Drug-Induced Gambling Disorder: Epidemiology, Neurobiology, and Management.

Problematic gambling has been suggested to be a possible consequence of dopaminergic medications used mainly in neurological conditions, i.e. pramipexole and ropinirole, and possibly by one antipsychotic compound, aripiprazole. Patients with Parkinson's disease, restless legs syndrome and other conditions potentially treated with dopamine agonists, as well as patients treated for psychotic disorders, are vulnerable patient groups with theoretically increased risk of developing gambling disorder (GD), for example due to higher rates of mental ill-health in these groups. The aim of the present paper is to review the epidemiological, clinical, and neurobiological evidence of the association between dopaminergic medications and GD, and to describe risk groups and treatment options. The neurobiology of GD involves the reward and reinforcement system, based mainly on mesocorticolimbic dopamine projections, with the nucleus accumbens being a crucial area for developing addictions to substances and behaviors. The addictive properties of gambling can perhaps be explained by the reward uncertainty that activates dopamine signaling in a pathological manner. Since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control. A causal relationship between the medications and GD seems likely, but the molecular mechanisms behind this association have not been fully described yet. More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.

[Behavioral (non-chemical) addictions and COVID-19]. / Povedencheskie (nekhimicheskie) zavisimosti i COVID-19.

The review examines the impact of the COVID-19 pandemic on the prevalence, manifestation, as well as the possibility of preventing and treating behavioral (non-chemical) addictions. Particular attention is paid to various manifestations of Internet addiction (IA): gaming, gambling, cybersexual and food addiction (FA). During the pandemic, Internet use increased significantly, leading to an increase in IA, mainly due to gaming, which correlated with the level of psychosocial problems. The increase in gambling occurred mainly in individuals with addiction or risk groups, while in the population the frequency of gambling decreased or did not change. Immediately after the start of the COVID-19 pandemic, the number of requests to porn sites increased dramatically, suggesting an increase in cybersex addiction. However, longitudinal studies in adolescents show a slight decrease in the interest in pornography in boys, and an increase from an initially low level in girls. The proportion of eating disorders and FA significantly increased. An increase in FA was associated with depression, anxiety, and also in obese individuals. In the era of COVID-19 prevention practices and general remedial activity should take into account the needs of the general population, emphasizing the importance of self-regulating and balanced lifestyles with moderate and sensible Internet use during the pandemic.

Gambling disorder duration and cognitive behavioural therapy outcome considering gambling preference and sex.

Gambling Disorder (GD) is a behavioural addiction that leads to high level of clinical distress and, in general, it is characterized by enduring symptomatology that presents high rates of chronicity. However, there is high variability of illness duration among patients who seek treatment for GD. Previous studies reported mixed results about the relevance of illness duration in GD treatment outcome. However, there are different profiles of patients who are diagnosed with GD. For this reason, this study aimed to evaluate the effect of illness duration in the treatment outcome of different profiles of GD patients according to their gambling preference and sex. The sample were 1699 patients diagnosed with GD. All patients received cognitive-behavioural therapy in a group format. Treatment outcome was evaluated in terms of relapsing to gambling behaviours and dropout from treatment. Results showed higher probability of poor outcome in the first years of the disorder for strategic gambling compared to non-strategic or mixed forms of gambling. Moreover, women also showed higher probability of poor outcomes than men since the first stages of the disorder. This study draws attention to the relevance of illness duration in the treatment outcome of specific profiles of GD patients. In particular, patients who presented a preference for strategic forms of gambling and women who are diagnosed with GD would have a higher risk of poor treatment outcomes since the first stages of the disorder. These results highlight the importance of an early intervention in these patients in order to prevent the chronicity of the disorder.

Case Study Demonstration of the Potential Acceptability and Effectiveness of a Novel Telehealth Treatment for People Experiencing Gambling Harm.

