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Gambling is more accessible and prevalent than it has ever been in the US. There are lotteries, sportsbooks, online and sweepstakes casinos, daily fantasy sports, and more recently, prediction markets.
Each offers that unique feeling of anticipation that only gambling can provide.
But it’s a two-edged sword. Gambling can provide adrenaline rushes and euphoria, but it can also cause anguish and depression, especially when it takes over someone’s life.
Allen R. Miller, PhD, MBA, is the executive director of Beck Institute for Cognitive Behavior Therapy, one of the leading cognitive behavioral therapy (CBT) research organizations in the world. Miller recently shared his expertise with PlayUSA, focusing on gambling disorders and how they can be treated.
A subtle start
The earliest signs of a developing gambling problem are subtle. There’s usually not a single moment or action where recreational play becomes dangerous. Miller said it’s a quieter slide.
“The shift from recreational gambling to problem gambling is rarely dramatic and tends to unfold gradually.
“An individual may spend more time thinking about gambling, even when not gambling. Individuals may become irritable or restless when unable to gamble or begin hiding their activity from loved ones.”
Secrecy is a significant signal. When gambling becomes something a person feels the need to conceal, the behavior has already shifted from entertainment into something else.
Which is what makes gambling problems hard to spot early on. Creeping changes are much harder to see than a dramatic breaking point.
What Is CBT?
The term cognitive behavioral therapy gets thrown around a lot in mental health conversations. But it’s worth understanding what it actually involves, and how it relates to gambling, Miller said.
“CBT is a structured, evidence-based form of talk therapy based on the idea that our thoughts, feelings, and behaviors are interconnected.”
The therapy is goal-oriented and can often produce measurable change in 12 to 20 sessions. More than 2,000 studies have backed its efficacy across a wide range of conditions.
The session-to-real-life pipeline is important here. Therapists don’t just talk with clients; they teach clients to evaluate their own thoughts and practice new skills outside of therapy. That active transfer of skills is a core feature, not a bonus. So where does gambling disorder fit in?
The psychological aspect
Miller argues that the cognitive profile of gambling disorder makes it particularly responsive to CBT, even more than substance-use disorders in some ways. He said gambling disorder is mostly caused by “psychological mechanisms,” as opposed to substance abuse, which is a chemical dependency.
There are no molecules to detox from. Instead, there is a set of deeply entrenched beliefs about how gambling works. These beliefs are often incorrect or harmful, and CBT is specifically designed to dismantle that type of mental framework.
Multiple randomized controlled trials have confirmed this. And Miller said the effects “tend to be durable well beyond the treatment period.”
The lies your brain tells you
The cognitive distortions that gamblers experience feel like logic.
Miller describes a few of the most common patterns. Gamblers may believe that “past random outcomes influence future ones, such as thinking a slot machine is ‘due’ for a payout after a long losing streak.” They may believe that “skill, ritual, or strategy can influence purely chance-based events.”
And many “vividly recall wins while minimizing or forgetting losses, which artificially inflates perceived success rate.”
That last distortion can be the most damaging. The selective memory around wins vs. losses creates a mental ledger that doesn’t reflect the actual ledger. Players build a self-image as someone who wins more than they lose. The losses genuinely don’t stick the way the wins do.
CBT targets all of this directly. The therapist helps the client see these thought patterns, evaluate them, and replace them with more accurate narratives.
What to do when the urge hits
Miller highlights practical CBT techniques for managing gambling urges in real time. These are specific, actionable tools gamblers can use to help themselves.
The first is urge surfing, which is recognizing that a craving, like a wave, will peak and subside on its own if you don’t act on it. This typically happens “within 20 to 30 minutes.”
The second involves working upstream from the urge. “Individuals can identify specific triggers – boredom, stress, sports notifications – that often lead to gambling and deliberately restructure their environment to reduce exposure to those cues.”
If notifications are a trigger, they can be disabled in a phone or app’s settings.
Next is catching the thought before it turns into a bet. Miller describes the process as “noticing thoughts – like ‘I can win it back’ – that often accompany gambling urges and coming up with rational and helpful responses.” That inner voice that says you’re due for a win is the unhelpful thought pattern talking.
And finally, building genuine alternatives, not as a distraction but as a competing source of meaning. “Calling a friend, going for a walk, or engaging in a hobby can help provide sources of pleasure and meaning that compete with gambling urges.”
RG tools like self-exclusion
One thing PlayUSA readers interact with regularly is the suite of responsible gambling tools that operators offer: deposit limits, session timers, self-exclusion programs, and app blockers.
“These tools function as environmental controls, essentially hardwiring barriers into the decision-making process before a high-risk moment even arrives,” Miller said. The key move is implementing them “during moments of clarity and resolve, reducing the reliance on willpower when urges surface.”
Miller said such tools are “not a substitute for therapy but can complement it by acting as scaffolding that supports the behavioral and cognitive changes happening in session.”
On the financial side, the approach can go further. Voluntary transfer of account control to a trusted family member, combined with a structured spending plan and third-party oversight of discretionary funds, removes easy access to money before the high-risk moment arrives.
Miller pairs this with internal work: helping clients “clarify their values and aspirations and then develop a detailed and emotionally resonant image of their life free from gambling.” The combination of external structure and internal motivation, he said, is more powerful than either alone.
Finding alternatives
When Miller talks about behavioral alternatives, he doesn’t mean generic advice to “find a hobby.” He means something more specific; activities that engage the same reward systems that gambling hijacks.
The difference? While gambling can often turn unhealthy, the alternatives can align with a person’s actual values, Miller said.
“Exercise is a great alternative because it releases dopamine and reduces stress. Social activities can fill the structural void that gambling often occupies. These activities could include a recreational sports league, a volunteer role, or a standing dinner with friends.”
What every gambler must understand
When we asked Miller for the one message he wishes every gambler understood, he didn’t hedge.
“Gambling is a legal, widely available product, but like many such products, its risks are systematically underrepresented to the very people most vulnerable to them. The house edge is a mathematical guarantee, engineered at the structural level of every game, that ensures the operator profits over time regardless of any individual’s skill, intuition, or luck.”
The game isn’t designed to be beaten. It’s designed to be played. Knowing that doesn’t make gambling less entertaining, but it changes how you engage with it. For anyone sliding from recreational to problem gambling, it’s an essential anchor to reality.
Finding help
The good news, Miller said, is that access to quality treatment has improved dramatically. Teletherapy has removed many historical barriers to getting help: location, transportation, stigma, and time.
But quality varies widely, and finding a competent CBT clinician is crucial.
The Beck Institute maintains a database of certified CBT clinicians who have met rigorous training and evaluation standards. For Americans looking for immediate support, the National Problem Gambling Helpline (1-800-522-4700) provides free, confidential referrals 24/7.
Many states also fund gambling treatment programs on a sliding-scale or no-cost basis. Gamblers Anonymous remains a widely available peer-support option. While it’s not a clinical treatment, it can be a meaningful source of accountability and community.
