From Play to Pathology: Mental Health, Risk Factors, Neurobiological Mechanisms, and Drivers of Gambling Addiction in Adolescents and Young Adults

Aanuoluwa Temitayo Iyiola, Esther Opeyemi Aworeni, Juke Chika Obasi, Sandra Ifechukwu Alukwe, Jennifer Ayomikun Abraham, Kendra Chime Kpea, Auwal Shehu Ali, Zainab Ajoke Olayiwola

Abstract

Gambling addiction in youth and young adults is a modern, complex public health issue rooted in a convergence of factors, including developmental risks, psychosocial challenges, and disordered neurotransmitter systems. This review of the literature highlights current research in the areas of epidemiology and mental health comorbidity, (i.e., depression, anxiety, ADHD, drug use, suicidality), psychosocial risk factors (i.e., family and peer social norms, socioeconomic disadvantage, internet advertising), and neurochemical processes (i.e., dopaminergic sensitisation, serotonergic dysregulation, GABAergic dysregulation, glutamatergic dysregulation, noradrenergic hyperarousal, endogenous opioid reinforcement) involved in the transition from recreational to pathological gambling. Online gambling formats (i.e., online gambling, micro-transactions, loot boxes) create an increased reinforcement density and accessibility that serves to elevate harms and downstream effects, including financial debt, substance co-use, and suicidality, especially among young adults. The primary contribution of this paper is both theoretical and integrative: it presents an interactional developmental model that specifies and extends the concept of neurodevelopmental immaturity, psychosocial forces, and neurotransmitter dysregulation, which together shift behaviours from play to pathology. The review addresses a critical gap in the knowledge base by showing how to connect epidemiological observations to neurobiological mechanisms and knowledge on prevention, while advocating for longitudinal and culturally appropriate research. 




Keywords


Gambling disorder; Adolescents; Young adults; Neurotransmitters; Risk factors; Digital gambling

Full Text:

PDF


References


1. Stetzka, R. M., & Winter, S. (2021). How rational is gambling? Journal of Economic Surveys, 37(4), 1432–1488. doi: 10.1111/joes.12473

2. Delfabbro, P., King, D. L., & Derevensky, J. L. (2016). Adolescent gambling and problem gambling: prevalence, current issues, and concerns. Current Addiction Reports, 3(3), 268–274. doi: 10.1007/s40429-016-0105-z

3. Tran, L. T., Wardle, H., Colledge-Frisby, S., Taylor, S., Lynch, M., Rehm, J., Volberg, R., Marionneau, V., Saxena, S., Bunn, C., Farrell, M., & Degenhardt, L. (2024). The prevalence of gambling and problematic gambling: a systematic review and meta-analysis. The Lancet Public Health, 9(8), 594–613. doi: 10.1016/s2468-2667(24)00126-9

4. Mantere, E. S., Savolainen, I., Vuorinen, I., Hagfors, H., Palomäki, J., & Oksanen, A. (2025). The Internet of problem gambling: A mixed-methods study of the role of Internet-enabled risk factors among Finnish adults. New Media & Society. doi: 10.1177/14614448251333739

5. Nigg, J. T. (2016). Annual Research Review: On the relations among self‐regulation, self‐control, executive functioning, effortful control, cognitive control, impulsivity, risk‐taking, and inhibition for developmental psychopathology. Journal of Child Psychology and Psychiatry, 58(4), 361–383. doi: 10.1111/jcpp.12675

6. Deans, E. G., Thomas, S. L., Daube, M., & Derevensky, J. (2016). The role of peer influences on the normalisation of sports wagering: a qualitative study of Australian men. Addiction Research & Theory, 25(2), 103–113. doi: 10.1080/16066359.2016.1205042

7. Dowling, N. A., Cowlishaw, S., Jackson, A. C., Merkouris, S. S., Francis, K. L., & Christensen, D. R. (2015). Prevalence of psychiatric comorbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 49(6), 519–539. doi: 10.1177/0004867415575774

8. Hearn, N. L. (2019). Exploring Pathways Towards and Away From Problematic Gambling (Thesis, University of Central Lancashire).

9. Browne, M., Langham, E., Rawat, V., Greer, N., Li, E., Rose, J., Rockloff, M., Donaldson, P., Thorne, H., Goodwin, B., Bryden, G., & Best, T. (2016). Assessing gambling-related harm in Victoria: a public health perspective. PRISM (University of Calgary). doi: 10.11575/prism/9419

10. Livazović, G., & Bojčić, K. (2019). Problem gambling in adolescents: what are the psychological, social and financial consequences? BMC Psychiatry, 19(1), 308. doi: 10.1186/s12888-019-2293-2

11. Dowling, N., Merkouris, S., Greenwood, C., Oldenhof, E., Toumbourou, J., & Youssef, G. (2016). Early risk and protective factors for problem gambling: A systematic review and meta-analysis of longitudinal studies. Clinical Psychology Review, 51, 109–124. doi: 10.1016/j.cpr.2016.10.008

