Reinforcement">reinforcing</a> stimuli</b> – stimuli that increase the probability of repeating behaviors paired with them</li> <li><b><a href="/wiki/Reward_system" title="Reward system">rewarding</a> stimuli</b> – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach</li> <li><b><a href="/wiki/Sensitization" title="Sensitization">sensitization</a></b> – an amplified response to a stimulus resulting from repeated exposure to it</li> <li><b><a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorder</a></b> – a condition in which the use of substances leads to clinically and functionally significant impairment or distress</li> <li><b><a href="/wiki/Drug_tolerance" title="Drug tolerance">tolerance</a></b> – the diminishing effect of a drug resulting from repeated administration at a given dose</li></ul> </td></tr><tr><td colspan="2" class="infobox-below" style="text-align:right; padding-top:0; padding-right:5px;"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output .hlist ol ol,.mw-parser-output .hlist ol ul,.mw-parser-output .hlist ul dl,.mw-parser-output .hlist ul ol,.mw-parser-output .hlist ul ul{display:inline}.mw-parser-output .hlist .mw-empty-li{display:none}.mw-parser-output .hlist dt::after{content:": "}.mw-parser-output .hlist dd::after,.mw-parser-output .hlist li::after{content:" · ";font-weight:bold}.mw-parser-output .hlist dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Addiction_glossary" title="Template:Addiction glossary"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Addiction_glossary" title="Template talk:Addiction glossary"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Addiction_glossary" title="Special:EditPage/Template:Addiction glossary"><abbr title="Edit this template">e</abbr></a></li></ul></div></td></tr></tbody></table> <p><b>Problem gambling</b>, <b>ludopathy</b><sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> or <b>ludomania</b> is repetitive gambling behavior despite harm and negative consequences. Problem gambling may be diagnosed as a mental disorder according to <i><a href="/wiki/DSM-5" title="DSM-5">DSM-5</a></i> if certain diagnostic criteria are met. Pathological gambling is a common disorder associated with social and family costs. </p><p>The <i>DSM-5</i> has re-classified the condition as an addictive disorder, with those affected exhibiting many similarities to those with substance addictions. The term <i>gambling addiction</i> has long been used in the recovery movement.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Pathological gambling was long considered by the <a href="/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> to be an <a href="/wiki/Impulse-control_disorder" title="Impulse-control disorder">impulse-control disorder</a> rather than an <a href="/wiki/Addiction" title="Addiction">addiction</a>.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> However, data suggest a closer relationship between pathological gambling and substance use disorders than exists between PG and <a href="/wiki/Obsessive%E2%80%93compulsive_disorder" title="Obsessive–compulsive disorder">obsessive–compulsive disorder</a>, mainly because the behaviors in problem gambling and most primary substance use disorders (i.e., those not resulting from a desire to "<a href="/wiki/Self-medication" title="Self-medication">self-medicate</a>" for another condition such as depression) seek to activate the brain's reward mechanisms while the behaviors characterizing obsessive-compulsive disorder are prompted by overactive and misplaced signals from the brain's fear mechanisms.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>Problem gambling is an addictive behavior with a high <a href="/wiki/Comorbidity" title="Comorbidity">comorbidity</a> with alcohol problems. A common tendency shared by people who have a gambling addiction is <a href="/wiki/Impulsivity" title="Impulsivity">impulsivity</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2022)">citation needed</span></a></i>]</sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Research by governments in Australia led to a universal definition for that country which appears to be the only research-based definition not to use diagnostic criteria: "Problem gambling is characterized by many difficulties in limiting money and/or time spent on gambling which leads to adverse consequences for the gambler, others, or for the community."<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/University_of_Maryland_Medical_Center" title="University of Maryland Medical Center">University of Maryland Medical Center</a> defines pathological gambling as "being unable to resist impulses to gamble, which can lead to severe personal or social consequences".<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>Most other definitions of problem gambling can usually be simplified to any gambling that causes harm to the gambler or someone else in any way; however, these definitions are usually coupled with descriptions of the type of harm or the use of diagnostic criteria.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2012)">citation needed</span></a></i>]</sup> The <i><a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">DSM-V</a></i> has since reclassified pathological gambling as <i>gambling disorder</i> and has listed the disorder under substance-related and addictive disorders rather than impulse-control disorders. This is due to the symptomatology of the disorder resembling an addiction not dissimilar to that of a <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorder</a>.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> To be diagnosed, an individual must have at least four of the following symptoms in 12 months:<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Needs to gamble with increasing amounts of money to achieve the desired excitement</li> <li>Is restless or irritable when attempting to cut down or stop gambling</li> <li>Has made repeated unsuccessful efforts to control, cut back, or stop gambling</li> <li>Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)</li> <li>Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed)</li> <li>After losing money gambling, often returns another day to get even ("chasing" one's losses)</li> <li>Lies to conceal the extent of involvement with gambling</li> <li>Has jeopardized or lost a significant relationship, job, education, or career opportunity because of gambling</li> <li>Relies on others to provide money to relieve desperate financial situations caused by gambling</li></ul> <div class="mw-heading mw-heading2"><h2 id="Factors_that_lead_to_gambling_addiction">Factors that lead to gambling addiction</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=2" title="Edit section: Factors that lead to gambling addiction"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Mayo_Clinic" title="Mayo Clinic">Mayo Clinic</a> specialists state that compulsive gambling may result from biological, genetic, and environmental factors, such as:<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/Mental_disorder" title="Mental disorder">mental health disorders</a> (the presence of substance use disorders, personality disorders, emotional states)</li> <li>age and sex (usually found in youth or middle-aged people, and more common to men than women)</li> <li>impact of family or friends</li> <li><a href="/wiki/Trait_theory" title="Trait theory">personality traits</a></li> <li>video games (including any factors that resemble gambling such as slot machines or loot boxes)<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup></li> <li>drugs with rare side-effects (for example, <a href="/wiki/Antipsychotic" title="Antipsychotic">antipsychotic</a> medications or <a href="/wiki/Dopamine_agonist" title="Dopamine agonist">dopamine agonists</a>).