Current Addiction Reports

, Volume 6, Issue 3, pp 273–295 | Cite as

A Review of the Evidence for Considering Gambling Disorder (and Other Behavioral Addictions) as a Disorder Due to Addictive Behaviors in the ICD-11: a Focus on Case-Control Studies

  • Hyoun S. KimEmail author
  • David C. Hodgins
ICD-11 (D King, S Higuchi and V Poznyak, Section Editors)
Part of the following topical collections:
  1. Topical Collection on ICD-11


Purpose of Review

To conduct a systematic review of recent case-control studies investigating the similarities and differences between gambling disorder (GD), substance use disorders (SUDs), and behavioral addictions (BAs).

Recent Findings

A total of 36 studies were identified for synthesis, with 56% comparing GD to SUDs, 36.11% comparing GD to other BAs, and 8.33% comparing to both. The results indicated that GD and SUDs/BAs do not present with overall differences in neurocognitive, clinical, and impulsivity dimensions. Rather, GD is associated with more nuanced differences in these dimensions. In contrast, GD was likely to present with significant differences in personality although with conflicting results in the directionality and dimensions of the personality trait compared to SUDs/BAs.


GD warrants classification as a disorder due to addictive behaviors. However, nuanced differences exist between GD and SUDs/BAs, which should be taken into account in the conceptualization of GD as an addiction.


Gambling disorder Substance use disorder Behavioral addictions Neurological Personality Comorbidity 



We are grateful to Alana Guidry and Ximena Garcia for their assistance in the preparation of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

40429_2019_256_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 12 kb)
40429_2019_256_MOESM2_ESM.docx (31 kb)
ESM 2 (30 kb)