12. Nower, L., & Blaszczynski, A. (2016). Development and validation of the Gambling Pathways Questionnaire (GPQ). Psychology of Addictive Behaviours, 31(1), 95–109. doi: 10.1037/adb0000234

13. Jauregui, P., Onaindia, J., & Estévez, A. (2017). Adaptive and Maladaptive Coping Strategies in Adult Pathological Gamblers and Their Mediating Role with Anxious-Depressive Symptomatology. Journal of Gambling Studies, 33(4), 1081–1097. doi: 10.1007/s10899-017-9675-5

14. Leeman, R. F., Patock-Peckham, J. A., Hoff, R. A., Krishnan-Sarin, S., Steinberg, M. A., Rugle, L. J., & Potenza, M. N. (2014). Perceived parental permissiveness toward gambling and risky behaviours in adolescents. Journal of Behavioural Addictions, 3(2), 115–123. doi: 10.1556/jba.3.2014.012

15. Aymamí, N., Jiménez-Murcia, S., Granero, R., Ramos-Quiroga, J. A., Fernández-Aranda, F., Claes, L., Sauvaget, A., Grall-Bronnec, M., Gómez-Peña, M., Savvidou, L. G., Fagundo, A. B., Del Pino-Gutierrez, A., Moragas, L., Casas, M., Penelo, E., & Menchón, J. M. (2015). Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder. BioMed Research International, 1–11. doi: 10.1155/2015/965303

16. Ioannidis, K., Hook, R., Wickham, K., Grant, J. E., & Chamberlain, S. R. (2019). Impulsivity in Gambling Disorder and problem gambling: a meta-analysis. Neuropsychopharmacology, 44(8), 1354–1361. doi: 10.1038/s41386-019-0393-9

17. Zhai, Z. W., Duenas, G. L., Wampler, J., & Potenza, M. N. (2020). Gambling, substance use and violence in male and female adolescents. Journal of Gambling Studies, 36(4), 1301–1324. doi: 10.1007/s10899-020-09931-8

18. Gerdner, A., & Håkansson, A. (2022). Prevalence and comorbidity in a Swedish adolescent community sample – gambling, gaming, substance use, and other psychiatric disorders. BMC Psychiatry, 22(1), 594. doi: 10.1186/s12888-022-04218-1

19. Richard, J. (2023). Understanding the Development of Problem Gambling and Gaming: The Role of Externalizing and Internalizing Problems from Childhood to Emerging Adulthood (Thesis, McGill University).

20. Armoon, B., Griffiths, M. D., Mohammadi, R., & Ahounbar, E. (2023). Suicidal Behaviours and Associated Factors Among Individuals with Gambling Disorders: A Meta-Analysis. Journal of Gambling Studies, 39(2), 751–777. doi: 10.1007/s10899-023-10188-0

21. Marionneau, V., & Nikkinen, J. (2022). Gambling-related suicides and suicidality: A systematic review of qualitative evidence. Frontiers in Psychiatry, 13, 980303. doi: 10.3389/fpsyt.2022.980303

22. Wardle, H., & McManus, S. (2021). Suicidality and gambling among young adults in Great Britain: results from a cross-sectional online survey. The Lancet Public Health, 6(1), 39–49. doi: 10.1016/s2468-2667(20)30232-2

23. Linnet, J. (2019). The anticipatory dopamine response in addiction: A common neurobiological underpinning of gambling disorder and substance use disorder? Progress in Neuro-Psychopharmacology and Biological Psychiatry, 98, 109802. doi: 10.1016/j.pnpbp.2019.109802

24. Lim, M., Jocham, G., Hunt, L., Behrens, T., & Rogers, R. (2015). Impulsivity and predictive control are associated with suboptimal action-selection and action-value learning in regular gamblers. International Gambling Studies, 15(3), 489–505. doi: 10.1080/14459795.2015.1078835

25. Limbrick-Oldfield, E. H., Mick, I., Cocks, R. E., McGonigle, J., Sharman, S. P., Goldstone, A. P., Stokes, P. R. A., Waldman, A., Erritzoe, D., Bowden-Jones, H., Nutt, D., Lingford-Hughes, A., & Clark, L. (2017). Neural substrates of cue reactivity and craving in gambling disorder. Translational psychiatry, 7(1), 992.

