Article

Assessing and treating problem gambling: Empirical status and promising trends

Clinical Research Department, Center for Addiction and Mental Health, Toronto, Ontario.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.41). 09/2004; 49(8):517-25.
Source: PubMed

ABSTRACT Ways to clinically assess and treat problem gambling evolve as our knowledge about this disorder increases. This paper summarizes current knowledge about treating problem gambling and describes developments in the assessment, psychology, and biology of problem gambling that may be important for treatment.
We reviewed recent published literature reporting advances in the assessment, psychology, and biology of problem gambling. We retained for review only controlled clinical trials in which subjects were randomized to either psychological or pharmacologic treatment.
Although several gambling treatments were found to be efficacious, support for any specific treatment modality is still limited. Cognitive-behavioural treatments were most effective. Although diagnostic assessment has improved, there are still very few measures of gambling-related variables. The contribution to gambling of sex, concurrent psychiatric disorders, cognitive distortions, and impulsivity has been described. Evidence implicating decision-making areas of the cortex and disturbances in serotonin and dopamine functioning has been reviewed. Available evidence for a genetic contribution to problem gambling is weak.
Improvements in the methodology of gambling-treatment research were discussed to advance the clinical approach to this disorder. Developments in the area of assessment, psychology, and biology of gambling should inform clinical approaches to a greater degree than they currently do. We identified the need to study different types of gambling separately, rather than combining them, as an important goal.

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    • "We used a non-standard threshold of three instead of five to include subclinical forms of problem gambling, which could be considered as forms of ''abuse of gambling'' similar to the notion of substance abuse. Previous literature supported the relevance of this categorization (Potenza 2006; Toneatto and Millar 2004). "
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    ABSTRACT: With the aim of validating the three pathways hypothesis of pathological gambling (Blaszczynski and Nower in Addiction 97:487-499, 2002) 372 pathological gamblers meeting DSM IV (2000) criteria were assessed via a structured clinical interview as well as being subjected to personality tests and evaluation of their gambling practices. Our results show that it is possible to identify three subgroups corresponding to the three pathways: behaviourally conditioned problem gamblers, emotionally vulnerable problem gamblers and antisocial impulsivist problem gamblers. Our results particularly demonstrate that impulsivist gamblers preferentially choose semi-skilful gambling (horse racing and sports gambling) whereas emotionally vulnerable gamblers are significantly more attracted to games of chance (one-armed bandits, scratch cards, etc.) This led us to propose a functional presentation of the three pathways model which differs somewhat from the Blaszczynski and Nower presentation.
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    • "Recently, some empirical contributions have shown the validity of the metacognitive approach to the study of gambling (pathological gambling: Dowling et al. 2007; problem gambling: Toneatto and Millar 2004; non pathological gambling: Weatherly and Flannery- Woehl 2009). The metacognitive approach focuses specifically on the control of stimuli and cognitions associated with gambling, aiming at restructuring and/or strengthening coping skills, emotions and cognitions challenging the addictive behaviour, and preventing recurrence. "
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    • "Cognitive distortions are thought to play a central role in the development and maintenance of gambling problems (Goodie & Fortune, 2013; Johansson, Grant, Kim, Odlaug, & Gö testam, 2009; Toneatto & Millar, 2004). Research has demonstrated that samples of problem gamblers are more likely than social gamblers to endorse such distortions (Joukhador, Maccallum, & Blaszczynski, 2003; McInnes, Hodgins, & Holub, under review; Myrseth, Brunborg, & Eidem, 2010; Toneatto, Blitz-Miller, Calderwood, Dragonetti, & Tsanos, 1997). "
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