Treatment Of Gambling Disorder Research Articles

Translational Models of Gambling-Related Decision-Making.

Gambling is a harmless, recreational pastime that is ubiquitous across cultures. However, for some, gambling becomes a maladaptive and compulsive, and this syndrome is conceptualized as a behavioural addiction. Laboratory models that capture the key cognitive processes involved in gambling behaviour, and that can be translated across species, have the potential to make an important contribution to both decision neuroscience and the study of addictive disorders. The Iowa gambling task has been widely used to assess human decision-making under uncertainty, and this paradigm can be successfully modelled in rodents. Similar neurobiological processes underpin choice behaviour in humans and rats, and thus, a preference for the disadvantageous "high-risk, high-reward" options may reflect meaningful vulnerability for mental health problems. However, the choice behaviour operationalized by these tasks does not necessarily approximate the vulnerability to gambling disorder (GD) per se. We consider a number of psychological challenges that apply to modelling gambling in a translational way, and evaluate the success of the existing models. Heterogeneity in the structure of gambling games, as well as in the motivations of individuals with GD, is highlighted. The potential issues with extrapolating too directly from established animal models of drug dependency are discussed, as are the inherent difficulties in validating animal models of GD in the absence of any approved treatments for GD. Further advances in modelling the cognitive biases endemic in human decision-making, which appear to be exacerbated in GD, may be a promising line of research.

Psychological treatments for gambling disorder.

This review discusses the research evidence for psychological treatment of gambling disorder. Several treatment options for gamblers have been explored, ranging from self-help and peer support, to brief and motivational interventions, to more intensive therapy approaches. Involvement in peer support programs seems to be optimal when combined with professional treatment; however, engagement and retention in peer support is limited. Self-directed interventions appear to benefit some gamblers; however, the involvement of therapist support, either in person or by telephone, may bolster these effects and such support need not be extensive. These self-directed options reduce the barriers associated with treatment-seeking, and may reach a wider range of gamblers than professionally delivered treatments alone. Brief and motivational approaches similarly may extend treatment options to more gamblers, namely at-risk and problem gamblers and those not seeking treatment. Of more extensive therapies, no consistent benefit of one approach emerges, although cognitive–behavioral interventions have been most often applied. Overall, several treatments have been developed for gambling disorder and results are promising, but variability in findings suggests a need for further systematic evaluation.

SY04-4 * NEW DEVELOPMENTS IN THE TREATMENT OF GAMBLING DISORDER

Background. Although there are no medications with indications for pathological gambling or gambling disorder, multiple pharmacotherapies and behavioral therapies have received empirical support in the treatment of pathological gambling or gambling disorder. Methods. Data from clinical trials will be reviewed, with an emphasis on findings from placebo-controlled, randomized clinical trials. Results. Both behavioral and pharmacological therapies appear efficacious in the treatment of gambling disorder. Behavioral therapies with varying degrees of empirical support include different forms of cognitive behavioral therapies, imaginal desensitization, motivational interviewing and brief interventions. Pharmacological therapies with varying degrees of support include opioid antagonists like naltrexone, mood stabilizers like lithium, serotonin reuptake inhibitors like paroxetine, and nutraceuticals like n-acetyl-cysteine. Recent data suggest that combinations of behavioral and pharmacological approaches hold promise and that co-occurring disorders may be used to guide selection of pharmacological agents. Conclusions. Although no medication currently has a formal indication for gambling disorder, multiple therapies have empirical support in the treatment of gambling disorder.

Psychiatric Epidemiology, Nosology, and Treatment: Considering Internet Gambling

In this article, we consider behavioral addiction by examining the psychiatric aspects of disordered gambling. In particular, we illustrate these considerations with examples based on the growing evidence base associated with Internet-based gambling. We begin our review by focusing on gambling, the epidemiology of gambling disorders, and the place of gambling disorders within the psychiatric nosology. We include a critical discussion about the games that people play and whether certain games are associated with higher rates of gambling disorder. This discussion also includes an evidence-based consideration of the relationship between gambling exposure and adaptation to this experience. We conclude our review by discussing several issues associated with the shift from DSM-IV to DSM-5 diagnostic criteria as well as the treatment of gambling disorder. Throughout this review, we use the Syndrome Model of Addiction as an overarching guide. [ Psychiatr Ann . 2014; 44(8):371–378.]

Treatment of Gambling Disorders.

