Contact
Log in Log in

Prevention and Treatment of Gambling-Related Harm

Position statement Last updated: Aug 2024 Published in Australia Reference: PS #45

This position statement outlines the impact of gambling-related harm and the need for evidence-based preventative measures and therapeutic interventions.

Purpose

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Royal Australasian College of Physicians (RACP) have developed this statement to outline their shared position on gambling-related harm and its impact on individuals, family, whānau and support networks (including carers). It highlights the need for stronger regulation to address the increasing burden of harm caused by gambling in Australia and Aotearoa New Zealand. It also outlines the need to address barriers preventing help-seeking and the need for assessment, diagnosis, treatment of harmful gambling behaviour. 

Key messages

  • Gambling-related harm impacts individuals, families, whānau, carers, and communities and can affect mental and emotional, social, financial, legal, and physical wellbeing. 
  • Comorbid disorders such as substance use disorders and mood disorders are frequently present in individuals experiencing gambling-related harm. 
  • Online gambling and electronic gaming machines (EGMs) pose significant risks to the health and wellbeing of individuals and communities and require strong regulatory measures to reduce these risks. 
  • Increasing evidence-based preventative measures is essential to reduce the burden of harm caused by gambling. This includes prohibiting all forms of gambling advertising through legislation. 
  • Evidence-based therapeutic interventions exist for those experiencing gambling-related harm but are insufficiently accessible. A trained and supported healthcare workforce should play an important role in identification and treatment alongside individuals experiencing gambling-related harm and their communities.   
  • More research is required to broaden options for early intervention, assessment, and treatment for individuals experiencing gambling-related harm.

Understanding gambling-related harm

Gambling is an activity which involves a prize of money (or something else of value), where money (or something of value) is staked, where the outcome involves an element of chance.[1] Gambling-related harm is harm or distress arising from, caused or exacerbated by an individual’s gambling.  Gambling-related harm occurs on a spectrum and can range in severity. Throughout the position statement, the term ‘problem gambling’ is used when referring to the clinical disorder. Where referring to an individual, person-first language is used.

The International Classification of Diseases 11th Revision (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), outline and describe the clinical condition ‘gambling disorder’, under the broad category of addictive behaviours and substance and addictive disorders.[2, 3] The ICD-11 also includes ‘hazardous gambling or betting’, a term which recognises the risk of harm caused by gambling when the threshold of ‘disorder’ is not met. Research suggests that gambling disorder is similar to substance disorders in diagnostic criteria, comorbidities, shared genetic underpinnings, comparable neurobiological effects and treatment approach.[4]  

Blaszczynski and Nower's pathways model provides an explanation for the ways in which people might fall into harmful gambling behaviours and has been validated through empirical studies.[5, 6] It categorises individuals into three subtypes and notes different motivations for gambling including: errant beliefs about gambling, enjoyment or escapism, or predisposition to impulsive decision-making. Understanding these pathways is important for addressing harmful gambling behaviour more effectively. 

The Problem Gambling Severity Index (PGSI) is a screening tool used to measure the severity of gambling-related harm. Categories used by the PGSI include: ‘non-problem gambler’, ‘low-risk’, ‘moderate-risk’ and ‘problem gambler’. ‘Problem gambler’ is the term for the highest risk category in this tool and these individuals most likely meet the threshold to receive a clinical diagnosis for their gambling behaviour.[7, 8] 

Impact of gambling-related harm 

Gambling-related harm is a significant public health issue in Australia and Aotearoa New Zealand and requires a concerted public health approach. Estimates suggest that Australians lost approximately $25 billion on legal forms of gambling in 2018–19, representing the largest per capita losses in the world.[9] Aotearoa New Zealand was among the top five countries with largest per capita loss due to gambling in 2017.[10] 

On individuals

Mental health conditions are often comorbid for individuals who experience gambling related harm and are more predisposed to feelings of guilt, shame, hospital presentation and risk of suicide as a result.[11-13] Comorbidities of concern include alcohol-use disorder, substance use disorders and mood disorders.[4] The use of addictive substances such as alcohol and nicotine may drive gambling activity and conversely gambling activity may influence the consumption of addictive substances.[14] While the true number of gambling-related deaths are underestimated, individuals are at a higher risk of mortality by suicide, often driven by feelings of indebtedness and shame.[15-17]  