</li></ul> <p>Other studies add the following triggers to the mentioned above:<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <ul><li>traumatic conditions</li> <li>job-related stress</li> <li>solitude</li> <li>other addictions</li></ul> <p>If not treated, problem gambling may cause severe and lasting effects on an individual's life:<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <ul><li>relationship-related issues</li> <li>problems with money, bankruptcy</li> <li>legal problems, imprisonment</li> <li>health problems</li> <li><a href="/wiki/Suicide" title="Suicide">suicide</a>, including suicidal thoughts and attempts</li></ul> <div class="mw-heading mw-heading3"><h3 id="Suicide_rates">Suicide rates</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=3" title="Edit section: Suicide rates"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A gambler who does not receive treatment for pathological gambling when in a desperation phase may contemplate <a href="/wiki/Suicide" title="Suicide">suicide</a>.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Problem gambling is often associated with increased <a href="/wiki/Suicidal_ideation" title="Suicidal ideation">suicidal ideation</a> and attempts compared to the general population.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Early onset of problem gambling may increase the lifetime risk of suicide.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Both <a href="/wiki/Comorbid" class="mw-redirect" title="Comorbid">comorbid</a> <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use</a><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> and comorbid mental disorders increase the risk of suicide in people with problem gambling.<sup id="cite_ref-Kausch_23-0" class="reference"><a href="#cite_note-Kausch-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> A 2010 Australian hospital study found that 17% of suicidal patients admitted to the <a href="/wiki/The_Alfred_Hospital" title="The Alfred Hospital">Alfred Hospital</a>'s emergency department were problem gamblers.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanisms">Mechanisms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=4" title="Edit section: Mechanisms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Biology">Biology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=5" title="Edit section: Biology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>According to the Illinois Institute for Addiction Recovery, evidence indicates that pathological gambling is an addiction similar to chemical addiction.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> It has been observed that some pathological gamblers have lower levels of <a href="/wiki/Norepinephrine" title="Norepinephrine">norepinephrine</a> than normal gamblers.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> According to a study conducted by Alec Roy, formerly at the <a href="/wiki/National_Institute_on_Alcohol_Abuse_and_Alcoholism" title="National Institute on Alcohol Abuse and Alcoholism">National Institute on Alcohol Abuse and Alcoholism</a>, norepinephrine is secreted under stress, arousal, or thrill, so pathological gamblers gamble to make up for their under-dosage.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>Studies have compared pathological gamblers to substance addicts, concluding that addicted gamblers display more physical symptoms during withdrawal.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>Deficiencies in <a href="/wiki/Serotonin" title="Serotonin">serotonin</a> might also contribute to compulsive behavior, including a gambling addiction. There are three important points discovered after these antidepressant studies:<sup id="cite_ref-grant2006_29-0" class="reference"><a href="#cite_note-grant2006-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <ol><li>Antidepressants can reduce pathological gambling when there is an effect on serotonergic reuptake inhibitors and 5-HT1/5-HT2 receptor antagonists.</li> <li>Pathological gambling, as part of obsessive-compulsive disorder, requires the higher doses of antidepressants as is usually required for depressive disorders.</li> <li>In cases where participants do not have or have minimal symptoms of anxiety or depression, antidepressants still have those effect.</li></ol> <p>A limited study was presented at a conference in Berlin, suggesting opioid release differs in problem gamblers from the general population, but in a very different way from people with a substance use disorder.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p><p>The findings in one review indicated the sensitization theory is responsible.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Dopamine_dysregulation_syndrome" title="Dopamine dysregulation syndrome">Dopamine dysregulation syndrome</a> has been observed in the aforementioned theory in people with regard to such activities as gambling.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p><p>Some medical authors suggest that the biomedical model of problem gambling may be unhelpful because it focuses only on individuals. These authors point out that social factors may be a far more important determinant of gambling behavior than brain chemicals, and they suggest that a social model may be more useful in understanding the issue.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> For example, an apparent increase in problem gambling in the UK may be better understood as a consequence of changes in legislation which came into force in 2007 and enabled <a href="/wiki/Casino" title="Casino">casinos</a>, <a href="/wiki/Bookmaker" title="Bookmaker">bookmakers</a>, and <a href="/wiki/Online_gambling" title="Online gambling">online betting</a> sites to advertise on TV and radio for the first time and which eased restrictions on the opening of betting shops and online gambling sites.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>Pathological gambling is similar to many other impulse-control disorders such as <a href="/wiki/Kleptomania" title="Kleptomania">kleptomania</a>.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> According to evidence from both community- and clinic-based studies, individuals who are pathological gamblers are highly likely to exhibit other psychiatric problems concurrently, including <a href="/wiki/Substance_use_disorder" title="Substance use disorder">substance use disorders</a>, <a href="/wiki/Mood_disorder" title="Mood disorder">mood</a> and <a href="/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorders</a>, or <a href="/wiki/Personality_disorder" title="Personality disorder">personality disorders</a>.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>Pathological gambling shows several similarities with substance use disorders. There is a partial overlap in diagnostic criteria; pathological gamblers are also likely to have a substance use disorder. The "telescoping phenomenon" reflects the rapid development from initial to problematic behavior in women compared with men. This phenomenon was initially described for alcoholism, but it has also been applied to pathological gambling. Also, biological data support a relationship between pathological gambling and substance use disorder.