Gambling and gaming disorder

Gambling involves risking money or other assets of value on an event with an uncertain outcome, with the expectation of making a profit. Unlike other recreational or sporting activities, the outcome depends wholly or partially on chance, although elements of skill or knowledge may play a role in some forms of the activity.

Gambling encompasses a wide variety of activities, including: sports betting; lotteries; bingo; slot machines; casino games; poker and other card games played for money; horse racing betting; and other forms of wagering on events.

These activities can take place in physical establishments or via digital platforms accessible through computers, mobile phones, and other electronic devices.

The digital transformation of gambling

In recent years, gambling has undergone a profound transformation driven by technological development and the expansion of the internet.

Digital platforms allow for betting at any time and place, lowering barriers to entry and increasing the availability of games. At the same time, mobile apps, electronic payment systems, personalized advertising, and real-time betting have changed the way people interact with these products.

Digitization has also facilitated market expansion into new demographic groups—particularly adolescents and young adults—as well as the introduction of new betting formats and increasingly rapid, continuous interaction mechanisms.

A continuum of participation, risk, and harm:

Not everyone who gambles experiences negative consequences.

The International Classification of Diseases (ICD-11) recognizes that gambling participation can be understood as a continuum ranging from occasional involvement to higher-risk patterns and, in some cases, the development of a gambling disorder.

This continuum includes:

- Gambling participation: Refers to individuals who participate occasionally or infrequently and do not experience significant consequences for their health or well-being. - Hazardous gambling: The ICD-11 defines this as a pattern of gambling that significantly increases the risk of harmful consequences for the physical or mental health of the individual or others around them. Although it does not meet the diagnostic criteria for gambling disorder, this pattern warrants preventive interventions and counseling from health services.

- Gambling disorder: Gambling disorder is a mental disorder recognized in the ICD-11. It is characterized by:

• A need to gamble with increasing amounts of money to achieve excitement.
• Restlessness or irritability when attempting to cut down or stop gambling.
• Repeated, unsuccessful efforts to control, reduce, or stop gambling.
• Constant preoccupation with gambling, including planning future bets or reliving past experiences.
• Gambling to relieve negative emotions such as anxiety, guilt, or depression.
• Attempts to recoup losses through further gambling.

This pattern causes significant impairment in personal, family, social, educational, or occupational areas of life and can occur in both in-person and online settings.

Harm extends beyond the disorder

The impact of gambling is not limited to individuals who meet the diagnostic criteria for a disorder.

Many people experience financial, family, social, or mental health consequences without developing a gambling disorder. Furthermore, the harm can extend to family members, close associates, and communities.

For this reason, public health responses focus not only on treating the disorder but also on preventing harm, reducing risk factors, and creating environments that protect the health and well-being of the population.

Gambling can cause a wide range of harms affecting individuals, families, and communities. These harms are not limited to those with a gambling disorder; they can also affect people with varying levels of involvement and risk.

From a public health perspective, understanding the impact of gambling means recognizing that its consequences extend beyond financial losses and can affect mental health, family relationships, educational and work performance, social cohesion, and community development.

Mental health harms

Gambling can affect emotional well-being and mental health in various ways. Financial losses, uncertainty, stress, and conflicts stemming from gambling can contribute to the onset or worsening of symptoms of anxiety, depression, sleep disorders, and other mental health issues.

For some individuals, gambling can escalate into a gambling disorder—recognized in the International Classification of Diseases (ICD-11)—characterized by a loss of control over gambling behavior and its persistence despite negative consequences.

Evidence also shows a link between gambling-related problems and an increased risk of suicidal ideation and attempts, particularly when financial difficulties, social isolation, or other mental health disorders are also present.

Economic harms

Economic consequences are among the most visible impacts of gambling.

Losses can lead to:

• Indebtedness.
• Difficulty meeting basic needs.
• Use of high-cost loans or credit.
• Loss of savings or assets.
• Difficulty maintaining housing.
• Financial problems affecting the entire family.

In some cases, these difficulties can trigger a chain of social and health consequences that persist for years.

Family and social harms

The effects of gambling can extend far beyond the individuals who gamble.

Frequently reported consequences include:

• Family conflicts.
• Loss of trust.
• Deterioration of romantic relationships.
• Domestic violence.
• Neglect of children or other dependents.
• Social isolation. 
• Severing of family and community ties.

Evidence shows that the harm caused can simultaneously affect multiple people in the individual's immediate circle and compromise the well-being of the entire family unit.

Harm to others

The impact of gambling is not limited to the gambler alone.

Financial losses, family conflicts, and emotional consequences can affect partners, children, other relatives, friends, and communities.

For this reason, gambling is considered a public health issue; its effects extend beyond the individual and can generate significant social costs.

The consequences of gambling can also span generations.

Financial hardship, the loss of family assets, the exposure of children and adolescents to persistent conflict, and reduced educational and social opportunities can all impact the well-being and development of future generations.

The harm goes beyond the diagnosis

Although gambling disorder represents the most severe manifestation of the problem, the majority of gambling-related harm does not occur exclusively among those who meet diagnostic criteria.

Many people experience financial losses, family conflict, mental health issues, or other consequences without developing a gambling disorder.

