Treatment Guidelines for Problem Gambling

Basal ganglia may be involving in gambling disorder

Problem gambling effects a number of individuals who engage in gambling behavior.

Gambling behavior that meets criteria as a Gambling Disorder according to the criteria of DSM-5 includes four or more of the following over a consecutive 12 month period of time:

1. Increased quantity of money gambled to achieve excitement
2. Restlessness/irritability when attempting to cut down gambling behavior
3. Repeated unsuccessful attempts to cut down or stop gambling
4. Preoccupation with gambling
5. Gambling common in response to feelings of distress
6. Chases losses by returning to gambling in attempt to get even
7. Lies about the amount of gambling behavior
8. Loss of relationships, jobs or other significant life opportunities
9. Uses money from other people to attempt to solve gambling-induced financial problems

DSM-5 notes clinicians should be sure to rule out mania as a primary cause for gambling as this is a common feature of bipolar disorder.

There are few published guidelines for the treatment of gambling disorder. One helpful guideline is the Management of Gambling Disorders published by the Singapore Ministry of Health in 2011.

Here is a summary of some of the recommendations that meet the higher grades of evidence in support of the action:

• Gambling screening is appropriate in high-risk populations including chronic psychological or physical problems, alcohol or substance abuse or mental disorders
• A comprehensive treatment plan that is multidisciplinary and multi-modal
• No specific drugs have been approved to treat gambling disorder-patients should be told pharmacological treatments are off-label and may have side effects
• Opioid antagonists such as naltrexone may reduce gambling urges and thoughts
• SSRI drugs such as fluvoxamine or paroxetine may also reduce gambling urges and thoughts
• Psychological treatments are important and can include motivational enhancement therapy, self-help books, cognitive behavioral therapy (CBT) and mindfulness therapy
• Family members should be engaged in treatment to reduce facilitating behaviors

Additionally, any alcoholism or drug use must be addressed in gambling disorders as they can block effects of treatment and contribute to relapse risk.

Individuals seeking treatment for gambling problems should make sure elements of treatment outlined above are available as part of a comprehensive treatment program.

Figure is a screen shot from the iPad 3D Brain app of basal ganglia thought to be involved in reward and impulsive behaviors like gambling.

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Readers with more interest in this topic can find the free full-text manuscript by clicking on the PMID link below.

Lee KM, Chan HN, Cheah B, Gentica GF, Guo S, Lim HK, Lim YC, Noorul F, Tan HS, Teo P, & Yeo HN (2011). Ministry of Health clinical practice guidelines: management of gambling disorders. Singapore medical journal, 52 (6) PMID: 21732000