Important Note: The following information is provided for your education. It should not be relied upon for personal diagnosis or treatment. If you believe that a particular therapy applies to you or someone you care about, be sure to consult a doctor before trying it.
   

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Previous Compulsive Gambling Research: 2002-2006   
The Compulsive Gambling File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Compulsive Gambling, click HERE.
 

Latest Research on
Compulsive Gambling
     
J Gambl Stud. 2008 Sep;24(3):393-409. Epub 2008 Jun 17.
Adapted Couple Therapy (ACT) for pathological gamblers: a promising avenue.
Bertrand K, Dufour M, Wright J, Lasnier B.
Département des Sciences de santé Communautaire, Service de Toxicomanie, Université de Sherbrooke, Campus de Longueuil, 1111, rue St-Charles Ouest, Tour Ouest, Bureau 500, Longueuil, QC, Canada J4K 5G4. karine.bertrand@usherbrooke.ca

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.

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J Adolesc Health. 2008 Jul;43(1):91-3. Epub 2008 Apr 11.
Gambling initiation in preadolescents.
Hurt H, Giannetta JM, Brodsky NL, Shera D, Romer D.
Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. hurt@email.chop.edu

Gambling has increased in the past decade, with growing opportunities for initiation by adolescents. More limited data, however, are available regarding gambling in preadolescents. In the investigation reported here, gambling for money was the most common risk behavior in 10- to 12-year-olds. Gamblers were more likely to be white, have tried alcohol, have positive affect toward gambling, and have friends who gamble.

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PLoS ONE. 2008 Jun 25;3(6):e2479.
Dopamine agonist increases risk taking but blunts reward-related brain activity.
Riba J, Krämer UM, Heldmann M, Richter S, Münte TF.
Department of Neuropsychology, University of Magdeburg, Magdeburg, Germany.

The use of D2/D3 dopaminergic agonists in Parkinson's disease (PD) may lead to pathological gambling. In a placebo-controlled double-blind study in healthy volunteers, we observed riskier choices in a lottery task after administration of the D3 receptor-preferring agonist pramipexole thus mimicking risk-taking behavior in PD. Moreover, we demonstrate decreased activation in the rostral basal ganglia and midbrain, key structures of the reward system, following unexpected high gains and therefore propose that pathological gambling in PD results from the need to seek higher rewards to overcome the blunted response in this system.

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Psychol Addict Behav. 2008 Jun;22(2):257-68.
Subtyping pathological gamblers on the basis of affective motivations for gambling: relations to gambling problems, drinking problems, and affective motivations for drinking.
Stewart SH, Zack M, Collins P, Klein RM.
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada. sstewart@dal.ca

Pathological gamblers who drink when gambling (n=158; 77% men; mean age=36.0 years) completed the Inventory of Gambling Situations (IGS) and gambling and drinking criterion measures. Principal components analysis on the IGS subscales revealed negative (e.g., Unpleasant Emotions) and positive (e.g., Pleasant Emotions) gambling situation factors. Subjecting IGS factor scores to cluster analysis revealed three clusters: (a) enhancement gamblers, with low negative and high positive factor scores; (b) coping gamblers, with very high negative and high positive factor scores; and (c) low emotion regulation gamblers, with low negative and positive factor scores (59%, 23%, and 18% of the sample, respectively). Clusters were validated with a direct measure of gambling motives. Additional validity analyses showed that coping gamblers scored higher than the other groups on a variety of different gambling activities, gambling problems, drinking frequency, drinking problems, and coping drinking motives, whereas low emotion regulation gamblers scored lower than the other groups on gambling frequency, gambling problems, drinking quantity, and enhancement drinking motives. The findings validate this empirical approach to subtyping gamblers and suggest consistency of motives across addictive behaviors. 2008 APA

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Mil Med. 2008 May;173(5):452-9.
Gambling and health risk-taking behavior in a military sample.
Steenbergh TA, Whelan JP, Meyers AW, Klesges RC, DeBon M.
Department of Psychology, Indiana Wesleyan University, 4201 South Washington, Marion, IN 46953, USA.

This study examined the gambling of a cohort of U.S. Air Force recruits (N = 31,104) and the relationship between their gambling and health-risk behaviors. Participants provided self-report data regarding gambling and health-related behaviors. Results suggest that 10.4% of participants gambled weekly or more often, 6.2% reported gambling problems, and 1.9% acknowledged loss of control over gambling. Men were more likely than women to report weekly gambling and possible problematic gambling. Minorities, compared to Caucasians, were more likely to experience gambling problems and report loss of control. Seven health-risk behaviors were significant predictors of frequent gambling; however, considerably fewer health behaviors were uniquely related to problematic gambling. These results suggest that gambling-related problems within the military warrant further attention.