Several priority population groups are disproportionately affected by gambling-related harm, further exacerbating existing socioeconomic and health inequalities. They include: Aboriginal and Torres Strait Islander peoples, Māori, culturally and linguistically diverse peoples, men, adolescents, individuals from a low-socioeconomic background and individuals who have been incarcerated.[9, 18-27]    

On families, whānau, carers and the broader community

Gambling-related harm extends beyond the individual and also impacts families, whānau, carers and the broader community, including through financial and legal difficulties causing damage to relationships.[28] This can escalate to intimate partner violence which, while not caused by gambling, may intersect in a range of ways.[29] Economic abuse is highly prevalent for women experiencing gambling-related intimate violence.[29] While less common, gambling can to lead to illegal activities motivated by an attempt to recover losses because of gambling activity.[30]  

Higher risk gambling platforms 

Electronic gaming machines (EGMs)

EGMs, colloquially known as ‘pokies’, are responsible for the majority of gambling revenue in Australia and Aotearoa New Zealand.[31-33] The risk of gambling-related harm increases significantly with an individual’s frequency of playing EGMs. EGM users are also more likely to significantly underestimate the duration of their gambling session and spend more than intended.[34] 

Given the disproportionate impact of EGMs use, including the financial risk, high participation rate and high frequency of play, EGM regulation should be considered a primary focus of policy action, including restricting the number of EGMs and reducing the maximum bet and limiting jackpots.[35, 36]

Online gambling

The rise in online gambling, including convergence between video gaming and gambling (i.e. through wagers, betting, randomised rewards in exchange for real-world money), has led to increased gambling-related harm.[37-40] In addition, the COVID-19 pandemic has accelerated the use of online gambling, especially among new gamblers recruited online, including young people.[41]

Online gambling is easily accessible, immersive, enables secretive behaviour, and is aggressively marketed, leading to devastating consequences for individuals and families.[17, 42] Online gambling sites are accessible 24 hours per day, do not require the person to leave their home, and lack physical/visual supervision from staff in public gambling venues. In Australia, online gambling is regulated by the Interactive Gambling Act 2001 (Cth), making it illegal for offshore gambling services to offer real money gambling to individuals accessing the internet in Australia. In Aotearoa New Zealand, offshore gambling services are not regulated.[43] Appropriate legislative responses are required to keep pace with these advances. 

Gaming convergence refers to the intermingling of gaming products with gambling elements. Loot boxes that are incorporated into games use comparable mechanics to EGMs where individuals are incentivised to spend real-world money for the chance to receive a rare in-game item.[43] There is preliminary evidence showing an association between video gaming problems and gambling behaviour, causing harm.[44] Further research is needed to understand the risks associated with gaming and its links to gambling-related harm. 

Prevention

Addressing gambling-related harm at its root is crucial and requires stronger government action. This includes the implementation of effective harm minimisation strategies, and regulations on the gambling industry.[45] Evidence-based preventative measures and harm reduction strategies are an effective way to mitigate gambling-related harm and promote positive health outcomes from a population health perspective before harm occurs.[46] Population-wide interventions are considered to be most effective in reducing the burden of gambling-related harm.[17] 

Education and awareness

Improved education regarding gambling behaviour and societal context’s role to prevent harmful gambling behaviour is required. Governments should prioritise enacting regulatory standards and expectations around education and awareness for the gambling industry and providers. Industry should be kept at a distance from policy development, advocacy and awareness-raising activities.[47]

Advertising

Advertising of gambling products is strongly associated with harmful gambling behaviour.[48] Gambling at sporting events has been normalised to the extent where many young people see gambling and sporting events as inextricably linked.[49] Legislation to prohibit gambling advertising is critical to preventing gambling-related harm. 