<sup id="cite_ref-grant2006_29-1" class="reference"><a href="#cite_note-grant2006-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> A comprehensive UK Gambling Commission study from 2018 has also hinted at the link between gambling addiction and a reduction in physical activity, poor diet, and overall well-being. The study links problem gambling to a myriad of issues affecting relationships, and social stability. </p><p>There have also been studies that showcase factors like gender and age can affect how a person is affected by gambling. Where the probability of addiction can be 11% stronger in men than in women, and the age range of 19-29 has the highest risk of developing problem gambling or pathological gambling habits.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Psychological">Psychological</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=6" title="Edit section: Psychological"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Several psychological mechanisms are thought to be implicated in the development and maintenance of problem gambling.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> First, reward processing seems to be less sensitive with problem gamblers.<sup class="noprint Inline-Template" style="margin-left:0.1em; white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify"><span title="The text near this tag may need clarification or removal of jargon. (November 2022)">clarification needed</span></a></i>]</sup> Second, some individuals use problem gambling as an escape from the problems in their lives (an example of <a href="/wiki/Negative_reinforcement" class="mw-redirect" title="Negative reinforcement">negative reinforcement</a>). Third, personality factors such as <a href="/wiki/Narcissism" title="Narcissism">narcissism</a>, risk-seeking, sensation-seeking, and impulsivity play a role. Fourth, problem gamblers have several cognitive biases, including the <a href="/wiki/Illusion_of_control" title="Illusion of control">illusion of control</a>,<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> unrealistic optimism, overconfidence and the <a href="/wiki/Gambler%27s_fallacy" title="Gambler's fallacy">gambler's fallacy</a> (the incorrect belief that a series of random events tends to self-correct so that the absolute frequencies of each of various outcomes balance each other out). Fifth, problem gamblers represent a chronic state of a behavioral spin process, a gambling spin, as described by the criminal spin theory.<sup class="noprint Inline-Template" style="margin-left:0.1em; white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify"><span title="The text near this tag may need clarification or removal of jargon. (November 2022)">clarification needed</span></a></i>]</sup><sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>Spain's gambling watchdog has updated its 2019–2020 Responsible Gaming Program, classifying problem gambling as a mental disorder.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2020)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=7" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The most common instrument used to screen for "probable pathological gambling" behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York City.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> In recent years the use of SOGS has declined due to a number of criticisms, including that it overestimates <a href="/wiki/False_positive" class="mw-redirect" title="False positive">false positives</a> (Battersby, Tolchard, Thomas & Esterman, 2002). </p><p>The <i>DSM-IV</i> diagnostic criteria presented as a checklist is an alternative to SOGS, it focuses on the psychological motivations underpinning problem gambling and was developed by the American Psychiatric Association. It consists of ten diagnostic criteria. One frequently used screening measure based upon the DSM-IV criteria is the National Opinion Research Center DSM Screen for Gambling Problems (NODS). The Canadian Problem Gambling Inventory (CPGI) and the Victorian Gambling Screen (VGS) are newer assessment measures. The Problem Gambling Severity Index, which focuses on the harms associated with problem gambling, is composed of nine items from the longer CPGI.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> The VGS is also harm based and includes 15 items. The VGS has proven validity and reliability in population studies as well as Adolescents and clinic gamblers.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (October 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=8" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Most treatment for problem gambling involves counseling, step-based programs, self-help, peer-support, medication, or a combination of these. However, no one treatment is considered to be most efficacious and, in the United States, no medications have been approved for the treatment of pathological gambling by the <a href="/wiki/U.S._Food_and_Drug_Administration" class="mw-redirect" title="U.S. Food and Drug Administration">U.S. Food and Drug Administration</a> (FDA). </p><p><a href="/wiki/Gamblers_Anonymous" title="Gamblers Anonymous">Gamblers Anonymous</a> (GA) is a commonly used treatment for gambling problems. Modeled after <a href="/wiki/Alcoholics_Anonymous" title="Alcoholics Anonymous">Alcoholics Anonymous</a>, GA is a <a href="/wiki/Twelve-step_program" title="Twelve-step program">twelve-step program</a> that emphasizes a mutual-support approach. There are <a href="/wiki/North_American_gambling_treatment_centers" title="North American gambling treatment centers">three in-patient treatment centers in North America</a>.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> One form of counseling, <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a> (CBT) has been shown to reduce symptoms and gambling-related urges. This type of therapy focuses on the identification of gambling-related thought processes, mood and <a href="/wiki/Cognitive_distortion" title="Cognitive distortion">cognitive distortions</a> that increase one's vulnerability to out-of-control gambling. Additionally, CBT approaches frequently utilize skill-building techniques geared toward relapse prevention, assertiveness and gambling refusal, problem solving and reinforcement of gambling-inconsistent activities and interests.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p>As to behavioral treatment, some recent research supports the use of both activity scheduling and desensitization in the treatment of gambling problems.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> In general, behavior analytic research in this area is growing<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> There is evidence that the <a href="/wiki/SSRI" class="mw-redirect" title="SSRI">SSRI</a> <a href="/wiki/Paroxetine" title="Paroxetine">paroxetine</a> is efficacious in the treatment of pathological gambling.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Additionally, for patients with both pathological gambling and a comorbid bipolar spectrum condition, sustained-release <a href="/wiki/Lithium_(medication)" title="Lithium (medication)">lithium</a> has shown efficacy in a preliminary trial.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> The opioid antagonist drug <a href="/wiki/Nalmefene" title="Nalmefene">nalmefene</a> has also been trialled quite successfully for the treatment of compulsive gambling.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> Group concepts based on <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">CBT</a>, such as the <a href="/wiki/Metacognitive_training" title="Metacognitive training">metacognitive training</a> for problem gambling<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> have also proven effective. </p> <div class="mw-heading mw-heading3"><h3 id="Step-based_programs">Step-based programs</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=9" title="Edit section: Step-based programs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>12 Step–based programs such as Gamblers Anonymous are specific to gambling and generic to healing addiction, creating financial health, and improving mental wellness. Commercial alternatives that are designed for clinical intervention, using the best of health science and applied education practices, have been used as patient-centered tools for intervention since 2007. They include measured efficacy and resulting recovery metrics.