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    DSM 5. DSM 5. Am J Psychiatr 2013. 991Google Scholar
  2. 2.
    Saunders JB. Substance use and addictive disorders in DSM-5 and ICD 10 and the draft ICD 11. Current Opinion in Psychiatry. 2017;30:227–37.CrossRefGoogle Scholar
  3. 3.
    Grant JE, Potenza MN, Weinstein A, Gorelick DA. Introduction to behavioral addictions. Am J Drug Alcohol Abuse. 2010;36(5):233–41.CrossRefGoogle Scholar
  4. 4.
    Goudriaan AE, Oosterlaan J, De Beurs E, Van Den Brink W. Pathological gambling: a comprehensive review of biobehavioral findings. Neurosci Biobehav Rev. 2004;28:123–41.CrossRefGoogle Scholar
  5. 5.
    Petry NM. Should the scope of addictive behaviors be broadened to include pathological gambling? Addiction. 2006;101:152–60.CrossRefGoogle Scholar
  6. 6.
    Albein-Urios N, Martinez-González JM, Lozano Ó, Clark L, Verdejo-García A. Comparison of impulsivity and working memory in cocaine addiction and pathological gambling: implications for cocaine-induced neurotoxicity. Drug Alcohol Depend. 2012;126:1–2):1–6.CrossRefGoogle Scholar
  7. 7.
    Tavares H, Zilberman ML, Hodgins DC, el-Guebaly N. Comparison of craving between pathological gamblers and alcoholics. Alcohol Clin Exp Res. 2005;29(8):1427–31.CrossRefGoogle Scholar
  8. 8.
    Castellani B, Rugle L. A comparison of pathological gamblers to alcoholics and cocaine misusers on impulsivity, sensation seeking, and craving. Subst Use Misuse. 1995;30(3):275–89.Google Scholar
  9. 9.
    Lee HW, Choi J-S, Shin Y-C, Lee J-Y, Jung HY, Kwon JS. Impulsivity in internet addiction: a comparison with pathological gambling. Cyberpsychol Behav Soc Netw. 2012;15(7):373–7.CrossRefGoogle Scholar
  10. 10.
    Ciarrocchi JW, Kirschner NM, Fallik F. Personality dimensions of male pathological gamblers, alcoholics, and dually addicted gamblers. J Gambl Stud. 1991;7(2):133–41.CrossRefGoogle Scholar
  11. 11.
    Orford J, Morison V, Somers M. Drinking and gambling: a comparison with implications for theories of addiction. Drug and Alcohol Review. 1996;15:47–56.CrossRefGoogle Scholar
  12. 12.
    Ciarrocchi J, Hohmann AA. The family environment of married male pathological gamblers, alcoholics, and dually addicted gamblers. J Gambl Behav. 1989;5(4):283–91.CrossRefGoogle Scholar
  13. 13.
    Goudriaan AE, Oosterlaan J, De Beurs E, Van Den Brink W. Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls. Addiction. 2006;101(4):534–47.CrossRefGoogle Scholar
  14. 14.
    Gearhardt AN, White MA, Potenza MN. Binge eating disorder and food addiction. Curr Drug Abus Rev. 2011;4(3):201–7.CrossRefGoogle Scholar
  15. 15.
    Smith DG, Robbins TW. The neurobiological underpinnings of obesity and binge eating: a rationale for adopting the food addiction model. Biol Psychiatry. 2013;73:804–10.CrossRefGoogle Scholar
  16. 16.
    Contreras-Rodríguez O, Albein-Urios N, Vilar-López R, Perales JC, Martínez-Gonzalez JM, Fernández-Serrano MJ, et al. Increased corticolimbic connectivity in cocaine dependence versus pathological gambling is associated with drug severity and emotion-related impulsivity. Addict Biol. 2016;21(3):709–18.CrossRefGoogle Scholar
  17. 17.
    Contreras-Rodríguez O, Albein-Urios N, Perales JC, Martínez-Gonzalez JM, Vilar-López R, Fernández-Serrano MJ, et al. Cocaine-specific neuroplasticity in the ventral striatum network is linked to delay discounting and drug relapse. Addiction. 2015;110(12):1953–62.CrossRefGoogle Scholar
  18. 18.
    Romanczuk-Seiferth N, Koehler S, Dreesen C, Wüstenberg T, Heinz A. Pathological gambling and alcohol dependence: neural disturbances in reward and loss avoidance processing. Addict Biol. 2015;20(3):557–69.CrossRefGoogle Scholar
  19. 19.
    Worhunsky PD, Malison RT, Rogers RD, Potenza MN. Altered neural correlates of reward and loss processing during simulated slot-machine fMRI in pathological gambling and cocaine dependence. Drug Alcohol Depend. 2014;145:77–86.CrossRefGoogle Scholar
  20. 20.
    Worhunsky PD, Potenza MN, Rogers RD. Alterations in functional brain networks associated with loss-chasing in gambling disorder and cocaine-use disorder. Drug Alcohol Depend. 2017;178:363–71.CrossRefGoogle Scholar
  21. 21.
    • Bae S, Han DH, Jung J, Nam KC, Renshaw PF. Comparison of brain connectivity between Internet gambling disorder and Internet gaming disorder: a preliminary study. J Behav Addict. 2017;6(4):1–11 One of the only studies to compare functional connectivity between gambling disorder and another behavioral addiction. CrossRefGoogle Scholar