Consequently, public health strategies aim to prevent and reduce harm across the entire spectrum of participation, risk, and harm through actions that promote healthier environments, reduce exposure to risk factors, and strengthen protections for the population.

Preventing gambling-related harm requires a comprehensive public health response. While individual choices play an important role, evidence shows that product characteristics, gambling availability, advertising, the digital environment, and other social and commercial determinants significantly influence exposure and the risk of experiencing harm.

Consequently, public policies aim to create environments that protect public health, reduce exposure to risk factors, and strengthen protective factors—particularly for children, adolescents, and other highly vulnerable groups.

A public health approach

Traditionally, responses to gambling have focused on individuals who develop a disorder and on "responsible gambling" strategies aimed at promoting safer individual choices.

These interventions alone are insufficient to reduce the population-level impact of gambling.

A public health approach recognizes that harm is also influenced by social, commercial, and environmental factors; it therefore combines interventions targeting individuals with policies that reduce exposure to risk and promote healthier environments.

Evidence indicates that the most effective responses combine multiple interventions implemented in a coordinated manner.

1. Strengthen regulation

Regulatory frameworks can help reduce gambling-related harms through measures such as:

• Regulating authorized forms of gambling.
• Establishing oversight and enforcement mechanisms.
• Strengthening consumer protection.
• Providing special protection for children and adolescents.
• Ensuring that policies prioritize public health.

2. Reduce exposure to risk

Decreasing exposure to gambling can help reduce harm. Strategies used by various countries include:

• Regulating the availability and accessibility of gambling.
• Establishing controls on operating hours and access methods.
• Implementing age verification measures.
• Strengthening protection mechanisms for at-risk individuals.

3. Regulate advertising, promotion, and sponsorship

Advertising and other marketing strategies can normalize gambling and increase participation, particularly among children, adolescents, and young adults. Public policies can include measures to:

• Limit exposure among minors.
• Regulate sports sponsorship.
• Control digital advertising.
• Oversee promotions and bonuses.
• Reduce commercial practices that may encourage higher-risk behaviors.

4. Promote community-based prevention

Prevention also involves actions that strengthen protective factors, reduce risk factors, and promote healthy choices.

These interventions can be carried out in:

• Schools.
• Universities.
• Communities.
• Workplaces.
• Health services.
• Media outlets.

Their goal is to strengthen the knowledge, skills, and capacity to recognize risks and seek support when needed.

5. Strengthen surveillance and research

Public policies require reliable information to guide decision-making. Surveillance systems can help monitor:

• Gambling participation.
• Associated harms.
• Exposure to advertising.
• The most affected groups.
• Market trends.

The impact of implemented interventions:

Prevention requires the participation of multiple sectors. The response to gambling does not depend solely on the health sector.

Addressing it requires the coordinated participation of various sectors, including those responsible for regulation, education, finance, child protection, sports, justice, consumer protection, the digital sphere, and other relevant stakeholders.

The health sector plays a fundamental role by generating evidence, strengthening surveillance, supporting the development of evidence-based policies, promoting preventive interventions, and ensuring access to care services for those affected.

Prevention of gambling-related harm: from the “responsible gambling” paradigm to the public health approach

Gaming refers to playing video games on various platforms, such as consoles, computers, mobile phones, and handheld devices. Video games are part of the entertainment and daily lives of millions of people worldwide and can offer recreational, social, educational, and competitive experiences.

For most people, playing video games is a leisure activity that neither causes negative health consequences nor requires intervention.

Gaming disorder is a recognized disorder in the International Classification of Diseases (ICD-11). It is characterized by a persistent or recurrent pattern of video game-related behavior that includes:

• Impaired control over gaming.
• Increased priority given to gaming over other activities.
• Continuation or escalation of gaming despite negative consequences.

To establish a diagnosis, this pattern must cause significant impairment in personal, family, social, educational, or occupational functioning and generally persist for at least 12 months, although this period may be shorter when symptoms are particularly severe.

It is important to note that gaming disorder is a rare condition and should not be confused with frequent or intensive video game use.

In digital environments, the boundaries between gaming and gambling have become blurred. Some video games incorporate mechanisms such as loot boxes, microtransactions, betting with virtual items, and other practices that share characteristics with gambling. These mechanisms can increase exposure to dynamics involving chance and spending, particularly among children, adolescents, and young adults. Preventing gambling-related harm requires a comprehensive public health response that combines regulation, exposure reduction, the protection of children and adolescents, surveillance, early detection, care, and treatment. Actions focused exclusively on individual responsibility are insufficient if issues such as availability, advertising, product design, and other social and commercial determinants are not also addressed.

There is no specific number of hours that determines whether a person has a gaming-related problem.

The most important factor is observing how this activity affects their daily life.

Some signs that may indicate a need to seek professional guidance include:

• Persistent difficulty controlling the time spent on video games.
• Neglecting important activities, such as studies, work, sports, or social relationships.
• Frequent conflicts related to gaming time.
• Continuing to play despite obvious negative consequences.
• Significant deterioration in well-being or daily functioning.

These signs should be interpreted within the context of the individual's situation and evaluated by qualified professionals.