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J Addict Dis. 2008;27(1):33-40.
Personality traits and disorders in pathological gamblers versus normal controls.
Sáez-Abad C, Bertolín-Guillén JM.
Unit of Mental Health of Torrente (Valencia), Health Department 9, Valencian Health Agency, Spain.

AIMS: To establish the personality traits and disorders of pathological gamblers in treatment by means of a descriptive cross-sectional study of two prospective matched-pair cohorts: 50 pathological gamblers versus a control group of 50 normal volunteers (non-patient and non-pathological gamblers). All the pathological gamblers of the sample followed treatment as out-patients in the province of Valencia (Spain-EU). Recruitment period: January-May 2004. MEASURE INSTRUMENTS: South Oaks Gambling Screen, Barratt Impulsivity Scale, Sensation Seeking Scale, and Structured Clinical Interview for Personality Disorders of Axis II of DSM-IV. FINDINGS AND CONCLUSIONS: Male pathological gamblers go more often to health and social care facilities. Pathological gamblers prefer to play slot machines, present a higher prevalence of personality disorders, most of them belonging to cluster B, are more impulsive and higher sensation seekers than the controls. There are no linear relationships between the severity of pathological gambling and the traits of impulsivity and sensation seeking respectively.

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J Gambl Stud. 2008 Mar 5 [Epub ahead of print]
Significant Others and Gambling Treatment Outcomes.
Ingle PJ, Marotta J, McMillan G, Wisdom JP.
Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.

Aims This study investigates the effect of significant others on treatment outcomes among treated pathological gamblers. Design This is a cohort study of individuals who received gambling treatment. Setting Oregon Problem Gambling Services (OPGS) for gamblers and their family members. Participants 4,410 adult gamblers who were discharged from treatment between August, 2001 and April, 2007. Measurements OPGS enrollment forms provided gambler gender, age, ethnicity, education level, employment status, gambling-related debt, and whether the gambler had a significant other at the time of enrollment. Termination forms provided information on the type of discharge (successful/unsuccessful) and treatment length (in days). Participation of the gambler's significant other in the family treatment program was identified. Findings Results showed that age, ethnicity, gambling debt, and having a significant other are associated with the odds of successful treatment. Education level moderates the effect of having a significant other on treatment success. Age, ethnicity, education, employment, and having a significant other participate in treatment significantly impacted gamblers' length in treatment. Conclusions These findings indicate that there may be a benefit to integrating significant others in gambling treatment methods. Significant others may act as social supports for gamblers seeking treatment, and involving loved ones in gambling treatment models may positively affect gambler treatment outcomes.

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Pharmacol Biochem Behav. 2008 Jan 7 [Epub ahead of print]
A double-blind, placebo-controlled trial of olanzapine for the treatment of video poker pathological gamblers.
Fong T, Kalechstein A, Bernhard B, Rosenthal R, Rugle L.
David Geffen School of Medicine at UCLA, 760 Westwood Boulevard, Room C8-887, Los Angeles, CA 90024, United States.

Emerging evidence suggests that dopaminergic and serotonergic functioning are altered in pathological gamblers; yet, there are no FDA-approved medications for pathological gambling and there have only been a limited number of clinical trials that have been conducted. Olanzapine was identified as a candidate medication for pathological gamblers because it modifies both dopaminergic and serotonergic function. Moreover, preliminary studies have shown that olanzapine effectively reduces impulsivity in other psychiatric disorders, a pharmacological target of interest for pathological gamblers. In this study, 21 pathological gamblers, whose primary gambling activity was video poker, were enrolled in a seven-week, double-blind, placebo-controlled trial. Outcome measures included self-reported urges for gambling, frequency of gambling behavior, and self-reported mood and anxiety levels. The results revealed that all study participants reported reduced levels of gambling urges, gambling behavior, and mood and anxiety symptoms. Olanzapine administration was not associated with an incremental effect versus placebo. While these findings suggest that olanzapine is not an efficacious treatment for video poker pathological gamblers, olanzapine may still be an effective treatment for a specific subset of pathological gamblers, including those with a co-occurring psychiatric disorder.

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J Clin Psychiatry. 2008 Jan 30;:e1-e8 [Epub ahead of print]
Olanzapine in the Treatment of Pathological Gambling: A Negative Randomized Placebo-Controlled Trial.
McElroy SL, Nelson EB, Welge JA, Kaehler L, Keck PE.
From the Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine (Drs. McElroy, Nelson, Welge, and Keck and Ms. Kaehler) and Mental Health Service Line and General Clinical Research Center, Cincinnati Veterans Affairs Medical Center (Dr. Keck), Cincinnati, Ohio.