26. Diederen, K. M., & Fletcher, P. C. (2021). Dopamine, Prediction Error and Beyond. The Neuroscientist, 27(1), 30-46.

27. Schultz, W. (2015). Neuronal reward and decision signals: From theories to data. Physiological Reviews, 95(3), 853–951. doi: 10.1152/physrev.00023.2014

28. Clark, L., & Limbrick-Oldfield, E. H. (2013). Disordered gambling: a behavioural addiction. Current Opinion in Neurobiology, 23(4), 655–659. doi: 10.1016/j.conb.2013.01.004

29. Stark, A. J., Smith, C. T., Lin, Y., Petersen, K. J., Trujillo, P., Van Wouwe, N. C., Kang, H., Donahue, M. J., Kessler, R. M., Zald, D. H., & Claassen, D. O. (2018). Nigrostriatal and Mesolimbic D2/3Receptor Expression in Parkinson's Disease Patients with Compulsive Reward-Driven Behaviours. Journal of Neuroscience, 38(13), 3230–3239. doi: 10.1523/jneurosci.3082-17.2018

30. Potenza, M. N., Balodis, I. M., Franco, C. A., Bullock, S., Xu, J., Chung, T., & Grant, J. E. (2013). Neurobiological considerations in understanding behavioural treatments for pathological gambling. Psychology of Addictive Behaviours, 27(2), 380–392. doi: 10.1037/a0032389

31. Spagnolo, P. A., Pérez, L. J. G., Terraneo, A., Gallimberti, L., & Bonci, A. (2018). Neural correlates of cue‐ and stress‐induced craving in gambling disorders: implications for transcranial magnetic stimulation interventions. European Journal of Neuroscience, 50(3), 2370–2383. doi: 10.1111/ejn.14313

32. Brown, R. E., & McKenna, J. T. (2015). Turning a Negative into a Positive: Ascending GABAergic Control of Cortical Activation and Arousal. Frontiers in Neurology, 6, 135. doi: 10.3389/fneur.2015.00135

33. Møller, A., Thomsen, K. R., Brooks, D. J., Mouridsen, K., Blicher, J. U., Hansen, K. V., & Lou, H. C. (2019). Attenuation of dopamine‐induced GABA release in problem gamblers. Brain and Behaviour, 9(3), 01239. doi: 10.1002/brb3.1239

34. Mather, M., Clewett, D., Sakaki, M., & Harley, C. W. (2015). Norepinephrine ignites local hotspots of neuronal excitation: How arousal amplifies selectivity in perception and memory. Behavioural and Brain Sciences, 39, 200. doi: 10.1017/s0140525x15000667

35. Genauck, A., Romanczuk-Seiferth, N. (2019). The Neurobiology of Gambling Disorder: Neuroscientific Studies and Computational Perspectives. In A. Heinz, N. Romanczuk-Seiferth, M. Potenza, M. Gambling Disorder (pp. 127-170). Springer doi: 10.1007/978-3-030-03060-5_7

36. Balconi, M., Angioletti, L., & Delfini, G. (2021). EFS in Pathological Gambling Disorder. In Advances in mental health and addiction (pp. 87–120). doi: 10.1007/978-3-030-82408-2_4

37. Kaasinen, V., Honkanen, E. A., Lindholm, K., Jaakkola, E., Majuri, J., Parkkola, R., Noponen, T., Vahlberg, T., Voon, V., Clark, L., Joutsa, J., & Seppänen, M. (2023). Serotonergic and dopaminergic control of impulsivity in gambling disorder. Addiction Biology, 28(2), 13264. doi: 10.1111/adb.13264

38. Ramnerö, J., Molander, O., Lindner, P., & Carlbring, P. (2019). What can be learned about gambling from a learning perspective? A narrative review. Nordic Psychology, 71(4), 303–322. doi: 10.1080/19012276.2019.1616320

39. Murch, W. S. (2020). Behavioural and physiological correlates of immersion in gambling using electronic gaming machines. Open Collections. doi: 10.14288/1.0394698

40. Abbott, M., Binde, P., Clark, L., Hodgins, D., Johnson, M., Manitowabi, D., Quilty, L., Spångberg, J., Volberg, R., Walker, D., & Williams, R. (2018). Conceptual Framework of Harmful Gambling: An International Collaboration, third edition. University of Calgary. doi: 10.11575/prism/43603

41. Estévez, A., Jáuregui, P., Lopez-Gonzalez, H., Mena-Moreno, T., Lozano-Madrid, M., Macia, L., Granero, R., Mestre-Bach, G., Steward, T., Fernández-Aranda, F., Gómez-Peña, M., Moragas, L., Del Pino-Gutierrez, A., Codina, E., Testa, G., Vintró-Alcaraz, C., Agüera, Z., Munguía, L., Baenas, I., Valenciano-Mendoza, E., Mora, B., Menchón, J. M., & Jiménez-Murcia, S. (2020). The severity of gambling and gambling-related cognitions as predictors of emotional regulation and coping strategies in adolescents. Journal of Gambling Studies, 37(2), 483–495. doi: 10.1007/s10899-020-09953-2

42. Muela Aguilera, I. (2024). Basic mechanisms of emotional regulation in gambling behaviour: implications for learned compulsivity and gambling cognitions (Thesis, Universidad de Granada).


Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.




Copyright (c) 2025 Aanuoluwa Temitayo Iyiola, Esther Opeyemi Aworeni, Juke Chika Obasi, Sandra Ifechukwu Alukwe, Jennifer Ayomikun Abraham, Kendra Chime Kpea, Auwal Shehu Ali, Zainab Ajoke Olayiwola

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.