Early intervention 

For individuals

Identifying individuals who experience harm from gambling early is critical. This can be achieved through enacting measures to identify gambling-related harm, with a focus on the priority populations we have previously identified.[9, 18-24] 

Empowering individuals to self-check for lower-risk gambling-related harm is an effective public health measure allowing for intervention at the earliest possible moment. In Australia, the empirically derived lower-risk gambling limits can be used to self-identify harm and include: gambling frequency of 20-30 times per year, spending 0.83-1.68% of gross personal income and engaging in two or more types of gambling per year.[50] More research is needed to identify lower-risk gambling limits in Aotearoa New Zealand. Limits need to be shared via an accessible guidance to help individuals make more informed choices about gambling. 

Family members, whānau and carers also play a crucial role in prompting individuals experiencing gambling-related harm to seek help and can create conditions that promote early intervention.[51, 52] 

Harm/loss minimisation through legislation and host responsibility

Changes to legislation to reduce the supply of land-based gambling products, restricting venues and licenses, increasing pricing and taxation, and limiting operating hours can prevent gambling-related harm. Risk reduction strategies which focus on ‘host responsibility’ such as training staff in evidence informed formal procedures (e.g., self-exclusion register, cashless gambling cards) can also decrease the risk of gambling-related harm.

Measures to minimise incentives for gambling, such as reducing maximum bets and limiting jackpots on EGMs, have been implemented in some Australian jurisdictions.[53] In Aotearoa New Zealand, changes have been made under the Gambling (Harm Prevention and Minimisation) Amendment Regulations 2023 to address harms associated with EGMs and recognise them as one of the most harmful forms of gambling.   

Treatment

Treatment for individuals who experience gambling-related harm should be person-centred and based on partnership between individuals, their community and the health professional.[54] Clinicians have a role in identifying gambling-related harm through routine screening during initial assessment of individuals.[55] Commonly used evidence-based screening tools include the Problem Gambling Severity Index (PGSI) or Brief Problem Gambling Screen (BPGS). Where mental health comorbidities are present, alternative therapies and treatments should be explored based on the individual’s presentation. Further assessment and referral to specialised services can also be made, as appropriate.[56]  

Models of treatment should reflect an inter-disciplinary approach, be adequately funded, and include clear referral pathways to address harmful gambling behaviour.[57, 58]  This may include contributions from addiction medicine physicians and psychiatrists, general practitioners, qualified psychologists and other therapists, social workers, financial counsellors, those with lived experience of gambling-related harm and peer support workers and mutual support groups (e.g. Gamblers Anonymous).[59] Treatment models should be guided by lived experience wisdom of individuals who experience gambling-related harm.[60] Treatment models should also recognise the role of family and whānau, by involving them in recovery and support options where possible. 

Cognitive behavioural therapy (CBT) is recognised as the most effective evidence-based treatment for gambling-related harm.[61] This is followed by motivational interview (MI) which emphasises the need for an empathic, patient-centred approach.[61] Other approaches to treatment include participation in community-based programs like Gamblers Anonymous which can assist individuals through mutual support, accountability and structure.[62, 63] Pharmacological interventions can be used to enhance first-line treatment when first-line treatments alone prove unsuccessful. Pharmacological interventions are recommended as part of a holistic treatment plan where appropriate precautions are taken.[64-66] This should be approached with awareness of the low certainty of a medium benefit regarding the short-term improvements found with the use of opioid antagonists such as naltrexone.  

Addressing barriers to treatment

Stigma is often encountered by individuals who experience gambling-related harm, which may exacerbate the harm and prevent help-seeking in these individuals.[37, 67, 68] Other challenges to receiving treatment for gambling-related harm may include previous history of trauma (including in childhood), societal attitudes, reluctance to seek help, geographic barriers, limited service availability, financial limitations, and lack of knowledge.[69-71] Almost three out of four individuals who experience gambling-related harm do not seek professional treatment or join support groups.[72] Overcoming these obstacles is crucial to ensure fair access to treatment and positive outcomes. This may include placement of services providing treatment of problem gambling where there is greatest need, including at-risk communities that are more likely to experience disproportionate harm from gambling.

