Prevalence, assessment, and treatment of pathological gambling: a review.

OBJECTIVE

Although pathological gambling is an increasing problem, many mental health providers are unfamiliar with its diagnosis and treatment. To improve recognition and treatment of pathological gambling, the authors reviewed the literature on its prevalence, assessment, and treatment.

METHODS

Entries in PsycLIT and MEDLINE were examined for the years 1984 to 1998.

RESULTS AND DISCUSSION

The prevalence of pathological gambling seems to be increasing with the spread of legalized gambling; casinos are now operating in 27 states. Point and lifetime prevalence rates of pathological gambling are reported to be as high as 1.4 percent and 5.1 percent, respectively. The most commonly used assessment instrument is the DSM-based, 20-item South Oaks Gambling Screen. There is no standard treatment for pathological gambling. Gamblers Anonymous (GA) is the most popular intervention, and about 1,000 chapters exist in the U.S. Studies suggest that only 8 percent of GA attendees achieve a year of abstinence. Combining professional therapy and GA participation may improve retention and abstinence. Marital and family treatments, including participation in Gam-Anon, the spousal component of GA, have not been sufficiently evaluated. The few studies of cognitive-behavioral treatments suggest that this approach, which may include cognitive restructuring, problem solving, social skills training, and relapse prevention, is promising. Carbamazepine, naltrexone, clomipramine, fluvoxamine, and lithium have been used with some effect. Therapists' manuals and self-help manuals are available. Although research evaluating their efficacy is necessary, manuals can provide a start for therapists who encounter patients with gambling problems. Brief motivational interviewing may be a useful strategy for decreasing gambling among heavy gamblers who are ambivalent about entering treatment or who do not desire abstinence.