OBJECTIVE: Pathological gambling is associated with bipolar disorder and dopamine dysfunction. Olanzapine is a second-generation antipsychotic with mood-stabilizing properties and antagonistic activity at several dopamine receptors. The purpose of this study was to evaluate olanzapine in the treatment of pathological gambling. METHOD: In this 12-week, single-center, randomized, double-blind, placebo-controlled, flexible-dose (2.5-15 mg/day) trial, 42 outpatients with pathological gambling by DSM-IV-TR criteria received olanzapine (N = 21) or placebo (N = 21). The primary outcome measure was the Pathological Gambling Adaptation of the Yale-Brown Obsessive Compulsive Scale (PG-YBOCS). The primary analysis of efficacy was a longitudinal analysis of the intent-to-treat sample, with treatment-by-time interaction as the effect measure. Subjects were enrolled from June 2, 2000, through November 28, 2005. RESULTS: Compared with placebo, olanzapine was associated with a similar rate of reduction in total scores on the PG-YBOCS scale, as well as in gambling episodes/week, hours gambled/week, and Clinical Global Impressions-Severity of Illness scale scores. The mean (SD) olanzapine daily dose at endpoint evaluation was 8.9 (5.2) mg/day. Eleven subjects (52%) receiving olanzapine and 6 (29%) receiving placebo discontinued prematurely; 3 subjects receiving olanzapine and 2 receiving placebo discontinued because of adverse events. Events causing olanzapine discontinuation were pneumonia, sedation, and hypomania. CONCLUSION: Olanzapine was not superior to placebo in the short-term treatment of pathological gambling. It was also associated with a high discontinuation rate. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00438776 (http://www.clinicaltrials.gov).

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Tidsskr Nor Laegeforen. 2008 Jan 17;128(2):174-6.
[Gambling and suicidal behaviour]
[Article in Norwegian]
Hansen M, Rossow I.
Statens institutt for rusmiddelforskning, Øvre Slottsgate 2b, 0105 Oslo. mh@sirus.no

BACKGROUND: The negative consequences of pathological gambling are related to social, economical and relational problems. Few studies are available on possible associations between gambling and suicidal behaviour. Updated literature reviews are needed. MATERIAL AND METHODS: PsychInfo, ISI and Google Scholar were searched for relevant literature and 38 publications were found. RESULTS AND INTERPRETATION: Problem gamblers seeking treatment often report suicidal thoughts or attempted suicide. Those with suicidal behaviour more often report mental health problems, alcohol or drug problems, relational difficulties and financial problems than other problem gamblers. Population surveys suggest that suicidal behaviour tends to occur more frequently among problem gamblers than among others. Studies of the association between gambling and suicidal behaviour at the aggregate level have provided ambiguous results. It is not clear whether gambling per se may increase the risk of suicidal
behaviour. However, the high prevalence of suicidal behaviour among problem gamblers suggests that suicide risk should be considered when they present for treatment.

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CNS Drugs. 2008;22(2):123-138.
Pathological Gambling: An Update on Neuropathophysiology and Pharmacotherapy.
Iancu I, Lowengrub K, Dembinsky Y, Kotler M, Dannon PN.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, IsraelPsychiatry B. Department, Beer Yaakov Mental Health Center, Tel Aviv University, Tel Aviv, Israel.

Neurobiological research has shown the potential involvement of serotonergic, dopaminergic and opioid dysfunction in the pathophysiology of pathological gambling. In this review, we present current theories of the neuropathology of pathological gambling, paying particular attention to the role of the neural circuitry underlying motivation, reward, decision-making and impulsivity. This review also presents a literature review of current pharmacological treatment strategies for pathological gambling, such as selective serotonin reuptake inhibitors (SSRIs), opioid receptor antagonists, anti-addiction drugs and mood stabilizers, and also discusses the role of nonpharmacological interventions.A hypothetical model of the clinical subtypes of pathological gambling is presented, e.g. the impulsive subtype, the obsessive-compulsive subtype and the addictive subtype. This model attempts to integrate current knowledge in the field of pathological gambling regarding neuropathology, psychiatric co-morbidity, family history, genetics, course of illness, gender and response to pharmacological treatment. Finally, it is proposed that the existence of possible clinical subtypes of pathological gambling may provide a potential framework for matching the various subtypes with specific pharmacotherapies.

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J Gambl Stud. 2007 Dec 20 [Epub ahead of print]
Life Skills, Mathematical Reasoning and Critical Thinking: A Curriculum for the Prevention of Problem Gambling.
Turner NE, Macdonald J, Somerset M.
Centre for Addiction and Mental Health, 33 Russell Street, T524, Toronto, ON, Canada, M5S 2S1, Nigel_Turner@camh.net.

Previous studies have shown that youth are two to three times more likely than adults to report gambling related problems. This paper reports on the development and pilot evaluation of a school-based problem gambling prevention curriculum. The prevention program focused on problem gambling awareness and self-monitoring skills, coping skills, and knowledge of the nature of random events. The results of a controlled experiment evaluating the students learning from the program are reported. We found significant improvement in the students' knowledge of random events, knowledge of problem gambling awareness and self-monitoring, and knowledge of coping skills. The results suggest that knowledge based material on random events, problem gambling awareness and self-monitoring skills, and coping skills can be taught. Future development of the curriculum will focus on content to expand the students' coping skill options.

