How to Overcome a Gambling Addiction

How can you overcome a gambling addiction? ‪CYOP‬’s Lisa Schaefer, LISW-S is finishing her gambling fellowship and shares strategies with Nick, CRNA. Increasing friction and creating time to react, CBT, and using specific treatments like TMS, psychiatric medications, or Spravato may have their place, but research also shows the benefits of friends—real ones, not the fake ones on ‪@DraftKings‬ commercials. We often use ketamine for serious addictions, because it alters the risk/reward system in the brain, but Lisa gives practical, holistic tips so that hopefully we won’t need powerful intravenous medications to stop patients from wrecking their lives. Transcript below.

Gambling Discussion with Lisa

Host:
All right, Lisa. I’ve got 20 bucks—maybe even 30. Let’s see what I’ve got. Twenty dollars says I can make a basket, but it has to be a bank shot off the wall with my non-dominant hand.

Lisa:
Okay.

Host:
Wait, wait, wait. I can do another ten bucks. This time, I’ll bounce the ball off my head and into the trash can behind me. Then I can double my money. Sound good?

Lisa:
You could probably double your money.

Host:
All right. Here’s my money. Thanks.

So, in case you missed it, today we’re going to talk about gambling. Lisa is thrilled to be here, which may surprise some people. Do guests have to get paid to come on the show? Well, apparently, I just paid you thirty dollars.

Before we get started, I should probably give a disclaimer, which I rarely do: this is not medical advice. My goal is to learn from experts so that we can better collaborate and refer patients appropriately. You’re welcome to watch, learn something new, and reach out to one of us if anything we discuss resonates with you.

Today’s topic is gambling.

Lisa:
And based on your opening demonstration, it looks like you might need a few lessons yourself.

Host:
That’s fair.

Lisa:
Your introduction is actually a simple illustration of what gambling is: the chance to win. We can look at the DSM criteria and discuss what qualifies as gambling disorder, but at its core, gambling is someone focusing on the possibility of winning.

When we look at our broader culture, that desire to win appears in many different areas of life.

Host:
That’s interesting. I’m not coaching soccer this season, and just yesterday my wife pointed out how much energy I invested into wanting to win. I always tried to be a good coach and give all the kids opportunities to play, but winning still mattered a lot to me. We won the championship last season, and afterward I thought, “Good. I’ve done it. I can retire now.”

Lisa:
Exactly. Most people think of gambling as something that only happens in casinos, at the lottery counter, or through private clubs that offer gambling activities. But today gambling extends far beyond those traditional settings.

Host:
I would show my phone as an example, except I gambled it away earlier.

Lisa:
Exactly. We now carry devices that give us instant access to countless gambling opportunities. As laws expand access to gambling, especially mobile gambling, participation becomes easier than ever.

Host:
So it has become frictionless. That applies not only to gambling but to many modern vices. There was a time when someone had to make a deliberate decision—drive somewhere, spend money, and accept the consequences. Now it’s effortless. You can lose money before you’ve even stopped to think about what you’re doing.

I recently saw an advertisement while watching basketball. It showed someone in the middle of the night checking their betting app, as if waking up at 3:00 a.m. to monitor your wagers was perfectly normal.

Lisa:
And the advertisements themselves are part of the issue. They present gambling as harmless entertainment. They also feature major celebrities: Kevin Hart, LeBron James, Shaquille O’Neal, and others. The message is clear: if these successful, likable people are doing it, maybe you should too.

Host:
Right. It’s all about using approachable stars. The marketing implies that gambling is a fun, social experience you can enjoy with your friends, rather than something that could leave you isolated and financially devastated.

I’ve noticed that especially during the NBA playoffs. This conversation may be watched years from now, but as of yesterday, the Cavaliers lost to the Knicks. I attended some playoff games this season, and I was disappointed by the loss. I would have been even more disappointed if I had money riding on it.

Lisa:
Especially living near Cleveland, where sports betting may not always be the safest financial strategy.