  22. 22.
    Bae S, Hong JS, Kim SM, Han DH. Bupropion shows different effects on brain functional connectivity in patients with internet-based gambling disorder and internet gaming disorder. Front Psychiatry. 2018;9(APR).Google Scholar
  23. 23.
    Sen YW, Li YH, Xiao L, Zhu N, Bechara A, Sui N. Working memory and affective decision-making in addiction: a neurocognitive comparison between heroin addicts, pathological gamblers and healthy controls. Drug Alcohol Depend. 2014;134(1):194–200.Google Scholar
  24. 24.
    Bottesi G, Ghisi M, Ouimet AJ, Tira MD, Sanavio E. Compulsivity and impulsivity in pathological gambling: does a dimensional-transdiagnostic approach add clinical utility to DSM-5 classification? J Gambl Stud. 2015;31(3):825–47.CrossRefGoogle Scholar
  25. 25.
    Kräplin A, Bühringer G, Oosterlaan J, Van den Brink W, Goschke T, Goudriaan AE. Dimensions and disorder specificity of impulsivity in pathological gambling. Addict Behav. 2014;39(11):1646–51.CrossRefGoogle Scholar
  26. 26.
    Mallorquí-Bagué N, Fagundo AB, Jimenez-Murcia S, De La Torre R, Baños RM, Botella C, et al. Decision making impairment: a shared vulnerability in obesity, gambling disorder and substance use disorders? Weinstein AM, editor PLoS One 2016;11(9):e0163901.Google Scholar
  27. 27.
    Zhou Z, Zhou H, Zhu H. Working memory, executive function and impulsivity in internet-addictive disorders: a comparison with pathological gambling. Acta Neuropsychiatr. 2016;28(2):92–100.CrossRefGoogle Scholar
  28. 28.
    Vanes LD, van Holst RJ, Jansen JM, van den Brink W, Oosterlaan J, Goudriaan AE. Contingency learning in alcohol dependence and pathological gambling: learning and unlearning reward contingencies. Alcohol Clin Exp Res. 2014;38(6):1602–10.CrossRefGoogle Scholar
  29. 29.
    Torres A, Catena A, Cándido A, Maldonado A, Megías A, Perales JC. Cocaine dependent individuals and gamblers present different associative learning anomalies in feedback-driven decision making: a behavioral and ERP study. Front Psychol. 2013;4(MAR):122.PubMedPubMedCentralGoogle Scholar
  30. 30.
    • Majuri J, Joutsa J, Johansson J, Voon V, Alakurtti K, Parkkola R, et al. Dopamine and opioid neurotransmission in behavioral addictions: a comparative PET study in pathological gambling and binge eating. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2017;42(5):1169–77 One of the only studies to compare neurotransmitter functioning in gambling disorder and behavioral addictions.CrossRefGoogle Scholar
  31. 31.
    Majuri J, Joutsa J, Johansson J, Voon V, Parkkola R, Alho H, et al. Serotonin transporter density in binge eating disorder and pathological gambling: a PET study with [11C]MADAM. Eur Neuropsychopharmacol. 2017;27(12):1281–8.CrossRefGoogle Scholar
  32. 32.
    Yip S, Morie K, Xu J, …, RC-B psychiatry, 2017 U. Shared microstructural features of behavioral and substance addictions revealed in areas of crossing fibers. Biol Psychiatry 2017;2(2):188–95.Google Scholar
  33. 33.
    Yip SW, Worhunsky PD, Xu J, Morie KP, Constable RT, Malison RT, et al. Gray-matter relationships to diagnostic and transdiagnostic features of drug and behavioral addictions. Addict Biol. 2018;23(1):394–402.CrossRefGoogle Scholar
  34. 34.
    Kober H, Lacadie CM, Wexler BE, Malison RT, Sinha R, Potenza MN. Brain activity during cocaine craving and gambling urges: an fMRI study. Neuropsychopharmacology. 2016;41(2):628–37.CrossRefGoogle Scholar
  35. 35.
    Ren Y, Fang J, Lv J, Hu X, Guo CC, Guo L, et al. Assessing the effects of cocaine dependence and pathological gambling using group-wise spare representation of natural stimulus fMRI data. Brain Imaging Behav. 2017;11(4):1179–91.CrossRefGoogle Scholar
  36. 36.
    •• Zilberman N, Yadid G, Efrati Y, Neumark Y, Rassovsky Y. Personality profiles of substance and behavioral addictions. Addict Behav. 2018;82:174–81 This study was one of the more comprehensive case-control studies. It compared gambling disorder to both behavioral addictions and substance use disordere on personality and impulsivity. CrossRefGoogle Scholar
  37. 37.
    Müller KW, Dreier M, Beutel ME, Wölfling K. Is sensation seeking a correlate of excessive behaviors and behavioral addictions? A detailed examination of patients with gambling disorder and internet addiction. Psychiatry Res. 2016;242:319–25.CrossRefGoogle Scholar
  38. 38.
    Choi S-W, Kim H, Kim G-Y, Jeon Y, Park S, Lee J-Y, et al. Similarities and differences among internet gaming disorder, gambling disorder and alcohol use disorder: a focus on impulsivity and compulsivity. J Behav Addict. 2014;3(4):246–53.CrossRefGoogle Scholar