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)"><span title="Material near this tag needs references to reliable medical sources. (June 2015)">medical citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Motivational_interviewing">Motivational interviewing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=10" title="Edit section: Motivational interviewing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Motivational_interviewing" title="Motivational interviewing">Motivational interviewing</a> is one of the treatments of compulsive gambling. The motivational interviewer's basic goal is promoting readiness to change through thinking and resolving mixed feelings. Avoiding aggressive confrontation, argument, labeling, blaming, and direct persuasion, the interviewer supplies <a href="/wiki/Empathy" title="Empathy">empathy</a> and advice to compulsive gamblers who define their own goal. The focus is on promoting freedom of choice and encouraging confidence in the ability to change.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Peer_support">Peer support</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=11" title="Edit section: Peer support"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A growing method of treatment is peer support. With the advancement of online gambling, many gamblers experiencing issues use various online peer-support groups to aid their recovery. This protects their anonymity while allowing them to attempt recovery on their own, often without having to disclose their issues to loved ones.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)"><span title="Material near this tag needs references to reliable medical sources. (June 2015)">medical citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Self-help">Self-help</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=12" title="Edit section: Self-help"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Research into self-help for problem gamblers has shown benefits.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> A study by <a href="/wiki/Wendy_Slutske" title="Wendy Slutske">Wendy Slutske</a> of the <a href="/wiki/University_of_Missouri" title="University of Missouri">University of Missouri</a> concluded one-third of pathological gamblers overcome it by natural recovery.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pharmaceutical_treatments">Pharmaceutical treatments</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=13" title="Edit section: Pharmaceutical treatments"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Addiction#Medication" title="Addiction">Addiction § Medication</a></div><p>Numerous pharmaceutical approaches to treating gambling addiction have been suggested including antidepressants, atypical antipsychotic agents, mood stabilizers, and opioid antagonists, however the best approach for treatment, treatment regime including dosage and timing is not clear.<sup id="cite_ref-:0_54-0" class="reference"><a href="#cite_note-:0-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> There is some evidence to suggest that opioid antagonists, for example, <a href="/wiki/Naltrexone" title="Naltrexone">naltrexone</a> or <a href="/wiki/Nalmefene" title="Nalmefene">nalmefene</a>, and <a href="/wiki/Atypical_antipsychotic" title="Atypical antipsychotic">atypical antipsychotics</a> such as <a href="/wiki/Olanzapine" title="Olanzapine">olanzapine</a>, may help reduce the severity of gambling symptoms in the short-term, however it is not clear if these medications are effective at improving other psychological symptoms associated with this disorder or for longer term symptom relief from problem gambling.<sup id="cite_ref-:0_54-1" class="reference"><a href="#cite_note-:0-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> The evidence suggesting the effectiveness of mood stabilizers is not clear.<sup id="cite_ref-:0_54-2" class="reference"><a href="#cite_note-:0-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p><div class="mw-heading mw-heading3"><h3 id="Self-exclusion">Self-exclusion</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=14" title="Edit section: Self-exclusion"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Self-exclusion" title="Self-exclusion">Self-exclusion</a></div> <p>Gambling self-exclusion (voluntary exclusion) programs are available in the US, the UK, Canada, Australia, South Africa, France, and other countries. They seem to help some (but not all) problem gamblers to gamble less often.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p><p>Some experts maintain that casinos in general arrange for self-exclusion programs as a public relations measure without actually helping many of those with problem gambling issues. A campaign of this type merely "deflects attention away from problematic products and industries", according to Natasha Dow Schull, a cultural anthropologist at <a href="/wiki/New_York_University" title="New York University">New York University</a> and author of the book <i>Addiction by Design</i>.<sup id="cite_ref-cbc.ca_56-0" class="reference"><a href="#cite_note-cbc.ca-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p><p>There is also a question as to the effectiveness of such programs, which can be difficult to enforce.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> In the province of <a href="/wiki/Ontario" title="Ontario">Ontario</a>, Canada, for example, the Self-Exclusion program operated by the government's <a href="/wiki/Ontario_Lottery_and_Gaming_Corporation" title="Ontario Lottery and Gaming Corporation">Ontario Lottery and Gaming Corporation</a> (OLG) is not effective, according to investigation conducted by the television series, revealed in late 2017. |"Gambling addicts ... said that while on the ... self-exclusion list, they entered OLG properties on a regular basis" in spite of the facial recognition technology in place at the casinos, according to the Canadian Broadcasting Corporation. As well, a CBC journalist who tested the system found that he was able to enter Ontario casinos and gamble on four distinct occasions, in spite of having been registered and photographed for the self-exclusion program. An OLG spokesman provided this response when questioned by the CBC: "We provide supports to self-excluders by training our staff, by providing disincentives, by providing facial recognition, by providing our security officers to look for players. No one element is going to be foolproof because it is not designed to be foolproof".<sup id="cite_ref-cbc.ca_56-1" class="reference"><a href="#cite_note-cbc.ca-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Impact_(Australia)"><span id="Impact_.28Australia.29"></span>Impact (Australia)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=15" title="Edit section: Impact (Australia)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>According to the Productivity Commission's 2010 final report into gambling, the social cost of problem gambling is close to 4.7 billion dollars a year. Some of the harms resulting from problem gambling include depression, suicide, lower work productivity, job loss, relationship breakdown, crime and bankruptcy.