Author: Renato Cesar Assef Rodrigues
Journal: Revista Científica de Alto Impacto, Volume 29, Issue 146, May 2025
DOI: 10.69849/revistaft/fa10202505032356
Abstract
Gambling addiction has followed humanity ever since social environments enabled a variety of interactions, including those oriented toward entertainment, those stimulating competitive spirit, and others intended to exploit the pursuit of advantage and pleasure.
As entertainment, competition, or challenge, there are electronic games, popularized on national and international platforms based on sports results, casinos with slot machine emulators (slots), which have become a socio-economic problem, with serious repercussions in professional, social, and family life.
Psychoanalysis has tools such as psychodynamics and may use others, like Cognitive Behavioral Therapy within Schema Therapy, to understand and assist in the treatment of compulsive gambling addiction, alongside other therapeutic approaches in order, at least, to mitigate the financial, physical, and social costs for users of gambling platforms, if not even to achieve remission of the gambling disorder itself.
This article aims to briefly expose the mechanisms of gambling dependence, through historical framework and context, physiological and psychological impacts, and the approaches that are offered and adapted to psychoanalytic knowledge aiming at confronting the problem — which has similarities with chemical dependency — to present data regarding compulsive behavior and what psychoanalytic analysis approach could be in the face of increasing cases and their social repercussions, including familial ones.
Keywords: Gambling Disorder, Gaming Disorder, Ludopathy, Bets, Slots
1. Introduction
Historical and archaeological records indicate that games have accompanied humanity since three millennia before Christ. The Chinese, Greeks, Romans, Egyptians … almost every civilization of antiquity developed or adopted the practice of playing, whether for pure enjoyment or aiming to gamble and profit. Initially they were dice games and cup games; cards arrived around the Middle Ages, probably in the 9th century, and were soon condemned by the Church, which was already charging deposits for its services.
Laws exempted the nobility from gambling, though the common folk were not excluded from this form of entertainment. With the popularization of gambling, there were those who began to study the introduction of probability in daily life as far back as ancient times.
(…) the topic began to be discussed by scholars — not only mathematicians, but also philosophers, lawyers and jurists, etc. — in relation to gambling, which was quite commonly practiced then. (Silva & Coutinho, 2005, cited in Tomaz, 2023, p. 4)
The bibliographic research is the methodology used to underpin the theory exposed and to point in the direction of the proposed approach — in the sense of obtaining answers about options within analytic treatment for gambling disorder. At this moment, science needs grounded positioning in order to broaden knowledge and the available therapeutic alternatives.
Articles and books were researched in Google Scholar, SciELO and the CAPES Periodicals Portal, in addition to specialized publications, first about research lines in gambling addiction and then research lines on substance addiction.
With much more variety found in the research involving substances, this work proposed to generate more comparative approaches between the classic symptoms of substance addiction and its similarity to the new frontier of work, to mitigate impacts brought by the ease of access to electronic games, slots and others.
Materials were chosen that could clarify the physiological, psychological, and social mechanisms of addiction and, by way of inferences, reach the point at which these situations overlap in relation to chemical and sensory stimuli.
Thus, the general objective is to present psychoanalytic possibilities, with analysis of therapeutic possibilities in reducing or remitting the respective disorder, in reducing family conflict and financial impairment. How can psychoanalysis offer tools to support the social impact of gambling dependence?
Specifically, this work seeks to align clinical practices adopted and others that can help in facing gambling disorder, from its onset to the impairment of family and social relationships.
2. Development
2.1 The beginning of the vicious cycle
Briefly, Sigmund Freud set as a principle the instinctive search for pleasure and the avoidance of suffering and pain. Paradoxically, it is observed that the pursuit of pleasure results exactly in that which everyone seeks to avoid: suffering and pain.
Addictions, whatever their type, begin with either the pursuit of pleasure or escape from reality which represents suffering — both situations perfectly intertwined or complementary, though not necessarily inseparable, since the social environment provides needs for pleasure or escapism unknown particularly to individuals (experimentation phase). The same idea was already shared by ancient hedonistic philosophers for whom the pursuit of pleasure and the denial of pain should drive the life of the Being.
