In Review Are There Cognitive and Behavioural Approaches Specific to the Treatment of Pathological Gambling?

lmost all treatment approaches for pathological gam-bling have been modelled after preexisting substance ad-diction models (1). Recent studies have provided initial evidence for the validity of gambling as “a dependence with-out drugs ” (2–4). Nonetheless, the overlap of etiologic and clinical aspects with substance dependence is not a complete one, calling for the investigation of treatment techniques spe-cific to gambling psychopathology. In the 1960s, the first behavioural approaches in gambling treatment were based mostly on aversion therapy; however, 22 Can J Psychiatry, Vol 48, No 1, February 2003 Objective: Treatment approaches for pathological gambling have been modelled after preexisting substance addiction models. This paper reviews cognitive-behavioural models in a search for original insights that are specific to gambling treatment. Method: A computerized search of major health care databases (Medline and PsycINFO) was performed. Results: New cognitive-behavioural approaches to the treatment of pathological gambling provide 3 original additions to the traditional multimodal treatment of addictions: cognitive restructuring, in vivo exposure, and imaginal desensitization. Other cognitive-behavioural techniques, such as relapse prevention, problem solving, and social skill training, are shared by gambling treatment and addictions treatment. Conclusions: When treating pathological gamblers, clinicians must consider introducing techniques to address cognitive distortions related to gambling. Also, cue exposure—whether in vivo or imaginal—may help deal with urges prompted by such cues. The blending of these new techniques into a multimodal addiction treat-ment potentially balances the rational and external orientation of the cognitive-behavioural approach with in-terpersonal and introspective components of the traditional addiction treatment. (Can J Psychiatry 2003;48:22–27) Information on funding and support and author affiliations appears at the end of the article