Given the importance and the burden of pathological gambling (PG) and its effect on gamblers and their relatives, better comprehension of the phenomena involved in its development and persistence is needed. The present paper describes the previous 5 years of studies on decision making and magnetic resonance imaging in people with PG. Twenty-six studies (456 participants with PG) were included. Perseveration in monetary tasks was associated with PG despite intact executive planning abilities. PG was linked with impairment in decision making under uncertainty. Hyperactivation of the reward pathway was repeatedly found. PG was also linked with neural hyperactivation of the reward pathway during high-risk conditions and hypoactivation in low-risk conditions. Furthermore, in PG, near misses activated the brain regions related to wins. Numerous similarities were found between PG and substance use disorders, highlighting the scientific basis of the recent reclassification of PG in the spectrum of addictive disorders.