Freud’s approach, then, proceeds at the scientific level of what is empirically observed throughout human history. There are physiological, psychological, social and even genetic and biological aspects involved in the process of addiction. The influence of each can exist in parallel at the beginning, being much more common the combination of two or more, except that physiological dependence tends to emerge later and becomes more responsible for maintaining the addiction. Once addiction is established, it matters little what initiated the cycle; a system becomes installed in the individual in which different factors act together to perpetuate the dependency.
2.2 Physiological mechanisms
Since the appearance of electronic games, their cerebral effects have been known. Ten years ago, Lemos et al. made a systematic review of studies on neuroimaging in addiction. They concluded: “The use of sound, image, graphics and all hypermedia potentials captivate players, who easily adapt to irresistible stimuli of involuntary and voluntary attention.”
According to Rolnik and Franco (2006), physiological dependence manifests in the presence of withdrawal symptoms (tachycardia, paleness, tremors, convulsions, etc.). This is the effect and, as might be expected, the same authors indicate the organic pathway, specifically in the brain, responsible for the initiation of addiction, generically named the “reward circuit.”
Part of this circuit is the mesocorticolimbic system, whose main neurotransmitter is dopamine. When activated, one of its components, the ventral tegmental area, releases dopamine through its projections (axons) to the nucleus accumbens (now considered the center of pleasure), as well as other brain structures: the amygdala, the limbic system (the system of emotions) and the frontal cortex (Planeta & Cruz, 2005, cited in Rolnik & Franco, 2006).
More recent authors consider other structures involved, such as the limbic system, as is the case with Favaretto (2021), who divides it into four structures, namely: amygdala, hippocampus, tuberomammillary nucleus and cingulate cortex.
There is an important difference — the inclusion of the cingulate cortex with the role of integrating memories and information to other brain regions, without neglecting other structures such as the frontal cortex which, jointly with the ventral tegmental area and the ventral pallidum, medial and accumbens nuclei, constitute the medial longitudinal bundle or the Reward System (Favaretto, 2021).
The objective of this article is not to explain exactly the function of the structures mentioned and their interconnections, but to indicate where addictions act at the level of the central nervous system to explain the changes in the brain that promote their establishment and progression, without also entering into the alterations caused in the peripheral and autonomic nervous systems, considering that the Reward System is the catalyst of the changes that interfere with the CNS.
“The medial longitudinal bundle — or Reward System — is the main determinant of addiction response in substance use and abuse. (…) stimulating it abnormally and creating the feeling of super-reward.” (Favaretto, 2021). Although the mentioned researcher is speaking about “substances”, in a broad sense it can be applied to gambling disorder because the same brain mechanism is involved.
Results indicate that online slot games stimulate the brain’s reward system through intermittent reinforcement, activating brain circuits linked to dopamine release, in a manner similar to what occurs with psychoactive substances such as cocaine and crack (Bruna, 2020, cited in Gobbo et al., 2024).
Obviously, it is not only drugs and other addictive activities that activate this circuit. Exercise, sex, eating, social relations, charitable actions and even work activate the same circuit, making it fundamental for human life in many aspects. Without it, we would not know society as it presents itself today: entertainment, technology, culture, political-social relationships, among other facets of contemporaneity.
For Lavratti and Vieira (2024), dopamine is essential in a healthy everyday life through daily activities, including leisure, and affective contacts. Its absence in these conditions induces compensatory searching in other available options.
Among some existing theories, evolutionary psychology discusses how natural selection and pleasure mechanisms are interconnected with survival, using addiction as an adaptive shortcut for life maintenance (Moraes, Torrecillas, 2014 cited in Lavratti, Vieira, 2024).
The organic system becomes a problem when corrupted by substances and/or activities whose frequent engagement centralizes all of the person’s efforts into seeking them, which is only possible with increasing exposure. Depressive states install quickly upon mere temporary suspension. At this point emotional balance, rationality (or consciousness) and moral principles become clouded, converting all of one’s energy into the pursuit of ever more ephemeral and unattainable pleasure. It is when the pursuit of pleasure becomes pain, potentially lethal via substance overdose or suicide, when it comes to activities that have become compulsive, among them sexual compulsive behavior, oniomania, gambling disorder or ludopathy.