The evidence base for internet therapies is building but little is known yet about the acceptability and effectiveness of providing telehealth online in a group format for the treatment of gambling disorders. Therefore, this uncontrolled, real-world study aimed to evaluate the feasibility and effectiveness of providing evidence-based treatment in a group format using an online platform. This innovative approach to treatment of people experiencing gambling harm was developed during the COVID pandemic so that gamblers could access evidence-based treatment from their homes. A closed group treatment program was developed using telehealth, enabling gamblers to come together weekly to engage in a treatment program based on behavioral therapy using cue exposure. Four online gamblers who met the criteria for Gambling Disorder were recruited from a gambling help service. A case report evaluation methodology was used to gain an in-depth understanding of the effectiveness of this approach to treatment. Treatment was conducted weekly over 12 months. All participants engaged with the program and after completing treatment participants no longer met the criteria for a Gambling Disorder, were abstinent for 12 months post treatment and achieved improved life functioning. This program provides preliminary evidence that providing treatment online in a group setting can be an acceptable and effective model in the delivery of treatment for clients unable to attend face-to-face clinics or preferring telemedicine as an option for treatment delivery. These findings warrant further exploration through a larger randomized controlled study.

Client Views of Contingency Management in Gambling Treatment: A Thematic Analysis.

Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.

Case Study Demonstration of the Potential Acceptability and Effectiveness of a Novel Telehealth Treatment for People Experiencing Gambling Harm.

The evidence base for internet therapies is building but little is known yet about the acceptability and effectiveness of providing telehealth online in a group format for the treatment of gambling disorders. Therefore, this uncontrolled, real-world study aimed to evaluate the feasibility and effectiveness of providing evidence-based treatment in a group format using an online platform. This innovative approach to treatment of people experiencing gambling harm was developed during the COVID pandemic so that gamblers could access evidence-based treatment from their homes. A closed group treatment program was developed using telehealth, enabling gamblers to come together weekly to engage in a treatment program based on behavioral therapy using cue exposure. Four online gamblers who met the criteria for Gambling Disorder were recruited from a gambling help service. A case report evaluation methodology was used to gain an in-depth understanding of the effectiveness of this approach to treatment. Treatment was conducted weekly over 12 months. All participants engaged with the program and after completing treatment participants no longer met the criteria for a Gambling Disorder, were abstinent for 12 months post treatment and achieved improved life functioning. This program provides preliminary evidence that providing treatment online in a group setting can be an acceptable and effective model in the delivery of treatment for clients unable to attend face-to-face clinics or preferring telemedicine as an option for treatment delivery. These findings warrant further exploration through a larger randomized controlled study.

Internet-based interventions for behavioral addictions: A systematic review.

Background and aims: Behavioral addictions are a public health problem that causes harm to both individuals and society. Internet-based interventions offer potential benefits over face-to-face therapy for the treatment of behavioral addictions, including their accessibility, perceived anonymity, and low costs. We systematically reviewed the characteristics and effectiveness of these interventions. Methods: A systematic literature search was conducted in: PubMed, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials. A standardized methodological quality assessment was performed on all identified studies via the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Results: Twenty-nine studies were assessed in this systematic review. Between them, considerable heterogeneity was noted in various study characteristics, including screening tools, inclusion criteria, and outcome measures. Attrition rates also ranged widely (9-89%), as did study quality, with three of the 29 studies rated strong, 12 moderate, and 14 weak methodologically. Twenty-two studies focused on gambling disorder, most revealing significant within-group effects for the assessed intervention on gambling-related symptoms and four of these studies identified significant between-group effects. Behavioral addictions studied in the remaining studies included gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder, revealing generally-promising, albeit limited results. Conclusions: Internet-based interventions seem promising at reducing gambling problems, but too few studies have been published, to date, for conclusions to be drawn for other behavioral addictions. Internet-based interventions targeting other behavioral addictions - like gaming disorder, internet use disorder, hoarding disorder, and pornography use disorder - remain under-examined, warranting considerable additional research to assess their effectiveness.

Update on Gambling Disorder.

Gambling disorder (GD) is estimated to be experienced by about 0.5% of the adult population in the United States. The etiology of GD is complex and includes genetic and environmental factors. Specific populations appear particularly vulnerable to GD. GD often goes unrecognized and untreated. GD often co-occurs with other conditions, particularly psychiatric disorders. Behavioral interventions are supported in the treatment of GD. No medications have a formal indication for the GD, although clinical trials suggest some may be helpful. Noninvasive neuromodulation is being explored as a possible treatment. Improved identification, prevention, and treatment of GD are warranted.

