Problem gamblers are people who have an addiction-like relationship to gambling activities that don\u2019t typically lead to major life disruptions for most individuals. As a rule, seriously affected gamblers qualify for diagnosis of a mental health condition called gambling disorder. In a study scheduled for publication in May 2014 in the journal NeuroImage, a team of British and American researchers used brain imaging to find out if people affected by serious gambling problems have an unusually hard time making a distinction between winning a gambling game and \u201calmost winning\u201d such a game. A failure to distinguish between these two outcomes could increase the chance a person will ultimately meet the criteria for a gambling disorder diagnosis. The Basics The term problem gambling is used fairly loosely to identify people who encounter serious difficulties related to their involvement in some form of gambling. Possible examples of these difficulties include such things as becoming overly preoccupied with gambling-related thinking, taking ever-increasing risks while gambling, participating in gambling instead of fulfilling essential personal and\/or social obligations, unsuccessfully attempting to get control over one\u2019s gambling-related behaviors, using gambling to avoid or regulate unpleasant emotional states, using deceit to gain the resources for gambling and using deceit to hide one\u2019s gambling activities. Someone simultaneously affected by several of these difficulties will likely meet the criteria for diagnosing gambling disorder. Gambling Disorder Gambling disorder is the first (and, as of 2014, the only) behavioral addiction officially listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a standard reference text used by doctors across the U.S. dealing with mental health concerns. People affected by this disorder have a behavioral addiction (identified in the DSM as an addictive disorder). This type of addiction does not stem from the use of alcohol or the broad range of drugs and medications known to act as targets for substance abuse. However, it does produce some of the critical brain changes found in individuals with substance-based addictions, in addition to producing classic symptoms of addiction such as craving, withdrawal and the establishment of a clearly dysfunctional pattern of daily behavior. The addictive disorders subcategory of illnesses was created in acknowledgment of the fact that a person affected by behavior-based addiction can experience just as many problems as a person affected by substance-based addiction, and therefore has the same basic need for appropriate treatment in order to regain long-term mental\/emotional well-being. Winning and \u2018Almost Winning\u2019 In the study published in NeuroImage, researchers from four British institutions and one American institution used a form of brain scanning called fMRI (functional magnetic resonance imaging) to compare the responses of problem gamblers during gambling situations to the responses of people unaffected by gambling-related issues. Specifically, these researchers wanted to know if \u201calmost winning\u201d\u2014the near-miss experience common to slot-machine gambling and certain other gambling games\u2014has an unusual impact on the brains of problem gamblers. During the study, they exposed a group of problem gamblers and a group of non-problem gamblers to a mixture of winning, losing and \u201calmost winning\u201d slot machine scenarios and then examined the brain activity in the two groups. The researchers found that, when faced with near-miss \u201calmost winning\u201d situations, the brains of both problem gamblers and non-problem gamblers experience a spike in a type of activity called theta activity. However, while non-problem gamblers only experience a minor or modest rise in their brains\u2019 theta activity, problem gamblers experience a fairly steep rise in this type of brain activity. In addition, the researchers concluded, the theta activity in any given individual rises in direct proportion to how many symptoms of problem gambling appear in that individual. The researchers also concluded that, in problem gamblers, the rise in theta activity occurs in combination with a decline in activity in two brain areas critical for rational thinking and decision-making. Significance and Considerations The authors of the study published in NeuroImage believe that their work shows that problem gamblers have an unusually strong tendency to view both wins and near-wins as rewarding outcomes of their gambling activities. The authors also believe that increased theta activity in the brain may act as a predictor of a person\u2019s chances of developing gambling problems and ultimately receiving a gambling disorder diagnosis. However, they note that the brain activity changes in affected individuals do not actually contribute to gambling problems; instead, they act as indicators of the presence of these problems. As a caveat, the study\u2019s authors note that their project only included men; further research will be needed to determine if the same changes in brain activity appear in women affected by problem gambling.