Editing Problem gambling (section)

==Treatment==
Most treatment for problem gambling involves counseling, step-based programs, self-help, peer-support, medication, or a combination of these. However, no one treatment is considered to be most efficacious and, in the United States, no medications have been approved for the treatment of pathological gambling by the [[U.S. Food and Drug Administration]] (FDA).

[[Gamblers Anonymous]] (GA) is a commonly used treatment for gambling problems. Modeled after [[Alcoholics Anonymous]], GA is a [[twelve-step program]] that emphasizes a mutual-support approach. There are [[North American gambling treatment centers|three in-patient treatment centers in North America]].<ref>{{cite web|url=https://www.ncpgambling.org/help-treatment/treatment-facilities/|title=Treatment Facilities {{!}} National Council on Problem Gambling |website=www.ncpgambling.org|access-date=2016-09-15}}</ref> One form of counseling, [[cognitive behavioral therapy]] (CBT) has been shown to reduce symptoms and gambling-related urges. This type of therapy focuses on the identification of gambling-related thought processes, mood and [[cognitive distortion]]s that increase one's vulnerability to out-of-control gambling. Additionally, CBT approaches frequently utilize skill-building techniques geared toward relapse prevention, assertiveness and gambling refusal, problem solving and reinforcement of gambling-inconsistent activities and interests.<ref>{{Cite web|url=https://www.antonpsych.org/~antonpsy/ieadmin/files/Stop_Addictions_Now.pdf|title=Cognitive–Behavioral Therapy for Pathological Gamblers}}</ref>

As to behavioral treatment, some recent research supports the use of both activity scheduling and desensitization in the treatment of gambling problems.<ref>{{cite journal |last1= Dowling |first1= Nicki |last2= Jackson |first2= Alun C. |last3= Thomas |first3= Shane A. |year= 2008 |title= Behavioral Interventions in the Treatment of Pathological Gambling: A Review of Activity Scheduling and Desensitization |journal= International Journal of Behavioral Consultation and Therapy |volume= 4 |issue= 2 |pages= 172–188 |doi= 10.1037/h0100841 |hdl= 10536/DRO/DU:30059283|hdl-access= free }}</ref> In general, behavior analytic research in this area is growing<ref>{{cite journal |last1= Weatherly |first1= Jeffrey N. |last2= Flannery |first2= Kathryn A. |year= 2007 |title= Facing the challenge: The behavior analysis of gambling |journal= The Behavior Analyst Today |volume= 9 |issue= 2 |pages= 130–142 |doi= 10.1037/h0100652}}</ref> There is evidence that the [[SSRI]] [[paroxetine]] is efficacious in the treatment of pathological gambling.<ref>{{cite journal |doi=10.4088/JCP.v63n0606 |vauthors=Kim SW, Grant JE, Adson DE, Shin YC, Zaninelli R |title=A double-blind placebo-controlled study of the efficacy and safety of paroxetine in the treatment of pathological gambling |journal=Journal of Clinical Psychiatry |volume=63 |issue=6 |year=2002 |pages=501–507 |pmid=12088161}}</ref> Additionally, for patients with both pathological gambling and a comorbid bipolar spectrum condition, sustained-release [[lithium (medication)|lithium]] has shown efficacy in a preliminary trial.<ref>{{cite journal |vauthors=Hollander E, Pallanti S, Allen A, Sood E, Baldini Rossi N |title=Does sustained release lithium reduce impulsive gambling and affective instability versus placebo in pathological gamblers with bipolar spectrum disorders? |journal=American Journal of Psychiatry |volume=162 |issue=1 |year=2005 |pages=137–145 |pmid=15625212 |doi=10.1176/appi.ajp.162.1.137}}</ref> The opioid antagonist drug [[nalmefene]] has also been trialled quite successfully for the treatment of compulsive gambling.<ref>{{cite journal|url= https://kdads.ks.gov/docs/default-source/CSP/CSP-Documents/bhs-documents/provider_reports/best_practice_problem_gambling_services.pdf|title= Best Practice in Problem Gambling Services|date= 1 June 2003|journal= Gambling Research Panel|access-date= 22 September 2015}}</ref> Group concepts based on [[Cognitive behavioral therapy|CBT]], such as the [[metacognitive training]] for problem gambling<ref>{{Cite journal|last1=Gehlenborg|first1=Josefine|last2=Bücker|first2=Lara|last3=Berthold|first3=Mira|last4=Miegel|first4=Franziska|last5=Moritz|first5=Steffen|date=2020-09-21|title=Feasibility, Acceptance, and Safety of Metacognitive Training for Problem and Pathological Gamblers (Gambling-MCT): A Pilot Study|journal=Journal of Gambling Studies|volume=37|issue=2|pages=663–687|language=en|doi=10.1007/s10899-020-09975-w|pmid=32955694|pmc=8144133|issn=1573-3602|doi-access=free}}</ref> have also proven effective.

