Dr. Miguel Esteves Carneiro, a psychiatrist at The Clinic of Change, spoke in an interview with Notícias ao Minuto in an article published in the aftermath of the World Cup, as the national soccer championship was getting underway, and amid growing access to online gambling platforms. The conversation addressed the warning signs of pathological gambling, risk factors, the consequences for mental health, and available therapeutic approaches.
What is pathological gambling?
The starting point is clear: pathological gambling is neither a weakness of character nor a moral failing. It is a serious, progressive psychological disorder formally recognized by the World Health Organization, involving well-documented neurobiological and emotional mechanisms. “Winning at gambling activates the same brain reward circuits as drugs such as cocaine or heroin,” explains the psychiatrist. The disorder is characterized by a loss of control over gambling behavior, even when the person recognizes the severe consequences it has on their personal, family, professional, and financial life.
A fine line—and one that's becoming increasingly hard to see
According to Miguel Esteves Carneiro, the line between entertainment and addiction is extremely fine—and today’s society makes it even harder to identify. “Gambling should be viewed as a problem as soon as it begins to interfere with emotional balance, negatively impacting work, family relationships, or money management,” he says. As long as a person is able to set and stick to clear limits on time and money, gambling remains within the realm of leisure. When those boundaries are systematically broken, the behavior evolves into an addictive disorder.
One of the biggest challenges in early detection is what the psychiatrist refers to as “normalization of deviance.” “The pathology blends in perfectly with social norms, since today practically everyone is looking at a screen, whether for work or leisure.” Online gaming exacerbates this problem. It’s available at any time on a cell phone, with no physical barriers and no immediate awareness of the money being lost.
Warning signs you shouldn't ignore
The main warning signs include a gradual increase in the time and money spent on gambling, frequent thoughts about gambling, the need to bet increasingly larger amounts to achieve the same level of pleasure, and the compulsive attempt to recoup lost money through new bets. Also cause for concern are the linking of gambling to self-esteem and the concealment of bank transactions. Family members and friends play a crucial role: they are often the first to notice changes in routine and unexplained spending.
Who is at the highest risk?
Anyone can develop this disorder, but the risk increases in the presence of factors such as a family history of the disorder, traits of impulsivity or extreme competitiveness, a history of depression or anxiety, and situations of financial or emotional crisis. Young adults and adolescents are particularly vulnerable groups, due to their early exposure to gambling and the ease of access. The psychiatrist also emphasizes that pathological gambling is rarely an isolated problem: “Rather, it functions as the dysfunctional ‘solution’ and the coping mechanism the patient has found to manage invisible suffering.”
The consequences of not seeking treatment
If left untreated, the disorder can have devastating consequences. In addition to financial ruin, there is a silent neurobiological consequence: “reward inflation.” The massive dopamine surges triggered by online gambling cause everyday stimuli to gradually lose their appeal—“real life begins to seem neurologically dull and gray,” the psychiatrist explains. Clinically speaking, the accumulated despair correlates with very high rates of suicidal ideation. The impact on the family is equally severe: constant lies, financial instability, and the destruction of bonds of trust.
Treatment is available and effective
Miguel Esteves Carneiro is clear: gaming disorder can be treated and overcome. At The Clinic of Change, the approach combines specialized psychotherapy with structured psychopharmacological support, tailored to each patient. The therapeutic goal is not total digital abstinence—“which is unrealistic in today’s world”—but rather the regaining of “digital sovereignty”: empowering the patient to have a conscious, intentional, and autonomous relationship with technology. The treatment also focuses on understanding what lies behind the compulsion and addressing the emotional factors that fuel it, rather than merely interrupting the behavior.
Major sporting events as a risk factor
When asked about the impact of events such as the World Cup or the start of the soccer season, the psychiatrist has no doubts: “Current data clearly suggest that people are gambling more, and this trend intensifies sharply during major international competitions.” The ubiquity of advertising and the association of gambling with high-level sports create a false sense of security and a social normalization of the behavior. For those in recovery, this period represents an extremely demanding test, and therapeutic support must be redoubled.
Miguel Esteves Carneiro’s conclusion is a call for collective responsibility: “Just as with alcohol consumption, the same rigor must be applied to gambling disorder. Since this is a widely recognized disorder within the medical community, it is our responsibility as a society to treat it with the utmost seriousness, investing in prevention and protecting our most vulnerable citizens.”
The full interview can be read in the online edition of Notícias ao Minuto.