Cognitive behavioral treatment for disordered gaming and problem gambling in adolescents: a pilot feasibility study.

Background: Disordered gaming and problem gambling (DG/PG) are associated with a range of functional impairments as well as psychiatric comorbidity. With the proliferation of digital gaming apps aimed at children and adolescents, which involve in-game purchases, there is increasing evidence that DG/PG are on the rise in this age range. The behavior can be detected in youth presenting at school-based health clinics and community psychiatric clinics. Cognitive behavioral therapy (CBT) is one of several recommended treatments for adults, but little evidence is available for the efficacy of this approach in adolescents with DG/PG. Aim: To evaluate the acceptability and feasibility of a CBT-based intervention developed for adolescents with DG/PG, which can be delivered in routine psychiatric care facilities. Methods: Adolescents who were patients at a child and adolescent psychiatry service were screened for DG/PG. Those aged 12-17 years with pronounced symptoms were invited to participate in a 7-week CBT program called Relapse Prevention. Nine adolescents agreed to participate and five consented to repeated assessments of outcome (pre-, post-treatment, and 6-month follow-up). In addition to acceptability and satisfaction with treatment, symptoms of DG were assessed with standardized interview and self-report measures. Results: There were no dropouts from the treatment. Participants who completed treatment and all outcome assessments reported satisfaction with the treatment. The participants showed fewer symptoms of DG after treatment, and the proportion who met criteria for computer game addiction decreased from 56 to 0%. There was no reduction in the number of participants who met criteria for PG. Conclusion: This study provides preliminary evidence for the acceptability and feasibility of a CBT-based intervention for DG/PG in adolescents. Preliminary data suggest that the treatment may be effective for DG but not PG. Further studies are needed to evaluate the efficacy of this approach for both conditions.

Telehealth treatment for gambling disorder in the COVID-19 era: seismic shifts and silver linings.

PURPOSE OF REVIEW: Gambling disorder is a serious mental health condition and the only behavioral addiction currently recognized by the American Psychiatric Association. Though prevalence and treatment seeking for gambling disorder have been stable for decades, the global COVID-19 pandemic has created a seismic shift in societal factors that influence gambling disorder and treatment availability. At the same time, the increasing availability of telehealth therapy for gambling disorder offers a new way to provide specialized treatment nationwide. RECENT FINDINGS: The present review discusses the seismic shifts in underlying risk factors, gambling availability, and reduced access to treatment. It also covers the emergence of telehealth treatment for gambling disorder, including its benefits and pitfalls. SUMMARY: In separate commentaries, several experts hypothesized that the pandemic was likely to increase mental health risk factors in society such as social isolation, job loss, and stress. In addition, access to online gambling also increased, while countries that locked down more strictly (like Singapore) saw a reduction in terrestrial gambling, countries that did not lock down strictly (like Sweden) did not see changes in gambling behavior. Telehealth was almost universally recommended as a good option for treatment in the studies we reviewed, though proper training and staffing are needed for telehealth to prove effective. Gambling disorder was only included in nationwide addiction telehealth programs in two countries.

Sports-betting-related gambling disorder: Clinical features and correlates of cognitive behavioral therapy outcomes.

