Are there specific treatments for excessive gambling?

Many different therapeutic approaches have been suggested for people presenting with gambling difficulties. With the exception of certain cognitive therapy techniques, no approach can be considered specific. In practice, different approaches are often combined. The most common models are as follows:

Cognitive-Behavioural Approach:
This type of treatment proposes that the player`s beliefs about the game may serve to develop and maintain excessive gambling. Particularly, excessive players have a tendency to overestimate the probability of winning. Furthermore, they believe they can influence the outcome of the game by their ability or experience. The cognitive-behavioural approach proposes that a person`s beliefs, behaviours and emotions are interrelated and reciprocally influence each other. The treatment involves questioning unhelpful beliefs, in order to modify gambling behaviour.  Another aspect of this approach is to identify situations associated with gambling and strategies to manage any "high risk situations". Cognitive-behavioural treatments can be provided on an individual or group basis.

Pharmacological Treatments:
This type of treatment is currently being researched. Studies focus on three systems: serotonin, mood stabilisers and opioid antagonists (inhibitors). There are 4 types of pharmacotherapy treatments for substance abuse: 1) relieving withdrawal symptoms; 2) replacing the effects of the drug; 3) blocking the reinforcement effects; 4) relieving an associated disorder, to indirectly reduce drug abuse. The final two types of treatment are also currently being considered in studies of pharmacological treatment for gambling. For serotonin, the medication that is used is clomipramine, citalopram (Seropram®), paroxetine (Deroxat®) and fluoxamine (Floxifral®). Concerning mood stabilisers, the medications that have been tested are carbamazepine (Tegretol®), lithium and valproate (Depakine®). For opioid antagonists, only naltrexone has been tested. In summary, studies show potentially positive effects but these need to be confirmed. Currently, no pharmacological treatment has been accepted by the different authorities involved in the drug approval.

Treatments for Family and Close Friends :

Excessive gambling not only affects the individual but also their friends and family. A study by Lobsinger & Beckett (1996) has shown that one problematic gambler directly affects an average of ten friends and family members. Those close to a gambler may be affected by financial loss, borrowing or illegal activities. Moreover, Trust and communication can break down and physical/verbal abuse may occur during times of crisis. Relatives frequently experience feelings of anger, depression, loneliness or guilt. Support for relatives can be provided in the form of individual, couple or family meetings. Effective interventions include listening to the player and developing an understanding of their problems within the context of their relationships.

Treatments Inspired by Psychoanalytic or Psychodynamic Psychotherapy
Psychodynamic orientated therapy aims to understand the relationship between unconscious emotional needs and gambling. According to the psychoanalytic perspective, the player can for example have an unconscious desire to lose. This would create in him feelings of guilt, especially towards authority figures like parents. The psychoanalytic approach is one of a variety of approaches, which share a common focus on the analysis of emotional processes. These processes, called transference and counter-transference, are observed within the therapeutic work. Psychotherapy sessions are offered at regular times on a medium to long term basis (months to years). The strategies and techniques can also be integrated with brief interventions, and other specific approaches to treat gambling problems. 

Treatments Based on the 12 Steps Programmes
This type of treatment is based on the principles used in Alcoholics Anonymous sessions. It includes fixed weekly meetings, during which players can discuss their mutual problems. This enables participants to identify with other players, overcome isolation and support each other. According to this approach, gambling is considered to be like an illness: Only total abstinence can lead to recovery. The Change Programme is based on the 12 Steps programme and leads gamblers to think about their problems. The aim of sessions is to change the player`s gambling, their beliefs about the game and its significance within their lives.

Therapeutic approaches are often combined, for example medication and family meetings may complement another intervention. It is also common for treatment programmes to include a socio-educational or socio-therapeutic element. That is to say, advice on money management, debt reduction and identifying activities for social and professional reintegration.

bandeau bottom CJE - Centre du jeu excessif UNIGE - Université de Genève IMSP - Institut de Médecine Sociale et Préventive CHUV - Centre Hospitalier Universitaire Vaudois

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