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Gamblers Anonymous and Gam-Anon
There is some evidence, from retrospective studies, that combining GA with professional help may improve the outcome of pathological gambling. Lesieur and Blume described the outcome of patients treated for pathological gambling in an inpatient program. Of 124 patients admitted for treatment, 72 were contacted between 6 and 14 months after discharge (the remaining 52 patients could not be contacted or refused to be interviewed). Gambling behavior had decreased significantly, and 64% of patients reported abstinence. Blackman and co-workers studied the outcome of 88 patients treated in a clinic specializing in the treatment of pathological gambling, and found significant decreases in indebtedness and gambling behavior from pretreatment levels in patients who attended GA.
Two studies in veterans also support the notion that GA plus professional treatment may be an effective treatment for pathological gambling. Russo and colleagues surveyed 60 of 124 individuals treated in a inpatient program (the mailed survey was not returned by 64 individuals). Patients were treated with individual and group psychotherapy, as well as attendance of GA. Abstinence was 55% by self-report. In a study by the same group, Taber et al. conducted a 6-month follow-up of 57 of 66 patients (9 patients were not located) consecutively admitted to the hospital. The self-reported rate of abstinence was almost identical to the previous study (56%), and improvements in associated psychiatric symptoms and psychosocial functioning were also documented.
Choice of Treatment
Fluvoxamine is the only medication that has been systematically studied to date. Although results appear modest at present, its safety and tolerability make it a reasonable option for patients agreeable to a trial of pharmacological treatment. Use in combination with cognitive-behavioral therapy is likely to improve compliance, similar to what has been found in the treatment of drug abuse, thus potentially increasing its therapeutic effect. Other SSRIs may be acceptable alternatives, although data regarding their efficacy are lacking. Use of other medications together or concomitantly in the presence of comorbidity may be considered, but there are no empirical data to support their efficacy at present.
There are currently no prospective studies of combined treatment for pathological gambling. However, based on our clinical experience and on the preceding review of the literature, we believe that it is unlikely that monotherapy (medication or psychotherapy) will be successful in the treatment of most patients. For that reason, in clinical practice, a multimodal approach, addressing both the symptoms and the psychosocial dysfunction of pathological gambling, may prove more fruitful. Attendance of GA, where available, should be encouraged as a complement to the treatment provided by professionals. Similarly, involvement of the family through Gam-Anon or through multifamily groups may be beneficial to both the patients and their relatives, and should be recommended. Given the frequent economic and criminal complications of pathological gambling, financial and legal counseling should also be an integral part of treatment.
- Blanco, C.; Ibáñez, A.; Sáiz-Ruiz, J.; Blanco-Jerez, C.; Nunes, E.V.; Epidemiology, Pathophysiology and Treatment of Pathological Gambling. CNS Drugs, 2000, Vol. 13 Issue 6, p397-407The article above contains foundational information. Articles below contain optional updates.
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