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Soc Psychiatry Psychiatr Epidemiol. 2007 Dec 15 [Epub ahead of print]
Gender differences in the associations between past-year gambling problems and psychiatric disorders.
Desai RA, Potenza MN.
Dept. of Psychiatry and Women and Addictive Disorders, Core of Women’s Health Research, Yale University School of Medicine, New Haven, CT, USA.

BACKGROUND: Psychiatric disorders frequently co-occur with pathological gambling. The extent to which co-occurence extends to subsyndromal levels of gambling or differs between women and men is incompletely understood. AIM: To examine whether the association between psychiatric disorders and past-year gambling problems is stronger in women than men. METHODS: Data from the national epidemiological survey of alcoholism and related disorders (NESARC) (n = 43,093) were analyzed. RESULTS: Increasing severity of past-year gambling problems was associated with increasing odds of most past-year Axis I and lifetime Axis II disorders, regardless of gender. Associations between gambling problems and major depression, dysthymia, panic disorder, and nicotine dependence were statistically stronger in women than in men. CONCLUSIONS: A severity-related association exists between past-year gambling problems and psychiatric disorders. The stronger associations in women suggest that gambling research, prevention and treatment efforts consider gender differences.

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J Clin Psychopharmacol. 2007 Dec;27(6):620-4.
12-month follow-up study of drug treatment in pathological gamblers: a primary outcome study.
Dannon PN, Lowengrub K, Musin E, Gonopolsky Y, Kotler M.
Tel Aviv University, Tel Aviv, Israel. pinhasd@post.tau.ac.il

BACKGROUND: Pathological gambling (PG) is a relatively common and highly disabling impulse control disorder. A range of psychotherapeutic agents including selective serotonin reuptake inhibitors, antiepileptic drugs, and opioid antagonists are shown to be effective in the short-term treatment of PG. The use of a wide range of pharmacological treatments for PG is consistent with the observation that PG shares features of obsessive-compulsive spectrum disorders, impulse control disorders, and addictive disorders. The aim of the study is to assess the rate of relapse in treatment-responder pathological gamblers after discontinuation of the active treatment. METHODS: Our study sample was composed of 43 male pathological gamblers who had been full responders to 1 of 4 drug treatment regimens (fluvoxamine, topiramate, bupropion SR, or naltrexone) from several previous acute open-label (12-week) comparison studies. Full response was defined as the absence of gambling for a 1-month duration together with improvement on the Clinical Global Improvement scale. The 43 full responders were then followed prospectively for an additional 9 months, which included a 3-month open-label continuation phase and a 6-month medication-free follow-up phase. Follow-up visits were performed on a monthly basis throughout the duration of study. At every follow-up visit, a comprehensive psychiatric diagnostic evaluation was performed on all patients, and patients were assessed for symptoms of gambling using a self-report instrument and collateral family reports. The Clinical Global Impression Improvement scale was also administered at every follow-up visit. Raters were blind to the previous drug treatment. RESULTS: Most patients did not relapse during the 6-month medication-free follow-up phase. Three of 6 patients with fluvoxamine, 3 of 9 with topiramate, 7 of 18 with bupropion SR, and 4 of 10 with naltrexone relapsed. Relapse was strictly defined as gambling behavior at any time during the 6-month medication-free follow-up period. Most of the patients did not gamble during the follow-up period, and the patients that did gamble reported a decrease in gambling losses. CONCLUSIONS: This naturalistic long-term follow-up outcome study demonstrates that among pathological gamblers who respond to a 6-month trial of medication, most patients seem to maintain full-response during a 6-month medication-free follow-up phase. Further studies are needed to confirm our findings.

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Rev Bras Psiquiatr. 2007 Oct 31 [Epub ahead of print]
Psychodynamic psychotherapy and the treatment of pathological gambling.
Rosenthal RJ.
University of California, Los Angeles, USA.

OBJECTIVE: The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. METHOD: After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970) psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. RESULTS: A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. CONCLUSIONS:A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.

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Rev Bras Psiquiatr. 2007 Aug 3 [Epub ahead of print]
Cognitive-behavioral treatment for impulse control disorders.
Hodgins DC, Peden N.
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

OBJECTIVES: This paper reviews the cognitive-behavioral treatment of kleptomania, compulsive buying, and pathological gambling. METHOD: A review of the published literature was conducted. RESULTS: Treatment research in all of these areas is limited. The cognitive-behavioral techniques used in the treatment of kleptomania encompass covert sensitization, imaginal desensitization, systematic desensitization, aversion therapy, relaxation training, and alternative sources of satisfaction. Regarding compulsive buying, no empirical support for treatment exists but common techniques examined were covert sensitization, exposure and response prevention, stimulus control, cognitive restructuring, and relapse prevention. Treatment of pathological gambling has been successful in both group and individual format using techniques such as aversive therapy, systematic desensitization, imaginal desensitization and multimodal behavior therapy (which have included in vivo exposure, stimulus control, and covert sensitization) along with cognitive techniques such as psychoeducation, cognitive-restructuring, and relapse prevention. CONCLUSIONS: There is a general consensus in the literature that cognitive-behavioral therapies offer an effective model for intervention for all these disorders. An individualized case formulation is presented with a case study example. Clinical practice guidelines are suggested for each disorder.

