Gambling Disorder

Gambling disorder is persistent problematic gambling with escalating stakes, loss of control, chasing losses and harm to function.

• Prevalence 0.2 to 2%, more in men; onset earlier in men; online gambling increases risk.
• Associated: impulsivity, dopaminergic dysfunction (dopamine agonists in Parkinson disease cause pathological gambling), substance misuse, ADHD, bipolar disorder, depression, personality disorders.
• Suicidality is high (up to 20% attempt); financial ruin, crime, relationship breakdown.

• Preoccupation, need to gamble with more money, repeated failed efforts to cut down, restlessness, gambling to escape distress, lying, chasing losses, borrowing, theft.
• Relationship, work and legal problems.
• Concealment; presentation with depression, anxiety, substance misuse or financial crisis.

• DSM-5 criteria (4 or more of 9); Problem Gambling Severity Index, South Oaks Gambling Screen.
• Screen for depression, bipolar disorder (mania induced gambling), ADHD, substance and alcohol use, suicidality.
• Medication review: dopamine agonists (pramipexole, ropinirole), aripiprazole.
• Assess financial and legal situation, safeguarding.

• CBT for gambling (cognitive correction, relapse prevention, exposure), motivational interviewing, brief interventions.
• Practical: financial control (third party management, blocking software, self exclusion programs, bank limits), debt counselling, Gamblers Anonymous, family support.
• Medication for comorbidity: SSRI for depression or anxiety, mood stabiliser for bipolar disorder, stimulants for ADHD; naltrexone 50 to 150 mg daily (may reduce urges, particularly with strong urges or family alcohol history), nalmefene 20 to 40 mg; lithium 600 to 1200 mg for bipolar spectrum.
• Reduce or stop dopamine agonists in Parkinson disease.
• Suicide risk assessment and crisis plan; long term follow up.