Trauma-informed practice

Individuals who experience gambling-related harm often have higher rates of trauma.[73] Trauma-informed practice is a strengths-based delivery approach that recognises the impact trauma can have on individuals to improve health outcomes and paths for recovery.[74] This includes recognising diversity of an individual’s experiences and presentation, understanding how trauma can impact functioning and behaviour and creating a safe environment to minimise re-traumatisation.[73] It is important to raise awareness and integrate trauma-informed practices into services addressing gambling-related harm.

Improving the evidence base

There is no universally accepted approach to measuring gambling-related harm. More research is needed to establish effective measures for regulating gambling. This includes incorporating harm reduction strategies and input from those with lived experience. Evidence-informed prevention and intervention efforts are necessary to address harmful gambling behaviour and develop international screening and diagnostic instruments for gaming disorder. Collaboration across jurisdictions and joint governance agreements are essential to improve regulatory practices and reduce harm for online gamblers.[75]

Regulatory and systemic measures must be evidence-based to prevent and reduce harm for people who experience gambling-related harm, with adjustments modifications as the evidence base develops. Assessment of services occurring both nationally and across jurisdictions, including their joint governance and data sharing agreements should take place, as appropriate.

Some assistance may be provided by the World Health Organization’s plan to develop new international screening and diagnostic instruments for gaming disorder and gambling disorder. This is intended to improve the evidence base to create comparable epidemiological data and provide a basis to facilitate training and capacity building for health professionals.[76]

Recommendations

The RANZCP and the RACP recommend that: 

  • Gambling-related harm is recognised as a public health issue with a significant impact on the health and well-being of individuals and families, whānau, carers, and communities.
  • Individuals and communities with lived experience of gambling-related harm are involved in the development of strategies to address gambling-related harm. 
  • There is adequate funding and equitable access to treatment and support for individuals experiencing gambling-related harm, including addressing stigma and other barriers to accessing treatment.
  • Public health campaigns increase their focus on early intervention particularly for priority population groups in addressing gambling-related harm.
  • The identification and treatment of gambling disorder is recognised as a health portfolio priority, and gambling-related harm is aligned with mental health within government portfolios.
  • Governments implement regulatory measures to restrict maximum bets, jackpots, and the number of electronic gaming machines (EGMs) in venues to mitigate its risks.  
  • Governments legislate for the cessation of gambling advertisements on television and online.
  • There is improved training for practitioners in identifying harmful gambling behaviour and provide resources for early identification and intervention to the workforce.
  • Practitioners screen individuals who experience comorbid mental health disorders for harmful gambling behaviour.
  • There is greater investment in research to improve the evidence base for gambling-related harm. 
  • There is greater investment in evidence-based treatment models that involve a multidisciplinary approach, including psychiatrists and physicians, allied health professionals and individuals with lived experience to address gambling-related harm effectively.