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Clin Neuropharmacol. 2007 Jul-Aug;30(4):206-12.
An open-label trial of escitalopram in the treatment of pathological gambling.
Black DW, Shaw M, Forbush KT, Allen J.
Department of Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA 52242, USA. donald-black@uiowa.edu

BACKGROUND: The effectiveness and tolerability of escitalopram was tested in the treatment of pathological gambling (PG). METHOD: Nondepressed outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PG received flexibly dosed escitalopram in a prospective, 10-week, open-label trial after a 2-week observation period. Subjects were evaluated at baseline and at 2-week intervals for assessment of gambling behavior, mood symptoms, and adverse experiences. The primary efficacy measure was the Yale-Brown Obsessive-Compulsive Scale modified for PG. Secondary efficacy measures included the Clinical Global Impression (CGI) Improvement and Severity Scales, a patient self-rated global rating, the Sheehan Disability Scale, and the Timeline Follow Back. RESULTS: Nineteen subjects (12 men and 7 women) had at least 1 postbaseline visit and were included in the analysis; 16 subjects (84%) completed the protocol. Significant improvement was found in all measures, including the Yale-Brown Obsessive-Compulsive Scale modified for PG, both CGI Scales, a patient self-rated global scale, the Timeline Follow Back, the Attention-Deficit/Hyperactivity Disorder Checklist, the Hamilton Depression Rating Scale, and all 3 Sheehan Disability Scale subscales. Fourteen subjects (73.7%) were considered responders (ie, achieved "much" or "very much" improvement on the CGI). Few adverse experiences were reported. CONCLUSION: The results suggest that escitalopram is well tolerated and may be effective in the treatment of PG.

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J Clin Psychopharmacol. 2007 Aug;27(4):357-364.
Outcome of Pharmacological Treatments of Pathological Gambling: A Review and Meta-Analysis.
Pallesen S, Molde H, Arnestad HM, Laberg JC, Skutle A, Iversen E, Støylen IJ, Kvale G, Holsten F.
*Department of Psychosocial Science, University of Bergen, †Bergen Clinics, Departments of ‡Clinical Psychology and §Psychiatry, University of Bergen, Bergen, Norway.

Although several qualitative reviews on pharmacological interventions for pathological gambling have been published, no quantitative review of this field has been conducted. METHODS:: Studies of pharmacological interventions of pathological gambling were identified by computer searches in the PsychINFO and MEDLINE databases covering the period from 1966 to July 2006, as well as from relevant reference lists. The inclusion criteria were as follows: the target problem had to be pathological gambling, the interventions were pharmacological, the study was written in English, and the study reported outcomes particularly pertaining to gambling. A total of 130 potential studies were identified of which 16 met the inclusion criteria. A total of 597 subjects were included in the outcome analyses of these studies. The grand mean age was 43.3 years. The overall proportion of men was 62.8%. The included studies were coded for outcome measures of pathological gambling. For each condition, means and SDs for gambling-related outcome measures were compiled at 2 points in time: baseline and posttreatment. RESULTS:: At posttreatment, the analysis showed that the pharmacological interventions were more effective than no treatment/placebo, yielding an overall effect size of 0.78 (95% confidence interval, 0.64-0.92). A multiple regression analysis showed that the magnitude of effect sizes at posttreatment was lower in studies using a placebo-control condition compared with studies using a predesign/postdesign without any control condition. Effect sizes were also negatively related to the proportion of male participants in the included studies. No differences in outcome between the 3 main classes of pharmacological interventions (antidepressants, opiate antagonists, mood stabilizers) were detected. CONCLUSION:: Pharmacological interventions for pathological gambling may be an adequate treatment alternative in pathological gambling.

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Addiction. 2007 Aug;102(8):1280-91.
Do coping skills mediate the relationship between cognitive-behavioral therapy and reductions in gambling in pathological gamblers?
Petry NM, Litt MD, Kadden R, Ledgerwood DM.
University of Connecticut Health Center, Farmington, CT, USA.

