Information for Clinicians

Problem gambling is a treatable addiction.

The DSM-5 classifies gambling disorder as an addiction rooted in the brain, like drug and alcohol addiction. Brain imaging studies have reported that substance use disorder and gambling disorder create similar types of dysfunctions regarding reward processing and decision-making.


People who experience problems with gambling often face other issues at the same time that may range from from health conditions to financial problems and social issues as well as other co-occuring mental health concerns, including substance use disorders.

Problem Gambling Rarely Occurs Alone.


Among Gamblers Anonymous members, 12-18% report having attempted suicide. Nearly 50% report having made plans to attempt suicide, and up to 80% reported suicidal ideation.

Substance abuse

Among those clinically diagnosed with Gambling Disorder many also suffer from substance use disorders. Nearly 75% struggle with an alcohol use disorder and 40-63% face a drug use disorder.

Psychiatric disorders

Those with psychiatric issues are more likely to experience problems with gambling. Specifically, mood disorders (60%), anxiety disorders (40%), and antisocial personality disorders (33%).

Depression: Lifetime depression rates among pathological gamblers is 70-76%.

Personality disorder: 87% of those clinically diagnosed with gambling disorder have been found to suffer from personality disorders.

Substance use disorder

Similarities with Problem Gambling

  • Emotional difficulties develop
  • Stress levels increase
  • Preoccupation with the activity builds
  • Dopamine levels rage and cravings intensify
  • Tolerance increases
  • Usage continues despite negative consequences
  • Impulsivity rises
  • Withdrawal symptoms can develop

Differences from Problem Gambling

  • With this “hidden addiction,” no chemical or blood tests exist to tell if a person has been gambling
  • No saturation point develops, so a person cannot overdose on gambling as is possible with substances
  • The high comes from internal stimuli
  • Fewer resources are available
  • Gambling is often viewed as a risk-free activity
  • Higher rates of suicide are measured among individuals with gambling disorder

Screening – Why it Matters

Clinicians should be aware of the importance of screening and understand that their clients may be at increased risk for developing a problem with gambling.

Screening helps to identify individuals who should seek further assessment for potential gambling-related problems. It does not provide a diagnosis. Many clinicians working with individuals with gambling disorder may not be aware of the client’s “hidden addiction.” Gambling Disorder leads to financial, emotional, social, occupational, and physical harms. Gambling Disorder affects about 5% of the adult population in North Carolina, with an additional 10-20% at risk. People experiencing gambling-related problems are more likely to smoke, consume excessive amounts of caffeine, and have more emergency department visits. Nearly 50% of people who have gambling problems are in treatment for a different mental health or addiction concern. Many cases of Gambling Disorder go undetected, due to limited assessment for this addiction.

Clinicians need to be aware that there is a high rate of suicide and suicidal thoughts among clients with gambling disorder. If left untreated, people experiencing problems with gambling may face negative consequences, such as physical illness, mental health conditions, financial difficulties or possibly criminal activity.

Problems with gambling affect more than the gambler, it’s estimated that an additional eight to ten people in the gambler’s social network will be directly affected.

Screening Tools

Screening and assessment for problematic gambling are two distinct activities. Screening helps you determine whether there is potentially a problem and if someone needs a full assessment.

There are various problem gambling screening tools. Routine screening is brief and narrow in scope, and can help you identify problems early. Screening tools such as the LIE BET, Brief Bio Psycho Social (BBGS) or the NODS-Clip can be added to an already existing intake process.

Open NODS Clip pdf >

Open Lie Bet pdf >

Assessment Tools

DSM-5 Diagnostic Gambling Disorder Criteria – The American Psychiatric Association provides guidelines used for gambling disorders. Five or more “yes” answers indicate a possible diagnosis for a Gambling Disorder. Fewer than five but more than zero indicates a potential problem and/or at-risk indicators that may warrant further support, education and treatment services.

NORC DSM IV Screen for Gambling Problems – The NODS is based on the DSM-IV criteria for Gambling Disorder and assesses both lifetime and past-year problem gambling.

The NORC screening tool or NODS-SA was designed to assist individuals in evaluating whether to modify or seek help for their gambling behavior.

Become an NCPGP Provider


The NCPGP has more than 80 trained, licensed providers across the state of North Carolina who can provide treatment for problems related to gambling. When adolescent and adults experiencing problems with gambling and concerned loved ones call the helpline, the person can be referred to one of the program’s network providers for clinical counseling services.

In order to qualify to submit an application to become a provider on the official registry, the individual must:

  • Be licensed as a clinician in the state of North Carolina.
  • Have an office setting for counseling services.
  • Adult clinicians should complete Sure Bet One and Sure Bet Two two-day training workshops.
  • Adolescent clinicians should complete the Blurring the Lines of Gambling (BLOG) 5-module self-paced workshop titled Introduction to Prevention and Treatment of Youth Problem Gambling and Gaming.

