Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy (MDN, FDC, CR, LM, MM, LD, AL, SM, GG, FM, MLC, SDP, LJ); Dipartimento di Epidemiologia, Regione Lazio, ASL Roma 1, Rome, Italy (FDC, GLD, LA); Pediatric University Hospital-Department (DPUO), Bambino Gesù Children's Hospital, Rome, Italy (FDC); Department of Psychiatry, University of Oxford, Oxford, UK (FDC); School of Hygiene and Preventive Medicine, University of Rome Tor Vergata, Rome, Italy (GLD); Mental Health Department, ASL Roma 1, Rome, Italy (IP).
J Addict Med. 2020 Jul/Aug;14(4):e15-e23. doi: 10.1097/ADM.0000000000000574.
Gambling disorder (GD) leads to impaired socioeconomical functioning and increased social costs. Although the research on GD has been rising over the years, approved treatment guidelines are currently not available. The aim of this study was to systematically review the literature on the pharmacological and psychosocial treatment of adults with GD, and to identify possible agreed-upon standards of care.
MEDLINE, PubMed, Cochrane, Web of Science, Embase, and CINAHL electronic databases were searched up to April 2019 for systematic reviews on pharmacological, psychosocial, and combined treatment of adults with GD. Twenty-six studies were eventually included in this meta-review.
Studies reported promising results of opioid antagonists and mood stabilizers in reducing GD-related symptomatology. Lithium was particularly effective in subjects with comorbid bipolar disorders. Cognitive behavioral therapy (CBT) was the most commonly used psychological intervention and reduced global severity, gambling frequency, and financial loss. Motivational interviewing (MI) seemed to improve several GD domains, alone or in combination with CBT. Self-help interventions (SHIs) showed some efficacy in promoting treatment-seeking, and in combination with other treatments.
We found moderate evidence of effect for CBT, but weaker evidence for pharmacotherapy and SHIs. Results suggested some efficacy for MI in the short but not in the long term. It is likely that certain interventions might be more effective than others on specific features of GD. Further studies are needed to compare the efficacy and acceptability of individual and combined psychosocial and pharmacological interventions, to deliver patient-tailored treatments.
赌博障碍（GD）会导致社会经济功能受损和社会成本增加。尽管近年来对 GD 的研究不断增加，但目前尚无经过批准的治疗指南。本研究旨在系统地回顾 GD 成人患者的药物和心理社会治疗的文献，并确定可能的共识治疗标准。
MEDLINE、PubMed、Cochrane、Web of Science、Embase 和 CINAHL 电子数据库检索了截至 2019 年 4 月的关于 GD 成人药物、心理社会和联合治疗的系统评价。最终纳入了 26 项研究进行meta 综述。
研究报告了阿片类拮抗剂和心境稳定剂在减轻 GD 相关症状方面的有前景的结果。在伴有共病双相情感障碍的患者中，锂的疗效尤为显著。认知行为疗法（CBT）是最常用的心理干预措施，可降低总体严重程度、赌博频率和经济损失。动机性访谈（MI）似乎可以单独或与 CBT 联合改善几个 GD 领域。自助干预（SHI）在促进寻求治疗方面显示出一定的效果，并且与其他治疗方法联合使用时也显示出一定的效果。
我们发现 CBT 的疗效具有中等证据，但药物治疗和 SHI 的证据较弱。结果表明 MI 在短期内可能具有一定疗效，但在长期内则不然。某些干预措施可能在 GD 的特定特征上比其他干预措施更有效。需要进一步研究比较个体和联合心理社会和药物干预的疗效和可接受性，以提供针对患者的治疗。
