Pathologies

Gambling: here are the brain mechanisms that foster addiction

The disorder is the outcome of an integrated dysfunction of different motivational, affective and cognitive systems, but prevention and early support are possible

by Gianluca Bruti*

17 April 2026

4' min read

Translated by AI

Versione italiana

4' min read

Translated by AI

Versione italiana

Gambling Disorder (GDD), defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) as a behavioural addiction, is today an issue of clinical and public health importance. Even in the Italia context, the phenomenon takes on significant dimensions and requires an approach that knows how to combine prevention, early recognition and adequate support tools.

The available data confirm the need for a non-marginal reading of the problem. According to the ISTISAN Report 19/28 of the Istituto Superiore di Sanità, published in 2019 on data collected in 2017, 36.4% of the Italian adult population, or about 18.4 million people, said they had engaged in gambling with cash winnings at least once in the previous 12 months. This figure describes the prevalence of gambling behaviour in the general population, and not the prevalence of the disorder. However, a more limited but clinically relevant share presents problematic characteristics: 3% according to Iss data referring to 2018 and 4% according to the Ipsad study recalled in 2023 on the population aged between 18 and 84. Again, these are estimates referring to problematic or risky behaviour, which do not automatically overlap with an overt diagnosis of ADI.

The dysfunction of motivational systems

From a neurobiological point of view, ADI can be read as the outcome of an integrated dysfunction of different motivational, affective and cognitive systems. In many subjects one observes a hyperactivation of the threat system, associated with states of alertness, anxiety and chronic stress, accompanied by a difficulty in accessing internal safety and regulation systems. Within this framework, gaming behaviour may assume a compensatory function, becoming a dysfunctional attempt to modulate internal tension, emotional emptiness or dysregulation.

At the same time, the dopaminergic reward system may undergo progressive sensitisation to the stimuli typical of gambling, especially in the presence of intermittent and unpredictable reinforcements. It is precisely this dynamic, well known in the addiction clinic, that fosters the transition from initially episodic behaviour to repetitive, increasingly less free and increasingly automated conduct.

A further central element in the psychopathology of ADI is neurocognitive distortions. These include the illusion of control, interpretative biases relating to winnings, minimisation of losses, mnestic selection of favourable episodes and an altered temporal and quantitative perception of gaming behaviour. These processes are not ancillary aspects, but maintenance mechanisms of the disorder: they reduce the subject's ability to realistically represent the economic, relational and psychological consequences of their behaviour and hinder the activation of a timely request for help.

The importance of patient awareness

For this reason, patient awareness is one of the central objectives of the intervention. Increasing metacognition, behaviour monitoring and the ability to read one's own internal states means intervening not only on the symptom, but on the processes that support it. In other words, fostering the possibility of observing what was previously acted out automatically already constitutes a therapeutically relevant step.

In this scenario, the integration of dedicated digital tools opens up an interesting perspective, especially on the side of prevention and early support. A first relevant function of technology concerns the fight against the dispersion of gaming behaviour, through the monitoring of the time spent, the frequency of episodes and, where possible, the money spent. The immediate visual restitution of this information, by means of graphs, alerts or trends, can represent a simple but clinically significant feedback modality: making visible what the brain tends to minimise.

A second function concerns the possible intervention in cognitive distortions. Contextual reminders, time thresholds, alert notifications and psycho-educational messages can help interrupt mental automatism, introducing a pause between stimulus and response. Even apparently elementary information, if inserted at the right moment, can reactivate reflexive processes that the subject, in the midst of impulsive behaviour, tends to suspend.

A third side is that of emotional regulation support. Digital tools including breathing exercises, grounding techniques, self-observation micro-practices or stabilisation-oriented content can offer preliminary help in managing the internal state, especially at times when play is used as an improper regulator of emotional activation.

Regulate instinct to play

Even more important is perhaps the contribution on the metacognition level. Experiential diaries, guided post-episode questions, personalised periodic reports and reconstruction of the link between emotional state and behaviour can help the subject to transform the acted into thinkable content. In this sense, the real clinically useful question is not just "how much did you play?", but "what were you trying to regulate, avoid or compensate for before you played?".

In a more advanced perspective, tools of this kind could also dialogue with structured therapeutic paths, in particular of cognitive-behavioural orientation, acting as a support to the continuity between the clinical setting and everyday life. But it is precisely on this point that clarity must be maintained: the digital medium, in this field, does not replace the therapeutic relationship nor the specialist care. It can, however, constitute a valuable bridge between initial awareness, demand for help and access to services.

The value of new technological tools, therefore, is not only functional or informative. It is, more profoundly, the possibility of transforming automatic behaviour into an observable, thinkable and at least partly adjustable process. In this perspective, tracking, alert notifications, psycho-educational contents and self-assessment tools are not mere technical accessories, but cognitive and emotional facilitation devices.

In conclusion, Gambling Disorder is a complex condition, resulting from the interaction between affective vulnerabilities, neurobiological alterations and cognitive distortions. Precisely because of this complexity, the response cannot be one-dimensional. Alongside clinical treatment and the network of services, interventions centred on awareness and enhanced by the targeted use of digital tools can be a useful resource both in terms of prevention and in supporting treatment pathways.

*President EurekAcademy ETS, PhD in neuroscience and maxillofacial surgery, La Sapienza University