<sup id="cite_ref-auto_58-0" class="reference"><a href="#cite_note-auto-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> A survey conducted in 2008 found that the most common motivation for <a href="/wiki/Fraud" title="Fraud">fraud</a> was problem gambling, with each incident averaging a loss of $1.1 million.<sup id="cite_ref-auto_58-1" class="reference"><a href="#cite_note-auto-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> According to Darren R. Christensen. Nicki A. Dowling, Alun C. Jackson and Shane A. Thomas, a survey done from 1994 to 2008 in Tasmania gave results that gambling participation rates have risen rather than fallen over this period.<sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevalence">Prevalence</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=16" title="Edit section: Prevalence"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Europe">Europe</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=17" title="Edit section: Europe"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In Europe, the rate of problem gambling is typically 0.5 to 3 percent.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> The "British Gambling Prevalence Survey 2007", conducted by the United Kingdom Gambling Commission, found approximately 0.6 percent of the adult population had problem gambling issues—the same percentage as in 1999.<sup id="cite_ref-2007uksurveyp10_61-0" class="reference"><a href="#cite_note-2007uksurveyp10-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> The highest prevalence of problem gambling was found among those who participated in <a href="/wiki/Spread_betting" title="Spread betting">spread betting</a> (14.7%), <a href="/wiki/Fixed_odds_betting_terminal" title="Fixed odds betting terminal">fixed odds betting terminals</a> (11.2%), and <a href="/wiki/Betting_exchange" title="Betting exchange">betting exchanges</a> (9.8%).<sup id="cite_ref-2007uksurveyp10_61-1" class="reference"><a href="#cite_note-2007uksurveyp10-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> In Norway, a December 2007 study showed the amount of current problem gamblers was 0.7 percent.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p><p>With gambling addiction on the rise worldwide and across Europe in particular, those calling gambling a disease have been gaining grounds. The UK Gambling Commission announced a significant shift in their approach to gambling<sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items" title="Wikipedia:Manual of Style/Dates and numbers"><span title="The time period mentioned near this tag is ambiguous. (July 2022)">when?</span></a></i>]</sup> through their reclassification of gambling as a disease, and therefore that it should be addressed adequately by the NHS. </p><p>The World Health Organization has also classified gambling a disease. In its 72nd World Health Assembly held on Saturday, May 25, 2019, ‘gaming disorder’ was recognized as an official illness. The 194-member meet added excessive gaming to a classified list of diseases as it revised its International Statistical Classification of Diseases and Related Health Problems (ICD-11).<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2022)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="North_America">North America</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=18" title="Edit section: North America"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Lizbeth García Quevedo, director of the Coordination with Federal Entities (CONADIC), spoke of pathological gambling as a strong addiction in Mexico: "It has very similar behaviors, that is why some experts consider it an addiction because it is similar in the behaviors, in the origins, some risk factors that can trigger pathological gambling, it can also trigger drug consumption". In Mexico there could be between one and three million people addicted to gambling. "They should be aware of what their children are doing, and on the other hand, they should motivate pro-active gambling, healthy gambling", commented Lizbeth García Quevedo. The Ministry of Health document highlights that a study on pathological gambling that analyzed 46 studies carried out in Canada, the United States, Australia, Sweden, Norway, England, Switzerland and Spain, revealed that the prevalence of pathological gambling is relatively higher among adolescents, which shows the continuity of the problem considering that many pathological gamblers state that they started their gambling behavior at an early age.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p><p>In the United States, the percentage of pathological gamblers was 0.6 percent, and the percentage of problem gamblers was 2.3 percent in 2008.<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> Studies commissioned by the <a href="/wiki/National_Gambling_Impact_Study_Commission_Act" title="National Gambling Impact Study Commission Act">National Gambling Impact Study Commission Act</a> has shown the prevalence rate ranges from 0.1 percent to 0.6 percent.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> Nevada has the highest percentage of pathological gambling; a 2002 report estimated 2.2 to 3.6 percent of Nevada residents over the age of 18 could be called problem gamblers. Also, 2.7 to 4.3 percent could be called probable pathological gamblers.<sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> </p><p>According to a 1997 meta-analysis by <a href="/wiki/Harvard_Medical_School" title="Harvard Medical School">Harvard Medical School</a>'s division on addictions, 1.1 percent of the adult population of the United States and Canada could be called pathological gamblers.<sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> A 1996 study estimated 1.2 to 1.9 percent of adults in Canada were pathological.<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> In Ontario, a 2006 report showed 2.6 percent of residents experienced "moderate gambling problems" and 0.8 percent had "severe gambling problems".<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> In Quebec, an estimated 0.8 percent of the adult population were pathological gamblers in 2002.<sup id="cite_ref-70" class="reference"><a href="#cite_note-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> Although most who gamble do so without harm, approximately 6 million American adults are addicted to gambling.<sup id="cite_ref-NCGP_71-0" class="reference"><a href="#cite_note-NCGP-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> </p><p>According to a survey of 11th and 12th graders in <a href="/wiki/Wood_County,_Ohio" title="Wood County, Ohio">Wood County, Ohio</a> found that the percentage who reported being unable to control their gambling rose to 8.3 percent in 2022, up from just 4.2 percent in 2018. The reasons for the increase cited, are the time spent online during the <a href="/wiki/COVID-19_pandemic" title="COVID-19 pandemic">COVID-19 pandemic</a>, gambling-like elements put into video games, and the increased legalization of <a href="/wiki/Sports_betting" title="Sports betting">sports betting</a> in a number of U.S. states.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> </p><p>According to Jennifer Trimpey, as the legality of online sport betting and online casino gambling increase across the United States, almost all governments of states with legal online gambling offer state-run self-exclusion programs, and most major online betting operators provide their own self-exclusion programs as well.