Specialist psychological therapies for people who gamble

Psychological therapies provided by services with specialist experience in gambling disorder therapy are beneficialCowlishaw, 2012. The largest body of evidence is for cognitive behavioural therapy (CBT)Ribeiro, 2021.

Individual or group CBT helps patients understand the gambling process and address distorted beliefs (eg unrealistic beliefs about the odds of winning). Significant improvements have been seen in follow-up from 3 months to 3 yearsRibeiro, 2021. The focus of behavioural change in CBT is on either avoidance of gambling situations (which may include using distraction) or graded exposure to the gambling urge. Both strategies offer benefit. Avoidance may lead to the fading of gambling urges with time, but it is increasingly challenging to maintain because gambling opportunities are ubiquitous. Graded exposure helps the patient identify their gambling triggers, learn to control the associated urge and ultimately eliminate it. A patient may not be able to focus on using other techniques until their attention is freed from the overriding urge to gamble.

Other interventions that a specialist may offer include motivational interviewing and motivational enhancement therapyThe Royal Australian and New Zealand College of Psychiatrists (RANZCP), 2017. Naltrexone is sometimes used by specialist services as an adjunct to either CBT or motivational interviewing (when either of these has not been successful alone) but is not approved by the Australian Therapeutic Goods Administration (TGA) for treatment of gambling disorder.

Contact details of specialist gambling therapy services, are available in a printable table.