There are similar neurobiological characteristics in addictions with and without substances, particularly in brain functions, neurochemistry, and cross-sensitization, a phenomenon of neuroadaptation in which repeated exposure leads to stronger responses at the level of reward circuits (Leeman; Potenza, 2013, cited in Antunes, 2019).
Addictions, including substance use disorders (SUDs), are multi-stage conditions that by definition require exposure to a dependence-causing agent. The broad variety of addictive agents includes drugs, food, sex, video games, and gambling (Barbanti, 2014, cited in Silveira; Rodrigues; Oh, 2022).
These are homeostatic changes that occur after continuous exposure to stimuli, and furthermore there is associative learning — acting like a cellular memory by interfering at the synapse in such a way as to imprint specific information about the stimulus, like a code. This is also known as operant conditioning, as described by the American psychologist Skinner (2003).
In his experiments, the researcher observed the adherence to a new behavior from positive reinforcement, the negative reinforcement being a punishment, which can be associated with deprivation or abstinence.
One of the effects of drugs in the brain is the increase of dopamine concentration, a neurotransmitter that produces pleasure. Pleasure thus acts as reinforcement for the behavior of using the substance. In addiction, an aggravating factor arises: if the person stops using the drug, they enter a state of withdrawal, which is characterized by intense anxiety, sometimes accompanied by tachycardia, sweating and other physiological discomforts.
All this scenario of discomfort acts as punishment. (…) (Faria; Mourão Jr., 2017, p.7)
In any case of addiction, there will be the phenomenon of Neuronal Habituation. According to Favaretto (2021), pre- and post-synaptic receptors of the medial longitudinal bundle — as described before — are altered to the point that increasing stimulation is required to obtain the same effect.
Behavioral manifestation of the phenomenon reflects in individual choices, which is explained by Heyman’s Choice Dependency Theory (2009) which, among other approaches, includes exactly that in which the reinforcer value of the addictive agent is greater than the reinforcer value of competing behaviors like those indicated in Maslow’s Hierarchy of Needs, inexorably configuring a dependency scenario.
Thus, the advance of addiction interposes itself in the face of other pleasurable activities previously mentioned and others more responsible for economic support, social relationship and leisure. The addictive activity ends up monopolizing the attention and individual resources. Finally, all conscious or unconscious action is undertaken aiming at the satisfaction of addiction.
The person is simultaneously near and far, because increasing positive reinforcement does not imply satisfaction of desire which, on the contrary, becomes stronger. As neuroadaptive change is potentially irreversible, absolute abstinence is the only “exit door” for resolution of the problem, in combination with therapy and specialized medical follow-up and medications, especially those aimed at treating predispositions of psychological and psychiatric order such as will be seen below.
2.3 Psychological, Psychiatric Mechanisms
There are factors that can predispose a person to gambling addiction: depression, anxiety, lack of self-control, shyness, low self-esteem etc. Lavratti and Vieira (2024) understand that psychological and psychiatric factors precede the first contact with the substance or addictive behavior. Moraes and Torrecillas (2013), citing Pinker and Ridley (2004), downplay the influence of the external environment as inducer of behavior.
Stress and trauma, especially in early childhood, can already trigger imbalance of brain homeostasis. Evolutionarily, painful emotions like pain, anger, guilt and fear “appear governed to ensure well-being” (Moraes and Torrecillas, 2013). However, maintaining them for a long period tends to produce imbalances capable of indicating shortcuts to pleasure mechanisms, when either psychoactive substances or compulsive behaviors enter.
Lavratti and Vieira emphasize situations of helplessness, when the person develops ways to cope with the problem, addiction becoming a protective barrier, serving support and defense of that reality.
… since it would not be possible to satisfy a need without the category just below being fully satisfied, as Maslow suggests; conceptually, however, it is still a good reference.
