Behavioural Intervention for Tackling Gambling Harms

The field of addiction treatment has expanded significantly since the 1980s, becoming more diverse, and being shaped and reshaped as research and scientific evidence have challenged policymakers and practitioners to broaden their views of addiction. As a result, new approaches to understanding and helping people with gambling problems have emerged, offering pathways that are conceptually and practically different from the disease and severity-based narratives. Some see these new narratives as opposing and contesting the established view of gambling disorders, while others suggest these developments are additive to what came before, contributing more scope and options to how addictive behaviours are understood and addressed. In this article we will explore the behavioural addiction framework of understanding gambling related harms and how recognizing gambling as a behavioural addiction can be crucial for effective prevention and treatment.

The Minnesota model and the disease model narratives see pathological gambling as a binary condition that a person either had or did not have, while the emerging dimensional approach recognizes that a population has people with varying degrees of addiction. Gambling problems are not necessarily progressive: some resolve even serious ones without formal help or GA membership. People engaging in behaviour with addictive potential, be it gambling or substance use, could be located along a continuum of severity. Now a much larger range of gambling problems could be identified in the population, most of whom would not identify as addicts or meet the older diagnostic threshold of pathological or compulsive gambling. They might see themselves as having a problem with gambling, but they are not likely to see that lifelong abstinence is the only goal or to view themselves as addicted.

The behavioural addiction framework helps us understand the reinforcement patterns that underlie gambling addiction. Like substance use disorders, gambling activates the brain's reward system. Players often experience a 'high' or a rush of dopamine during gambling, similar to the effects of drugs or alcohol. This feeling can be so reinforcing that the individual continues to gamble despite any negative outcomes. Over time, this leads to neurological adaptations that affect impulse control and judgment.

Several factors can increase the risk of developing gambling problems. These include genetic predisposition, underlying mental health disorders, social environment, and personal coping styles. Stressful life events or even certain personalities that are more impulsive or seek high-risk experiences might be particularly susceptible.

Triggers such as financial strain, relationship conflicts, or even certain environments like casinos can prompt gambling behaviours. Recognizing and understanding these triggers is a pivotal step in managing the harms caused by gambling.

The past several decades have seen the advance of research-based evidence shape interventions for people with addiction problems at points all along the continuum from mild to severe. Compared to other addictive disorders, gambling treatment research has in many ways lagged in this regard, even as gambling has expanded dramatically worldwide. Funding for gambling research and treatment, in countries where gambling is legal, while adding significant revenue to government coffers, has been in no way proportional. With these developments, gambling problems and other harms to individuals, families and communities have become more apparent, as has public awareness of them. This awareness reframes gambling problems as not just the troubles of a small percentage of 'pathological gamblers' (using DSM-IV language), but as wide-reaching issues. It also opens the possibility of approaches to prevention and early identification of gambling. Harm reduction perspectives appear to stand in stark opposition to the abstinence approaches at the heart of the Twelve Step and disease model approaches.

Growing evidence points to the efficacy of brief treatments and other less intense interventions, particularly for people with mild or moderate gambling problems. These approaches are radically different from the established disease model interventive methods, expanding treatment goals from total abstinence as the only option to choosing moderation and control of gambling behaviour. Treatment then focuses on reducing symptoms, urges to gamble, frequency, and other psycho-social markers such as stress and overall functioning. From this point of view, having gambling problems does not always require lifelong abstinence or the prescriptive direction to enroll in GA for continued recovery support. While it can be said that CBT approaches have been the most thoroughly researched, most addiction treatments tend to produce comparable results in clinical trials. The classic study in the addiction field, Project MATCH (Project MATCH, 1997), compared CBT with Motivational Enhancement Therapy (MET) and Facilitated Twelve Step (FTS). This was the first randomized control study comparing a Twelve Steps approach with conventional treatments. Participants showed strong outcomes in each condition, results that held over a 3-year follow-up, with no significant differences between them. This research and later studies have resulted in belated respect for mutual aid and the Twelve Steps approach among researchers. However, a key distinction here is that the FTS was delivered by professional therapists as a formal treatment in this study, whereas GA is a peer fellowship which does not rely on professionals but radically insists on mutual aid as the guiding principle.

Gambling Disorder is the only behavioural addiction in DSM-5. The International Classification of Diseases (ICD), the WHO diagnostic manual, recently added gaming disorder to its diagnostic list of addictive disorders. With more research support, it appears only a matter of time before internet addiction and technology use disorders are also added. Moreover, this broadening mental health lens sets the stage for the fourth key framework shaping our understanding of problem gambling.

Understanding gambling through a behavioural addiction framework allows both psychologists and the public to better grasp the complexities of this disorder. This perspective also supports more compassionate and effective interventions that can lead to recovery and rehabilitation. As we continue to explore and understand this framework, it is my hope that we can reduce the stigma associated with gambling addiction and provide better support systems for those affected.