New research into long COVID suggests impacts on brain chemistry that could put gamblers at increased risk of problematic behavior patterns. The science of COVID-19 is still in its infancy, and the medical community is still uncertain about many things. These include why some people continue to suffer the effects of a COVID-19 infection for months or years, while others appear to make a full recovery in days or weeks.
Theories are beginning to emerge, however. Neurological symptoms are common among those who report lasting effects. Many experience “brain fog,” a colloquial term for general issues with mental processing and recalling information.
Emerging research on such symptoms points to an area of neurological science that intersects with gambling-related behavioral pathologies. Though further investigation is needed, it looks as if gambling could be especially risky for people suffering from brain fog after a COVID infection.
This inference comes from putting together two separate findings:
- Post-COVID neurological symptoms correlate with lower serotonin levels
- Low serotonin levels correlate with riskier gambling behavior
Conflicting Research About Long COVID
Though opinions on long COVID vary in the medical community, a group of Yale researchers led by Dr. Shelli F. Farhadian1 defined the term:
Long COVID … refers to a range of symptoms that may persist for weeks to months after acute COVID-19.
Many other pieces of research likewise describe long COVID as a “post-acute” COVID-19 infection.
The study goes on to state that some people with the condition “report neuropsychiatric symptoms.” Another report, by a large team out of the National Institutes of Health (NIH) Clinical Center led by Dr. Yair Mina2, examined those symptoms more deeply.
It states that in the experimental study group:
The most common neuro-PASC symptoms were cognitive difficulties and fatigue, and there was evidence for mild cognitive impairment in half of the patients.
These studies also serve as examples of how unsettled the science around long COVID is at this point. The NIH study states:
The main proposed mechanisms of neuropathology in acute COVID-19 are systemic inflammation, neuroinflammation, and microvascular injury with leakage of blood products into the parenchyma and microthrombosis.
Farhadian’s team, on the other hand, failed to support that hypothesis:
When comparing individuals with neuro-PCC with control participants who had never had COVID-19, we found no evidence of overt neuroinflammation … or blood-brain barrier dysfunction … suggesting that persistent central nervous system immune activation is not a primary driver of neurological long COVID-19.
During this exploratory stage, it’s typical that findings can seem to contradict one another, particularly for a disease as multi-faceted as long COVID. Another study has suggested that a particular chemical — serotonin — could play a role in some symptoms.
Possible Link Between Long COVID, Low Serotonin
This third paper, from a large team led by Dr. Andrea Wong3, drew on data collected across multiple other studies and concluded that:
A common feature of both acute and post-acute SARS-CoV-2 infection is the formation of microthrombi […] the findings imply that thrombocytopenia may diminish the carrying capacity of the systemic circulation for serotonin.
Thrombocytopenia is a condition in which a person has a low number of platelets in their blood. That condition, in turn, can reduce the blood’s ability to move serotonin around the body.
Serotonin is both a neurotransmitter and a hormone, sometimes described as the brain’s “feel good” chemical (not to be confused with dopamine, the “reward” chemical). Among other things, it is responsible for carrying messages throughout the body relevant to cognition, memory, and mood. Normal serotonin levels are associated with feelings of calm and well-being.
Following the study data further, the authors conclude that “reduced serotonin storage, coupled with the induction of MAO enzymes, may enhance the turnover of serotonin and excretion of its degradation products.”
In simpler language, the study identified a strong correlation between long COVID and reduced serotonin levels.
A correlation doesn’t necessarily mean that one causes the other, but it raises that possibility.
That connection is potentially relevant to the study of problem gambling because of earlier findings that serotonin levels influence gamblers’ behavior.
Why Serotonin Matters for Gamblers
Academic literature on the role of serotonin in gambling-related behavioral pathologies isn’t abundant, but does exist. It points to a correlation between reduced serotonin levels and a higher instance of problem gambling.
A 2011 study4 published in Neuropsychopharmacology by Dr. Daniel Campbell-Meiklejohn et al. concluded that “serotonin activity appears to play a role in sustaining loss-chasing behavior.”