References

  1. Victorian Gambling and Casino Control Commission. Gambling and gambling-related offences. 2003; Available from: https://www.vgccc.vic.gov.au/gambling/wagering-and-sports-betting/about-wagering-and-sports-betting/gambling-and-gambling-related-offences#:~:text=Gambling%20definition,other%20valuable%20consideration%20to%20participate.
  2. World Health Organisation, International Classification of Diseases, Eleventh Revision (ICD-11). 2019/2021.
  3. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition ed. 2013: American Psychiatric Association.
  4. Rash, C.J., J. Weinstock, and R.V. Patten, A review of gambling disorder and substance use disorders. Subst Abuse Rehabil, 2016. 7: p. 3-13.
  5. Blaszczynski, A. and L. Nower, A pathways model of problem and pathological gambling: Pathways model of gambling. Addiction, 2002. 97(5): p. 487-499.
  6. Mena-Moreno, T., et al., A serious game to improve emotion regulation in treatment-seeking individuals with gambling disorder: A usability study. Frontiers in psychology, 2021. 12: p. 621953.
  7. Miller, N.V., et al., Validation of the problem gambling severity index using confirmatory factor analysis and rasch modelling. Int J Methods Psychiatr Res., 2013. 22(3): p. 235-255.
  8. ACT Gambling and Racing Commission, Strategy for gambling harm prevention in the ACT: A public health approach 2019-2024. 2019, ACT Gambling and Racing Commission: ACT, Canberra.
  9. Australian Institute of Health and Welfare, Gambling in Australia. 2021.
  10. Statista. Countries with the largest gambling losses per adult worldwide in 2017. 2023; Available from: https://www.statista.com/statistics/552821/gambling-losses-per-adult-by-country-worldwide/.
  11. Dowling, N.A., et al., Prevalence of psychiatric co-morbidity in treatment-seeking problem gamblers: A systematic review and meta-analysis. Australian & New Zealand Journal of Psychiatry, 2015. 49(6): p. 519-539.
  12. Dowling, N.A., et al., The prevalence of comorbid personality disorders in treatment-seeking problem gamblers: a systematic review and meta-analysis. Journal of Personality Disorders, 2015. 29(6): p. 735-754.
  13. Lorains, F.K., S. Cowlishaw, and S.A. Thomas, Prevalence of comorbid disorders in problem and pathological gambling: systematic review and meta-analysis of population surveys: Comorbid disorders in pathological gambling. Addiction, 2011. 106(3): p. 490-498.
  14. Bussu, A. and C. Detotto, The bidirectional relationship between gambling and addictive substances. International Gambling Studies, 2015. 15(2): p. 285-308.
  15. Livingstone, C. and A. Rintoul, Gambling-related suicidality: stigma, shame, and neglect. The Lancet Public Health, 2021. 6(1): p. e4-e5.
  16. Marionneau, V. and J. Nikkinen, Gambling-related suicides and suicidality: A systematic review of qualitative evidence. Front. Psychiatry, 2022. 13(980303).
  17. House of Representatives Standing Committee on Social Policy and Legal Affairs, You win some, you lose more: Online gambling and its impacts on those experiencing gambling harm. 2023, Commonwealth of Australia Canberra.
  18. Ramanauskas, S., Crime and Problem Gambling: A Research Landscape. 2020, Howard League for Penal Reform.
  19. Hing, N., et al., Effects of wagering marketing on vulnerable adults. 2018, Victorian Responsible Gambling Foundation: Melbourne.
  20. Bellringer, M., et al., Gambling behaviours and associated risk factors for 17 year old Pacific youth. 2019, Auckland University of Technology, Gambling and Addictions Research Centre: Auckland.
  21. Maltzahn, K., et al., Gambling in the Sunraysia Aboriginal Community: An Exploratory Study. 2017, La Trobe University.
  22. MacLean, S., et al., Gambling in Two Regional Australian Aboriginal Communities: A Social Practice Analysis. Journal of Gambling Studies, 2019. 35(4): p. 1331-1345.
  23. Maltzahn, K., et al., Impacts of Gambling on Young Aboriginal People in Gippsland and East Gippsland. 2018, La Trobe University:.
  24. Palmer du Preez, K., et al., A Mixed Methods Analysis of Gambling Harm for Women in New Zealand. 2019, Auckland University of Technology, Gambling and Addictions Research Centre: Auckland.
  25. Hauora, M.o.H.M. Gambling harm. 2023; Available from: https://www.health.govt.nz/our-work/mental-health-and-addiction/addiction/gambling-harm.
