As outlined previously, pathological gambling exhibits behaviors that bear comparison to those associated with substance-use disorders including alcoholism. These disorders involve the persistence of motivated behaviors—gambling and drug use—in the face of their considerable, but readily apparent, adverse health-related, occupational, and social consequences. In terms of more clearly defined diagnostic criteria, pathological gamblers can experience symptoms of withdrawal, tolerance and cravings apparently comparable to those experienced by individuals with substance dependence disorders (Shaffer et al., 2004). Consistent with this, problem gambling is associated with some, but not all, of the neuropsychological impairments observed in alcoholic-dependent individuals (Lawrence et al., 2009a). Several of these seem to reflect impulsivity phenotypes, including an inability to maintain action restraint (“go-no go” performance), deficient capacity to tolerate delays to larger rewards and problems in risky decision-making. Collectively, the above observations have increased the prospects that pathological gambling will be included alongside the substance use disorders within the formulation of DSM-V (O’Brien, Addiction vs. Dependence for DSM V, College of Problems of Drug Dependence 71st Annual Scientific Meeting, Reno, June 22nd 2009).
