[To an integrative management of pathological gamblers]

C Bonnaire
L'Encéphale 2011, 37 (6): 410-7

INTRODUCTION: Recent researches on pathological gambling indicate that the various gambling activities are heterogeneous by nature. Indeed, some findings support the view that gambling cannot be seen as a homogeneous activity. Therefore, pathological gamblers do not represent a homogeneous population. However, treatment does not appear to take into account this heterogeneity and studies in the field have assessed the efficacy of the various types of treatment. Furthermore, recent empirical data emphasize the need for delineating distinct subtypes of pathological gambling presenting similar symptoms but which, at the same time, differ on certain variables. These subtypes will be essential in the management, treatment, and prognosis of pathological gambling.

LITERATURE FINDINGS: Blaszczynski and Nower (2002) identified three subtypes of gamblers. The first subtype, referred to as the "emotionally vulnerable problem gamblers", includes gamblers who mainly gamble to escape painful emotional experiences. The second includes "antisocial impulsivist problem gamblers" who are mainly driven by impulsivity and sensation seeking. The last one, referred to as the "behaviourally conditioned problem gamblers", includes gamblers who gamble because of behavioural contingencies offered by the game, rather than psychological difficulties. Each group is characterized by specific psychological variables, and each may require a different treatment approach. Hence, these subgroups should be used and taken into account in the choice of the treatment.

AIM OF THE PAPER: The purpose of this article is to provide an integrative model of treatment of this disorder based on the typology of pathological gamblers. Many studies have tried to understand this pathological behaviour by exploring motivational, psychological, biological and ecological correlates of gambling to explain the aetiology. An approach integrating various orientations, at the same time cognitive-behavioural, motivational, psychoanalytical and bodily-centred is the most relevant for this behavioural disorder. On the one hand, treatment should focus on the similarities displayed by the gambler. On the other hand, treatment should evaluate and focus on the specificities of each subtype of pathological gamblers. This last point refers to the question of the role played by the game for the gambler. All pathological gamblers present similar symptoms. Concerning those common points, professionals should evaluate and treat comorbidities, wrong perceptions/cognitions, motivation to change, gambling behaviour and social aspects of the gambling behaviour. Concerning the specificities, professionals should evaluate to which subtype or pathway the gambler corresponds, and then adapt the treatment. For example, for emotionally vulnerable problem gamblers gambling to escape painful emotional experiences and presenting alexithymia components, specific psychotherapeutic techniques improving affect identification and differentiation should be applied. Thus, add-on individual psychoanalytical oriented sessions and relaxation sessions should be included in the treatment.

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