Gambling is a worldwide activity with some 1 billion people participating in it each year. It has gone through several waves of popularity and decline, including a major wave in the 1800s when it was popular on Mississippi riverboats and in frontier towns. However, in the early 20th century moral conservativism took hold and gambling declined. Currently, there are only two states that don’t allow gambling: Utah and Hawaii.

Despite the fact that most people who gamble do so without any problems, a small percentage develop a gambling disorder. This condition is characterized by compulsive and irrational gambling behaviours that result in negative consequences for the gambler and others. The objective of this review is to examine current research on the risks and benefits of gambling, particularly pathological gambling. It will also discuss the growing role of evaluating gambling behaviour in primary care settings and screening strategies for problem and pathological gambling.

The positive and negative effects of gambling can be structured using a model that distinguishes between costs and benefits. The model classifies these into three classes: financial, labor and health and well-being. These impacts manifest at personal, interpersonal and societal/community levels. Personal and interpersonal level costs are non-monetary in nature and include invisible costs that are often overlooked by researchers (e.g., emotional stress, relationship problems, lying to family members and therapists, the desire to get even after losing money, etc.). Similarly, society/community level external costs are often overlooked as they are difficult to evaluate in monetary terms.