Information for Clinicians

Problem gambling is a treatable addiction.

Gambling disorder is a behavioral addiction diagnosis introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5).This was the first formal recognition of behavioral addiction in the psychiatry text. The previous version DSM-IV called the condition “pathological gambling” and it was classified as an impulse control disorder rather than as the addictive disorder. Gambling disorder, or problem gambling, is a an addiction rooted in the brain, like drug and alcohol addiction. Brain imaging studies have reported that substance use disorder and gambling disorder create similar types of dysfunctions regarding reward processing and decision-making. Gambling behaviors occur on a spectrum, ranging for no harm, at risk, problematic levels and meeting the criteria for gambling disorder. No cost treatment is available for adolescents and adults, as well as affected others, who are experiencing problems related to gambling

Dual Diagnosis

People who experience problems with gambling often face other issues at the same time that may range from physical and mental health conditions to financial problems and social issues as well as substance misuse disorders.

Problem Gambling Rarely Occurs Alone.

Approximately 96% of individuals diagnosed with a Gambling Disorder also experienced one or more other mental health condition.
Of those diagnosed with Gambling Disorder
64% experienced three or more other mental health conditions
10% experienced two or more other mental health conditions
22% experienced one or more other mental health conditions
Only 3.37% of people met the criteria for just Gambling Disorder


Among Gamblers Anonymous members, 12-18% report having attempted suicide. Nearly 50% report having made plans to attempt suicide, and up to 80% reported suicidal ideation.

Substance Misuse

Among those clinically diagnosed with Gambling Disorder many also suffer from substance use disorders. Nearly 75% struggle with an alcohol use disorder and 40-63% face a drug use disorder.

Mental Health Conditions

Those with psychiatric issues are more likely to experience problems with gambling. Specifically, mood disorders (60%), anxiety disorders (40%), and antisocial personality disorders (33%).

Depression: Lifetime depression rates among pathological gamblers is 70-76%.

Personality disorder: 87% of those clinically diagnosed with gambling disorder have been found to suffer from personality disorders.

Substance use disorder

Similarities with Problem Gambling

  • Emotional difficulties develop
  • Stress levels increase
  • Preoccupation with the activity builds
  • Dopamine levels rage and cravings intensify
  • Tolerance increases
  • Usage continues despite negative consequences
  • Impulsivity rises
  • Withdrawal symptoms can develop

Differences from Problem Gambling

  • With this “hidden addiction,” no chemical or blood tests exist to tell if a person has been gambling
  • No saturation point develops, so a person cannot overdose on gambling as is possible with substances
  • The high comes from internal stimuli
  • Fewer resources are available
  • Gambling is often viewed as a risk-free activity
  • Higher rates of suicide are measured among individuals with gambling disorder

Screening – Why it Matters

Clinicians should be aware of the importance of screening and understand that their clients may be at increased risk for developing a problem with gambling.

Screening helps to identify individuals who should seek further assessment for potential gambling-related problems. It does not provide a diagnosis. Many clinicians working with individuals with gambling disorder may not be aware of the client’s “hidden addiction.” Gambling Disorder leads to financial, emotional, social, occupational, and physical harms. Gambling Disorder affects about 5% of the adult population in North Carolina, with an additional 10-20% at risk. People experiencing gambling-related problems are more likely to smoke, consume excessive amounts of caffeine, and have more emergency department visits. Nearly 50% of people who have gambling problems are in treatment for a different mental health or addiction concern. Many cases of Gambling Disorder go undetected, due to limited assessment for this addiction.

Clinicians need to be aware that there is a high rate of suicide and suicidal thoughts among clients with gambling disorder. If left untreated, people experiencing problems with gambling may face negative consequences, such as physical illness, mental health conditions, financial difficulties or possibly criminal activity.

Problems with gambling affect more than the gambler, it’s estimated that an additional eight to ten people in the gambler’s social network will be directly affected.

Screening Tools

Screening and assessment for problematic gambling are two distinct activities. Screening helps you determine whether there is potentially a problem and if someone needs a full assessment.

There are various problem gambling screening tools. Routine screening is brief and narrow in scope, and can help you identify problems early. Screening tools such as the LIE BET, Brief Bio Psycho Social (BBGS) or the NODS-Clip can be added to an already existing intake process.

Open NODS Clip pdf >

Open Lie Bet pdf >

Assessment Tools

DSM-5 Diagnostic Gambling Disorder Criteria – The American Psychiatric Association provides guidelines used for gambling disorders. Five or more “yes” answers indicate a possible diagnosis for a Gambling Disorder. Fewer than five but more than zero indicates a potential problem and/or at-risk indicators that may warrant further support, education and treatment services.

NORC DSM IV Screen for Gambling Problems – The NODS is based on the DSM-IV criteria for Gambling Disorder and assesses both lifetime and past-year problem gambling.