<sup id="cite_ref-73" class="reference"><a href="#cite_note-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> </p><p>Signs of a gambling problem include:<sup id="cite_ref-NCGP_71-1" class="reference"><a href="#cite_note-NCGP-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup><sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Identifying_reliable_sources_(medicine)" title="Wikipedia:Identifying reliable sources (medicine)"><span title="Material near this tag needs references to reliable medical sources. (June 2015)">medical citation needed</span></a></i>]</sup> </p> <ul><li>Using income or savings to gamble while letting bills go unpaid</li> <li>Repeated unsuccessful attempts to stop gambling</li> <li>Chasing losses</li> <li>Losing sleep over thoughts of gambling</li> <li>Arguing with friends or family about gambling behavior</li> <li>Feeling depressed or suicidal because of gambling losses</li></ul> <div class="mw-heading mw-heading3"><h3 id="South_America">South America</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=19" title="Edit section: South America"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>For Isabel Sánchez Sosa, coordinator of the Compulsive Gamblers Association of Argentina, "gambling addiction is growing a lot in the country because the offer is impressive" and in this sense she asserted that the presence of bingos is a common issue in all neighborhoods. In the province of Buenos Aires there are 46 bingos.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Oceania_(Australia)"><span id="Oceania_.28Australia.29"></span>Oceania (Australia)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=20" title="Edit section: Oceania (Australia)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Casinos and poker machines in pubs and clubs facilitate problem gambling in Australia. The building of new hotels and casinos has been described as "one of the most active construction markets in Australia"; for example, AUD$860 million was allocated to rebuild and expand the Star Complex in Sydney.<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> </p><p>A 2010 study, conducted in the Northern Territory by researchers from the <a href="/wiki/Australian_National_University" title="Australian National University">Australian National University</a> (ANU) and <a href="/wiki/Southern_Cross_University" title="Southern Cross University">Southern Cross University</a> (SCU), found that the proximity of a person's residence to a gambling venue is significant in terms of prevalence. Harmful gambling in the study was prevalent among those living within 100 metres of any gambling venue, and was over 50% higher than among those living ten kilometres from a venue. The study's data stated: </p> <blockquote><p> Specifically, people who lived 100 metres from their favourite venue visited an estimated average of 3.4 times per month. This compared to an average of 2.8 times per month for people living one kilometre away, and 2.2 times per month for people living ten kilometres away.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup></p></blockquote> <p>According to the Productivity Commission's 2016 report into gambling, 0.5% to 1% (80,000 to 160,000)<sup id="cite_ref-77" class="reference"><a href="#cite_note-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup> of the Australian adult population had significant problems resulting from gambling. A further 1.4% to 2.1% (230,000 to 350,000) of the Australian adult population experienced moderate risks making them likely to be vulnerable to problem gambling.<sup id="cite_ref-pcgovau203_78-0" class="reference"><a href="#cite_note-pcgovau203-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup> Estimates show that problem gamblers account for an average of 41% of the total gaming machine spending.<sup id="cite_ref-pcgovau203_78-1" class="reference"><a href="#cite_note-pcgovau203-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=21" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Gamblers_Anonymous" title="Gamblers Anonymous">Gamblers Anonymous</a></li> <li><a href="/wiki/Gambler%27s_Lament" title="Gambler's Lament">Gambler's Lament</a>, an ancient poem about gambling</li> <li><a href="/wiki/Gambling_Commission" title="Gambling Commission">Gambling Commission</a> (Great Britain)</li> <li><a href="/wiki/GamCare" title="GamCare">GamCare</a></li> <li><a href="/wiki/Gaming_law" title="Gaming law">Gaming law</a></li> <li><a href="/wiki/National_Council_on_Problem_Gambling_(Singapore)" title="National Council on Problem Gambling (Singapore)">National Council on Problem Gambling (Singapore)</a></li> <li><a href="/wiki/National_Council_on_Problem_Gambling_(United_States)" title="National Council on Problem Gambling (United States)">National Council on Problem Gambling (United States)</a></li> <li><a href="/wiki/Problem_Gambling_Foundation_of_New_Zealand" title="Problem Gambling Foundation of New Zealand">Problem Gambling Foundation of New Zealand</a></li> <li><a href="/wiki/Video_game_addiction" title="Video game addiction">Video game addiction</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Problem_gambling&action=edit&section=22" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFDavid_ZendleRachel_MeyerHarriet_Over2019" class="citation journal cs1">David Zendle; Rachel Meyer; Harriet Over (June 2019). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599795">"Adolescents and loot boxes: links with problem gambling and motivations for purchase"</a>. <i>Royal Society Open Science</i>. <b>6</b> (6): 190049. <a href="/wiki/Bibcode_(identifier)" class="mw-redirect" title="Bibcode (identifier)">Bibcode</a>:<a rel="nofollow" class="external text" href="https://ui.adsabs.harvard.edu/abs/2019RSOS....690049Z">2019RSOS....690049Z</a>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1098%2Frsos.190049">10.1098/rsos.190049</a></span>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599795">6599795</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/31312481">31312481</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Royal+Society+Open+Science&rft.atitle=Adolescents+and+loot+boxes%3A+links+with+problem+gambling+and+motivations+for+purchase&rft.volume=6&rft.issue=6&rft.pages=190049&rft.date=2019-06&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6599795%23id-name%3DPMC&rft_id=info%3Apmid%2F31312481&rft_id=info%3Adoi%2F10.1098%2Frsos.190049&rft_id=info%3Abibcode%2F2019RSOS....690049Z&rft.au=David+Zendle&rft.au=Rachel+Meyer&rft.au=Harriet+Over&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6599795&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProblem+gambling" class="Z3988"></span></span> </li> <li id="cite_note-Cellular_basis-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-Cellular_basis_2-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNestler_EJ2013" class="citation journal cs1">Nestler EJ (December 2013). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898681">"Cellular basis of memory for addiction"</a>. <i>Dialogues in Clinical Neuroscience</i>. <b>15</b> (4): 431–443. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898681">3898681</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24459410">24459410</a>. <q>Despite the importance of numerous psychosocial factors, at its core, drug addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drive the compulsive seeking and taking of drugs, and loss of control over drug use, that define a state of addiction. ... A large body of literature has demonstrated that such ΔFosB induction in D1-type [nucleus accumbens] neurons increases an animal's sensitivity to drug as well as natural rewards and promotes drug self-administration, presumably through a process of positive reinforcement ... Another ΔFosB target is cFos: as ΔFosB accumulates with repeated drug exposure it represses c-Fos and contributes to the molecular switch whereby ΔFosB is selectively induced in the chronic drug-treated state.