Skip Navigation Links

Helping Professionals

Attention Deficit and Hyperactivity Disorder

by Samuel Law 

There has been a significant amount of research done in the field of Attention Deficit and Hyperactivity Disorder and problem gambling. The core features of ADHD are a persistent pattern of inattention and high level of non-productive activity, often impulsively performed. Inattentiveness may be manifested in an inability to sustain attention in school or at work, manifested by fidgeting, squirming, impatience, difficulty in delaying response, etc. Clients are usually impaired in functioning and are predominantly inattentive and/or hyperactive.

See the brief screening scale: Assessment and Screening Tools This is an untested questionnaire — refer for proper assessment if client scores 2 or higher on more than a third of the items.

Research Findings on Relationship Between Problem Gambling and ADHD

There has been a recent surge in recognizing, diagnosing and treating adults who have adhd. The traditional belief is that one grows out of adhd and stimulant medications (e.g., Ritalin® (methylphenidate), Cylert® (pemoline). These cause harm that outstrips the benefit when used in adults. As well, adults are presumed to have learned appropriate behaviours and can cope with adhd more effectively. But that view is under some reconsideration, particularly with problem gamblers, as some studies have shown a possible association between problem gambling and adhd (Goldstein et al., 1985, Carleton et al., 1987; Carlton and Manowitz, 1992; Rugle and Melamed, 1993).

Studies show around 20% of (a sample of 40) pathological gamblers had adhd and another 18% had some symptoms while not qualifying for a full diagnosis (Specker et al., 1995). There has been some observation that men with adhd tend to be hyperactive and impulsive, and women tend to be more inattentive. However, these differentiations remain controversial, as a recent report found no such differences (personal communication, APA Conference, 2000).

Counselling Issues

Clinically, it may be understandable that people with ADHD would find the fast-paced, highly stimulating, consistently structured nature and environment of gambling attractive and conducive to their short attention spans and easily distracted tendencies. It can be hypothesized that those clients with ADHD are particularly easily drawn to fast-paced, quickly rewarded forms of gambling (e.g., video gambling). Careful inquiry of the nature of their gambling may help to clarify this diagnosis.

Psychiatric experts are still divided in their opinions on whether pharmacological ADHD treatment’s benefits outweigh the potential harm. The decision will remain largely a personal one, as there are many strong believers on this issue. Some see it as a drug to be abused; others as a cure.

Stimulant medications such as Ritalin® and Dexedrin® have been proven to be most effective. However, they may have some side-effects such as cardiac arrhythmia, sleep disturbance, anorexia and abuse potential.

The current treatment trend is to use medication that has fewer side effects (e.g., SSRI has the potential of becoming a first-line treatment).

Note that a client’s subjective positive response to the use of stimulant medications is not a reliable indicator of adhd, as it is common for those without adhd to experience some improvement in energy, alertness and concentration after taking stimulant medications.

When to Refer for a Psychiatric Assessment

  • when the diagnosis is unclear, needing more sophisticated diagnostic process and instruments
  • when the medication is ineffective or needs re-evaluation or adjustment
  • when the client would like to know about more recent developments in treatment for ADHD
  • when the family needs psychoeducation about the disorder and advice on how to cope with a hyperactive family member who gambles.


American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.).Washington: American Psychiatric Association.

Bergler, E. (1957). The Psychology of Gambling. New York: Hill & Wang.

Black, D.W., Goldstein, R.B., Noyes Jr., R. & Blum, N. (1994). Compulsive behaviors and obsessive-compulsive disorder (ocd): lack of a relationship between OCD, eating disorders, and gambling. Comprehensive Psychiatry, 35, 145-148.

Bland, R.C., Newman, S.C., Orn, H. & Stebelsky, G. (1993). Epidemiology of pathological gambling in Edmonton. Canadian Journal of Psychiatry, 38, 108-112. Blaszczynski, A. (1998). Overcoming Compulsive Gambling: A Self-Help Guide Using Cognitive Behavioural Techniques. London: Robinson.

Blaszczynski, A. & McConaghy, N. (1989). Anxiety and/or depression in the pathogenesis of addictive gambling. The International Journal of the Addictions, 24, 337-350.

Carlton, P.L. & Manowitz, P. (1992). Behavioural restraint and symptoms of attention deficit disorder in alcoholics and pathological gamblers. Neuropsychobiology, 25, 44-48.

Carlton, P.L., Manowitz, P., McBride, H., Nora, R., Swartzburg, M. & Goldstein, L. (1987). Attention deficit disorder and pathological gambling. Journal of Clinical Psychiatry, 48, 47-48.

Cleckley, H.M. (1976). The Mask of Sanity: An Attempt to Clarify Some Issues About the So Called Psychopathic Personality (5th ed.) St Louis, MO: Mosby.

Corless, A. & Dickerson, M.G. (1989). Gamblers’ self-perceptions of determinants of impaired control. British Journal of Addictions, 84, 1527-1537.

Crockford, D.N. & el-Guebaly, N. (1998b). Psychiatric comorbidity in pathological gambling: A critical review. Canadian Journal of Psychiatry, 43 (1), 43-50.

Cunningham-Williams, R.M., et al. (1998). Taking chances: Problem gamblers and mental health disorders — results from St. Louis Epidemiological Catchment Area Study. American Journal of Public Health, 88 (7), 1093-1096.

Dell, L.J., Ruzicka, M.F. & Palisi, A.T. (1981). Personality and other factors associated with the gambling addiction. The International Journal of the Addictions, 16, 149-156.

Dopamine function in pathological gambler. The Wager, 2 (1), issue 18, 1997.

Feigelman,W.,Wallisch, L.S. & Lesieur, H.R. (1998). Problem gamblers, problem substance abusers, and dual-problem individuals: An epidemiological study. American Journal of Public Health, 88 (3), 467-470.