===Step-based programs===
12 Step–based programs such as Gamblers Anonymous are specific to gambling and generic to healing addiction, creating financial health, and improving mental wellness. Commercial alternatives that are designed for clinical intervention, using the best of health science and applied education practices, have been used as patient-centered tools for intervention since 2007. They include measured efficacy and resulting recovery metrics.{{medical citation needed|date=June 2015}}

===Motivational interviewing===
[[Motivational interviewing]] is one of the treatments of compulsive gambling. The motivational interviewer's basic goal is promoting readiness to change through thinking and resolving mixed feelings. Avoiding aggressive confrontation, argument, labeling, blaming, and direct persuasion, the interviewer supplies [[empathy]] and advice to compulsive gamblers who define their own goal. The focus is on promoting freedom of choice and encouraging confidence in the ability to change.<ref>{{cite journal|last=Harvard Medical School|title=The Harvard mental health letter|journal=Factiva|year=2004|volume=20|issue=9|pages=1}}</ref>

===Peer support===
A growing method of treatment is peer support. With the advancement of online gambling, many gamblers experiencing issues use various online peer-support groups to aid their recovery. This protects their anonymity while allowing them to attempt recovery on their own, often without having to disclose their issues to loved ones.{{medical citation needed|date=June 2015}}

===Self-help===
Research into self-help for problem gamblers has shown benefits.<ref>{{cite web|url=http://modelprograms.samhsa.gov/pdfs/promising/minimal-intervention-approach-to-problem-gambling.pdf|title=Minimal Intervention Approach to Problem Gambling|archive-url=https://web.archive.org/web/20090320120726/http://modelprograms.samhsa.gov/pdfs/promising/minimal-intervention-approach-to-problem-gambling.pdf|archive-date=2009-03-20}}</ref> A study by [[Wendy Slutske]] of the [[University of Missouri]] concluded one-third of pathological gamblers overcome it by natural recovery.<ref>{{cite journal |last=Slutske |first=Wendy |date=February 2006 |title=Natural Recovery and Treatment-Seeking in Pathological Gambling: Results of Two U.S. National Surveys |journal=[[American Journal of Psychiatry]] |volume=163 |issue=2 |pages=297–302 |doi=10.1176/appi.ajp.163.2.297 |pmid=16449485}}</ref>

===Pharmaceutical treatments===
{{Main|Addiction#Medication}}Numerous pharmaceutical approaches to treating gambling addiction have been suggested including antidepressants, atypical antipsychotic agents, mood stabilizers, and opioid antagonists, however the best approach for treatment, treatment regime including dosage and timing is not clear.<ref name=":0">{{Cite journal |last1=Dowling |first1=Nicki |last2=Merkouris |first2=Stephanie |last3=Lubman |first3=Dan |last4=Thomas |first4=Shane |last5=Bowden-Jones |first5=Henrietta |last6=Cowlishaw |first6=Sean |date=2022-09-22 |title=Pharmacological interventions for the treatment of disordered and problem gambling |url= |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=9 |pages=CD008936 |doi=10.1002/14651858.CD008936.pub2 |issn=1469-493X |pmc=9492444 |pmid=36130734}}</ref> There is some evidence to suggest that opioid antagonists, for example, [[naltrexone]] or [[nalmefene]], and [[atypical antipsychotic]]s such as [[olanzapine]], may help reduce the severity of gambling symptoms in the short-term, however it is not clear if these medications are effective at improving other psychological symptoms associated with this disorder or for longer term symptom relief from problem gambling.<ref name=":0" /> The evidence suggesting the effectiveness of mood stabilizers is not clear.<ref name=":0" /><!-- This section was moved from "Biology" because it closely describes pharmaceutical outcomes -->