Aims Cognitive-behavioral therapy (CBT) is useful for treating substance abusers, and recent data suggest it is also efficacious for pathological gamblers. CBT is purported to exert its beneficial effects by altering coping skills, but data supporting coping changes as the mechanism of action are mixed. This study examined whether coping skills acquisition mediated the effects of CBT on decreasing gambling in pathological gamblers. Design Participants were assigned randomly to CBT plus referral to Gamblers Anonymous (GA) or to GA referral alone. Setting Out-patient clinic. Participants A total of 127 pathological gamblers. Measurements Participants completed the Coping Strategies Scale (CSS) before treatment and 2 months later; indices of gambling behavior and problems were administered pretreatment and at months 2 and 12. Findings Overall, CSS scores increased for participants in both conditions, but those receiving CBT evidenced larger increases than those in the GA condition (P < 0.05), and they also reduced gambling more substantially between pretreatment and month 2. Changes in CSS scores mediated the relationship between treatment assignment and gambling outcomes from pretreatment to month 2, but little evidence of mediation occurred for the long-term follow-ups. Conclusions CBT's beneficial effects in decreasing gambling may be related partly to changes in coping responses, and improvements in coping are associated with long-term changes in gambling. However, relationships between coping skills and gambling behavior are fairly strong, regardless of treatment received.

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Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001521.
Interventions for pathological gambling.
Oakley-Browne M, Adams P, Mobberley P.

BACKGROUND: With the legalization of new forms of gambling there are increasing numbers of individuals who appear to have gambling related problems and who are seeking help. The individual and societal consequences are significant. Pathological gambling can result in the gambler jeopardizing or losing a significant relationship or job and committing criminal offences. Pathological gamblers may develop general medical conditions associated with stress. Increased rates have been reported for mood disorders, attention-deficit/hyperactivity disorder, substance abuse or dependence. There is a high risk of suicide and a high correlation with antisocial, narcissistic and borderline personality disorders and alcohol addiction. With increasing public awareness of gambling related problems health funders and practitioners are asking questions about the efficacy of treatments. Consequently quality research into gambling treatment is crucial. OBJECTIVES: The objective of this review was to complete a systematic review and meta-analysis of all randomised controlled trials (RCTs) of psychological and pharmacological treatments for pathological gambling, from both published and unpublished scientific reports. SEARCH STRATEGY: Published and unpublished RCTs of treatments of pathological gambling were identified by searches of electronic databases and hand searching journals likely to contain RCTs of gambling treatments. Researchers and gambling treatment centres were contacted by letter. Bibliographies of all identified research studies were scanned to identify other relevant references. SELECTION CRITERIA: All RCTs of treatments for pathological gambling were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The data was entered into the Cochrane Review Manager software (REVMAN). The component RCTs were quality rated, with special emphasis on the concealment of treatment allocation and blinding. Relative risk analyses were conducted for the dichotomous outcome of controlled vs. uncontrolled gambling. The relative risks were aggregated using both fixed and random effects models. Tests for heterogeneity were undertaken. Both short-term (1 month or less) and long-term (6 months or longer) outcomes were considered. MAIN RESULTS: Only four RCTs of psychological treatments were identified. These RCTs were heterogeneous in terms of design, interventions, outcome measurement and follow-up periods. All had small numbers of participants. The studies had poor methodological quality features. The experimental interventions, behavioural or cognitive-behavioural therapy (BT/CBT), were more efficacious than the control interventions in the short-term (relative risk 0.44, 95% confidence interval (CI) 0.24-0.81). There was a trend for long-term treatment with BT/CBT to be more efficacious than the control treatments, but the statistical significance of this was sensitive to the statistical model used for meta-analysis. With a fixed effect model the relative risk was 0.56 (95% CI 0.33-0.95); the relative risk with a random effects model was 0.61 (95% CI 0.25-1.47). AUTHORS' CONCLUSIONS: This systematic review revealed a paucity of evidence for effective treatment of pathological gambling. As gambling is becoming more accessible in many countries and there is epidemiological evidence of increasing rates of pathological gambling, more rigorous RCTs are required.

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Cogn Behav Ther. 2007;36(2):74-84.
Prevention of pathological gambling: a randomized controlled trial.
Doiron JP, Nicki RM.
Psychology Department, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada. jpdoiron@upei.ca

Although the gambling industry is expanding rapidly throughout North America and around the world, there are only a few empirically evaluated programs aimed at the prevention of pathological gambling (PG). The purpose of this study was to measure the effectiveness of a new prevention program aimed at PG. The Stop & Think! program was designed to teach at-risk video lottery terminal (VLT) gamblers cognitive restructuring and problem-solving skills that may help to prevent the development of PG. These skills were taught through a variety of methods - including an automated educational presentation, video and text vignettes, audio training tapes, and skill rehearsal. The program was evaluated using a randomized, 2-group experimental design with a wait-list control group and pre-, post-, and follow-up measures. Results indicated that, compared with the control group, the experimental group was less at risk for developing a gambling problem after the program. The experimental group endorsed fewer gambling-related cognitive distortions, engaged in less VLT gambling, and had lower scores on a measure of PG. The results of this study provide the basis for the implementation of the Stop & Think! program in the province of Prince Edward Island, Canada, and perhaps other jurisdictions too.

