This week, an investigation – led by Investigate Europe and involving The Irish Times and media outlets in 15 other countries – lifted the lid on Ireland’s role in a vast, online gambling empire. The regulatory issues are stark: the investigation found that Irish authorities granted gambling licences to six companies at the heart of a global network of black-market betting and casino websites. But the human stories are even more troubling – stories of addiction, depression, despair.Gambling disorder is an addiction similar to alcohol or drug addiction. Like them, gambling destroys lives, ruins families and erodes communities in towns and villages across Ireland.The trauma from gambling can be transgenerational. If a family home is lost to gambling, the children of that family suffer adversity that may impact their mental health for the rest of their lives.Traditionally, we have been lenient towards gambling in this country: a flutter on the horses, a bet on a match, a scratch card. But gambling is a problem for one in 30 adults in Ireland, according to the Economic and Social Research Institute (ESRI). There are particular risks with high-intensity online gambling, which often leads to other forms of gambling, addiction and exploitation. Online, there are no guardrails for the vulnerable.In the past, there was protracted debate about whether or not gambling disorder was an addiction, similar to alcohol and drugs. We now know that gambling acts on the brain’s systems of reward, anticipation and learning in ways that closely resemble alcohol and drugs. On a brain scan, these addictions cannot be told apart.Gambling is especially seductive because the brain’s dopamine circuits respond not only to reward, but also to the possibility of reward. When there is even a remote chance of winning, we get a rush of chemical excitement across our brains and through our bodies.If we win, we want more. If we lose, we want the excitement of trying again. We primarily seek the rush, not the prize. Logically, we know we will not win, but we still get the thrill from trying, the dopamine hit of possibility, the seductiveness of hope.The stories told to The Irish Times this week illustrate this dynamic in action. One man said: “I was gambling eight hours or more until the morning. I wouldn’t think about work the next day; the only thing that mattered was rolling the slots.”A woman described how “VIP managers would send me emails all the time with rewards and bonuses”, adding: “If I ran out of money, I could ask them and they’d give me more funds.”That possibility – the next scratch card, the next race, the next goal, the next spin – is precisely where gambling exerts its psychological force. It is not about winning as much as it is the possibility of winning – and possibility has no limit.Given the evidence that severe gambling resembles substance addictions in its clinical pattern and neurobiology, the World Health Organisation recently reclassified gambling disorder from a “habit and impulse disorder” to a “disorder due to substance use or addictive behaviours”, putting it in the same bracket as alcohol and drugs. The person has “impaired control over gambling” such that “gambling takes precedence over other life interests and daily activities”. In practice, this means damaged relationships, neglected children, lost jobs, anxiety disorders, depression and self-harm. For many people, these problems are compounded by cross-addiction to alcohol or drugs, social alienation, homelessness and early death. As a psychiatrist, I see these problems every week.In Ireland, we have spent too long treating gambling harm as a failure of character, when the science points to a disorder of reward, learning, anticipation and control. On this basis, there is a great deal more we can do to prevent and treat gambling disorder.The establishment of the Gambling Regulatory Authority of Ireland (GRAI) is a major step forward, but it needs to have serious teeth and then it needs to use those teeth. Gambling is a massive industry that supports jobs but is designed to optimise profit. It is a huge vested interest.The gambling industry – online and offline – needs to take full responsibility for its addictive products. The industry should have no role in setting regulatory standards. None. Its co-operation with GRAI should be meaningful and substantive, rather than superficial and performative.The GRAI aims “to prevent gambling from being a source or support to crime, putting certain limits on advertising and inducements, and raising greater awareness of gambling harms”. It will need to be ruthless to achieve these aims.Robust regulation makes a huge difference in industries linked with addiction. We know from studies of alcohol that the younger someone has their first drink, the greater the chances of alcohol problems in later life. In Ireland, we start gambling young: two-thirds of Irish people have gambled before the age of 18. That can be much better regulated and should be a priority for the GRAI.The GRAI website has helpful information for people who are worried that they or someone in their family is gambling to excess. It is best to act sooner rather than later. Intervention can help enormously.Unfortunately, Ireland’s mental-health services and addiction services are separate structures within our health system. The 2020 mental-health policy, Sharing the Vision, promised to address this anomaly, but the situation is unchanged on the ground. The health system still treats mental illness and addiction as two separate problems in the same person. This makes no sense. It should be remedied at once.Finally, advertising. The gambling industry – like the drinks industry and tobacco industry – is prone to specious lip service. Messages like “Please gamble responsibly” are deeply unhelpful and act as an advertisement for the industry.For someone with gambling disorder, such advice shifts responsibility from the supplier of the addictive product to the person who is addicted. That is simply exploitative. It allows the gambling industry to virtue-signal while – incredibly – still asking people to “Please gamble”.If the industry is serious about addressing gambling disorder, it should design less addictive gambling environments, co-operate meaningfully with regulation and fund services for the many, many people it harms.If the industry also wants to add a health message to their deeply addictive product, that message should simply read: “Don’t gamble.”If you have been affected by the issues in this article, please visit the “Get Help” section on https://www.grai.ie/. Brendan Kelly is professor of Psychiatry at Trinity College Dublin