Preclinical and clinical research implicate several neurotransmitter systems in the pathophysiology of gambling disorder (GD). In particular, neurobiological research suggests alterations in serotonergic, dopaminergic, glutamatergic and opioidergic functioning. The relative efficacy of medications targeting these systems remains a topic of ongoing research, and there is currently no Food and Drug Administration (FDA) approved medication with an indication for GD. Considering co-occurring disorders may be particularly important when devising a treatment plan for GD: extant data suggest that the opioid antagonist naltrexone may by the most effective form of current pharmacotherapy for GD, particularly for individuals with a co-occurring substance-use disorder (SUD) or with a family history of alcoholism. In contrast, lithium or other mood stabilizers may be most effective for GD for patients presenting with a co-occurring bipolar-spectrum disorder (BSD). Further, serotonin reuptake inhibitors (SRIs) may be efficacious in reducing GD symptoms for individuals also presenting with a (non-BSD) mood or anxiety disorder. Finally, elevated rates of GD (and other Impulse Control Disorders; ICDs) have been noted among individuals with Parkinson's Disease (PD), and clinicians should assess for vulnerability to GD when considering treatment options for PD. Reducing levodopa or dopamine agonist (DA) dosages may partially reduce GD symptoms among patients with co-occurring PD. For GD patients not willing to consider drug treatment, n-acetyl cysteine or behavioral therapies may be effective. Ongoing research into the effectiveness of combined behavioral and pharmacotherapies is being conducted; thus combined treatments should also be considered.

Targeting the glutamatergic system to treat pathological gambling: current evidence and future perspectives.

Pathological gambling or gambling disorder has been defined by the DSM-5 as a behavioral addiction. To date, its pathophysiology is not completely understood and there is no FDA-approved treatment for gambling disorders. Glutamate is the principal excitatory neurotransmitter in the nervous system and it has been recently involved in the pathophysiology of addictive behaviors. In this paper, we review the current literature on a class of drugs that act as modulating glutamate system in PG. A total of 19 studies have been included, according to inclusion and exclusion criteria. Clinical trial and case series using glutamatergic drugs (N-acetylcysteine, memantine, amantadine, topiramate, acamprosate, baclofen, gabapentin, pregabalin, and modafinil) will be presented to elucidate the effectiveness on gambling behaviors and on the related clinical dimensions (craving, withdrawal, and cognitive symptoms) in PG patients. The results have been discussed to gain more insight in the pathophysiology and treatment of PG. In conclusion, manipulation of glutamatergic neurotransmission appears to be promising in developing improved therapeutic agents for the treatment of gambling disorders. Further studies are required. Finally, we propose future directions and challenges in this research area.

Pharmacological treatments in gambling disorder: a qualitative review.

Gambling disorder (GD) is a psychiatric condition associated with both social and family costs; DSM-5 currently includes GD among addictive disorders. Despite the high burden of this condition, to date there are no treatment guidelines approved by Food and Drug Administration (FDA). Purpose of this paper is to offer a qualitative overview about the different pharmacologic agents used for the treatment of GD. Our analysis, conducted on a final selection of 75 scientific papers, demonstrates that a variety of pharmaceutical classes have been utilised, with different results. Published data, although limited by brief duration of the studies and small number of enrolled subjects, shows mixed evidence for serotonergic antidepressants, opioid antagonists, and mood stabilizers. Other compounds, such as glutamatergic agents and psychostimulants, deserve further studies.

Economic and Psychosocial Impact of Problem Gambling in South Korea

Abstract The study examined the harmful effects of casino gambling in Korean society from economic and psychosocial perspectives. Interviews with gambling addicts were conducted in order to gain insight into the impacts of pathological gambling. Using snowball sampling, 12 gambling addicts were recruited in Kohan, South Korea. Findings of the study suggest that gambling addicts suffer various harmful effects, including an increased susceptibility to financial and employment problems, such as debt and accumulated interest, bankruptcy, job loss, and decreased productivity. Participants in the study complained of physiological problems, including headaches, high blood pressure, arthritis, indigestion, a stomach disorder, and rapid weight loss. Common psychological problems reported included symptoms of high-level stress, depression, anxiety, insomnia, and suicidal ideation. For some interviewees who smoked and drank alcohol, consumption of these substances increased in response to their gambling. All participants reported disrupted relationships with their immediate family, relatives and friends. Moreover, they experienced stigma, discrimination, and feelings of alienation. With regard to criminal and legal problems, they were exposed to increased risk of litigation and violence. Clinical and political attention should be paid to the issue of gambling addiction in Korea, with a view to the prevention and treatment of gambling disorders. Management of gambling problems needs to consider economic and financial wellbeing, employment, physical and psychological health, interpersonal relationships, and the risk of criminal involvement and other legal issues.