BACKGROUND AND AIMS: The number of patients with gambling disorder (GD) whose gambling preference is sports betting is increasing. However, their clinical profile and their responses to psychological treatments -compared to patients with other forms of gambling- have not been thoroughly studied. Therefore, the aims of this study were: (1) to compare the clinical characteristics of GD patients whose primary gambling activity was sports betting (SB+; n = 113) with GD patients with other primary gambling activities (SB-; n = 1,135); (2) to compare treatment outcomes (dropout and relapses) between SB + and SB- patients; and (3) to explore relationships between specific variables (GD severity, psychological distress and personality features) and treatment outcome in SB + and SB- GD patients, through correlation models and path-analysis. METHODS: The cognitive behavioral treatment consisted of 16 weekly sessions. Personality features, psychopathology, and sociodemographic and clinical factors were assessed. RESULTS: The SB + group included higher proportions of younger patients who were single and had higher educational levels, older ages of GD onset, and greater GD severities. Regarding treatment outcomes, the dropout rate was lower in the SB + group, and no between-group differences were found regarding relapse. Dropout within the SB + group was related to being unemployed, and relapse was related to being unmarried and experiencing more psychological distress. DISCUSSION AND CONCLUSION: The differences between SB + and SB- GD patients suggest that GD patients with sports-betting problems may benefit from tailored therapeutic approaches.

Integrative couple treatment for pathological gamblers with an emphasis on forgiveness processes: A case study with three couples.

Gambling's impact on a couple's relationship is an essential element in the gambling disorder (GD). Gamblers tend to lie to their partner to conceal the extent of their gambling problems and debts, which can lead to a serious relational transgression for the couple. One promising avenue is a couple treatment focusing on forgiveness processes. The objective of this study was to determine whether the Integrative Couple Treatment for Pathological Gamblers (ICT-PG) with an emphasis on forgiveness processes helped couples to enhance these processes. A Single-Case Research Design (SCRD) was used with three couples in which one of the members had a GD. The results highlight the importance of jointly analyzing the forgiveness processes between the gamblers and their partner, which constantly influenced each other. These promising results illustrate the relevance of integrating forgiveness processes in treatment for couples where one of the members has a GD.

Client's Experiences Using a Location-Based Technology ICT System during Gambling Treatments' Crucial Components: A Qualitative Study.

Cognitive Behavioral Therapy is the treatment of choice for Gambling Disorder (GD), with stimulus control (SC) and exposure with response prevention (ERP) being its two core components. Despite their efficacy, SC and ERP are not easy to deliver, so it is important to explore new ways to enhance patient compliance regarding SC and ERP. The aim of this study is to describe and assess the opinion of two patients diagnosed with problem gambling and GD that used the Symptoms app, a location-based ICT system, during SC and ERP. A consensual qualitative research study was conducted. We used a semi-structured interview, developed ad-hoc based on the Expectation and Satisfaction Scale and System Usability Scale. A total of 20 categories were identified within six domains: usefulness, improvements, recommendation to other people, safety, usability, and opinion regarding the use of the app after completing the intervention. The patients considered the app to be useful during the SC and ERP components and emphasized that feeling observed and supported at any given time helped them avoid lapses. This work can offer a starting point that opens up new research paths regarding psychological interventions for gambling disorder, such as assessing whether location-based ICT tools enhance commitment rates.

Psychological online interventions for problem gambling and gambling disorder - A meta-analytic approach.

OBJECTIVE: The Covid-19 pandemic has reignited discussions about the prevalence of and treatment options for problem gambling and gambling disorder (PGGD). Since affected persons seldom seek professional help, online interventions can improve accessibility. Thus, this study aimed to investigate the effectiveness of psychological online interventions on PGGD. METHODS: We conducted a systematic review and meta-analysis and searched in PubMed, PsycINFO, and Google Scholar for peer-reviewed experimental and quasi-experimental research published between 2010 and 2021. We calculated two meta-anlyses, one for treatment control comparisons (TCC), and one for pre-post-comparisons (PCC). RESULTS: We included six studies (ten TCC and n = 2076) in meta-analysis 1 and five studies (six PCC and n = 781) in meta-analysis 2. Online interventions turned out to be effective in both analyses with Hedges g = 0.41, 95% confidence interval = [0.22 to 0.60], p < .001, for meta-anaylsis 1 and Hegdes g = 1.28, 95% confidence interval = [0.85 to 1.71], p < .001, for meta-analysis 2. CONCLUSIONS: We identified significant effects of online interventions on PGGD in both analyses, indicating the potential of online applications. We discuss methodological aspects and further research directions.

