Problem gambling
Problem gambling refers to gambling that disrupts or damages personal, family or recreational pursuits. The DSM uses the term pathological gambling.
The 2010 British Gambling Prevalence Survey found that 7.3% of adults fell into the at risk group, i.e. those who gamble problematically and who are at risk of developing more severe gambling problems. The survey also found that an additional 0.7% (George 2013) of British adults were problem gamblers. The prevalence of problem gambling in psychiatric patients ranges from 6 to 12% (George 2005).
Problem gambling typically begins in early adolescence in males (later in females) and runs a chronic, progressive course, punctuated by periods of abstinence and relapses.
Screening
There is no 'gold standard'.
The NODS-CLiP contains three questions:
A positive response to any one question is considered a positive screen, which should be followed by a more extensive diagnostic interview.
The South Oaks Gambling Screen (SOGS) is perhaps the most widely used. This is a lengthier 20-item, self-administered questionnaire, and a score of 5 or above indicates a probable problem gambler.
Brief interventions
Brief interventions have yielded success in decreasing gambling. For example, in a randomised trial, Petry et al (George 2013) compared a brief 10-minute intervention with an assessment-only control, one session of motivational enhancement therapy (MET), and a session of MET plus three sessions of cognitive behavioural therapy (CBT). The one session of MET was the only intervention to yield clinically significant reductions in gambling at 9 months follow-up.
Pharmacological interventions
Trials have shown that selective serotonin reuptake inhibitors (SSRIs), naltrexone and mood stabilisers are all effective, although none has demonstrated superiority over others. The existence of comorbidity might often help determine the choice of drug. For example, choose an SSRI if there is coexisting obsessive-compulsive spectrum disorder or depression; choose a mood stabiliser in the presence of comorbid bipolar disorder, and prefer naltrexone if pathological gambling is associated with other impulse-control disorders.
Psychological interventions
Although a number of psychological interventions are effective in the treatment of pathological gambling, no one approach has clear superiority. Cognitive-behavioural treatments look particularly promising, but results need to be replicated in larger and more representative samples. Major limitations of psychological treatment studies are the lack of long-term follow-up and high drop-out rates. Studies comparing psychological and pharmacological interventions are warranted.
George (2005) Pathological gambling: an overview of assessment and treatment. APT, 11:450-456.
George (2013) Problem gambling: what can psychiatrists do? The Psychiatrist Online, 37:1-3.
The 2010 British Gambling Prevalence Survey found that 7.3% of adults fell into the at risk group, i.e. those who gamble problematically and who are at risk of developing more severe gambling problems. The survey also found that an additional 0.7% (George 2013) of British adults were problem gamblers. The prevalence of problem gambling in psychiatric patients ranges from 6 to 12% (George 2005).
Problem gambling typically begins in early adolescence in males (later in females) and runs a chronic, progressive course, punctuated by periods of abstinence and relapses.
Screening
There is no 'gold standard'.
The NODS-CLiP contains three questions:
- Have you ever tried to stop, cut down, or control your gambling?,
- Have you ever lied to family members, friends or others about how much you gamble or how much money you lost on gambling?
- Have there been periods lasting 2 weeks or longer when you spent a lot of time thinking about your gambling experiences, or planning out future gambling ventures or bets?
A positive response to any one question is considered a positive screen, which should be followed by a more extensive diagnostic interview.
The South Oaks Gambling Screen (SOGS) is perhaps the most widely used. This is a lengthier 20-item, self-administered questionnaire, and a score of 5 or above indicates a probable problem gambler.
Brief interventions
Brief interventions have yielded success in decreasing gambling. For example, in a randomised trial, Petry et al (George 2013) compared a brief 10-minute intervention with an assessment-only control, one session of motivational enhancement therapy (MET), and a session of MET plus three sessions of cognitive behavioural therapy (CBT). The one session of MET was the only intervention to yield clinically significant reductions in gambling at 9 months follow-up.
Pharmacological interventions
Trials have shown that selective serotonin reuptake inhibitors (SSRIs), naltrexone and mood stabilisers are all effective, although none has demonstrated superiority over others. The existence of comorbidity might often help determine the choice of drug. For example, choose an SSRI if there is coexisting obsessive-compulsive spectrum disorder or depression; choose a mood stabiliser in the presence of comorbid bipolar disorder, and prefer naltrexone if pathological gambling is associated with other impulse-control disorders.
Psychological interventions
Although a number of psychological interventions are effective in the treatment of pathological gambling, no one approach has clear superiority. Cognitive-behavioural treatments look particularly promising, but results need to be replicated in larger and more representative samples. Major limitations of psychological treatment studies are the lack of long-term follow-up and high drop-out rates. Studies comparing psychological and pharmacological interventions are warranted.
George (2005) Pathological gambling: an overview of assessment and treatment. APT, 11:450-456.
George (2013) Problem gambling: what can psychiatrists do? The Psychiatrist Online, 37:1-3.