Economic and Psychosocial Impact of Problem Gambling in South Korea

The study examined the harmful effects of casino gambling in Korean society from economic and psychosocial perspectives. Interviews with gambling addicts were conducted in order to gain insight into the impacts of pathological gambling. Using snowball sampling, 12 gambling addicts were recruited in Kohan, South Korea. Findings of the study suggest that gambling addicts suffer various harmful effects, including an increased susceptibility to financial and employment problems, such as debt and accumulated interest, bankruptcy, job loss, and decreased productivity. Participants in the study complained of physiological problems, including headaches, high blood pressure, arthritis, indigestion, a stomach disorder, and rapid weight loss. Common psychological problems reported included symptoms of high-level stress, depression, anxiety, insomnia, and suicidal ideation. For some interviewees who smoked and drank alcohol, consumption of these substances increased in response to their gambling. All participants reported disrupted relationships with their immediate family, relatives and friends. Moreover, they experienced stigma, discrimination, and feelings of alienation. With regard to criminal and legal problems, they were exposed to increased risk of litigation and violence. Clinical and political attention should be paid to the issue of gambling addiction in Korea, with a view to the prevention and treatment of gambling disorders. Management of gambling problems needs to consider economic and financial wellbeing, employment, physical and psychological health, interpersonal relationships, and the risk of criminal involvement and other legal issues.

Review of A cognitive behavioural therapy program for problem gambling, therapist manual.

A Cognitive Behavioural Therapy Program for Problem Gambling, Therapist Manual, by Namrata Ray Iu and Tian Po Oei. Routledge Taylor and Francis Group, 2010, 258 pages (ISBN 978-0-415-54816-8, US $51.95, Paperback) Reviewed by DAVID HODGINS DOI: 10.1037/a0023399 A Cognitive Behavioural Therapy Program for Problem Gambling, Therapist Manual, arrived in the mail the day before I was scheduled to start with a new client referred for a gambling problem. Perfect, I thought, let's see how this manualized treatment protocol fits. A Cognitive Behavioural Therapy Program for Problem Gambling, Therapist Manual, provides a session by session protocol for outpatient treatment of problem gambling. The protocol was developed for an efficacy study comparing individual and group treatment but has been repackaged for a broader audience. In the research study, both the individual and group participants showed good outcomes in comparison with a waiting list control with no differences between individual and group formats. This work adds to the growing evidence base for cognitive-behavioural and motivational treatments for gambling disorders. The treatment program comprises 10 core and 3 elective sessions. As with many CBT protocols, the first two sessions focus on assessment and psychoeducation. The remaining eight core sessions cover cognitive and behavioural strategies, relaxation, imaginai exposure, problem-solving skills, management of negative emotions, and relapse prevention. The three elective sessions focus on helping clients with assertiveness and dealing with debt, and helping concerned significant others cope with the gambling problems. As is indicated in the Preface, this manual is written for professional health workers with some knowledge of CBT but limited knowledge of problem gambling. The aim of providing the relevant background in gambling disorders is accomplished effectively in two ways. First, the book provides a concise but comprehensive review of the research literature on the etiology, maintenance, and treatment of gambling disorders in the second chapter. This chapter is essentially a welcome updated version of Raylu and Oei's previous well-cited review published in Clinical Psychology Review. Second, a connection is made to the background literature in providing the rationale for specific areas of focus, interventions, and topics for each session. For example, a session focused on helping clients manage negative emotions briefly reviews the research on the role of depression and anxiety in relapse to gambling problems. Sessions focusing on cognitive distortions summarise qualitative investigations of the thinking styles of active problem gamblers. This repletion and elaboration of the information provided in chapter 2 serves to strengthen the science-practice orientation of the book. Although the session content is detailed and specific, the approach is also concise and pithy. Each session includes an overall rationale followed by a set of 6 to 10 ordered steps for the therapist (e.g., Review homework, Discuss aim for the session, Discuss challenging gambling specific thinking errors, Practice challenging gambling specific thinking errors, Generate rational selfstatements, Introduce home exercises). Although the content is excellent, a weakness of the book is that the focused style of writing for these sections, including lots of bullet points, is choppy. Moreover, it is unfortunate that the sections that provide the most direct advice to therapists are presented in a very small font in relation to the rest of the book. It is confusing that some of the client handouts and worksheets are included in the session chapters and some are provided in an Appendix to the book. …