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Curr Treat Options Neurol. 2007 May;9(3):189-97.
Management of impulse control disorders in Parkinson's disease.
Galpern WR, Stacy M.
Mark Stacy, MD Duke University Medical Center, Division of Neurology, 932 Morreene Road, MS 3333, Durham, NC 27705, USA. stacy002@mc.duke.edu.

Impulse control disorders (ICDs) are a set of behaviors, including pathologic gambling, hypersexuality, compulsive shopping, compulsive eating, and punding, which are now recognized to occur in a subset of patients with Parkinson's disease (PD). Although the underlying pathophysiology of these behaviors is poorly understood, they appear to be associated with the use, and sometimes overuse, of dopaminergic agents prescribed for the treatment of the motor symptoms of PD. At present, there are limited data to support any particular therapeutic strategy. Approaches worth considering in the management of the PD patient with an ICD include reduction or discontinuation of dopamine agonist therapy, trials of various pharmacologic agents, psychosocial interventions, and deep brain stimulation of the subthalamic nucleus. However, the management of each patient must be tailored for the particular clinical setting, and the development of evidence-based treatment strategies awaits future prospective studies and randomized controlled trials.

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J Clin Psychopharmacol. 2007 Apr;27(2):143-150.
Bupropion in the Treatment of Pathological Gambling: A Randomized, Double-Blind, Placebo-Controlled, Flexible-Dose Study.
Black DW, Arndt S, Coryell WH, Argo T, Forbush KT, Shaw MC, Perry P, Allen J.
*Department of Psychiatry, University of Iowa Roy J. and Lucille A. Carver College of Medicine; daggerDepartment of Biostatistics, University of Iowa College of Public Health, Iowa City, IA; double daggerDivision of Pharmacy Practice, University of Texas College of Pharmacy, Austin, TX; section signDepartment of Psychology, University of Iowa College of Liberal Arts and Sciences, and parallelUniversity of Iowa College of Pharmacy, Iowa City, IA.

We tested the efficacy of bupropion in the treatment of persons with pathological gambling (PG). Nondepressed, healthy subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PG were randomly assigned to placebo or flexibly dosed bupropion in a 12-week double-blind trial. Outcome measures included the Yale-Brown Obsessive-Compulsive Scale modified for PG, the Gambling Severity Assessment Scale, the Clinical Global Impression Improvement and Severity Scales, the Global Assessment Scale, the Timeline Follow Back, the Attention-Deficit/Hyperactivity Disorder Rating Scale, and the Sheehan Disability Scale. Thirty-nine subjects (28 men, 11 women) were randomized to bupropion (n = 18) or placebo (n = 21). The 2 groups were similar on demographic and clinical measures. There were few differences between the treatment groups on any primary or secondary outcome measure, although subjects in each cell experienced significant improvement. Of subjects with at least 1 postrandomization visit, 35.7% of bupropion and 47.1% of placebo recipients experienced "much" or "very much" improvement on the Clinical Global Impression Improvement Scale. The trial was complicated by a high noncompletion rate (43.6%). Bupropion was well tolerated. Bupropion and placebo recipients did equally well in a short-term trial, with improvement seen as early as the first week of treatment. The high placebo response rate and the high noncompletion rate each reflect the challenge inherent in treating persons with PG.

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J Gambl Stud. 2007 Mar 9; [Epub ahead of print]
Vulnerability and Comorbidity Factors of Female Problem Gambling.
Boughton R, Falenchuk O.
Problem Gambling Service, Center for Addiction and Mental Health, 175 College Street, Toronto, ON, Canada, M5T 1P7, Roberta_Boughton@CAMH.net.

This study helps to address a deficiency of gender-specific research into problem gambling. It focuses on the gambling behaviors, family and personal histories and comorbid psychological disorders of 365 female gamblers from across Ontario, Canada, who responded to a mail-in survey. Specifically, this study looks at rates of depression and anxiety, concurrent struggles with other behaviors (such as alcohol and drug use, disordered eating, overspending and criminal activity) and abuse history reported by female gamblers. The reported rates are considerably higher than for the general female population. The findings of this study agree with previous research. They suggest that prevention strategies and treatment practices for female problem gamblers should take into account women's mental health, addiction and trauma history as contributing factors in the development of problematic gambling.

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J Gambl Stud. 2007 Mar;23(1):41-54.
Does providing extended relapse prevention bibliotherapy to problem gamblers improve outcome?
Hodgins DC, Currie SR, El-Guebaly N, Diskin KM.
Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada, T2N 1N4, dhodgins@ucalgary.ca.

