Current Approaches to the Identification and Management of Gambling Disorder: A Narrative Review to Inform Clinical Practice in Australia and New Zealand

Abstract

Gambling disorder is a recognised psychiatric disorder in the Diagnostic and statistical manual of mental disorders (DSM-5) and is classified as an addiction alongside alcohol and substance use disorders. The DSM-5 describes a past-year timeframe, episodic or persistent specifiers, early or sustained remission specifiers, and three gambling disorder severity specifiers (mild, moderate and severe). Although anyone can develop gambling disorder, there are known risk factors. In studies involving general adult populations, the likelihood of developing the disorder varies with the type of gambling, and is particularly high for internet gambling, casino table games and poker machines. Australia and New Zealand have shifted the focus of gambling disorder to the identification of gambling harm, in recognition that efforts targeting the prevention of harm may be more effective as they potentially influence a larger segment of the population. Temporal categories of gambling harm (crisis harms versus legacy harms) affect help-seeking and need for treatment. Crisis harms often motivate people to change their behaviour or seek help, whereas treatment addresses legacy harms, which emerge or continue to occur after gambling behaviour ceases. The evidence base and clinical guidelines recommend cognitive behavioural therapy and motivational interviewing but there are many gaps in our understanding of treatment for gambling disorder, including an absence of high quality evaluations that assess treatment effectiveness over the longer term, especially for treatment delivered in community settings. There is also an urgent need to understand how, why and for whom treatment works so that interventions can be optimised to individual needs, thereby facilitating client engagement. Because of limited access to health care and poor retention in treatment, in recent years there has been an increase in treatment choices in the form of internet therapies and smartphone applications.