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Despite the prevalence and impact of problem gambling, few summaries or guidelines address treatment.Searching the guideline.gov website shows no recent additions to the guideline literature.
A guideline was published by the Singapore Ministry of Health in 2011. This guideline is still relevant and highlights some of the key elements of a problem gambling treatment program.
I will summarize some of these key elements from this source titled: "Management of gambling disorders". In their summary they highlight the level of evidence and research for each element. I will focus on those with the highest level of research support.
Screening: Screening for problem gambling is not recommended for all the general primary care population. However, screening for problem gambling is recommended for patients at high risk including those with "frequent physical or psychological complaints, or who have a history of substance/alcohol use problems". Additionally screening for problem gambling is recommended as part of psychiatric assessments for mental health evaluation.
Assessing elements of gambling history:
- Initiation, progression and frequency information (days per week, hours per day)
- Severity in money lost compared to income
- Factors promoting maintenance of gambling behavior
- Features of dependence similar to other addictive disorders
- Gambling consequences: Review of list of potential gambling-related behaviors:
- Financial (credit card debt, neglect of payment of essential items such as utilities, rent, car payments)
- Social/interpersonal: marital conflict, neglect of usual social support activities, conflict with family members or friends
- Vocational: absence from work, neglect of work activities due to time spent gambling
- Legal: Legal consequence of being in debt, stealing from family or work to finance gambling
- Cognitive behavioral therapy is the primary recommended psychological intervention
- Motivational enhancement therapy may be helpful for some individuals
- Additionally, mindfulness therapy may be used as an adjunct therapy
- Self-help support groups are not recommended as a primary source of treatment and should only be used in conjunction with individual professional treatment
- Financial counselling may be needed to address gambling-related debt issues
Psychopharmacological Interventions: The Singapore guidelines do note some evidence-based support for opioid antagonists drugs naltrexone and nalmefene. Unfortunately, since 2011 additional evidence-based support for the opioid antagonists is sparse. Use of selective serotonin receptor inhibitor drugs such as fluvoxamine and paroxetine are also noted in the guideline. These may be helpful in problem gamblers with a comorbid depression or anxiety disorder.
The Singapore guidelines do note the need for comprehensive assessment of axis I and II (personality disorder) issues in problem gamblers. I will take a look at the comorbidity topic in more depth in a future post.
Readers with more interest in the Singapore Ministry of Health problem gambling treatment guidelines can access the summary here.
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Lee KM, Chan HN, Cheah B, Gentica GF, Guo S, Lim HK, Lim YC, Noorul F, Tan HS, Teo P, & Yeo HN (2011). Ministry of Health clinical practice guidelines: management of gambling disorders. Singapore medical journal, 52 (6) PMID: 21732000.
See the original article:
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