other individuals it manifests during middle  or even older adulthood. Generally, gam-
bling disorder develops over the course of years, although the progression appears to be
more rapid in females than in males. Most  individuals who develop a gambling disorder
evidence a pattern of gambling that gradually  increases in both frequency and amount of
wagering. Certainly, milder fo rms can develop into more severe cases. Most individuals
with gambling disorder report that one or tw o types of gambling are most problematic for
them, although some individuals participate in  many forms of gambling. Individuals are
likely to engage in certain types of gambling (e.g., buying scratch tickets daily) more fre-
quently than others (e.g., playing slot machin es or blackjack at the casino weekly). Fre-
quency of gambling can be related more to the type of gambling than to the severity of the
overall gambling disorder. For example, purcha sing a single scratch ticket each day may
not be problematic, while less frequent casino , sports, or card gambling may be part of a
gambling disorder. Similarly, amounts of money spent wagering  are not in themselves in-
dicative of gambling disorder. Some individuals can wager thousands of dollars per
month and not have a problem with gambling, while others may wager much smaller
amounts but experience substantia l gambling-related difficulties. 
Gambling patterns may be regular or episod ic, and gambling disorder can be persis-
tent or in remission. Gambling can increase during periods of stress or depression and
during periods of substance use or abstinen ce. There may be periods of heavy gambling
and severe problems, times of total abstin ence, and periods of nonproblematic gambling.
Gambling disorder is some times associated with  spontaneous, long-term remissions.
Nevertheless, some individual s underestimate their vulner ability to develop gambling