When we talk about sports betting, many people focus on betting whether a team wins or loses. But modern gambling goes much deeper than that. There are wagers on individual pitches, strikeouts, walks, home runs, and countless other events. Entire online communities participate in betting on what will happen next in real time.

That can become a very slippery slope and often leads to increased isolation and loneliness.

Host:
What’s fascinating is that even highly analytical people struggle with this. My older brother has a Ph.D. in operations research, helped found the sports blog Deadspin, and understands game theory as well as anyone. After studying these systems, he ultimately concluded that they are designed so well that even someone with that level of expertise cannot consistently beat them.

Yet many people convince themselves they can.

We see that same thinking in day trading. People tell themselves they’re investing in their future when, in reality, some are simply gambling through a different platform.

Lisa:
Absolutely. People often imagine themselves as the next financial genius when they’re really just chasing the next dollar. The problem is that many opportunities for impulsive financial risk are available at our fingertips.

If impulse control is weak, financial instability can follow very quickly. Because gambling outcomes are immediate—whether a free throw goes in or not—there’s very little time to think through the consequences. It becomes a constant stream of dopamine rewards.

Host:
That’s why I think one of the most important questions is how people can intentionally create friction in the process.

If someone says, “I’m going to the casino tonight and I know I’ll probably lose some money,” at least there’s awareness. That’s very different from repeatedly placing bets on a phone without even realizing how much money is disappearing.

I remember hearing a story on The Dave Ramsey Show about a woman who claimed her husband “accidentally” gambled away $30,000. Ramsey’s response was that nobody accidentally loses $30,000 gambling. At some point, there were many decisions made along the way.

So how do people slow down and become aware of what they’re doing?

Lisa:
A lot of that comes back to cognitive behavioral therapy. We examine the relationship between thoughts, emotions, and behaviors.

What are people telling themselves when they’re winning? What are they thinking when they’re losing? More importantly, what distorted beliefs are they using to justify continuing to gamble?

Host:
And I imagine some of that is the sunk-cost fallacy: “I’ve already lost so much money, so I need to keep going to win it back.”

Lisa:
Exactly. Casinos are designed around the concept of “playing to extinction,” meaning the goal is to keep someone playing until there’s no money left.

Even incentives that seem harmless can contribute. For example, imagine a casino offers free parking if you gamble for thirty minutes. People focus on saving the parking fee but ignore how much they might lose while trying to earn that reward.

Host:
Does gambling work like other addictions, where once the process starts, the brain is essentially primed to continue?

Lisa:
Sometimes, but gambling is unique. With substances, addictions often overlap because similar neurological pathways are involved. Gambling is more behavioral.

A person might be unable to control themselves inside a casino yet have no trouble spending twenty dollars at a bingo hall and walking away. Different gambling environments affect different people differently.

There are tools available to help create barriers. People can voluntarily place themselves on exclusion lists, and there are apps designed to help monitor gambling behavior and financial consequences.

The question becomes: where can we insert enough friction to interrupt the cycle?

Host:
And unlike alcohol or drugs, gambling can be hidden for a very long time.

Lisa:
Exactly. There are usually no obvious physical signs. A person can be deeply involved in gambling and nobody around them knows.

Unfortunately, that isolation contributes to one of the greatest risks associated with gambling disorder: suicide. Suicide prevention is one of the major reasons we work so hard to increase awareness and treatment.

Host:
That’s an important point. It also sounds like social connection can be incredibly protective.

The advertising tells people that gambling will help them connect with friends. Maybe the reality is the opposite: genuine friendships and healthy communities are what help protect people from gambling problems.

Lisa:
Absolutely. Community is one of the most effective tools we have against addiction. That’s why support groups and 12-step programs remain valuable. People need others who understand what they’re experiencing and can help them make healthier choices.

And prevention starts much earlier than most people realize. We should also be asking how children are being introduced to gambling-like behaviors through gaming.