Neurobiological disorders such as ADHD are considered by researchers as predisposing to addiction; their carriers are considered risk groups. Among the complications of ADHD, one should highlight substance use disorders (SUDs). In a study with 120 adults diagnosed with ADHD, Biederman et al. observed greater risk of alcohol and drug problems in the ADHD group (52%) than in the control group (27%). (Castro, Pedroso, Araujo, 2010)
Thus, psycho-affective and neurobiological alterations must be considered as risk factors, particularly when they are not isolated from the social context, which will be addressed next.
2.4 Social Mechanisms
The dissemination, variety and ease of access to addictive substances and content have brought changes in relationships. Both personal and digital interaction have the power to induce behaviors, which explains particularly the involvement of influencers in promoting online games (slots).
The need for belonging, group identification, overcoming social isolation induce adoption of a group’s way of life, including meeting places and consumption forms. According to Santana et al. (2022), adolescence by virtue of its biopsychosocial peculiarities is a complex and contradictory stage, therefore more vulnerable.
Proof of such claim is a study conducted by the Institute of Psychology of the University of São Paulo (USP) in 2022, resulting in the involvement of practically 30% of Brazilian adolescents with Internet Gambling Disorder, with social and emotional harms.
For decades, contemporary researchers accept gambling as part of culture, not only because of its presence in all social layers, but also as a form of dissemination of information, narratives, and customs.
Notably in the case of bets, the backdrop is popular sports — besides soccer, fans of tennis, basketball and other sports may also be attracted by numerous betting houses. Gallo (2007) in his studies stressed that games have become one of the most popular and sophisticated cultures today.
Recently, Soares and Mesquita (2021, cited in Silva & Soares, 2023) argue that culture reinforces the relationship between game and player by affirming symbolic interactions between both, that is, the game is something meaningful to the player in the form of language and/or a real prospect of gain.
Inserted in society in this way and with technological innovation in its favor, one may discard any alternative of restricting access outright, being only possible its usage in a playful and responsible manner in cases where that is viable.
Specifically in the case of games leading to ludopathy, legal control will only permit taxation of major betting houses for the redistributive function of the State which, in principle, must use part of the revenue in reducing harms caused by compulsive gambling. Hard to imagine banning irregular platforms in face of unlimited access via apps hosted on servers outside the country.
Thus, a mental health policy to confront the socioeconomic effects of addiction is more urgent — and more effective — than any legal decree. Not that the latter is dispensable.
2.5 Genetic, Biological and Environmental Mechanisms
Science does not ignore the influence of hereditary factors as predisposed to chemical dependency or compulsive behavior. Several researchers deal with genetic or hereditary predisposition as one of the components of addiction. Formigoni et al. (2017) highlight results of epidemiological studies showing a strong hereditary component in the development of alcoholism, around 40 to 60% risk for the disorder compared to people without first-degree addicted relatives.
Messas and Vallada Filho (2004) already cited these and other studies involving family, twin, and adopted children methodologies. All three approaches are necessary to isolate environmental from genetic factor, since within families one may coexist or dominate one or the other factor. According to these authors, research points to the existence of heritability for alcoholism and other drugs.
They also claim they can detect the genetic component in all substance addictions from reviews of third-party research, something quite doubtful and generic. One cannot assert categorically that there is a genetic component in all cases — also due to the influence of other factors as demonstrated. More pragmatically, the study by Formigoni et al. argues that the existence of genetic influence does not mean a dependency wholly inherited or predetermined, but it is clearly a risk factor. Brooken et al. (2017) emphasize also that only genetic predisposition is not by itself the sole cause of addiction. Thus the general understanding is that vulnerability, whose manifestation depends on internal factors (emotional and/or psychological and psychiatric) and external (environment — family and peer groups — and availability of stimulus and lifestyle). At this point, the knowledge of epigenetics is useful and explains how the influence of genes is altered depending on where the individual is inserted, as well as by aging.
It is more important to highlight other research regarding addiction in other drugs aiming to reinforce the presence of genetic and environmental factors analyzed also symmetrically in cases of absence of substances. Scheffer, Passa and Almeida (2010) cite that little more than half of chemical dependency cases (53%) are related to environmental (family) factors and neurobiological vulnerabilities (genetics). Brooken et al. present similar numbers, considering the genetic factor (~50%) but without absolutely dissociating environmental and biopsychosocial factors.
