Treating problem gambling
- A number of screening tools are available to assess the presence and severity of problem gambling.
- Cognitive behavioural therapy (CBT) is the recommended psychological treatment for gambling problems (PGTRC, 2011).
In Australia, the term problem gambling is often used in reference to conditions characterised by:
- behaviours such as gambling more than intended and returning to win back losses, and
- negative consequences known as ‘gambling-related harms’
Gambling-related harms include financial losses and impacts on emotional wellbeing, as well as major impacts on family and friends such as debt and relationship conflicts (Langham et al., 2015). A typical 'problem gambler' will affect four to six other people (Goodwin et al., 2017).
The term at-risk gambling can be used to describe sub-clinical or low severity gambling problems that are targets for early intervention.
Australia has a highly accessible gambling environment by international standards, with large numbers of electronic gambling machines (‘pokies’) located in pubs, clubs and casinos, as well extensive advertising of online sports betting.
A study of currently serving military personnel from Australia indicated around 8% who reported at least some gambling problems (including problem gambling and sub-clinical ‘at risk’ gambling) in the post-deployment period (Cowlishaw et al., 2020).
Although there is very little information regarding Australian ex-service personnel, a study of veterans in PTSD treatment indicated that gambling problems were an issue for around 29% of patients (Biddle et al., 2005).
Studies of the Australian general community indicate that young males aged 18-24 report particularly high levels of gambling problems and harms (Armstrong and Carroll, 2017).
Problem gambling is high among people with other mental health problems, including mood, anxiety, and substance use problems (Cowlishaw et al., 2014; Lorains et al, 2011).
Screening and assessment
Practitioners are advised to screen and assess for problem gambling in veterans with mental health problems. A one-item screen recommended in the current Australian guidelines Problem Gambling Research and Treatment Centre (PGTRC, 2011) is:
- Have you ever had an issue with your gambling?
If the veteran answers ‘yes’ to this question, further assessment of his or her gambling habits is recommended.
A number of screening tools are available to assess the presence and severity of problem gambling. Scales include:
- Control, Lying, and Preoccupation scale, also known as the NODS-CLiP (Toce-Gerstein et al., 2009)
- Problem Gambling Severity Index (PGSI)
Clinical responses to gambling problems will depend on the level of severity. Low intensity interventions include psychoeducation and self-help strategies.
Severe problem gambling requires more intensive psychological treatment delivered by gambling treatment specialists. In such instances, the immediate clinical response should focus on:
- preliminary support and validation
- referral to a specialist service or provider for intensive treatment
Recent developments in public health approaches to gambling (Abbott, 2020) emphasise the need to improve:
- prevention, which includes a focus on changing high-risk gambling environments
- early intervention, before the onset of significant negative consequences (e.g. relationship breakdown)
Cognitive behavioural therapy (CBT)
CBT has the strongest evidence base among psychological treatment for gambling problems (Cowlishaw et al., 2012). Practitioner-delivered CBT may include some or all of the following elements:
- motivational interviewing – to increase the readiness for making changes to their gambling behaviours
- cognitive therapy – to challenge and modify any cognitive errors related to gambling. E.g. the misunderstanding of randomness and the odds of winning
- identification of triggers and high-risk situations for gambling, and coping strategies to use in these situations
- exposure therapy – techniques such as imaginal desensitisation, in vivo exposure and response prevention
- activity scheduling – encouraging the scheduling of enjoyable activities as an alternative to gambling
Psychological treatment setting and duration
Problem gambling is often treated in an outpatient setting. There is currently insufficient evidence to:
- recommend an optimal duration of psychological treatment
- suggest whether therapy is best delivered in a group or individual format
Psychological treatments for problem gambling can be provided by specialised private practitioners. Free telephone or face-to-face counselling services are also available in some states.
Psychoeducation and self-management strategies
Providing information on gambling problems while encouraging self-management strategies is useful. For example, the practitioner can:
- discuss gambling harms in a supportive and non-judgemental manner
- identify common signs of gambling problems
- listen carefully to the veteran’s reactions and concerns
- acknowledge the likelihood of ambivalence about reducing gambling. For example, advise the veteran about the degree of risk and consequences associated with his or her gambling
- ask the veteran to outline the benefits and costs of continuing to gamble at the current level
- help set goals that are realistic and involve a reduction or elimination of gambling
- identify strategies to reduce gambling. The veteran may have already used some strategies with success. Begin with his or her suggestions then add others.
- Refer to information that dispels gambling myths. For example, the odds of winning and how pokies work (gamblershelp.com.au).
There is a modest body of research regarding pharmacological treatments for problem gambling. Preliminary evidence suggests that opioid antagonists and mood stabilisers may be helpful in the short-term. However, the duration of effects are unknown. The potential side effects and risks of any particular pharmacological intervention for problem gambling are important to consider.
Almost everyone gambles from time to time. However, gambling can become a problem for some people when they have trouble setting limits on the time and money involved. If you’re worried about your gambling, find out more about gambling problems and how you can get them under control.
Regularly making risky or dangerous choices - such as getting into fights, drink driving or unsafe sex - can indicate an underlying problem that should be addressed. If you are worried about your risky behaviour, or that of a loved one, help is available.
Gambling Help provides confidential online, telephone and face-to-face counselling. The website contains useful information for people with gambling issues and their families. They can be contacted 24 hours a day on 1800 858 858 or at: www.gamblinghelponline.org.au