Gambling
Gambling Addiction and the Brain: Risk, Reward, and Neurotransmitters
Nov 6, 2025
Gambling addiction is a serious mental health condition that can devastate emotional wellbeing, financial stability, and relationships if left untreated. What may begin as casual entertainment can evolve into an uncontrollable cycle of risk and reward that overwhelms the brain’s natural learning and motivation systems.
If you or someone you know feels hopeless or is having thoughts of self-harm related to gambling, please seek help immediately. In the United States, you can call or text 988 to reach the Suicide and Crisis Lifeline or dial 911 for emergency assistance. Recovery is possible, and effective treatments exist to help individuals regain control of their lives.
Understanding Gambling Disorder
Gambling disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a non-substance-related addictive disorder.<sup>1</sup>) Individuals with this disorder display persistent and recurrent symptoms that lead to significant impairment or distress. Some of these symptoms may include preoccupation with gambling, increased tolerance levels regarding gambling excitement, and gambling as a way to cope with challenging emotions.
Click HERE for a more comprehensive overview of Gambling Disorder.
This will be covered more in-depth below, but growing research suggests gambling disorder mirrors both the symptoms and neurology behind substance use disorders. The same brain systems that respond to drugs are activated during gambling, reinforcing the behavior and perpetuating relapse risk.<sup>2</sup>
The Brain’s Reward System and How Gambling Hijacks It
Dopamine and Gambling
One potential neurological root of gambling addiction is the mesolimbic dopamine pathway, the brain’s central reward circuit. This pathway connects the ventral tegmental area (VTA) to the nucleus accumbens, regions largely responsible for motivation and reinforcement learning. Dopamine release within this circuit signals that something rewarding has occurred, reinforcing behaviors that may increase survival or pleasure.<sup>3</sup>
When a person gambles, unpredictable outcomes can trigger dopamine surges, even in the absence of a win. Dopamine is a neurotransmitter (a brain-based chemical messenger) that plays a role in the pursuit of pleasure, memory, attention, learning, and motivation. Because of this, sometimes the anticipation of a reward can be as stimulating as the reward itself.<sup>4</sup> Over time, the brain learns to associate gambling cues with these dopamine bursts, strengthening the urge to play. Gambling cues vary from person to person, but can look like flashing lights, slot machine sounds, or certain gambling app interfaces.
The Neurochemistry of Risk and Reward
While dopamine often takes center stage, other neurotransmitters may contribute to the cycle of addiction:
Serotonin helps regulate mood and impulse control. Low serotonergic activity has been associated with impulsivity and compulsive behavior, both common in gambling disorder.<sup>5</sup>
Norepinephrine modulates arousal and stress. Elevated norepinephrine levels may explain the “rush” or excitement felt during high-stakes bets.<sup>6</sup>
Glutamate influences learning and decision-making; abnormal glutamatergic signaling can impair judgment and heighten risk-taking.<sup>7</sup>
Together, these systems reinforce gambling behavior through a potent mix of excitement, anticipation, and emotional relief.
Variable Ratio Reinforcement and the “Near-Miss” Effect
Harmful gambling behavior may be informed by variable ratio reinforcement schedule. This means that when gambling wins occur unpredictably, it may keep the brain guessing, engaged, and persistent. This unpredictability strengthens the neural connection between risk and reward, making gambling behavior difficult to extinguish.<sup>8</sup>
Equally influential is the near-miss effect, in which losing outcomes that are almost wins (or are perceived as near-wins) trigger brain activation similar to actual victories. Neuroimaging studies show that near misses engage areas of the brain that reinforce continued play despite potentially harmful losses.<sup>9</sup>
Beyond Pleasure: Stress and Decision-Making Systems
It is overly simplistic to attribute gambling addiction solely to pleasure. The brain’s stress, reward, and executive control systems can all contribute to continued risky behavior.. Chronic stress and dysregulated cortisol release can heighten vulnerability to addictive behavior, while impaired functioning in the prefrontal cortex (a critical area of the brain in charge of decision-making and impulse control) reduces a person’s ability to weigh long-term consequences.<sup>10</sup>
Multiple Theories: Impulse Control and Addiction
The DSM-5 categorizes gambling disorder as an addictive disorder, but some researchers argue it shares traits with impulse control disorders such as kleptomania or trichotillomania. Neurobiological evidence supports the following views:
Impulse control perspective: Studies have shown altered serotonin metabolites in both pathological gamblers and individuals with impulse control disorders.<sup>11</sup> Reduced serotonin function may lead to impaired behavioral inhibition and increased impulsivity.
Addiction perspective: Similarities between gambling and substance use disorders include tolerance, withdrawal, craving, and relapse patterns. Functional imaging studies show comparable dopamine release patterns between gamblers and individuals using stimulant drugs.<sup>12</sup>
“Natural Addiction”: Recent theories frame gambling disorder as one of the “natural addictions”, which are defined by behaviors that activate the brain’s reward system in the absence of an external substance. Activities such as gambling, sex, and overeating all release endogenous opioid peptides within the VTA and nucleus accumbens, creating powerful feelings of pleasure and reinforcement.<sup>13</sup> In fact, the medication naltrexone, an opioid antagonist (blocker) commonly used in alcohol and opioid use disorder is also effective for gambling.
The Brain’s Capacity for Change: Neuroplasticity and Recovery
When an individual is in recovery from gambling disorder, the brain may start a healing process where it retrains its neural pathways. The concept of neuroplasticity describes the brain’s ability to reorganize itself in response to new experiences. Over time, healthy habits and therapeutic interventions can strengthen new connections that support impulse control and emotional regulation.<sup>14</sup>
Behavioral and Psychotherapeutic Approaches
Cognitive-behavioral therapy (CBT) helps patients identify distorted thought patterns about chance and control, while mindfulness-based therapies enhance awareness of cravings and reduce reactivity. Additionally, motivational interviewing supports individuals in resolving ambivalence about change. These approaches promote the rewiring of circuits associated with habit formation and decision-making.
Pharmacological Interventions
In some cases, medications such as antidepressants like SSRIs and mood stabilizers are used to treat co-occurring issues like depression or anxiety . Opioid antagonists can also play a role in decreasing the urge to gamble. Naltrexone, for instance, blocks opioid receptors that mediate pleasure, reducing the “high” associated with gambling wins.<sup15</sup>
Together, behavioral therapy and pharmacological support can leverage neuroplasticity to restore balance within the brain’s reward and control systems.
Understanding Gambling and Recovery
Gambling disorder is not a sign of moral weakness but a treatable neurobehavioral condition. Its roots lie in the same reward and stress systems that evolved to help humans seek pleasure, learn from uncertainty, and adapt to change. Understanding the neurobiology of gambling allows clinicians, researchers, and individuals in recovery to approach the disorder with compassion and evidence-based interventions. Continued study of the brain’s reward circuits and capacity for neuroplastic change will help refine treatments and improve outcomes for those in need of support.
If you or someone you love is struggling with gambling addiction:
Call or text 988 in the U.S. for 24/7 crisis support.
Visit Gamblers Anonymous (www.gamblersanonymous.org) for peer-led meetings and resources.
Speak with a licensed therapist or addiction counselor specializing in behavioral addictions.
