From Play to Pathology: Mental Health, Risk Factors, Neurobiological Mechanisms, and Drivers of Gambling Addiction in Adolescents and Young Adults

Gambling addiction in youth and young adults is a modern, complex public health issue rooted in a convergence of factors, including developmental risks, psychosocial challenges, and disordered neurotransmitter systems. This review of the literature highlights current research in the areas of epidemiology and mental health comorbidity, (i.e., depression, anxiety, ADHD, drug use, suicidality), psychosocial risk factors (i.e., family and peer social norms, socioeconomic disadvantage, internet advertising), and neurochemical processes (i.e., dopaminergic sensitisation, serotonergic dysregulation, GABAergic dysregulation, glutamatergic dysregulation, noradrenergic hyperarousal, endogenous opioid reinforcement) involved in the transition from recreational to pathological gambling. Online gambling formats (i.e., online gambling, micro-transactions, loot boxes) create an increased reinforcement density and accessibility that serves to elevate harms and downstream effects, including financial debt, substance co-use, and suicidality, especially among young adults. The primary contribution of this paper is both theoretical and integrative: it presents an interactional developmental model that specifies and extends the concept of neurodevelopmental immaturity, psychosocial forces, and neurotransmitter dysregulation, which together shift behaviours from play to pathology. The review addresses a critical gap in the knowledge base by showing how to connect epidemiological observations to neurobiological mechanisms and knowledge on prevention, while advocating for longitudinal and culturally appropriate research.