Freud, S. (1928). Dostoevsky and patricide. In J. Strachey (Ed.), Sigmund Freud: Collected Papers. New York: Basic Books.

Gabbard, G.O. (1994) Psychodynamic Psychiatry in Clinical Practice — The dsm-iv Edition.Washington: American Psychiatric Press.

Goldstein, L., Manowitz, P., Nora, R., Swartzburg, M. & Carlton, P.L. (1985). Differential eeg activation and pathological gambling. Biological Psychiatry, 20, 1232-1234.

Hare, R.D. (1983). Diagnosis of antisocial personality disorder in two prison populations American Journal of Psychiatry 140, 887-890.

Hollander, E., DeCaria, C.M., Mari, E.,Wong, C.M., Mosovich, S., Grossman, R. & Begaz, T. (1998). Short-term single blind fluvoxamine treatment of pathological gambling. American Journal of Psychiatry, 155 (12), 1781-1783.

Kernberg, O.F. (1984). Severe Personality Disorder: Psychotherapeutic Strategies. New Haven: Yale University Press. Lesieur, H.R. & Rosenthal, R.J. (1991). Pathological gambling: a review of the literature. Prepared for the American Psychiatric Association Task Force on the dsm-iv Committee on Disorders of Impulse Control Not Elsewhere Classified. Journal of Gambling Studies, 7 (1), 5-39.

Lesieur, H.R. (1984). The Chase: The Compulsive Gambler (2nd ed.). Rochester VT: Schenkman Books, Inc.

Linden, M.D., Pope Jr., H.G. & Jonas, J. M. (1986). Pathological gambling and major affective disorder: preliminary findings. Journal of Clinical Psychiatry, 47, 201-203.

Lopez, V.C. & Miller,W.R. (1997). Treatment approaches for pathological gamblers. Clinical Psychology Review 17 (7), 689-702.

McCormick, R.A., Russo, A.M., Ramirez, L.F. & Taber, L.F. (1984). Affective disorders among pathological gamblers seeking treatment. American Journal of Psychiatry, 141, 215-218.

McCormick, R.A., Taber, L., Kruedelbach, N. & Russo, A. (1987). Personality profiles of hospitalized gamblers: the California Personality Inventory. Journal of Clinical Psychology, 43, 521-527.

McElroy, S.L., Hudson, J.I., Pope, H.G.J., Keck, P.E.J. & Aizley, H.G. (1992). The dsm-iii-r Impulse Control Disorders Not Elsewhere Classified: clinical characteristics and relationships to other psychiatric disorders. American Journal of Psychiatry, 149 (3), 318-327.

Miller, D.C. & Bymes, J.P. (1997). The role of contextual and personal factors in children’s risk taking. Developmental Psychology, 3395, 814-823.

Moravec, J.D. & Munley, P.H. (1983). Psychological test findings on pathological gamblers in treatment. International Journal of Addiction, 18, 1003-1009.

The neurobiology of reward. The Wager, 3 (34), 1998.

Proimos, J., DuRant, R.H., Pierce, J.D. & Goodman, E. (1998). Gambling and other risk behaviours among 8th- to 12th grade students. Pediatrics, 102 (2).

Regier, D.A., Boyd, J.H., Burke Jr, J.D., Rae, D.S.,Myers, J.K., Kramer, M., Robins, L.N., George, L.K., Karno, M. & Locke, B.Z. (1988). One Month Prevalence of Mental Disorders in the United States. Archives of General Psychiatry, 45, 1981.

Reid,W.H. (1985). The antisocial personality: a review. Hospital and Community Psychiatry 36: 831-837.

Rosenthal, R.J. & Lesieur, H.R. (1996). Pathological gambling and criminal behaviour. In L.B. Schlesinger (Ed.), et al, Explorations in criminal psychopathology: Clinical syndromes with forensic implications. Springfield, IL: Charles C. Thomas Publisher.

Roy, A., Ardinoff, B., Roehrich, L., Lamparski, D., Custer, R., Lorenz, V. et al. (1988). Pathological gambling: a psychobiological study. Archives of General Psychiatry, 45, 369-373.

Rugle, L. & Melamed, L. (1993). Neuropsychological assessment of attention problems in pathological gamblers. Journal of Nervous and Mental Disease, 181, 107-112.

Smart, R. & Ferris, J. (1996). Alcohol, drugs and gambling in the Ontario adult population, 1994. Canadian Journal of Psychiatry, 41 (1), 36-45.

Specker, S.M., Carlson, G.A., Christenson, G.A. & Marcotte, M. (1995). Impulse control disorders and attention-deficit disorder in pathological gamblers. Annals of Clinical Psychiatry, 7 (4), 175-179.

Specker, S.M., Carlson, G.A., Edmonson, K.M. & Johnson, P.E. (1996).Psychopathology in pathological gamblers seeking treatment. Journal of Gambling Studies, 12 (1), 67-81.

Taber, J.I.,McCormick, R.A., Russo, A.M., Adkins, B.J. & Ramirez, L.F. (1987). Follow-up of pathological gamblers after treatment. American Journal of Psychiatry, 144, 757-761.

Walters, G.D. (1997). Problem gambling in a federal prison population: results from the South Oaks Gambling Screen. Journal of gambling Studies, 13 (1), 7-24.

Back to Special Treatment Issues: Concurrent Disorders

DISCLAIMER: Information on this site is not to be used for diagnosis, treatment or referral services. CAMH does not provide diagnostic, treatment or referral services through the Internet.
CAMH accepts no responsibility for such use. Individuals should contact their personal physician, and/or their local addiction or mental health agency regarding any such services.
Technical enquiries: webmaster@problemgambling.ca