  26. Pampel, F.C., P.M. Krueger, and J.T. Denney, Socioeconomic Disparities in Health Behaviors. Annu Rev Sociol, 2010. 36: p. 349-370.
  27. Kryszajtys, D. and F.I. Matheson, Problem gambling and crime and its costs. 2017, Gambling Research Exchange Ontario: Ontario, Canada.
  28. Dowling, N., The impact of gambling problems on families, in AGRC Discussion Paper. 2014, Australian Gambling Research Centre: Melbourne, Australia.
  29. Australia's National Research Organisation for Women's Safety, Problem gambling and intimate partner violence: Key findings and future directions, in Research to policy and practice. 2020, ANROWS: Sydney.
  30. Adolphe, A., et al., Crime and Gambling Disorders: A Systematic Review. Journal of Gambling Studies, 2019. 35(2): p. 395-414.
  31. Andelane, L., Gambling: Kiwis blow almost $1b on the pokies per year - but where could that money be going?, in Newshub. 2020, Newshub: New Zealand.
  32. Bond, J., New Zealand gamblers record losses of more than $843m, in NZ Herald. 2016: New Zealand.
  33. Productivity Commission, Gambling. Vol. 50. 2010, Canberra: Productivity Commission.
  34. Rintoul, A. and A. Thomas, Pre-commitment systems for electronic gambling machines: preventing harm and improving consumer protection. 2017, Australian Gambling Research Centre, Australian Institute of Family Studies: Melbourne, VIC.
  35. Sulkunen, P., et al., Setting limits: gambling, science and public policy—summary of results. Addiction, 2021. 116(1): p. 32-40.
  36. Browne, M., et al., Unambiguous evidence that over half of gambling problems in Australia are caused by electronic gambling machines: Results from a large-scale composite population study. Journal of Behavioral Addictions, 2023. 12(1): p. 182-193.
  37. Hing, N., et al., The stigma of problem gambling: Causes, characteristics and consequences. 2015, Victorian Responsible Gambling Foundation: Victoria.
  38. King, D.L. and P.H. Delfabbro, The convergence of gambling and monetised gaming activities. Current Opinion in Behavioral Sciences, 2020. 31: p. 32-36.
  39. Li, W., D. Mills, and L. Nower, The relationship of loot box purchases to problem video gaming and problem gambling. Addictive Behaviors, 2019. 97: p. 27-34.
  40. Spicer, S.G., et al., Loot boxes, problem gambling and problem video gaming: A systematic review and meta-synthesis. New Media & Society, 2022. 24(4): p. 1001-1022.
  41. Lejoyeux, M., [Psychological and social impact of online gambling]. Bulletin De l'Academie Nationale De Medecine, 2012. 196(1): p. 27-34; discussion 35-36.
  42. Financial Counselling Australia, Duds, Mugs and the A-list: The impact of uncontrolled sports betting. 2015.
  43. Te Tari Taiwhenua | Department of Internal Affairs. Review of Online Gambling in New Zealand. 2021; Available from: https://www.dia.govt.nz/onlinegamblingconsultation.
  44. Ministry of Health – Manatū Hauora, Strategy to Prevent and Minimise Gambling Harm 2022/23 to 2024/25. 2022, Ministry of Health: Wellington.
  45. Suicide Prevention Australia and Financial Counselling Australia, Gambling and Suicide Prevention - A Roadmap for Change. 2022.
  46. Velasco, V., et al., Prevention and Harm Reduction Interventions for Adult Gambling at the Local Level: An Umbrella Review of Empirical Evidence. Int J Environ Res Public Health. , 2021. 18(9484).
  47. Van Schalkwyk, M.C.I., et al., A public health approach to gambling regulation: countering powerful influences. The Lancet Public Health, 2021. 6(8): p. e614-e619.
  48. Torrance, J., et al., Emergent gambling advertising; a rapid review of marketing content, delivery and structural features. BMC Public Health, 2021. 21(1): p. 718.
  49. Gridley, H., The increasing harm from advertising and promotion of gambling in sport. InPsych, 2013. 35(June).
  50. Dowling, N.A., et al., The Development of Empirically Derived Australian Low-Risk Gambling Limits. J Clin Med, 2021. 10(2).
  51. Buchner, U.G., et al., Is an e-mental health programme a viable way to reach affected others of disordered gamblers? A feasibility study focusing on access and retention. International Gambling Studies, 2019. 19(1): p. 85-105.
  52. Orford, J., et al., Stress, strain, coping and social support for affected family members attending the National Problem Gambling Clinic, London. International Gambling Studies, 2017. 17(2): p. 259-275.