When we were kids, you bought a game, brought it home, and played it. Today, many games are built around in-game purchases, skins, upgrades, and loot boxes.

Those systems introduce the same reward mechanisms found in gambling.

Host:
Even the visual design is similar. The colors, sounds, flashing lights, and constant rewards look a lot like casino slot machines.

Lisa:
Exactly. Everything is designed to keep people engaged indefinitely. All they need is a credit card number.

Sometimes parents don’t realize how quickly children can spend money until they receive the next credit card statement and discover that several hundred dollars were spent on in-game purchases.

Host:
One practical solution might be encouraging more cooperative activities, whether digital or in person. Board games are great because they require social interaction and patience.

Lisa:
I agree. Bring back board games. Bring back activities that connect people to each other.

Host:
And board games teach an important lesson: not every experience provides a constant dopamine reward. Sometimes you stay engaged simply because you committed to doing something with other people.

That seems like a good transition into discussing dopamine itself…

Dopamine, Gambling Triggers, and Treatment

Host:
We’ve talked quite a bit about dopamine, so it may be helpful to explain what we mean by that.

When I refer to dopamine, I’m talking about the brain’s reward circuitry. Certain behaviors become reinforced over time, creating increasingly strong neural pathways. At Ascend, we use treatments such as TMS, psychiatric medications, and ketamine infusions to help address conditions that involve these kinds of brain circuits—including gambling addiction.

Typically, when we have guests on the show, I’ll make a general comment like, “If you connect with one of us, feel free to reach out.” In this case, though, I think people struggling with gambling should probably start with you. You completed specialized training in gambling treatment, and I consider you the expert in this area.

What happens is that the brain develops these powerful connections. Eventually, the default response becomes, “I’ll grab my phone,” whether I’m happy, stressed, bored, anxious, or simply have a few free minutes. The brain always finds a reason, and that pattern becomes difficult to break.

What I find fascinating is that gambling addiction doesn’t always operate like substance addiction. For example, when someone attends an AA meeting, many people end up replacing one addictive behavior with another. But you’re saying that with gambling, a person may be able to manage one gambling activity while completely losing control in another.

Lisa:
That’s right. I’m not sure I’d call it a social construct as much as a preference for how a person receives their dopamine reward.

Some people are drawn to slot machines—the lights, sounds, animations, and constant sensory stimulation. Others prefer poker, where the pace is much slower and anticipation becomes part of the reward. The question becomes: what type of experience does a person find most reinforcing?

Do they enjoy waiting for the outcome and building anticipation? Or do they prefer the rapid-fire excitement of flashing lights, spinning reels, vibrations, and immediate results?

The answer varies from person to person, and those preferences often determine where someone is most vulnerable.

Every March is Gambling Awareness Month, and the Problem Gambling Network of Ohio hosts educational events, including tours of casinos throughout the state. These tours help professionals learn about casino operations while also observing gambling behavior in real-world settings.

When you watch people enter a casino, it’s fascinating. Some barely make it through the door before putting money into the first machine they see. They may stay there for a few minutes, depending on whether they’re winning or losing, then cash out and move immediately to another machine, and then another.

You can almost watch someone move through a familiar ritual. The cognitive distortions involved are often significant. People develop very strong beliefs about why they’re winning, why they’re losing, or why one machine is somehow “better” than another.

Host:
That’s interesting because there are entire online communities built around those beliefs. Whether it’s Reddit forums or other discussion groups, people share strategies and theories about how to beat the system.

Does that make gambling addiction more challenging for certain populations? I’m thinking specifically about people with ADHD or other neurodivergent conditions, since you work extensively with those groups.

Lisa:
In many cases, yes. People with ADHD and other neurodivergent presentations may be more susceptible to impulsive behaviors. You can think of it as a nervous system that’s already operating at a higher level of stimulation.

Another area receiving increased attention is what happens during menopause. As estrogen levels decline, dopamine regulation changes as well. Research suggests this can create a period of increased vulnerability to gambling addiction for some women.