A series of anti-depressant studies were conducted to determine their efficacy in treating problematic gambling. These studies produced three critical findings:<ref name="grant2006" />
# Antidepressants can reduce pathological gambling when there is an effect on serotonergic reuptake inhibitors and 5-HT<sub>1</sub>/5-HT<sub>2</sub> receptor antagonists.
# Pathological gambling, as part of obsessive–compulsive disorder, requires the higher doses of antidepressants as is usually required for depressive disorders.
# In cases where participants do not have or have minimal symptoms of anxiety or depression, antidepressants still have those effect.
===Self-exclusion===
{{Main|Self-exclusion}}

Gambling self-exclusion (voluntary exclusion) programs are available in the US, the UK, Canada, Australia, South Africa, France, and other countries. They seem to help some (but not all) problem gamblers to gamble less often.<ref>{{cite journal|last1=Gainsbury|first1=Sally M.|title=Review of Self-exclusion from Gambling Venues as an Intervention for Problem Gambling|journal=Journal of Gambling Studies|date=January 22, 2013|volume=30|issue=2|pages=229–251|doi=10.1007/s10899-013-9362-0|pmc=4016676|pmid=23338831}}</ref>

Some experts maintain that casinos in general arrange for self-exclusion programs as a public relations measure without actually helping many of those with problem gambling issues. A campaign of this type merely "deflects attention away from problematic products and industries", according to Natasha Dow Schull, a cultural anthropologist at [[New York University]] and author of the book ''Addiction by Design''.<ref name="cbc.ca">[https://www.cbc.ca/news/canada/self-exclusion-program-failing-addicts-1.4438251 'Nobody stopped me' at the casino: Ontario self-exclusion program fails to keep gambling addicts out]</ref>

There is also a question as to the effectiveness of such programs, which can be difficult to enforce.<ref>[https://books.google.com/books?id=7YsZnam8uVcC&q=self-exclusion+effectiveness Casino Industry in Asia Pacific: Development, Operation, and Impact], page 153</ref> In the province of [[Ontario]], Canada, for example, the Self-Exclusion program operated by the government's [[Ontario Lottery and Gaming Corporation]] (OLG) is not effective, according to investigation conducted by the television series, revealed in late 2017. |"Gambling addicts ... said that while on the ... self-exclusion list, they entered OLG properties on a regular basis" in spite of the facial recognition technology in place at the casinos, according to the Canadian Broadcasting Corporation. As well, a CBC journalist who tested the system found that he was able to enter Ontario casinos and gamble on four distinct occasions, in spite of having been registered and photographed for the self-exclusion program. An OLG spokesman provided this response when questioned by the CBC: "We provide supports to self-excluders by training our staff, by providing disincentives, by providing facial recognition, by providing our security officers to look for players. No one element is going to be foolproof because it is not designed to be foolproof".<ref name="cbc.ca"/>

===Impact (Australia)===
According to the Productivity Commission's 2010 final report into gambling, the social cost of problem gambling is close to 4.7 billion dollars a year. Some of the harms resulting from problem gambling include depression, suicide, lower work productivity, job loss, relationship breakdown, crime and bankruptcy.<ref name="auto">[https://www.pc.gov.au/__data/assets/pdf_file/0010/95680/gambling-report-volume1.pdf Productivity Commission Inquiry Report, Gambling, Vol 1, 2010]</ref> A survey conducted in 2008 found that the most common motivation for [[fraud]] was problem gambling, with each incident averaging a loss of $1.1 million.<ref name="auto"/> According to Darren R. Christensen. Nicki A. Dowling, Alun C. Jackson and Shane A. Thomas, a survey done from 1994 to 2008 in Tasmania gave results that gambling participation rates have risen rather than fallen over this period.<ref>{{cite journal|last1=Christensen|first1=Darren R.|last2=Dowling|first2=Nicki A.|last3=Jackson|first3=Alun C.|last4=Thomas|first4=Shane A.|date=2015-12-01|title=Gambling Participation and Problem Gambling Severity in a Stratified Random Survey: Findings from the Second Social and Economic Impact Study of Gambling in Tasmania|journal=Journal of Gambling Studies|volume=31|issue=4|pages=1317–1335|doi=10.1007/s10899-014-9495-9|issn=1573-3602|pmid=25167843|s2cid=23762935|hdl=11343/283028|hdl-access=free}}</ref>