Gambling Disorder
Screening and Assessment
When To Screen
| Consider routine screening | Ask about gambling routinely as part of the social history (while asking about smoking, alcohol consumption, or substance use) during holistic assessments, routine health checks, GP registration, or contacts with social services |
| Proactively screen for gambling in the presence of factors that significantly increase the risk of gambling-related harms | ANY of the following:
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How To Screen
Direct specific screening questions should be used:
- “Do you gamble?”
- “Are you worried about your own or another person’s gambling?”
If a patient expresses any concerns, encourage them to complete the self-assessment questionnaire available on the NHS website (which is based on the Problem Gambling Severity Index)
Post-Screening
If screening indicates a potential issue, perform a full clinical assessment that evaluates:
- Mental health + immediate safety (self-harm / suicidal ideation and intent must be checked for explicitly)
- Gambling profile (e.g. gambling history, start and progression, types and location of gambling, frequency)
- Also assess for triggers, cravings, and emotions driving the gambling, the cognitive functions or motivations it serves, and the impact of advertising and marketing on their behaviour
- Comorbidities and history (e.g. medical history, neurodevelopmental history, brain injuries, childhood development, other co-existing addictions)
- Impact on relationships, housing, employment, education, legal issues, and financial health (e.g. proportion of income spent, debt, borrowing, or stealing)
- Medication review
NICE recommends using 2 primary validated tools to assess the severity of gambling (for those who are part of dedicated gambling treatment services)
- Problem Gambling Severity Index (PGSI) – most commonly used tool in UK
- South Oaks Gambling Screen (SOGS)
NICE committee noted the lack of evidence on the accuracy of simple, brief (1-5 item) screening tools for identifying gambling-related harms in non-specialist healthcare settings.
Referral
Consider referring patients via an NHS triage service to ensure they are assigned to the appropriate care level, for example
- Community-based services for lower severity, or
- Specialist clinics for highly complex / co-occurring needs
Inform the patient that they can self-refer via an NHS triage service or the National Gambling Helpline
Diagnosis
DSM-5 criteria for gambling disorder, ALL must be met: [Ref]
- Persistent and recurrent problematic gambling behaviour leading to clinically significant impairment or distress
- Presence of at least 4 of the following in a 12-month period:
- Often preoccupied with gambling (e.g. having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)
- Needs to gamble with increasing amounts of money in order to achieve the desired excitement
- Repeated unsuccessful efforts to control, cut back, or stop gambling
- Restless or irritable when attempting to cut down or stop gambling
- Often gambles when feeling distressed (e.g. helpless, guilty, anxious, depressed)
- After losing money gambling, often returns another day to get even (“chasing” one’s losses)
- Lies to family members, therapist, or others to conceal the extent of involvement with gambling
- Jeopardised or lost a significant relationship, job, or educational or career opportunity because of gambling
- Relies on others to provide money to relieve a desperate financial situation caused by gambling
- The gambling behaviour is NOT better explained by a manic episode
Gambling-Related Harms
| Harm category | Description |
|---|---|
| Mental and physical health |
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| Relationships and family life |
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| Financial resources and housing |
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| Legal and criminal harms | To finance their gambling, the patient may commit crimes such as theft, fraud, forgery, or embezzlement |
Management
Since gambling disorder is a dominant risk factor for suicide and self-harm, one must ask directly about suicidal intent.
If an immediate risk is present, refer urgently to crisis teams or emergency mental health services.
Key management principles:
| Category | Description |
|---|---|
| Practical self-exclusion | Actively discuss and set up immediate barrier methods to prevent gambling, including
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| Psychological interventions | Choice of psychological interventions:
Motivational interviewing is recommended to strengthen a patient’s confidence and commitment to change, especially if they are hesitant or have reservations about starting treatment Peer support should also be offered as an important part of care |
| Pharmacological management | Naltrexone (opioid-receptor antagonist) is recommended (but off-label) to reduce gambling severity under specific circumstances
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