Relapse rates among pathological gamblers are high with as many as 75% of gamblers returning to gambling shortly after a serious attempt to quit. The present study focused on providing a low cost, easy to access relapse prevention program to such individuals. Based on information collected in our ongoing study of the process of relapse, a series of relapse prevention booklets were developed and evaluated. Individuals who had recently quit gambling (N = 169) were recruited (through media announcements) and randomly assigned to a single mailing condition in which they received one booklet summarizing all of the relapse prevention information or a repeated mailing condition in which they received the summary booklet plus 7 additional booklets mailed to them at regular intervals over the course of a year period. Gambling involvement over the course of the 12-month follow-up period, confirmed by family or friends, was compared between the two groups. Results indicated that participants receiving the repeated mailings were more likely to meet their goal, but they did not differ from participants receiving the single mailing in frequency of gambling or extent of gambling losses. The results of this project suggest that providing extended relapse prevention bibliotherapy to problem gamblers does not improve outcome. However, providing the overview booklet may be a low cost, easy to access alternative for individuals who have quit gambling.

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J Gambl Stud. 2007 Mar;23(1):85-94.
Self-exclusion program: a longitudinal evaluation study.
Ladouceur R, Sylvain C, Gosselin P.
School of Psychology, Laval University, Quebec, Quebec, Canada, G1K 7P4, robert.ladouceur@psy.ulaval.ca.

Few self-exclusion programs have been evaluated and their long-term impact remains unknown. This study has two main goals: (1) to assess changes in gambling behaviour and gambling problems for self-excluded patrons, and (2) to follow self-excluded gamblers for a two-year period (during and after the self-exclusion period). Individuals who excluded themselves (N = 161 at the initial stage) participated in telephone interviews after signing the self-exclusion agreement and were followed at 6, 12, 18 and 24-months. Results show that according to the DSM-IV, 73.1% of the participants were pathological gamblers. The self-exclusion program has many positive effects. During the follow-ups, the urge to gamble was significantly reduced while the perception of control increased significantly for all participants. The intensity of negative consequences for gambling was significantly reduced for daily activities, social life, work, and mood. The DSM score was significantly reduced over time. This reduction also took place between the baseline and the 6-month follow-up. The clinical implications of the results are discussed in relation to the effectiveness of the program. Suggestions are provided in order to increase compliance of self-excluded patrons.

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J Gambl Stud. 2007 Jan 24; [Epub ahead of print]
Minimal Treatment Approaches for Concerned Significant Others of Problem Gamblers: A Randomized Controlled Trial.
Hodgins DC, Toneatto T, Makarchuk K, Skinner W, Vincent S.
Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada, T2N1N4, dhodgins@ucalgary.ca.

The goal of this study was to examine the efficacy of minimal treatment interventions for concerned significant others (CSOs) of problem gamblers. One hundred and eighty-six participants (82% females, 56% spouses) were randomly assigned to one of three groups: the first minimal intervention group received a self-help workbook [based on behavioral principles, modified from the Community Reinforcement and Family Therapy (CRAFT) model] and the second minimal intervention group received the workbook plus telephone support. The control condition received a treatment resource information package. Overall, all participants reported significant improvement in personal and relationship functioning and gambling behavior and consequences at the 3- and 6-month follow-up. The data demonstrated differences in favor of the interventions in three areas: days gambling, satisfaction with the program, and number who had their needs met. There was no difference in the number who had entered treatment. It may be that CSOs require more guidance and follow-up support to achieve these goals using the CRAFT procedures and strategies.

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Expert Rev Neurother. 2006 Dec;6(12):1845-51.
Pharmacotherapy of pathological gambling: review of new treatment modalities.
Lowengrub K, Iancu I, Aizer A, Kotler M, Dannon PN.
Ness Ziona and Beer Ya'akov Medical Complex and Tel Aviv University, The Rehovot Community Mental Health & Rehabilitation Center, Remez Street 80, Rehovot, 76449, Israel. jalow@netvision.net.il

Pathological gambling is classified in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition as an impulse-control disorder. In the International Classification of Diseases of the WHO, pathological gambling is coded under the heading of 'Habit and Impulse Disorders'. Pathological gambling is a chronic, progressive disorder, which has a prevalence of 1-3.4% among western civilizations. The enormous personal and social consequences of this disorder include a high rate of suicide attempts, job loss, marital and family problems, legal problems, and criminal behavior. Recent studies have demonstrated that pathological gambling patients respond well to treatment with selective serotonin reuptake inhibitors, mood stabilizers and opioid antagonists. These findings support the idea that pathological gambling and other disorders of impulse control may be conceptualized as part of the obsessive-compulsive spectrum disorders or addictive disorders. This article will discuss possible treatment strategies according to different behavior patterns in pathological gambling and also remind the physicians who intend to treat this disorder of the possible diagnosis of pathological gambling.
  
Previous Compulsive Gambling Research: 2002-2006   
The Compulsive Gambling File also contains summaries of past research that has shown promise and may still be standard practice among many physicians. To download earlier research findings on Compulsive Gambling, click HERE.
 

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