<sup>41</sup> ... Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dialogues+in+Clinical+Neuroscience&rft.atitle=Cellular+basis+of+memory+for+addiction&rft.volume=15&rft.issue=4&rft.pages=431-443&rft.date=2013-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3898681%23id-name%3DPMC&rft_id=info%3Apmid%2F24459410&rft.au=Nestler+EJ&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3898681&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProblem+gambling" class="Z3988"></span></span> </li> <li id="cite_note-Addiction_glossary-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-Addiction_glossary_3-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMalenkaNestlerHyman2009" class="citation book cs1">Malenka RC, Nestler EJ, Hyman SE (2009). 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Depending on the level of severity, this disorder is classified as mild, moderate, or severe.<br />Addiction: A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicated by compulsive drug taking despite the desire to stop taking the drug. 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The descent of a modern sports fan"</a></span>. <i>The Athletic</i><span class="reference-accessdate">. Retrieved <span class="nowrap">October 16,</span> 2024</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Athletic&rft.atitle=%27I+literally+can%27t+stop.%27+The+descent+of+a+modern+sports+fan&rft.aulast=Quick&rft.aufirst=Jason&rft_id=https%3A%2F%2Fwww.nytimes.com%2Fathletic%2F5777632%2F2024%2F10%2F14%2Fsports-betting-addiction-problem-fans%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AProblem+gambling" class="Z3988"></span> <span class="cs1-visible-error citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_news" title="Template:Cite news">cite news</a>}}</code>: </span><span class="cs1-visible-error citation-comment">Unknown parameter <code class="cs1-code">|Date=</code> ignored (<code class="cs1-code">|date=</code> suggested) (<a href="/wiki/Help:CS1_errors#parameter_ignored_suggest" title="Help:CS1 errors">help</a>)</span></li></ul> <div class="navbox-styles"><style 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.navbox-image img{max-width:none!important}@media print{body.ns-0 .mw-parser-output .navbox{display:none!important}}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q748309" class="extiw" title="d:Q748309">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/F63.0">F63.0</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=312.31">312.31</a></li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/606349">606349</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D005715">D005715</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/001520.htm">001520</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Reinforcement_disorders:_addiction_and_dependence" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Addiction" title="Template:Addiction"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Addiction" title="Template talk:Addiction"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Addiction" title="Special:EditPage/Template:Addiction"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Reinforcement_disorders:_addiction_and_dependence" style="font-size:114%;margin:0 4em"><a href="/wiki/Reinforcement" title="Reinforcement">Reinforcement</a> disorders: <a href="/wiki/Addiction" title="Addiction">addiction</a> and <a href="/wiki/Substance_dependence" title="Substance dependence">dependence</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Addiction" title="Addiction">Addiction</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Drug</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">Alcohol</a></li> <li><a href="/wiki/Amphetamine#Addiction" title="Amphetamine">Amphetamine</a></li> <li><a href="/wiki/Cocaine_addiction" class="mw-redirect" title="Cocaine addiction">Cocaine</a></li> <li><a href="/wiki/Methamphetamine#Addiction" title="Methamphetamine">Methamphetamine</a></li> <li><a href="/wiki/Methylphenidate#Addiction_and_dependence" title="Methylphenidate">Methylphenidate</a></li> <li><a href="/wiki/Nicotine_addiction" class="mw-redirect" title="Nicotine addiction">Nicotine</a></li> <li><a href="/wiki/Opioid_use_disorder" title="Opioid use disorder">Opioid</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Behavioral_addiction" title="Behavioral addiction">Behavioral</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Financial <ul><li><a class="mw-selflink selflink">Gambling</a></li> <li><a href="/wiki/Compulsive_buying_disorder" title="Compulsive buying disorder">Shopping</a></li></ul></li> <li><a href="/wiki/Food_addiction" title="Food addiction">Palatable food</a></li> <li>Sex-related <ul><li><a href="/wiki/Sexual_addiction" title="Sexual addiction">Intercourse</a></li> <li><a href="/wiki/Pornography_addiction" title="Pornography addiction">Pornography</a></li></ul></li> <li>Internet-related <ul><li><a href="/wiki/Internet_addiction_disorder" title="Internet addiction disorder">Internet addiction disorder</a></li> <li><a href="/wiki/Internet_sex_addiction" title="Internet sex addiction">Internet sex addiction</a></li></ul></li> <li><a href="/wiki/Video_game_addiction" title="Video game addiction">Video game addiction</a></li> <li><a href="/wiki/Digital_media_use_and_mental_health" title="Digital media use and mental health">Digital media addictions</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Cellular<br />mechanisms</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Transcription_factor" title="Transcription factor">Transcriptional</a> <ul><li><b><a href="/wiki/FOSB#ΔFosB" title="FOSB">ΔFosB</a></b></li> <li><a href="/wiki/C-Fos" class="mw-redirect" title="C-Fos">c-Fos</a></li> <li><a href="/wiki/Cdk5" class="mw-redirect" title="Cdk5">Cdk5</a></li> <li><a href="/wiki/CREB" title="CREB">CREB</a></li> <li><a href="/wiki/GluR2" class="mw-redirect" title="GluR2">GluR2</a></li> <li><a href="/wiki/NF-%CE%BAB" title="NF-κB">NF-κB</a></li></ul></li></ul> <ul><li><a href="/wiki/Histone-modifying_enzymes" title="Histone-modifying enzymes">Epigenetic</a> <ul><li><b><a href="/wiki/G9a" class="mw-redirect" title="G9a">G9a</a></b></li> <li><a href="/wiki/G9a-like_protein" class="mw-redirect" title="G9a-like protein">G9a-like protein</a></li> <li><b><a href="/wiki/HDAC1" title="HDAC1">HDAC1</a></b></li> <li><b><a href="/wiki/HDAC2" class="mw-redirect" title="HDAC2">HDAC2</a></b></li> <li><b><a href="/wiki/HDAC3" title="HDAC3">HDAC3</a></b></li> <li><a href="/wiki/HDAC4" title="HDAC4">HDAC4</a></li> <li><a href="/wiki/HDAC5" class="mw-redirect" title="HDAC5">HDAC5</a></li> <li><a href="/wiki/HDAC9" title="HDAC9">HDAC9</a></li> <li><a href="/wiki/HDAC10" title="HDAC10">HDAC10</a></li> <li><a href="/wiki/SIRT1" class="mw-redirect" title="SIRT1">SIRT1</a></li> <li><a href="/wiki/SIRT2" class="mw-redirect" title="SIRT2">SIRT2</a></li> <li>...