Gambling Disorder: Diagnosis and Treatment

Pathologic gambling, also known as gambling disorder, is a behavioral addiction. The prevalence of gambling disorder has increased in recent years as gambling has become more accessible. Gambling disorder is often underdiagnosed and may have disabling effects on patients. Although men are more often affected, the rate of gambling disorder has been increasing in women. Risk factors include comorbid substance use disorder, mental health diagnoses, lower socioeconomic status, and participation in other risky behaviors. The US Preventive Services Task Force has not addressed screening for gambling disorders. In the United Kingdom, the National Institute for Health and Care Excellence has developed a guideline for case-finding based on expert opinion; the guideline suggests asking a direct question, such as “Do you gamble?,” to assess patients for gambling disorder. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision criteria should be used to confirm the diagnosis and classify severity. Pharmacologic interventions such as naltrexone or olanzapine may reduce symptom severity in the short-term, although more study is needed. Psychotherapy, including cognitive behavior therapy and motivational interviewing, offers short-term benefits; however, its long-term effectiveness is uncertain. Self-help and family support groups have limited evidence but provide safe places for affected individuals and loved ones to alleviate the stress associated with the financial and emotional consequences of gambling.