Petry N M, Armentano C
Department of Psychiatry, University of Connecticut School of Medicine, Farmington 06030-2103, USA.
Psychiatr Serv. 1999 Aug;50(8):1021-7. doi: 10.1176/ps.50.8.1021.
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.
Entries in PsycLIT and MEDLINE were examined for the years 1984 to 1998.
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.
尽管病理性赌博问题日益严重，但许多心理健康服务提供者对其诊断和治疗并不熟悉。为提高对病理性赌博的识别和治疗水平，作者回顾了关于其患病率、评估和治疗的文献。
检索了1984年至1998年PsycLIT和MEDLINE数据库中的条目。
随着合法赌博的普及，病理性赌博的患病率似乎在上升；目前有27个州设有赌场。据报道，病理性赌博的时点患病率和终生患病率分别高达1.4%和5.1%。最常用的评估工具是基于《精神疾病诊断与统计手册》的20项南橡树赌博筛查量表。病理性赌博尚无标准治疗方法。匿名戒赌会（GA）是最受欢迎的干预方式，美国约有1000个分会。研究表明，只有8%的GA参与者能做到一年不赌博。将专业治疗与参与GA相结合可能会提高留存率和戒赌成功率。婚姻和家庭治疗，包括参与GA的配偶组织“嗜赌者互诫会”，尚未得到充分评估。少数关于认知行为治疗的研究表明，这种方法（可能包括认知重构、解决问题、社交技能训练和预防复发）很有前景。卡马西平、纳曲酮、氯米帕明、氟伏沙明和锂盐已被使用并取得了一定效果。有治疗师手册和自助手册可供使用。虽然有必要对其疗效进行研究评估，但手册可为遇到赌博问题患者的治疗师提供一个起点。简短动机访谈可能是一种有用的策略，可减少那些对接受治疗犹豫不决或不渴望戒赌的重度赌徒的赌博行为。