Genetic and/or environmental characteristics may explain why even individuals exposed to substances or other digital stimulants do not develop virtual or chemical dependency. It is known that family or group experiences interfere with behavior as a form of repetition (customs / mores). That is why it is difficult to establish a proportional number a priori about predisposition to addiction. The identification of genes has been recorded in research carried out in the last three decades as recently cited by Silveira, Rodrigues and Oh (2022) and Souza, Oliveira and Fabiano (2023). Older research indicated alleles responsible for higher risk in alcoholism and smoking that alter dopamine receptors.
The reviewers cited identified other genes considered vulnerable to psychotropics, which though not directly tied to this article’s aims will not be detailed here. It suffices to conclude — in agreement with Souza, Oliveira and Fabiano — the role of genes involved in the reward circuit that are activated to re-link reward circuits and cause intense craving for substances during abstinence.
No studies were found correlating this branch of knowledge to gambling disorder or ludopathy. Environmental and social factors, in this case, are more evident. Without more advanced studies, it is not possible to determine the influence of alleles in predisposition for the addictions under interest in this article, since until the present moment the research has concentrated on substance addictions, which does not alter the addictive character of other types of stimuli, as already aligned.
2.6 Psychoanalysis in the context of treating gambling compulsion
The bibliographic research to this point served to identify elements of addiction and also the symmetry in almost all mechanisms involved in addictive processes. From here the article analyzes therapeutic alternatives and evaluates the approach exclusively for the disorders under scrutiny, namely: Gambling Disorder or Ludopathy.
The World Health Organization (WHO) recognized gambling disorder via the International Classification of Diseases (ICD) 10 under category F63, which covers habitual and impulse control disorders, including among others pathological gambling. In 2019, the ICD was revised and the code for the disorder became 6C50, defined as Gaming Disorder and Gambling Disorder.
Divided into subcategories, the classification admits addiction in on-line, off-line and hybrid modes. The diagnosis is aligned from the person’s involvement with gambling at a priority level over other activities and deepening of addiction, though the evident harm of personal, familial, educational, occupational and other domains. The pattern may be continuous or occasional, but always recurring.
It is notable the greater description and complexity that classification has given to dependency behaviors, separating them, including, from other impulse control disorders, thereby acquiring its diagnostic specificity.
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) keeps the category F63 for gambling disorder. Unlike the ICD, which addresses the disorder more generically, not expressly focusing on economic loss as a diagnostic bias, the DSM-5 opens with the criterion of spending increasing amounts of money, and among its nine criteria, four involve financial loss, including obsessive thought about recovering losses.
One of the most worrying criteria is when the gambler begins to take financial rescue initiatives, turning to family and/or assuming illicit attitudes (fraud, deception or theft) to apply resources to gambling. Traditionally, this situation has always occurred with addicts in clandestine casinos or even official prognosis games.
With the availability of apps, websites and platforms accessible to anyone (including minors) via smartphones, there are no limits to access and gaming time. The only limit possible is the resources available.
A pattern of “chasing losses” may develop, accompanied by an urgent need to continue gambling (frequently with larger bets or higher risks) to undo a loss or series of losses. The individual may abandon his gambling strategy and try to recover all losses at once. Although many gamblers may exhibit this feature during brief periods, this recurrent and typically prolonged attitude is characteristic of gambling disorder (DSM-5, 2023, p. 587).
Also according to the Manual, depression accompanies most compulsive gamblers in treatment, with half having suicidal ideation and 17% having attempted the act. It is not unusual for mood alterations, such as anxiety and depression, to occur among compulsive gamblers. The authoring entity of the Manual (The American Psychiatric Association) observes that gambling involves risking something valuable in the hope of obtaining something more valuable. It is the classical definition.
