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Cited by 73Gambling Behavior and TreatmentsSubstance Abuse Treatment and OutcomesPersonality Disorders and Psychopathology

Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research

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Dowling, N.A., Merkouris, S.S., Lorains, F.K.·2016·Addictive Behaviors
DOI 10.1016/j.addbeh.2016.02.012
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Abstract

Despite significant psychiatric comorbidity in problem gambling, there is little evidence on which to base treatment recommendations for subpopulations of problem gamblers with comorbid psychiatric disorders. This mini-review draws on two separate systematic searches to identify possible interventions for comorbid problem gambling and psychiatric disorders, highlight the gaps in the currently available evidence base, and stimulate further research in this area. In this mini-review, only 21 studies that have conducted post-hoc analyses to explore the influence of psychiatric disorders or problem gambling subtypes on gambling outcomes from different types of treatment were identified. The findings of these studies suggest that most gambling treatments are not contraindicated by psychiatric disorders. Moreover, only 6 randomized studies comparing the efficacy of interventions targeted towards specific comorbidity subgroups with a control/comparison group were identified. The results of these studies provide preliminary evidence for modified dialectical behavior therapy for comorbid substance use, the addition of naltrexone to cognitive-behavioral therapy (CBT) for comorbid alcohol use problems, and the addition of N-acetylcysteine to tobacco support programs and imaginal desensitisation/motivational interviewing for comorbid nicotine dependence. They also suggest that lithium for comorbid bipolar disorder, escitalopram for comorbid anxiety disorders, and the addition of CBT to standard drug treatment for comorbid schizophrenia may be effective. Future research evaluating interventions sequenced according to disorder severity or the functional relationship between the gambling behavior and comorbid symptomatology, identifying psychiatric disorders as moderators of the efficacy of problem gambling interventions, and evaluating interventions matched to client comorbidity could advance this immature field of study.

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  • The disordered gambling treatment outcome literature has generally ignored heterogeneity, excluded individuals with comorbid psychiatric disorders, or employed small samples that prevent detection of subgroup differences.

    “The disordered gambling treatment outcome literature has generally ignored this heterogeneity, excluded individuals with comorbid psychiatric disorders, or employed small samples that prevent the detection of subgroup differences in treatment responses (Cowlishaw et al., 2012;Dowling, Merkouris, & Lorains, 2016;Thomas et al., 2011).”

    From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Dowling et al., 2016

  • A recent mini-review identified a limited number of studies that directly examined the efficacy of targeted interventions for comorbid disordered gambling and psychiatric disorders, with preliminary evidence available only for a small number of psychiatric comorbidities, including the use of naltrexone and CBT in the treatment of alcohol use disorders.

    “This review identified a limited number of studies that directly examined the efficacy of targeted interventions for these subgroups, with preliminary evidence available only for a small number of psychiatric comorbidities, including the use of naltrexone and CBT in the treatment of alcohol use disorders.”

    From Predictors of outcomes of psychological treatments for disordered gambling: A systematic review (2016) · cites this paper as Dowling et al., 2016

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Authors
Dowling, N. A., Merkouris, S. S., & Lorains, F. K.
Affiliations
  • Australian National University (AU)
  • Deakin University (AU)
Corresponding author
Dowling, N.A.
ORCID
Venue
Addictive Behaviors
Publisher
Elsevier BV
Published
2016-07
Volume
58
Pages
21-30
ISSN
0306-4603 (ISSN-L)
DOI
10.1016/j.addbeh.2016.02.012
OpenAlex
W2262963135
Cited by
73
References
86
Citations by year
2026: 7 · 2025: 2 · 2024: 7 · 2023: 9 · 2022: 6 · 2021: 2 · 2020: 6 · 2019: 6 · 2018: 11 · 2017: 14 · 2016: 3
FWCI
1.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Addictive Behaviors (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
problem gambling, psychiatric comorbidity, naltrexone, cognitive behavioral therapy, N-acetylcysteine, motivational interviewing, lithium, escitalopram, schizophrenia, bipolar disorder, anxiety disorders, nicotine dependence, substance use disorders, treatment moderators
MeSH terms
Acetylcysteine, Anxiety Disorders, Behavior Therapy, Mental Disorders, Bipolar Disorder, Gambling, Humans, Naltrexone, Narcotic Antagonists, Schizophrenia, Tobacco Use Disorder, Antipsychotic Agents, Citalopram, Comorbidity, Cognitive Behavioral Therapy, Free Radical Scavengers, Selective Serotonin Reuptake Inhibitors, Lithium Compounds, Antimanic Agents, Motivational Interviewing

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