  39. 39.
    Albein-Urios N, Martinez-González JM, Lozano Ó, Verdejo-Garcia A. Monetary delay discounting in gambling and cocaine dependence with personality comorbidities. Addict Behav. 2014;39(11):1658–62.CrossRefGoogle Scholar
  40. 40.
    del Pino-Gutiérrez A, Jiménez-Murcia S, Fernández-Aranda F, Agüera Z, Granero R, Hakansson A, et al. The relevance of personality traits in impulsivity-related disorders: from substance use disorders and gambling disorder to bulimia nervosa. J Behav Addict. 2017;6(3):396–405.CrossRefGoogle Scholar
  41. 41.
    Mallorquí-Bagué N, Fernández-Aranda F, Lozano-Madrid M, Granero R, Mestre-Bach G, Baño M, et al. Internet gaming disorder and online gambling disorder: clinical and personality correlates. J Behav Addict. 2017;6(4):669–77.CrossRefGoogle Scholar
  42. 42.
    Farré JM, Fernández-Aranda F, Granero R, Aragay N, Mallorquí-Bague N, Ferrer V, et al. Sex addiction and gambling disorder: similarities and differences. Compr Psychiatry. 2015;56:59–68.CrossRefGoogle Scholar
  43. 43.
    Granero R, Fernández-Aranda F, Mestre-Bach G, Steward T, Baño M, del Pino-Gutiérrez A, et al. Compulsive buying behavior: clinical comparison with other behavioral addictions. Front Psychol. 2016;7(JUN):914.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Jiménez-Murcia S, Granero R, Moragas L, Steiger H, Israel M, Aymamí N, et al. Differences and similarities between bulimia nervosa, compulsive buying and gambling disorder. Eur Eat Disord Rev. 2015;23(2):126–32.CrossRefGoogle Scholar
  45. 45.
    Granero R, Fernández-Aranda F, Steward T, Mestre-Bach G, Baño M, del Pino-Gutiérrez A, et al. Compulsive buying behavior: characteristics of comorbidity with gambling disorder. Front Psychol. 2016;7(APR):625.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Tonioni F, Mazza M, Autullo G, Cappelluti R, Catalano V, Marano G, et al. Is Internet addiction a psychopathological condition distinct from pathological gambling? Addict Behav. 2014;39(6):1052–6.CrossRefGoogle Scholar
  47. 47.
    Grbeša L, Martinac M, Romić M, Palameta N, Soldo V. Personality of alcoholics and gamblers in the Union of Clubs of Treated Alcoholics and Gamblers. Alcohol Psychiatry Res. 2016;52(2):125–32.CrossRefGoogle Scholar
  48. 48.
    Müller KW, Beutel ME, Egloff B, Wölfling K. Investigating risk factors for internet gaming disorder: a comparison of patients with addictive gaming, pathological gamblers and healthy controls regarding the big five personality traits. Eur Addict Res. 2014;20(3):129–36.CrossRefGoogle Scholar
  49. 49.
    Gavriel-Fried B, Rabayov T. Similarities and differences between individuals seeking treatment for gambling problems vs. alcohol and substance use problems in relation to the progressive model of self-stigma. Front Psychol. 2017;8(JUN):957.CrossRefGoogle Scholar
  50. 50.
    Schwaninger PV, Mueller SE, Dittmann R, Poespodihardjo R, Vogel M, Wiesbeck GA, et al. Patients with non-substance-related disorders report a similar profile of childhood trauma experiences compared to heroin-dependent patients. Am J Addict. 2017;26(3):215–20.CrossRefGoogle Scholar
  51. 51.
    Manning V, Koh PK, Yang Y, Ng A, Guo S, Kandasami G, et al. Suicidal ideation and lifetime attempts in substance and gambling disorders. Psychiatry Res. 2015;225(3):706–9.CrossRefGoogle Scholar
  52. 52.
    Derogatis L, Unger R. Symptom checklist-90 revised. Corsini Encycl Psychol 2010;1–2.Google Scholar
  53. 53.
    Hindmarch I, Kerr JS, Sherwood N. The effects of alcohol and other drugs on psychomotor performance and cognitive function. Alcohol Alcohol. 1991;26(1):71–9.PubMedGoogle Scholar
  54. 54.
    Shaffer HJ, LaPlante DA, LaBrie RA, Kidman RC, Donato AN, Stanton MV. Toward a syndrome model of addiction: multiple expressions, common etiology. Harv Rev Psychiatry. 2004;12(6):367–74.CrossRefGoogle Scholar
  55. 55.
    Billieux J, Schimmenti A, Khazaal Y, Maurage P, Alexandre H. Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research. J Behav Addict. 2015;4(3):119–23.CrossRefGoogle Scholar
  56. 56.
    Kim HS, Hodgins DC. Component model of addiction treatment: a pragmatic transdiagnostic treatment model of behavioral and substance addictions. Front Psychiatry 2018;9(403).Google Scholar
  57. 57.
    Hodgins DC, Stea JN, Grant JE. Gambling disorders. Lancet. 2011;378(9806):1874–84.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of CalgaryN.W. CalgaryCanada

Personalised recommendations