Healthy living Gambling addiction (pathological gambling)

Gambling addiction, also known as pathological gambling, is an addiction in which the person affected has a strong urge to gamble.

Gambling is often easily accessible. For example, slot machines are not only found in arcades where access is restricted but also in freely accessible restaurants and other entertainment venues. The Internet and cellphones in particular make it easier to access gambling.

Slot machines, either in arcades or online, are associated with a particularly high risk of developing a gambling addiction. Other forms of gambling that often lead to addiction include:

• casino games, such as roulette, cards or dice
• online games, such as online poker
• betting on sports and horse racing

People with a gambling addiction experience a strong urge to gamble, wagering money or valuable items. They find themselves unable to stop gambling even when they suffer serious financial loss, get into debt and risk losing their family, relationship or career.

Typical features of a gambling addiction include:

• an urge to gamble that is difficult to control
• thinking constantly about gambling
• neglecting personal, family and professional responsibilities
• lying and engaging in criminal activity to obtain money
• attempting to recoup money lost by gambling again (chasing losses)
• withdrawing from activities that were previously enjoyed
• failed attempts to quit
• mood swings and sudden outbursts of anger

Most people enjoy having a gamble at some point in their lives. Only a small number develop a gambling addiction. Certain groups of people are at an increased risk of developing a gambling addiction. Certain types of gambling are also associated with a higher risk of causing addiction. Slot machines, online gambling and live sports betting are associated with a particularly high risk of addiction.

Who is at an increased risk of developing a gambling addiction?

The following groups are considered to be particularly at risk:

• Men
• Adolescents and young adults
• People on low incomes and those currently seeking employment
• People with a low level of education
• People from a migrant background
• Family members of people with a gambling addiction, especially children from a family affected by gambling addiction

Why are slot machines, online gambling and live sports betting especially addictive?

These types of gambling are associated with a particularly high risk of gambling addiction because they:

• use a rapid sequence of actions
• make players feel that they regularly have near-wins
• offer tempting opportunities to win big
• convert money stakes into gaming points, so that losses are downplayed
• are widely available
• give players the illusion that they are in control

Gambling is widespread: almost 80 percent of the German population have gambled at least once. One in ten people who gamble do so exclusively online.

According to a study from 2023, 2.4 percent of adults in Germany were addicted to gambling, with the problem affecting more men than women. 

Although gambling is only permitted from the age of 18, around 0.3 to 3.0 percent of adolescents under 18 engage in problematic gambling behavior. Boys are affected much more often than girls. 

Young men are most likely to gamble with card games, slot machines, sports betting, bingo and scratch cards.

A gambling addiction progresses in three phases:

Initial positive phase

Initial wins convey a positive impression of gambling. Wins are increasingly attributed to one’s own skill rather than to the principle of chance.

Critical habit-forming phase

The frequency of gambling and the amount of money that is staked both increase. Players try to recoup their debts by gambling even more (chasing losses). In this phase, the person affected can still go without gambling for short periods. 

The addiction phase

Players lose control over the amount of time and money they spend on gambling. Lying, anxiety and feelings of guilt all increase. Negative consequences of the addiction may be felt, such as debt, relationship problems or difficulties at work. Those affected tend to experience depression and suicidal thinking. The gambling addiction may be accompanied by other addictions, such as alcohol dependence.

Gambling addiction can be difficult to diagnose because people affected may be reluctant to acknowledge the problem or may try to conceal it. Family members or loved ones are often first to raise the issue.

A gambling addiction is usually diagnosed using a short questionnaire completed by the person affected. A diagnosis can be made by a doctor or psychotherapist.

If someone suspects they may have a gambling addiction, they can seek the advice of an addiction counseling center or take an online self-test. However, it should be pointed out that a self-test, while useful, cannot replace a diagnosis by a doctor or psychotherapist.

The Federal Institute for Public Health (Bundesinstitut für Öffentliche Gesundheit, BIÖG) offers a gambling addiction self-test.