What the compulsive gambler no longer notices is that they are no longer merely gambling money, they are risking everything in their life; the much-sought prize is just a chimera incapable of recovering even a small portion of what was lost, even if realized. In therapy, therefore, one must work to reduce the incidence of gambling situations, while understanding that abstinence may be unlikely, or to focus on harm reduction and quality of life in any case.
Oliveira et al. (2022) raise an alarm about the lack of offered treatment for this disorder. There are isolated initiatives like the Institute of Psychiatry of the Clinics Hospital of the University of São Paulo (USP) and some cities that have groups of Anonymous Gamblers. The research identified groups only in the cities of São Paulo, Rio de Janeiro and Limeira.
There is also an online service, but religious in nature, which is not adequate due to its restrictive character in imposing a belief system at the outset. Indeed that is one form of treatment for Gambling Disorder. There are others according to Fong (2005, cited in Oliveira et al., 2022): Cognitive Behavioral Therapy (CBT), Behavioral Therapy (BT), Psychodynamic Psychotherapy (PP), Family Therapy, harm reduction and support lines.
Research conducted provides validation of Jeffrey Young’s Schema Theory, which fundamentally uses a series of therapeutic instruments traversing both the roots of the problem and present maladaptation, altering current schemas which cause suffering and pain.
This theory is an integrative approach expanding the classical CBT approach, integrating contributions from Gestalt, Psychoanalysis, and Constructivism into a new psychotherapy system (Young, Klosko & Weishaar, 2008, cited in Isoppo, 2012).
Below is a synthetic definition of each:
-
CBT: The touchstones of this approach are the cognitions themselves which influence emotions and behavior and which in turn, in a cyclical manner, affect patterns of thought and emotions. It is through cognition that a person evaluates emotional states and real or imagined external events. Work is done on conscious attention level and strengthening rational decision-making, altering maladaptive thinking (automatic/preconscious thoughts and schemas or belief systems). Cognitive restructuring involves Socratic questioning, examining evidence, cognitive rehearsal (e.g. role-play) among other methods. The behavioral approach involves increasing frequency of healthy pleasurable activities, reducing painful emotions, developing coping skills, others.
-
BT (Behavioral Therapy): can be considered a subdivision of CBT, in that the focus is on emotions and behavior. It might be considered a reduction of CBT’s breadth by ignoring origins of the manifestations and its cyclical or self-reinforcing character. Criticisms of the model are quite old. Guedes (1993) considered the approach superficial and irrelevant, citing existing criticisms that its use was limited to simple, routine clinical problems (e.g. study habits, eating and rest routines). The author also accuses the therapist of arbitrarily manipulating the patient’s environment, which may be deduced from one of Lettner’s statements (1988) recommending knowledge of the factors involved as base for therapeutic planning, i.e., changing environmental factors for a positive treatment impact. In this article, the inclusion of this approach is for didactic objectives, since it is still mentioned in recent articles, but clearly does not fully meet the object of study proposed.
-
PP (Psychodynamic Psychotherapy): Ablon and Jones (1998, cited in Rosenthal, 2008) assumed in their studies that there exist significant components of CBT in psychodynamic treatments and vice versa. That fact was confirmed in studies by Schneider et al. (cited in Schmidt, Gastaud and Ramires, 2018). While less systematic than in CBT, psychodynamics seek the motivations that lead to behavior patterns and emotions in patients, including historical and relational aspects. From this the conclusion by said researchers that even using both approaches has promising potential, particularly for depressive and anxiety disorders. This is Sousa et al.’s (2024) position indicating clinical studies and reviews that indicate significant results in improving quality of life, remittance of depressive symptoms and psychosocial functioning with this integrative therapy, which is considered an evolution in clinical practice.
Family Psychotherapy: The issue of family dysfunction is whether this is prior to the problem to be treated clinically or the opposite: the imbalance began with the introduction of a new element (person or status). In any event, the family is impacted by compulsive behavior, especially in nuclear and extended types. Therefore, the family environment is also affected by the disorders presented by the patient.
