The search to understand the causes and cures for Pathological Gambling is in its infancy. Government funding is now directed toward evaluating the psychosocial treatment for pathological gamblers through National Institutes for Mental Health. Funding is also available for research "regarding the initiation, nature, and course of youth gambling in the context of other youth behaviors and factors." The broader body of research includes research on the following:

• Basic behavioral studies on decision-making, risk-taking, self-control and compulsive behavior;
• Neurobiological studies on how behaviors such as gambling alter brain function resulting in compulsion and loss of control;
• Clinical studies on mood disorders, compulsive behaviors and the relationship between the two;
• Treatments and preventive interventions and their delivery in real world settings.

The causes of Pathological Gambling are not fully known but there appear to be a variety of contributing factors identified by the National Research Council of the National Academy of Sciences review of thousands of gambling references including over 300 empirical studies. They found that "certain patterns of behavior may predispose a person to develop a gambling problem":

• Pathological gambling often occurs in conjunction with other behavioral problems such as substance abuse, mood disorders, and personality disorders.
• Pathological gamblers are more likely than non-pathological gamblers to report that their parents were pathological gamblers. (This could be either genetic or role model factors, or both.)
• The earlier a person begins to gamble, the more likely he/she is to become a pathological gambler. (Many people do report "aging out" of gambling that was begun in their youth.)
• The availability of opportunities to gamble is a significant factor ' the presence of a gambling facility within 50 miles doubles the prevalence of problem and pathological gamblers. Currently all but two states (Hawaii and Utah) have legalized gambling. For information on each state check http://www.naspl.org

"It is the confluence of psychological, social and biological forces that determines addiction. No single set of factors adequately represents the multi-factorial causes of addiction." ⁱ

Pathological gambling has psychological, social, and biological components. Recently there have been advances in research on biological factors that contribute to the development and persistence of gambling problems.

Biological markers of addiction. ⁱⁱ Deficits in some brain functions have been implicated in pathological gambling.
The prefrontal cortex of the brain mediates decision-making. Research for over a decade supports that damage or deficits in the prefrontal cortex of the brain can lead to impaired decision-making. Additionally, a decade of research also supports that problems in the brain's reward processing pathways are implicated in problem gambling. Major findings include:

• Several neurotransmitters, including serotonin and dopamine, are involved in the development of pathological gambling.
• Pathological gamblers demonstrate lower activity in an enzyme that breaks down neurotransmitters. This might be a sign of the dysfunction in the pathway involving serotonin.
• Particular genetic configurations are noted in pathological gamblers. These genetic variations may cause neurotransmitter and other deficiencies in the reward pathway.
• Medications that target particular neurotransmitters, such as serotonin, have been effective in treating pathological gambling.
• These areas of the brain, the middle frontal, inferior frontal, and orbital gyrus, appear to be involved in decision-making - deficits in these area could contribute to the development of gambling problems.

Development of neuroanatomical regions, impulsivity, and increased prevalence of gambling during adolescence. Recent research ⁱⁱⁱ makes the case for the role of neurobiology in problem gambling and for a common basis of other behavioral addictions, drug addictions, and impulse control disorders. More research is needed to determine direct links, but the initial research indicates the following:
Adolescents can develop problems with gambling as a result of their normal stage of neurodevelopment:

• Impulse control in adolescents is not fully developed neurologically - brain development is still incomplete and this incomplete impulse control leads to impaired decision making.
• Problem gambling shares symptoms and "reward-driven" nature with other impulse control disorders.
• Neuroimaging studies show that problem gamblers neurological reactions to gambling situations mirror reactions to drugs of people with substance use disorders.

Human activities stimulate naturally occurring neurotransmitters. This activity is likely to be important in process addictions as well as in substance addictions. Just as physical exercise and meditation influence neurochemistry, the activity of gambling also influences neurochemistry. Gambling appears to be one of those "activities that shift subjective experience". The most reliable, fast-acting and robust "shifters" hold the greatest potential to stimulate the development of addictive disorders." Yet because the strength and consistency of an activity to shift a subjective state will vary in an individual, it cannot be predicted precisely who will become addicted to what activity.

ⁱ Page 4; www.divisiononaddictions.org/html/whatisaddiction.htm.
ⁱⁱ Biology, Addiction, and Gambling. The WAGER, Vol 8 No 30, July, 2003. http://www.basisonline.org/the_wager/
ⁱⁱⁱ Biology, Addiction, and Gambling. The Wager, Weekly Addiction Gambling Education Report. Harvard Medical School. Vol 8, No. 40 ' October 1, 2003. http://www.basisonline.org/the_wager/