Cruise ships are another interesting example.

Host:
The “win a free cruise” strategy?

Lisa:
Exactly. You win a free cruise, which sounds wonderful. But how do they encourage you to come back?

You return to the cruise, which places you right back in the casino environment. Then you try to win another cruise.

The important question becomes: How much money did someone spend to win that “free” cruise? It’s similar to the person spending hundreds of dollars trying to earn free parking at a casino.

From the company’s perspective, it’s a win-win situation. Either the customer returns and continues gambling, or they eventually run out of money and are no longer a customer.

Host:
That’s a sobering way to look at it.

By the way, when did you complete your gambling fellowship? It’s been several months, hasn’t it?

Lisa:
It’s been about eight or nine months overall. I started the program in September and officially graduate next month.

It has been a wonderful experience. Through the Problem Gambling Network of Ohio, I’ve met incredible professionals doing important work.

Unfortunately, the demand for gambling treatment is extremely high, while the number of trained providers remains relatively low. To provide gambling-specific services ethically and effectively, specialized training is essential.

Host:
Absolutely.

If someone watching realizes they may have a gambling problem, what’s the best place for them to start?

Lisa:
They can visit the Carve My Own Path website. They can also access resources through the Problem Gambling Network of Ohio.

If someone believes they may be struggling, they can explore self-exclusion programs, treatment options, and other resources that create barriers between themselves and gambling activities. The goal is to find what feels most appropriate and manageable for their situation.

Host:
In other words, create friction.

Lisa:
Exactly. Create friction.

Host:
For those looking for support through Ascend, you can visit Ascend Health Center or call us directly. We can help address many of these issues as well.

We also have an anxiety workshop coming up with Paula from Creative Calm Coaching, who previously worked as one of our nurses. Sometimes gambling behavior is connected to anxiety, and when people learn how to calm their nervous system, they become better equipped to make healthy decisions.

Do you have any educational programs coming up?

Lisa:
Yes. We’re offering a series of free continuing education courses for licensed professionals.

Topics include ethics, supervision, gambling and substance-use crossover, and embodied or somatic therapy interventions. These programs are available through a grant we received and will be offered free to the public.

Host:
That’s fantastic because gambling treatment is highly individualized. There isn’t a single intervention that works for everyone.

Sometimes a person benefits from a medical intervention. Sometimes they need therapy. Sometimes they benefit from somatic approaches that help them recognize the physical sensations that occur before they place a bet.

If they can recognize those sensations early enough, they may be able to interrupt the cycle before they act.

And gambling has become such a major issue in Ohio. Even elected officials have expressed concerns about how rapidly sports betting has expanded. New regulations have already been introduced because college athletes were receiving threats from gamblers angry about game outcomes.

This is a growing problem.

Lisa:
It is. And legislation is only one piece of the puzzle.

The next area we’ll likely be discussing is online casino gaming, or “iGaming.” The potential implications are significant.

When there is a tremendous amount of money involved, there will always be pressure to expand access, which makes education and prevention even more important.

We also need to think critically about things like sweepstakes, raffles, and other games of chance. We use some of these activities for fundraising and community events. They often seem harmless, but they also introduce people to gambling-related concepts and behaviors.

At a conference I attended, several speakers discussed the black market surrounding gaming items, such as character skins, digital weapons, and other virtual assets.

One virtual item in a game was reportedly valued at around $8,000. That’s not a real-world asset, yet people were willing to spend enormous amounts of money because they believed it would improve their status or performance within the game.

Many think, “I’ve invested so much already that this is the next logical step.”

The same mentality can create opportunities for scams, fraud, and all kinds of get-rich-quick schemes online.

Host:
Absolutely.

Well, Lisa, thank you for joining us today.

Lisa:
Thanks for having me.

Host:
And thank you to everyone watching the Ascend Health Show.

Announcer:
You are watching WCTV, Wadsworth Community Television.