La terapia de grupo online en el juego patológico: una modalidad desconocida descubierta en tiempos de pandemia / Online group therapy in gambling: an unknown treatment modality discovered in times of pandemic

En los últimos años el uso de las tecnologías en el ámbito de la psicoterapia está en un crecimiento continuo, por lo que resulta fundamental investigar sobre sus ventajas y limitaciones.Producto de la actual pandemia y de la importancia que está adquiriendo la teleterapia comoalternativa terapéutica, surge el objetivo de este trabajo que es revisar la literatura científicaexistente sobre la terapia de grupo online para las adicciones en general y en el juego patológico en particular, además de trasladar nuestra propia experiencia de terapia grupal, onliney en vivo en el campo del juego patológico. Se han realizado búsquedas en las bases de datosPsycINFO, MEDLINE, PubMed y Web of Science, en las que se examinaron los resultadospublicados desde enero de 2010 hasta agosto de 2020 combinando diferentes descriptores.Tras realizar dichas búsquedas los resultados encontrados mostraron que en la actualidad noexisten trabajos que investiguen la terapia de grupo online en vivo como modalidad terapéutica en el ámbito de las adicciones, en dichas bases de datos y con los descriptores utilizados.Por ello, ante la ausencia de literatura científica relacionada con el tema a tratar, se proponenuna serie de cuestiones a considerar en futuras investigaciones basadas en la experienciarecogida en las terapias de grupo online en vivo con jugadores patológicos desarrolladaspor la Asociación de Psicoterapeutas para el Estudio de las Adicciones Psicológicas ante lanecesidad de distancia social producto de la pandemia ocasionada por el virus SARS-CoV-2. (AU)

In recent years the use of technologies in the field of psychotherapy has been growing continuously, this rapid development creates the need of evaluate its advantages and limitations intherapy. As a result of the current pandemic and the importance that teletherapy is acquiring asa therapeutic alternative, the goal of this paper is to carry out a review of the existing scientificliterature on internet-based group intervention in addictions and in pathological gambling in particular. Additionally, experience from the authors on group intervention (internet and live) willbe described and used as a resource for conclusions. Searches have been carried out in the databases PsycINFO, MEDLINE, PubMed and Web of Science, in which the results published fromJanuary 2010 to August 2020 were examined by combining different descriptors. After performing these searches, the results found showed that there are currently no published paper thatresearch group therapy live online as a therapeutic modality in the field of addiction, in those databases with the descriptors used. For this purpose, in the absence of scientific literature relatedto the subject, some ideas are proposed in this paper to be considered for future research, basedon the experience gathered in the group therapy live online with players pathological developedby the Association of Psychotherapists for the Study of Addiction Psychological response to theneed for social distance product of the pandemic caused by the virus SARS-CoV-2. (AU)

Filling the GAP: Integrating a gambling addiction program into a shelter setting for people experiencing poverty and homelessness.

The burden of harm from problem gambling weighs heavily on those experiencing poverty and homelessness, yet most problem gambling prevention and treatment services are not designed to address the complex needs and challenges of this population. To redress this service gap, a multi-service agency within a shelter setting in a large urban centre developed and implemented a population-tailored, person-centred, evidence-informed gambling addiction program for its clients. The purpose of this article is to report on qualitative findings from an early evaluation of the program, the first designed to address problem gambling for people experiencing poverty and/or homelessness and delivered within a shelter service agency. Three themes emerged which were related to three program outcome categories. These included increasing awareness of gambling harms and reducing gambling behaviour; reorienting relationships with money; and, seeking, securing, and stabilizing shelter. The data suggest that problem gambling treatment within the context of poverty and homelessness benefits from an approach and setting that meets the unique needs of this community. The introduction of gambling treatment into this multi-service delivery model addressed the complex needs of the service users through integrated and person-centered approaches to care that responded to client needs, fostered therapeutic relationships, reduced experiences of discrimination and stigma, and enhanced recovery. In developing the Gambling Addiction Program, the agency drew on evidence-based approaches to problem gambling treatment and extensive experience working with the target population. Within a short timeframe, the program supported participants in the process of recovery, enhancing their understanding and control of their gambling selves, behaviours, and harms. This project demonstrates that gambling within the context of poverty requires a unique treatment space and approach.