The application can be submitted after the items listed above are completed. Please have your references contact the state administrator directly. This will speed up the application process.

Adult Clinician Applications contact:

Amanda Winters, NCPGP State Administrator
Cell 919-713-3233

Benefits and Requirements

  • Helpline referrals and reimbursement for gambling disorder counseling.
  • Opportunities to exhibit the NCPGP table at events and conferences and to speak to groups of people or organizations in your community. By doing this, providers help build awareness of problem gambling and available services.
  • One or two provider calls each year. The provider calls are virtual meetings that can be accessed by phone or online with presentations and discussions on a certain aspect of problem gambling. The calls provide free Continuing Education Units (CEUs).
  • When funds are available, access to annual training at the North Carolina Foundation for Alcohol and Drug Studies (NCFADS) summer school, typically held at UNC Wilmington. The program offers scholarships for providers to attend that includes registration, on-campus housing and on-campus meals (as funds are available). This is not mandatory but is encouraged.
  • Encouragement to attend Sure Bet Three each year and attend Sure Bet One and Sure Bet Two again every five years.
Adolescent Clinician Applications contact:

Alison Drain, Youth Prevention and Treatment Specialist
Cell 919-800-8482


Sure Bet Training Series

To raise awareness and provide education, the North Carolina Problem Gambling Program (NCPGP) sponsors a three-part workshop to provide in-depth knowledge about problem gambling and treatment interventions. In this training, topics of problem and pathological gambling, gambling counseling theory and practice, regulations and ethical issues, and financial aspects of remuneration will be addressed. Trainings are held several times a year.

Sure Bet One

What constitutes problem or pathological gambling? And how do professionals assist individuals whose gambling is creating problems in their home and work lives? This workshop will provide in-depth knowledge about problem and pathological gambling and treatment interventions, gambling counseling theory and practice, regulations and ethical issues, and financial aspects of remuneration. Participants will learn the basics of problem gambling, be introduced to ways to assess the client regarding issues of pathological/problem gambling, gain tips on how to identify recommended outpatient treatment methods and examine the financial aspects of treatment for pathological/problem gamblers.

Sure Bet Two

This workshop will provide in-depth knowledge and practice skills using Motivational Interviewing and financial counseling in problem gambling services to special populations (e.g., military, adolescents, young adults, older adults and females) and their non-gambling family members. Participants will learn how to identify and provide services for special populations, including military, teens, seniors and women; and how to provide culturally competent counseling for problem gamblers and concerned others; and how to conduct in-depth financial counseling for problem gamblers and concerned others.

Sure Bet Three

This workshop focuses on problem gambling with teenagers and young adults. It’s also during these sensitive years that many young adults step onto college campuses to experience their first few years of independence and make some very important initial life decisions. Many of these decisions will have lifelong ramifications and will often be influenced by the plethora of recreational options that are accessible to students in the modern era college experience. These options include all the gambling and gaming opportunities available today due to industry and technological developments. Participants will learn about the vulnerabilities, motivations and types of gambling that young adults encounter during their college years on our nation’s campuses. Also, participants will gain an understanding of prevention strategies and the clinical implications of serving this population during this phase of their young lives.

Blurring the Lines of Gambling

(BLOG) is a workshop series designed to provide training on the prevention and treatment for youth affected by problem gambling and gaming.

  • BLOG >

    The Introduction to Prevention and Treatment for Youth Problem Gambling and Gaming is located at the Behavioral Health Springboard and is a 5-module self-paced course open to anyone. This no cost online training is directed to child and adolescent mental health and school-based clinicians and healthcare professionals to integrate problem gambling and gaming screening, interventions, and treatment pathways into their practices. These modules are also required for all those adolescent clinicians interested in applying to join the registry.

    While these workshops are open to anyone, completion of these events will meet the requirements necessary for application for the NCPGP Provider Registry. Participation in this training does not ensure that a provider will be selected for the registry, but it is required to become an NCPGP provider. Participants must attend 100% of the program to receive credit. Partial credit will not be given.

    Open Sure Bet flyer pdf >

    Visit Youth Problem Gambling and Stacked Deck – Train the Trainer Workshop site >

Webinars and ongoing trainings

The North Carolina Problem Gambling Program (NCPGP) offerers a series of free webinars focusing on the treatment of problem gambling. The NCPGP, along with the NC Division of Mental Health, Developmental Disabilities and Substance Use Services, Morneau Shepell, and UNC Chapel Hill School of Social Work/Behavioral Health Springboard work together to bring to our state the Sure Bet Training Series and to develop the NCPGP Provider Registry. These beginner-level webinars are intended to educate NCPGP Providers, as well as other behavioral health providers, about risk factors, incidence rates, impact, and treatment strategies for working with people with problematic gambling behavior.

Becoming a Provider >

Stacked Deck Program >