The NORC screening tool or NODS-SA was designed to assist individuals in evaluating whether to modify or seek help for their gambling behavior.

Become an NCPGP Provider

Become an NCPG Provider

NCPGP providers receive referrals and payment for gambling disorder assessment and counseling services. Through the UNC School of Social Work, Behavioral Health Springboard clinicians can access over 32 hours of no cost trainings with free Continuing Education Units (CEUs). Along with opportunities for professional growth and networking.


The NCPGP has more than 80 trained, licensed providers across the state of North Carolina who can provide treatment for problems related to gambling. When people experiencing problems with gambling and concerned loved ones call the helpline, they can be referred to one of the program’s network providers for clinical counseling services.

In order to qualify to submit an application to become a provider on the official registry, the individual must:

• Be a masters level licensed clinician in the state of North Carolina.
• Have an office setting for counseling services.
• Adult clinicians should complete Sure Bet One and Sure Bet Two two-day training workshops.(
• Adolescent clinicians should complete the Blurring the Lines of Gambling (BLOG) 5-module self-paced workshop titled Introduction to Prevention and    Treatment of Youth Problem Gambling and Gaming. (

Adult Clinician Applications contact:

Amanda Winters, NCPGP State Administrator
Cell 919-713-3233


Sure Bet Training Series

To raise awareness and provide education, the North Carolina Problem Gambling Program (NCPGP) sponsors a three-part workshop to provide in-depth knowledge about problem gambling and treatment interventions. In this training, topics of problem and pathological gambling, gambling counseling theory and practice, regulations and ethical issues, and financial aspects of remuneration will be addressed. Trainings are held several times a year.

Sure Bet One

What constitutes problem or pathological gambling? And how do professionals assist individuals whose gambling is creating problems in their home and work lives? This workshop will provide in-depth knowledge about problem and pathological gambling and treatment interventions, gambling counseling theory and practice, regulations and ethical issues, and financial aspects of remuneration. Participants will learn the basics of problem gambling, be introduced to ways to assess the client regarding issues of pathological/problem gambling, gain tips on how to identify recommended outpatient treatment methods and examine the financial aspects of treatment for pathological/problem gamblers.

Sure Bet Two

This workshop will provide in-depth knowledge and practice skills using Motivational Interviewing and financial counseling in problem gambling services to special populations (e.g., military, adolescents, young adults, older adults and females) and their non-gambling family members. Participants will learn how to identify and provide services for special populations, including military, teens, seniors and women; and how to provide culturally competent counseling for problem gamblers and concerned others; and how to conduct in-depth financial counseling for problem gamblers and concerned others.

Sure Bet Three

This workshop focuses on problem gambling and finances. Effective money management strategy and quality mental health principles often work together when discussing any issue connected to smart financial living; but with gambling disorder, there are additional unique challenges that clinicians should consider for more effective treatment outcomes. Specifically speaking, money is often over-valued and considered the “drug” by those who suffer from this behavioral addiction disorder. This distorted thinking can complicate the most basic budgeting & financial-based decision-making activities essential to an overall healthy and balanced lifestyle. Learn more about these unhealthy thinking patterns and the different techniques to utilize when working with those experiencing problem gambling behaviors. Also, gain an overall understanding of what healthy money management principles look like and how to apply them in your sessions with clients and their families.

Blurred Lines Between Gambling and Gaming

(BLOG) is a workshop series designed to provide training on the prevention and treatment for youth affected by problem gambling and gaming.

  • BLOG >

    Blurred Lines Between Gambling and Gaming is a self-paced workshop designed to provide training on the prevention and treatment for youth affected by problem gambling and gaming. This Introduction to Prevention and Treatment for Youth Problem Gambling and Gaming is located at the Behavioral Health Springboard and is a 5-module self-paced course open to anyone. This no cost online training is directed to child and adolescent mental health and school-based clinicians and healthcare professionals to integrate problem gambling and gaming screening, interventions, and treatment pathways into their practices. These modules are also required for all those adolescent clinicians interested in applying to join the registry.
    While these workshops are open to anyone, completion of these events will meet the requirements necessary for application for the NCPGP Provider Registry. Participation in this training does not ensure that a provider will be selected for the registry, but it is required to become an NCPGP provider. Participants must attend 100% of the program to receive credit. Partial credit will not be given.

    Introduction to Prevention and Treatment for Youth Problem Gambling and Gaming



Webinars and ongoing trainings

The North Carolina Problem Gambling Program (NCPGP) offers a series of free webinars focusing on emerging topics in the field of problem gambling. The NCPGP, along with the UNC Chapel Hill School of Social Work Behavioral Health Springboard work together to bring to our state the no-cost trainings, along with on-demand self-paced modules, and live Sure Bet Training opportunities to grow the knowledge, strength, and member base of the problem gambling treatment provider registry.