National Drug Strategy
National Drug Strategy

Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician

11.1 Gambling

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Problem gambling affects a large proportion of the population(426-429). Pathological gambling is listed in the DSM-IV as an impulse control disorder. These disorders are initially driven by pleasure, arousal and gratification.

Recurrent gambling behaviour causes significant disruptions in personal, family, social and vocational pursuits(426-429). People preoccupied with gambling may report that they are seeking action or an aroused, euphoric state, more so than the money itself(426, 428).

The features of pathological gambling are persistent. Over time, patients develop unpleasant feelings, physiological activation and dysphoria which are relieved when the compulsive behaviour is undertaken.

In a manner similar to substance use disorders, as the opportunities for gambling increase (e.g. easily accessible internet gambling can be likened to an increase in the 'supply' of a substance of misuse), so does the proportion of the population that develops gambling associated problems. Hence, gambling disorders and problem gambling continue to rise(426, 428-430).

Gambling addictions typically begin in early adolescence in males and later in life for females(428, 431). Males are significantly more likely to experience gambling-related problems than females(431-436).

Gambling is a complex phenomenon and may also be viewed as:

There is evidence, however, that gambling behaviours persist over time in contrast to substance use related problems which become less prevalent as people age(68, 432, 437). The above theories have provided the theoretical rationale for the use of certain pharmacological agents to treat people affected by problem gambling(427, 438).

The clinical course of gambling can be separated into three phases(428).

Management approaches

Antidepressants

SSRIs

Other antidepressants

Opioid antagonists

The mechanism by which naltrexone may be effective in reducing problem gambling is by reducing the
urge to gamble****(454-456).

Mood stabilisers and anticonvulsants