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Gambling disorder

Abstract

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

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Fig. 1: Psychiatric comorbidities with gambling disorder.
Fig. 2: Theoretical model for neural differences in gambling disorder.
Fig. 3: Neurobiology of gambling disorder.
Fig. 4: Proposed treatment algorithm for gambling disorder.
Fig. 5: Quality of life in gambling disorder.

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Acknowledgements

The research for and preparation of this report was supported in part by grants R01 DA039136, K01DA039299 and R21 DA042900 from the National Institutes of Health; the Connecticut State Department of Mental Health and Addiction Services; the Connecticut Mental Health Center; the Connecticut Council on Problem Gambling; and a Center of Excellence in Gambling Research Award from the National Center for Responsible Gaming. This work was also partially supported by the Peter Boris Centre for Addictions Research and Gambling Research Exchange of Ontario. This work was also partially supported by a Career Development Fellowship of the Australian Medical Research Future Fund (MRF1141214). A.V.-G. is supported by a Career Development Fellowship of the Australian Medical Research Future Fund (MRF1141214). The funding agencies did not provide input or comment on the content of the manuscript, and the content of the manuscript reflects the contributions and thoughts of the authors and does not necessarily reflect the views of the funding agencies.

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Contributions

Introduction (M.N.P.); Epidemiology (S.W.Y. and M.N.P.); Mechanisms/pathophysiology (A.V.-G., S.W.Y., M.N.P. and I.M.B.); Diagnosis, screening and prevention (N.M.P. and J.D.); Management (N.M.P. and J.E.G.); Quality of life (J.E.G.); Outlook (M.N.P.); Overview of Primer (M.N.P.). The authors alone are responsible for the content and writing of this manuscript.

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Correspondence to Marc N. Potenza.

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Competing interests

The authors report no conflicts of interest with respect to the content of this manuscript. M.N.P. has consulted for and advised Shire, INSYS, RiverMend Health, Addiction Policy Forum, Game Day Data, the National Council on Problem Gambling, Opiant/Lightlake Therapeutics and Jazz Pharmaceuticals; has received unrestricted research support from Mohegan Sun Casino and grant support from the National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; has consulted for and advised legal and gambling entities on issues related to addictions and impulse control disorders; provides clinical care in the Connecticut Department of Mental Health and Addiction Services Problem Gambling Services Program; has performed grant reviews for the National Institutes of Health and other agencies; has edited journals and journal sections; has given academic lectures in grand rounds, Continuing Medical Education events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts. S.W.Y. is on the Board of Directors for the Connecticut Council on Problem Gambling and has received funding support from the National Center for Responsible Gaming. N.M.P. served on the American Psychiatric Association Workgroup for the DSM-5, for which travel costs were covered but she received no compensation. N.M.P. also wrote a report for the National Gambling Trust, has reviewed grants for NIH and other agencies, and has served as an expert for legal cases related to gambling and impulse control disorders. I.M.B. has received funding from the National Center for Responsible Gaming and from the Gambling Research Exchange of Ontario. The other authors report no disclosures.

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It is with significant sadness that we note the passing of Dr Nancy M. Petry on 17 July 2018. Dr Petry made many important contributions to the field of gambling research and addiction research more generally. We will miss her and her important contributions in the areas of treatment development, nomenclature and mentorship, among others.

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Potenza, M.N., Balodis, I.M., Derevensky, J. et al. Gambling disorder. Nat Rev Dis Primers 5, 51 (2019). https://doi.org/10.1038/s41572-019-0099-7

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