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Gambling excitement is believed to be associated with biological measures of pathological gambling. Here, we tested the hypothesis that dopamine release would be associated with increased excitement levels in Pathological Gamblers compared with Healthy Controls. Pathological Gamblers and Healthy Controls were experimentally compared in a non-gambling (baseline) and gambling condition. We used Positron Emission Tomography (PET) with the tracer raclopride to measure dopamine D 2/3 receptor availability in the ventral striatum during a non-gambling and gambling condition of the Iowa Gambling Task (IGT). After each condition participants rated their excitement level. Laboratory experiment. 18 Pathological Gamblers and 16 Healthy Controls. Pathological Gamblers with dopamine release in the ventral striatum had significantly higher excitement levels than Healthy Controls despite lower IGT performance. No differences in excitement levels and IGT performance were found between Pathological Gamblers and Healthy Controls without dopamine release. Pathological Gamblers showed a significant correlation between dopamine release and excitement level, while no such interaction was found in Healthy Controls. In pathological gamblers dopamine release in the ventral striatum appears to be associated with increased excitement levels despite lower IGT performance. The results might suggest a 'double deficit' function of dopamine in pathological gambling, where dopamine release reinforces maladaptive gambling through increasing excitement levels, reducing inhibition of risky decisions, or a combination of both. These findings may have implications for the understanding of dopamine in pathological gambling and other forms of addiction. [ABSTRACT FROM AUTHOR]