Treatment planning for problem gamblers

Abstract

Treatment dropout and relapse among problem gamblers (PGs) are high. Due to the heterogeneity of PGs, one form of treatment (i.e., mono-therapy) may not be sufficient in maintaining PGs in treatment or leading to successful outcomes. This paper aims to provide an overview of the status of the current problem gambling (PG) treatments before discussing tailoring interventions to address this heterogeneity. Although a number of effective pharmacological and psychological interventions exist for treating PG, currently there is no one treatment specifically recommended. Thus, treatment programs need to be tailored to individual needs. This requires good assessment of the problem behaviour and associated factors (e.g., risk and protective factors, gambling consequences, and comorbid psychological problems). Pictorial case formulations showing causal and maintenance factors would aid in choosing relevant techniques to address these factors. Treatment goals, controlled gambling versus abstinence, need to be decided with clients prior to commencing treatment. Given the high dropout rate among PGs, and depending on clients' willingness to make changes, what is initially covered in treatment is vital. Different combinations of interventions need to be chosen depending on clients' presenting problems. Treatment suggestions for different types of PGs are discussed. Finally, good measures (assessing symptoms, cognitions and behaviours) are required to track progress and evaluate outcomes