Rapid expansion of legalized
gambling has been associated with increased rates of
gambling disorders among adults and adolescents worldwide. Epidemiologic studies suggest that, in North America, up to 6% of adults and 20% of adolescents have a
gambling problem. Despite increasing prevalence rates of
gambling disorders, little research is available on how to treat such disorders in adolescents. Much of what is known about how to treat adolescent problem and
pathological gambling comes from research on psychosocial and psychopharmacologic treatments for adult
pathological gambling. Risk factors for adolescent
gambling disorders include male gender, alcohol and
drug use, deviant peers, family history of
gambling, and impulsive behavior. While several risk factors characterize disordered
gambling among adolescents, the extent to which these characteristics are related remains to be determined. In terms of screening for adolescent problem and
pathological gambling, several instruments designed to reflect the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for
pathological gambling are available. Psychosocial approaches used to treat adult
pathological gambling include Gamblers Anonymous, cognitive-behavioral therapy (CBT), and motivational enhancement
therapy (MET). Among adolescents, CBT as well as an eclectic
therapy have been helpful in reducing problematic
gambling behavior. In terms of
pharmacotherapy, three classes of
psychotropic drugs have been used to treat adult
pathological gambling -
serotonin reuptake inhibitors,
opioid antagonists, and mood stabilizers. While some of these
pharmacotherapies have been efficacious in treating adult
pathological gambling, additional double-blind, placebo-controlled studies are needed to determine the long-term effectiveness of these treatments. No known study has evaluated the use of psychopharmacologic agents in treating adolescent
pathological gambling. Possible reasons for the lack of research on treatment for adolescent
gambling disorders include lack of motivation to pursue treatment, feelings of self-control, and negative perception of
therapy. Referrals from parents, teachers, and peers of adolescents, as well as community outreach programs, may be useful in successfully deriving a treatment population. Clinicians are advised to be sensitive to behavioral risk factors and to screen for disordered
gambling in high risk adolescents. A combination of CBT and MET, as well as medication for any comorbid psychiatric condition, is recommended.