Psychiatrists create criteria to differentiate between pathological and recreational gamblers.

Psychiatrists establish clinical criteria to differentiate between recreational gamblers and those addicted to betting. Loss of control over the habit, concrete financial loss, and a progressive reduction of social life to gambling activities are the three central dimensions of addiction, according to experts interviewed by Folha de S.Paulo.

Between the occasional gambler and the clinically dependent individual, there is a third profile, identified by psychiatrist Aderbal Vieira Júnior, head of the Behavioral Addiction Treatment Clinic at Proad (Program for Guidance and Assistance to Addicts) at Unifesp: the so-called "deluded investor." This refers to someone who believes they have discovered a strategy capable of guaranteeing consistent gains from gambling. Vieira Júnior, who has treated compulsive gamblers for about 30 years, states that this profile "also creates problems, may also meet the criteria for a diagnosis of gambling disorder, but is not necessarily an addict."

The debate is taking on legal dimensions in the Superior Labor Court (TST), which is discussing whether the rules applied to cases of alcoholism should also apply to gambling addiction in dismissal proceedings. In a summary consolidated in 2012, the TST establishes that the dismissal of a worker with a stigmatizing illness presumes discrimination and may lead to reinstatement. A faction of ministers is considering extending this protection to dismissals linked to gambling addiction.

Minister Alexandre Agra Belmonte, national coordinator of the Safe Work Program at the Superior Labor Court (TST), summarized the dilemma: "It is necessary to differentiate, using technical criteria, what constitutes reprehensible behavior and what constitutes a clinical condition that requires protection."

What defines dependency?

The DSM-5, the 2013 version of the Diagnostic and Statistical Manual of Mental Disorders, lists nine criteria for the diagnosis of gambling disorder, defined as "persistent and recurrent problem behavior" with clinically significant distress or impairment. The diagnosis is confirmed by the presence of at least four of them:

⇒ The need to wager increasing amounts to achieve the desired excitement;

⇒ Restlessness or irritability when trying to reduce or stop the habit;

⇒ Repeated and frustrating efforts to control or stop gambling;

Frequent preoccupation with gambling, including planning bets and seeking money to gamble;

⇒ Gambling frequently during times of distress;

⇒ Return to the game to try to recover losses;

Lying to conceal involvement with gambling;

⇒ To suffer losses in relationships, employment, or professional opportunities because of gambling;

⇒ Depending on third parties to settle debts caused by gambling.

According to Vieira Júnior, diagnosis becomes especially difficult in cases that reach the Labor Court. “The extremes are always easy to diagnose. It's what's in the middle that will be more difficult to diagnose,” he states. In these cases, the psychiatrist argues that the court-appointed expert should conduct an in-depth evaluation to distinguish between indiscipline and pathology.

Gambling and alcoholism; clinical connections

The comparison between gambling addiction and alcoholism is supported by biology. Vieira Júnior argues that, in gambling, the brain develops the same dependent response observed in substance use, without any drug being ingested. "Addiction is a relationship, not an effect that a drug causes in you," he says.

Psychiatrist Lívia Beraldo, from the Sírio-Libanês Hospital, points out that three out of four pathological gamblers have at least one associated psychiatric diagnosis. Alcohol is among the most frequent and, along with smoking, forms what she calls the classic gambler triad. Alcohol abuse occurs more frequently after gambling sessions, as a way to cope with the anxiety of losses or to facilitate sleep.

In clinical studies, approximately 50% of people with gambling disorder report substance abuse. Among those seeking treatment for gambling, up to 63% have experienced a substance use disorder at some point in their lives, according to Beraldo. Neuroimaging studies point to a shared neural circuit between the two conditions.

A pharmacological approach is also relevant. Naltrexone, a drug already approved for the treatment of alcohol dependence, has shown effectiveness in reducing gambling cravings, according to Beraldo. The drug treats gambling disorder broadly, a category that includes betting, but is not limited to it.

This clinical convergence led the DSM-5, in 2013, to reclassify gambling disorder from the category of impulse control disorders to that of addictions, alongside substance use disorders. The change reflected evidence of similarity in phenomenology and biology between the two groups; people with gambling disorder report craving before gambling and experience reduced anxiety and euphoria comparable to the effects of psychoactive substances.

The scale of the problem in Brazil is growing. The Ministry of Health recorded 6.157 in-person consultations in the SUS (Unified Health System) related to gambling in 2025, a number close to double the 3.490 consultations in 2024. The TIC Domicílios 2025 survey, by Cetic.br, indicates that approximately 30 million Brazilians over the age of 10 have already gambled online , equivalent to about one in five internet users in the country. The practice is more frequent among men (25%) than among women (14%).