, Volume 219, Issue 2, pp 469-490

First online:

Similarities and differences between pathological gambling and substance use disorders: a focus on impulsivity and compulsivity

  • Robert F. LeemanAffiliated withDepartment of Psychiatry, Yale University School of Medicine Email author 
  • , Marc N. PotenzaAffiliated withDepartment of Psychiatry, Yale University School of MedicineDepartment of Neurobiology, Yale University School of MedicineChild Study Center, Yale University School of Medicine

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Pathological gambling (PG) has recently been considered as a “behavioral” or nonsubstance addiction. A comparison of the characteristics of PG and substance use disorders (SUDs) has clinical ramifications and could help advance future research on these conditions. Specific relationships with impulsivity and compulsivity may be central to understanding PG and SUDs.


This review was conducted to compare and contrast research findings in PG and SUDs pertaining to neurocognitive tasks, brain function, and neurochemistry, with a focus on impulsivity and compulsivity.


Multiple similarities were found between PG and SUDs, including poor performance on neurocognitive tasks, specifically with respect to impulsive choice and response tendencies and compulsive features (e.g., response perseveration and action with diminished relationship to goals or reward). Findings suggest dysfunction involving similar brain regions, including the ventromedial prefrontal cortex and striatum and similar neurotransmitter systems, including dopaminergic and serotonergic. Unique features exist which may in part reflect influences of acute or chronic exposures to specific substances.


Both similarities and differences exist between PG and SUDs. Understanding these similarities more precisely may facilitate treatment development across addictions, whereas understanding differences may provide insight into treatment development for specific disorders. Individual differences in features of impulsivity and compulsivity may represent important endophenotypic targets for prevention and treatment strategies.


Iowa Gambling Task Delay discounting Neuroimaging Alcohol Cocaine Dopamine Serotonin Glutamate Frontal cortex Striatum