According to Minuchin (1982), “the family structure is the invisible set of functional demands that organize the ways members of the family interact. It is the set of rules that govern family transactions.” The referred therapist understands the family predominantly in nuclear form and the theoretical definition of family is an assumption for therapeutic intervention under this angle. The framework for participation, power rules or hierarchy, etc., are structural aspects. He emphasizes that family therapy is an “action therapy” to modify the present and is not designed to explore or interpret the past.
Not for nothing that Minuchin recommends understanding conceptually the family as (for example) L’Abbate, Frly and Wagner (cited in Gomes, 1986) pointing out as structural aspects the limit or rules of participation and hierarchy or power rules. He emphasizes that the therapist’s initiative is not to unify with the family to educate or socialize them, but to modify or restore their functionalities (socialization, support, regulation, and protection) for its members so that they better fulfill their task. Believing also in the self-perpetuation of the family system, once changes are produced they will be sustained.
A support line and harm-reduction: According to Araújo (2019) treatment directed toward harm reduction is “low demand”, contrasting with treatments that aim for abstinence. The most classic modern example is distribution of needles to avoid HIV spread among injectable drug users. That is, the focus has shifted to avoiding disease and not addiction and its direct consequences. This approach includes health information, counselling, greater access to health and social assistance services, distribution of supplies, and encouragement not to share them, etc. (Araújo, 2019, p.17)
In short, the author defined both the harm reduction strategy and support network, which may be public or private. Few groups are organizing around compulsive gambling. Michels, Machado and Pizzinato (2022) cite that the attendance setting foreseen by Freud in his text Paths of Psychoanalytic Therapy, read during the 5th International Psychoanalytic Congress (Budapest, 2018), is very similar to the current Public Mental Health Care Centers (CAPS), “the main public service for mental health attention in the population.” According to Freud:
(…) consulting rooms employing physicians trained in psychoanalytic formation, so that by means of analysis, men who otherwise would surrender to drink, women who threaten to succumb under the burden of deprivation, children who have only before them the choice between neurosis and brutalization, are kept capable of resistance and achievement. These treatments will be free. (Freud, 2018, p. 291, cited in Michels, Machado and Pizzinato, 2022)
The same authors note that the psychoanalyst is challenged to act in venues different from those for which they were trained and accustomed. This was also affirmed by the French naturalized Argentine psychoanalyst Enrique Pichon Rivière, as addressed in Caderno de Atenção Básica nº 34 (Mental Health) of the Brazilian Ministry of Health (2013, p.124).
In that document, Pichon’s theory of operative groups aims to promote active adaptation to reality, breaking stereotypes, revising social roles, elaborating everyday losses and overcoming resistances to changes. Among fields of operation of the groups are community and institutional, which may be, besides public establishments, schools, churches, associations, unions and others, promoting activities closer to the population.
The harm-reduction approach can be applied to compulsive behaviors aiming to control adverse health and social side effects of the activity — especially those affecting relationships social and professional. However, it should not be the therapist’s first choice, insofar as the desired result is abstinence or significant reduction in frequency (high-demand strategies).
The therapist’s stance should be consistent with seeking the best possible result, without dismissing alternatives — even harm reduction and the inclusion of a support network — as means to reach treatment goals.
As a harm-reduction strategy in the case of gambling disorder, it is possible to recommend suspending games involving financial bets in favor of others, online or offline, in which the factor of financial risk is absent. It is not an automatic process, because in cases involving Bets and Slots there is the component of financial loss and the sense of loss, which can prevent or hinder the transition.
3. Final Considerations
The mechanisms through which addiction known as Gambling Disorder or Ludopathy occurs align compulsive behavior with that of substance use addiction. It is not negligible that the gambler may also use licit or illicit substances as part of the dependency scenario, showing that we face a complex situation that does not exclude a multidisciplinary approach, even integrating medicated therapy to control depression and anxiety, for example.
In psychoanalysis, combining strategies — CBT, PP (Psychodynamic Psychotherapy), and Family Therapy — may lead to more expressive results. To define the approach, active listening is the main means the therapist employs to understand the extent of the disorder, while still considering the possibility that the patient ameliorates the condition, which complicates both diagnosis and therapy itself.