  53. Stevens, M. and C. Livingstone, Evaluating changes in electronic gambling machine policy on user losses in an Australian jurisdiction. BMC Public Health, 2019. 19(1): p. 517.
  54. Royal Australian and New Zealand College of Psychiatrists. Mental health for the community. 2018; Available from: https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/mental-health-for-the-community.
  55. Problem Gambling Research and Treatment Centre, Guidelines for screening, assessment and treatment in problem gambling. 2011, Clayton, Vic.: Monash University.
  56. Dowling, N.A., et al., Screening for problem gambling within mental health services: a comparison of the classification accuracy of brief instruments. Addiction, 2018. 113(6): p. 1088-1104.
  57. Browne, M., et al., A framework for indirect elicitation of the public health impact of gambling problems. BMC Public Health, 2020. 20(1): p. 1717.
  58. Price, A., M. Hilbrecht, and R. Billi, Charting a path towards a public health approach for gambling harm prevention. Journal of Public Health, 2021. 29(1): p. 37-53.
  59. Australian Department of Health and Aged Care, National Mental Health Workforce Strategy 2022-23. 2023.
  60. Miller, H.E., S.L. Thomas, and P. Robinson, From problem people to addictive products: a qualitative study on rethinking gambling policy from the perspective of lived experience. Harm Reduction Journal, 2018. 15(1): p. 16.
  61. Cowlishaw, S., et al., Psychological therapies for pathological and problem gambling. Cochrane Database of Systematic Reviews, 2012.
  62. Battersby, M., et al., Cognitive Behavioral Therapy for Problem Gamblers, in In the Pursuit of Winning, M. Zangeneh, A. Blaszczynski, and N.E. Turner, Editors. 2008, Springer US: Boston, MA. p. 179-197.
  63. Fong, T.W., Types of Psychotherapy for Pathological Gamblers. Psychiatry (Edgmont), 2005. 2(5): p. 32-39.
  64. Castrén, S., et al., Treating gambling disorder with as needed administration of intranasal naloxone: a pilot study to evaluate acceptability, feasibility and outcomes. BMJ Open, 2019. 9(8): p. e023728.
  65. Lahti, T., et al., Treatment of pathological gambling with naltrexone pharmacotherapy and brief intervention: a pilot study. Psychopharmacology Bulletin, 2010. 43(3): p. 35-44.
  66. Ward, S., N. Smith, and H. Bowden-Jones, The use of naltrexone in pathological and problem gambling: A UK case series. Journal of Behavioral Addictions, 2018. 7(3): p. 827-833.
  67. Hing, N., et al., Stigma and problem gambling: current knowledge and future research directions. International Gambling Studies, 2014. 14(1): p. 64-81.
  68. Lubman, D., et al., Problem gambling in people seeking treatment for mental illness. 2017, Victorian Responsible Gambling Foundation: Melbourne.
  69. Dąbrowska, K. and Ł. Wieczorek, Perceived social stigmatisation of gambling disorders and coping with stigma. Nordic Studies on Alcohol and Drugs,, 2020. 37(3): p. 279-297.
  70. Levy, J., C. O’Driscoll, and A. Sweet, Disproportionate Burdens of Gambling Harms Amongst Minority Communities: A Review of the Literature. 2020, GambleAware: London, England.
  71. Roberts, A., et al., Gambling and negative life events in a nationally representative sample of UK men. Addictive Behaviors, 2017. 75: p. 95-102.
  72. Dąbrowska, K., J. Moskalewicz, and Ł. Wieczorek, Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence? J Gambl Stud. , 2017. 33(2): p. 487–503.
  73. Gambling, G.a.T.U.G. Trauma-informed care. 2024; Available from: https://kmb.camh.ca/ggtu/knowledge-translation/trauma-informed-care.
  74. Royal Australian and New Zealand College of Psychiatrists. Trauma-informed practice. 2020; Available from: https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/trauma-informed-practice.
  75. The Royal Australian and New Zealand College of Psychiatrists and Royal Australasian College of Physicians. Joint RANZCP/RACP submission - Inquiry into online gambling and its impacts on those experiencing gambling harm (Australian House of Representatives Standing Committee on Social Policy and Legal Affairs). 2023; Available from: https://www.ranzcp.org/getmedia/9c3df649-b329-4d24-b93a-77fc0397941d/ranzcp-and-racp-joint-sub-to-online-gambling-inquiry.pdf.
  76. Carragher, N., et al., Brief overview of the WHO Collaborative Project on the Development of New International Screening and Diagnostic Instruments for Gaming Disorder and Gambling Disorder. Addiction 2021. 117(7): p. 2119-2121.