Outpatient addiction advice centers, inpatient addiction clinics, self-help groups for addiction and psychotherapists can all help people to manage their addiction. However, only around one in five people with a gambling addiction seek the available help. Often, feelings of shame, a desire to keep the issue hidden, or a wish to solve the problem on their own prevent those affected from seeking support.

People can be treated for a gambling addiction on an inpatient or outpatient basis. Outpatient treatment is aimed at people who:

• are in regular employment
• have a stable living situation
• have a social support system around them
• are already in a position to actively participate in the treatment process and abstain from gambling
• can easily access the treatment center

If these conditions are not met, inpatient treatment in a hospital, clinic or other treatment center can help to break the cycle of gambling addiction. Inpatient treatment is also advised if the person has other conditions and dependencies.

The addiction to gambling is treated in individual or group therapy sessions. These focus on various aspects:

• accepting problems and acknowledging the gambling addiction
• identifying the causes of the gambling addiction
• building the motivation to change
• developing strategies for self-control
• learning how to manage money and debt
• building social connections
• developing strategies to prevent a relapse
• learning relaxation techniques and problem-solving skills

Loved ones often also participate in therapy. Joining a self-help group can help people to manage an addiction and to maintain the progress they have made.

There are various approaches to prevent a gambling addiction. These include awareness-raising programs as well as legal regulations and restrictions, such as:

• Information campaigns and education programs for schools and sports clubs
• Restricting the number of locations that offer gambling
• No gambling venues in disadvantaged urban areas
• Less attractive locations for gambling venues
• Limiting opening times
• Controlled entry and identity checks
• Banning alcohol consumption and smoking on the premises
• No nearby cash terminals and limits on cashless payments
• Limiting highly addictive games
• Raising awareness about the odds of winning and losing
• Changing the structure of games – limiting stakes, wins, losses and game speed
• Limiting and banning advertising
• Providing information about support options
• Training staff in the early detection of problematic gambling behavior
• Gambling block information and services

What is a gambling block?

A gambling block prevents people from gambling. A person with a gambling addiction can exclude themselves from gambling using a gambling block. This is known as self-exclusion. 

Family members of those affected and gambling providers can also apply to have individuals blocked from gambling. This is known as third-party exclusion. All lottery companies, casinos, slot machine operators, and state-licensed betting shops and online gambling providers in Germany are connected to the nationwide OASIS gambling block system.

For more information about gambling blocks, see check-dein-spiel.de, a service provided by the Federal Institute for Public Health (BIÖG).

There are many ways to seek advice and information about this topic by phone, in person or online.

For a comprehensive overview of the various support options available, see bundesweit-gegen-gluecksspielsucht.de.

Where can I get advice over the phone?

For free, anonymous advice, the Federal Institute for Public Health (BIÖG) can be contacted by phone seven days a week at 0800 - 137 27 00. Telephone counseling is provided from 10 a.m. to 10 p.m. Monday to Thursday and from 10 a.m. to 6 p.m. Friday to Sunday.

The helpline of the Professional Association for Gambling Addiction (Fachverband Glücksspielsucht e.V.) can be reached by dialing 0800 - 0776611.

Which websites provide information about gambling addiction?

Information about gambling addiction, as well as contact details for or links to help and support services are available online at:

• check-dein-spiel.de
• verspiel-nicht-dein-leben.de
• gluecksspielsucht.de
• forum-gluecksspielsucht.de

Some websites offer self-tests that allow people to assess their own gambling behavior and determine whether they may have a problem. These include:

• check-dein-spiel.de
• verspiel-nicht-dein-leben.de
• automatisch-verloren.de

The Federal Institute for Public Health (BIÖG) also offers a free and anonymous online quitting program called “Check out”.

Where can I find an advice center close to me?

There are 1,400 addiction advice centers in Germany, 300 of which specialize in supporting people with a gambling addiction and their loved ones. 

The German Center for Addiction Issues (Deutsche Hauptstelle für Suchtfragen e.V., DHS) provides a zip code search that lists local advice centers – see dhs.de.

The federal state coordinating bodies for gambling addiction (Landeskoordinierungsstellen Glücksspielsucht) also provide a search function for local counseling services.