Spread of gambling abstinence through peers and comments in online self-help chat forums to quit gambling.

Habit formation occurs in relation to peer habits and comments. This general principle was applied to gambling abstinence in the context of online self-help forums to quit gambling. Participants in this study, conducted between September 2008 and March 2020, were 161 abstinent and 928 non-abstinent gamblers who participated in online self-help chat forums to quit gambling. They received 269,317 comments during their first 3 years of forum participation. Gamblers had an increased likelihood of 3-year continuous gambling abstinence if they had many peers in the forums. However, they had a decreased likelihood of gambling abstinence if they received rejective comments from the forums. Based on these results, online social network-based interventions may be a new treatment option for gamblers.

Emotion regulation as a transdiagnostic factor in eating disorders and gambling disorder: Treatment outcome implications.

BACKGROUND: A first approach addressed to ascertain whether emotion regulation (ER) could be a transdiagnostic construct between eating disorders (EDs) and gambling disorder (GD) (through a joint clinical clustering analysis of both disorders) was performed by Munguía et al. (2021). Both conditions were represented by a severe, moderate, and low ER profile subgroups, according to the degree of ER difficulties. Results showed a linear relationship between the severity of ER difficulties and the severity of the disorder and the psychopathological state. AIMS: Based on the aforementioned cross-sectional study, the objective of this longitudinal research was to explore the treatment response of the different ER subgroups. METHODS: 459 adult patients (n = 277 ED; n = 182 GD) were included. Several clinical variables, as well as outcome indicators (after completing 16 weeks of cognitive-behavioral therapy), were evaluated. RESULTS: The three subgroups found in the previous cross-sectional study were taken for the performance of the present research. ED and GD distribution in each subgroup replicates the one exposed by Munguía et al. (2021), as well as their characterization, considering psychopathology, disorder severity and personality traits. The low ER subgroup reported a better response to treatment, whereas the severe group had the highest rates of non-remission and dropouts. CONCLUSIONS: Our results suggest that greater difficulties in ER lead to poorer treatment outcomes. Therefore, tailored treatments for patients with poor ER abilities would be recommended to improve adherence and treatment outcomes.

Evaluation of the Conversations About Gambling Mental Health First Aid course: effects on knowledge, stigmatising attitudes, confidence and helping behaviour.

BACKGROUND: The effects of problem gambling are wide-ranging, affecting many aspects of health and negatively impacting the person who gambles, their family and friends, and their community. People experiencing problem gambling have low rates of help-seeking and perceive many barriers to treatment, although evidence suggests that encouragement and support from friends and family can increase rates of help-seeking. Mental Health First Aid Australia's Conversations About Gambling course aims to teach members of the public evidence-based strategies for recognising and responding to signs of problem gambling in a person they know. METHODS: This research evaluated the effects of the Conversations About Gambling course on participants' knowledge, confidence, stigmatising attitudes, intended helping behaviour and actual helping behaviour towards a person experiencing problem gambling. Participants from Australia completed surveys before the course, immediately after the course and six months later. Changes over time (pre-course to post-course, and pre-course to 6-month follow-up) were assessed with linear mixed models. Descriptive statistics and content analyses of open-ended questions pertaining to participants' satisfaction with the course were also produced. RESULTS: Between 2018 and 2020, 166 participants were recruited into this study. At 6-month follow-up 87 participants (52.4%) provided data. Participants' knowledge about gambling and gambling problems, confidence, desire for social distance and intentions to help a person experiencing problem gambling significantly improved from pre-course to post-course, and from pre-course to 6-month follow-up. The quality of some actions taken to support a person they knew who was experiencing problem gambling also improved from pre-course to 6-month follow-up, in line with the teachings of the course. Participants perceived the course to be highly acceptable. CONCLUSIONS: The results of this initial evaluation of Mental Health First Aid Australia's Conversations About Gambling course suggest that it is an effective and acceptable educational intervention for those who wish to support a person experiencing problem gambling.

Gambling disorder in the UK: key research priorities and the urgent need for independent research funding.

Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries.