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Gambling Disorder: Current Theoretical, Prevention and Treatment Considerations
03 September 2019 (online)
Introduction In both the DSM-5 and ICD-11, pathological gambling has been renamed gambling disorder and reclassified as a behavioral addiction. This reclassification, based on data from clinical, epidemiological, genetic, and neurobiological domains, has important implications for prevention and treatment efforts. When considering how to optimize prevention and treatment interventions, considering the current gambling environment is important, particularly given increased availability of internet-based gambling and changes in regulations.
Methods Recent investigations into the etiology and treatment of gambling disorder will be described, and prevention related to gambling disorder will be considered.
Results Gambling disorder shares neurobiological features with substance addictions including relatively blunted activation of the striatum during anticipatory phases of processing of monetary rewards. Similarities appear to extend to neural correlates of decision-making when processing losses, and transdiagnostic studies suggest a link between the neural correlates of reward processing and risk/reward decision-making. Cue-reactivity studies suggest similarities and differences in the neural correlates of craving and reward/loss processing across drug and gambling disorders in prefrontal and subcortical regions. While no medications have indications for gambling disorder, randomized controlled trials suggest that opioid antagonists may be helpful for specific individuals and co-occurring disorders may be useful in considering appropriate pharmacotherapies. Although several behavioral therapies (e.g., cognitive behavioral therapy) have significant empirical support, other approaches (e.g., mindfulness) have been less well studied. Prevention approaches that limit the development of gambling disorder have arguably received less empirical study. Given that most people with gambling disorder do not receive treatment, the need for developing tertiary prevention interventions is important. The inclusion of a hazardous gambling construct in the ICD-11 could help advance prevention efforts and promote public health.
Conclusion Changes in the ICD-11 should help promote responsible gambling efforts, and empirically testing science-informed approaches should help minimize the impact of harmful patterns of gambling.