It is expected, of course, that difficulties in therapist-patient relationship remain restricted to the start of sessions, with the psychoanalyst’s role being to deepen the relationship by means of learned techniques, enabling the occurrence of transference and treatment of resistances, which only happen in an environment of reciprocal trust and belief in the therapy.
Fostering self-knowledge is another objective of the analyst, with potential for the patient to find a way out of the disorder. From the study conducted in this article, the need for dopamine in physiological balance was noted. From this observation, it is foreseen the possibility of substituting compulsive behavior with another activity as positive reinforcement. Such approach must be extremely careful and should not fall at the beginning of treatment.
It is up to the analyst to assess the “timing” of the proposed intervention according to the patient’s initial or intermediate evolution. If rushed, the analyst may “burn” options, whose recovery will prove more complicated.
Even without being novel in recent decades, Gambling Disorder deserves more studies due to its potential for expansion driven by technology and the regulation being considered by the Federal Government for casinos, bingos, and “jogo do bicho” (illegal lottery-type game).
Regulation itself does not inherently increase the number of gamblers and still provides for taxation that can help fund prevention campaigns for abusive gambling and treatments in public support networks, in addition to legally recognizing the reality in which people gamble regardless of restrictions. It can make a difference for the portion of the population concerned with legal or moral rules and those reluctant to gambling.
Except for that, already legalized online casinos have been fulfilling their role of expanding the base of players and, unfortunately, among them, compulsive gamblers.
Se quiser, posso revisar esta tradução para publicação acadêmica: ajustar estilo, consistência terminológica, referências, etc. Quer que eu faça isso?
Você disse:
sim
O ChatGPT disse:
Aqui está a versão em inglês do artigo solicitado:
A Psychoanalytic Approach to the Rise of Gambling Disorder Caused by Bets and Virtual Casinos
Renato Assef
The spread of online betting platforms and virtual casinos has significantly transformed the contemporary landscape of addictions. What was once a physical activity confined to gaming houses, racetracks, or local betting centers has now entered the daily lives of millions of people through their cell phones, tablets, and computers. This phenomenon has not only increased accessibility but has also intensified the psychological consequences of gambling disorder (ludopathy).
From a psychoanalytic perspective, gambling is more than a mere pursuit of money. It functions as a complex psychic mechanism where the subject seeks satisfaction in chance, risk, and the illusion of control. The game replaces reality with a space where fantasies of omnipotence, denial of limits, and repetition compulsion are activated. In this sense, gambling represents an attempt at psychic regulation that, paradoxically, leads to greater imbalance and suffering.
The advance of digital platforms has created an environment with powerful stimuli: visual seduction, instant results, seductive advertising, and bonus offers that keep the individual in a continuous loop. The unconscious is captured by promises of victory that echo primitive fantasies of immediate satisfaction and unlimited enjoyment. The subject, then, becomes hostage to a vicious circle: the more they lose, the more they play in an attempt to recover, repeating the traumatic compulsion that Freud described.
The clinical challenge is enormous. Increasingly, young people and adults are developing pathological dependence on betting platforms, often hidden from family and friends until serious financial and emotional consequences emerge. Feelings of guilt, shame, and despair intertwine with moments of euphoria, creating a psychic oscillation that reinforces addiction.
The psychoanalytic approach allows us to understand that the subject does not gamble only for money but to symbolically fill a lack, to deal with anguish, or to escape emptiness. Treatment, therefore, cannot be restricted to financial education or behavioral restrictions. It is essential to offer a listening space that gives meaning to the subject’s history, their desires, and their unconscious motivations.
In addition, society must recognize gambling disorder as a public health issue. Awareness campaigns, regulation of advertising, and preventive actions in schools and communities are urgent. Psychoanalysis contributes by denouncing the mechanisms of alienation present in these platforms and by offering tools for deeper understanding of psychic suffering.
Ultimately, the rise of gambling through bets and virtual casinos reveals the vulnerability of the human subject in the face of the seductions of the digital age. If the unconscious always seeks satisfaction, it is up to psychoanalysis to point to other possibilities of elaboration, desire, and encounter with reality — beyond the repetitive and destructive logic of gambling.