A 2010 review paper5 from Dr. David Nussbaum et al. in the Journal of Gambling Studies likewise includes sections on serotonin. It states:
A variant in the promoter region of the serotonin transporter gene (5-HTTLPR) was found to be significantly associated with [problem gambling]. These findings are consistent with the model’s proposition linking 5-HT deficiency with inhibition deficits in [problem gambling].
In other words, these authors also observed a link between depleted serotonin levels and riskier gambling behavior.
Putting two and two together: If long COVID correlates with low serotonin, and low serotonin correlates with risky gambling behavior, it’s possible that future research could uncover a connection between long COVID and problem gambling as well.
Gambling Disorder Comorbidities
A possible connection between long COVID and gambling disorder is a thread researchers haven’t pulled yet. However, various studies have shown that gambling disorder rarely occurs in a vacuum. It’s most often found alongside other physical or mental health issues.
Part of the task of healthcare professionals is informing patients of potential health risks they may face. Unfortunately, a possible loss of control while gambling isn’t always part of that conversation.
Dr. Michael Auer, a psychologist and statistician who has published over 40 studies on gambling, told Bonus:
We’ve seen in a variety of markets that signs of gambling addiction are unfortunately not sufficiently understood by healthcare practitioners. Signs of problematic gambling are often comorbid with other ailments or health challenges, whether depression, anxiety, long COVID or something else. Overall, we need to continue to educate our healthcare providers on the risks of problematic gambling, how to identify such behaviors, and how to address them effectively.
When it comes to potential problem gambling, it’s important to remember that an ounce of prevention is worth a pound of cure. Regulated gambling operators provide players with responsible gaming tools to set limits or even cut themselves off as needed. Players need to be aware of these options, especially if they choose to gamble while experiencing other factors that might increase their risk.
Auer continued, telling Bonus:
Any form of entertainment can become problematic — watching TV, social media use, shopping, eating, and more — and people who are experiencing other cognitive impairments are at higher risk.
We already see tools in some of this sort of entertainment for people to manage their use. Think of the notifications from Netflix that ask you if you’re still watching.
In gaming, we have really sophisticated mechanisms available to help people control their use so that it remains safe entertainment for them, even if they are experiencing other challenges in their lives. For example, pop-ups and notifications for players create a chance for a player to temporarily disengage and consider their game play.
Similarly, tools like self-assessments where players answer questions about how much they have played or spent and then learn how that compares to players similar to them are a great interactive tool to engage players and ask them to think carefully about their actions. All of these tools are designed to create a way for players to understand their game play in a neutral and non-judgmental way, allowing the player to make the choice that is right for them at that point in time.”
As research progresses, more data on the nature of long COVID and how it can affect people’s cognitive abilities should become available. For now, though, people who are suffering from the condition might want to consider utilizing responsible gambling tools if and when they play.
An Important Caveat
To be clear, there is not sufficient research at this time to state definitively that people with long COVID are at a greater risk of developing a gambling-related behavioral issue. The science on long COVID is simply too young, and no one has yet investigated whether there is any correlation, much less a causal link, between those two phenomena.
However, if the COVID-serotonin and serotonin-gambling links each hold up to further research, it may be worth investigating whether this translates into a COVID-gambling link. And a correlational link doesn’t always imply causality.
That said, it would be a mistake to point to any single factor as the reason some people struggle more with gambling than others. Gambling-related behavioral pathologies are often the result of many factors. So, it’s a problem that calls for a holistic approach.
What this data does suggest, however, is that people experiencing neurological symptoms stemming from long COVID might want to take greater care to gamble responsibly. It likewise points to another topic that healthcare professionals treating people with long COVID might want to discuss with those patients.
- Farhadian S, et al. (2023), Self-Reported Neuropsychiatric Post–COVID-19 Condition and CSF Markers of Neuroinflammation
- Mina Y, et al. (2023), Deep Phenotyping of Neurologic Postacute Sequelae of SARS-CoV-2 Infection
- Wong A, et al. (2023), Serotonin reduction in post-acute sequelae of viral infection
- Campbell-Meiklejohn D, et al. (2011), Serotonin and Dopamine Play Complementary Roles in Gambling to Recover Losses
- Nussbaum D, et al. (2010), An Eight Component Decision-Making Model for Problem Gambling: A Systems Approach to Stimulate Integrative Research