</li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Substance_dependence" title="Substance dependence">Dependence</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Concepts</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Adverse_childhood_experiences" title="Adverse childhood experiences">Adverse childhood experiences</a></li> <li><a href="/wiki/Physical_dependence" title="Physical dependence">Physical dependence</a></li> <li><a href="/wiki/Psychological_dependence" title="Psychological dependence">Psychological dependence</a></li> <li><a href="/wiki/Drug_withdrawal" title="Drug withdrawal">Withdrawal</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Disorders</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Drugs <ul><li><a href="/wiki/Alcoholism" title="Alcoholism">Alcoholism</a></li> <li><a href="/wiki/Amphetamine_dependence" title="Amphetamine dependence">Amphetamine</a></li> <li><a href="/wiki/Barbiturate_dependence" title="Barbiturate dependence">Barbiturate</a></li> <li><a href="/wiki/Benzodiazepine_dependence" title="Benzodiazepine dependence">Benzodiazepine</a></li> <li><a href="/wiki/Caffeine_dependence" title="Caffeine dependence">Caffeine</a></li> <li><a href="/wiki/Cannabis_dependence" class="mw-redirect" title="Cannabis dependence">Cannabis</a></li> <li><a href="/wiki/Cocaine_dependence" title="Cocaine dependence">Cocaine</a></li> <li><a href="/wiki/Nicotine_dependence" title="Nicotine dependence">Nicotine</a></li> <li><a href="/wiki/Opioid_use_disorder" title="Opioid use disorder">Opioid</a></li></ul></li> <li>Non-drug stimuli <ul><li><a href="/wiki/Tanning_dependence" title="Tanning dependence">Tanning dependence</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Treatment_and_management_of_addiction" title="Treatment and management of addiction">Treatment <br />and <br />management</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Detoxification</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0;text-align: left;"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alcohol_detoxification" title="Alcohol detoxification">Alcohol detoxification</a></li> <li><a href="/wiki/Drug_detoxification" title="Drug detoxification">Drug detoxification</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Behavioral <br />therapies</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0;text-align: left;"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a> <ul><li><a href="/wiki/Relapse_prevention" title="Relapse prevention">Relapse prevention</a></li> <li><a href="/wiki/Contingency_management" title="Contingency management">Contingency management</a></li></ul></li> <li><a href="/wiki/Community_reinforcement_approach_and_family_training" title="Community reinforcement approach and family training">Community reinforcement approach and family training</a></li> <li><a href="/wiki/Motivational_enhancement_therapy" title="Motivational enhancement therapy">Motivational enhancement therapy</a></li> <li><a href="/wiki/Motivational_interviewing" title="Motivational interviewing">Motivational interviewing</a></li> <li><a href="/wiki/Motivational_therapy" title="Motivational therapy">Motivational therapy</a></li> <li><a href="/wiki/Neurobiological_effects_of_physical_exercise#Addiction" title="Neurobiological effects of physical exercise">Physical exercise</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Treatment <br />programs</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0;text-align: left;"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Drug_rehab" class="mw-redirect" title="Drug rehab">Drug rehab</a> <ul><li><a href="/wiki/Residential_treatment_center" title="Residential treatment center">Residential treatment center</a></li></ul></li> <li><a href="/wiki/Heroin-assisted_treatment" title="Heroin-assisted treatment">Heroin-assisted treatment</a></li> <li><a href="/wiki/Intensive_outpatient_program" title="Intensive outpatient program">Intensive outpatient program</a></li> <li><a href="/wiki/Methadone_maintenance" class="mw-redirect" title="Methadone maintenance">Methadone maintenance</a></li> <li><a href="/wiki/Smoking_cessation" title="Smoking cessation">Smoking cessation</a> <ul><li><a href="/wiki/Nicotine_replacement_therapy" title="Nicotine replacement therapy">Nicotine replacement therapy</a></li> <li><a href="/wiki/Tobacco_cessation_clinics_in_India" title="Tobacco cessation clinics in India">Tobacco cessation clinics in India</a></li></ul></li> <li><a href="/wiki/Twelve-step_program" title="Twelve-step program">Twelve-step program</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Support groups</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0;text-align: left;"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addiction_recovery_groups" class="mw-redirect" title="Addiction recovery groups">Addiction recovery groups</a></li> <li><a href="/wiki/List_of_twelve-step_groups" title="List of twelve-step groups">List of twelve-step groups</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Harm_reduction" title="Harm reduction">Harm reduction</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0;text-align: left;"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Category:Harm_reduction" title="Category:Harm reduction">Category:Harm reduction</a></li> <li><a href="/wiki/Drug_checking" title="Drug checking">Drug checking</a> <ul><li><a href="/wiki/Reagent_testing" title="Reagent testing">Reagent testing</a></li></ul></li> <li><a href="/wiki/Low-threshold_treatment_programs" class="mw-redirect" title="Low-threshold treatment programs">Low-threshold treatment programs</a></li> <li><a href="/wiki/Managed_alcohol_program" title="Managed alcohol program">Managed alcohol program</a></li> <li><a href="/wiki/Moderation_Management" title="Moderation Management">Moderation Management</a></li> <li><a href="/wiki/Needle_exchange_program" class="mw-redirect" title="Needle exchange program">Needle exchange program</a></li> <li><a href="/wiki/Responsible_drug_use" title="Responsible drug use">Responsible drug use</a></li> <li><a href="/wiki/Stimulant_maintenance" title="Stimulant maintenance">Stimulant maintenance</a></li> <li><a href="/wiki/Supervised_injection_site" title="Supervised injection site">Supervised injection site</a></li> <li><a href="/wiki/Tobacco_harm_reduction" title="Tobacco harm reduction">Tobacco harm reduction</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">See also</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Addiction medicine</a></li> <li><a href="/wiki/Allen_Carr" title="Allen Carr">Allen Carr</a></li> <li><a href="/wiki/Category:Addiction" title="Category:Addiction">Category:Addiction</a></li> <li><a href="/wiki/Category:Vaccines_against_drugs" title="Category:Vaccines against drugs">Category:Vaccines against drugs</a></li> <li><a href="/wiki/Discrimination_against_drug_addicts" title="Discrimination against drug addicts">Discrimination against drug addicts</a></li> <li><a href="/wiki/Dopamine_dysregulation_syndrome" title="Dopamine dysregulation syndrome">Dopamine dysregulation syndrome</a></li> <li><a href="/wiki/Cognitive_control" class="mw-redirect" title="Cognitive control">Cognitive control</a> <ul><li><a href="/wiki/Inhibitory_control" title="Inhibitory control">Inhibitory control</a></li></ul></li> <li><a href="/wiki/Motivational_salience" title="Motivational salience">Motivational salience</a> <ul><li><a href="/wiki/Motivational_salience#Incentive_salience" title="Motivational salience">Incentive salience</a></li></ul></li> <li><a href="/wiki/Sober_companion" title="Sober companion">Sober companion</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow hlist" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <a href="/wiki/Category:Addiction" title="Category:Addiction">Category</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link 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href="/wiki/Help:Authority_control" title="Help:Authority control">Authority control databases</a> <span class="mw-valign-text-top noprint" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q748309#identifiers" title="Edit this at Wikidata"><img alt="Edit this at Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">National</th><td class="navbox-list-with-group navbox-list navbox-odd" 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