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Second, some individuals use problem gambling as an escape from the problems in their lives (an example of negative reinforcement). Several psychological mechanisms are thought to be implicated in the development and maintenance of problem gambling. These authors point out that social factors may be a far more important determinant of gambling behavior than brain chemicals, and they suggest that a social model may be more useful in understanding the issue.
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Some experts maintain that casinos in general arrange for self-exclusion programs as a public relations measure without actually helping many of those with problem gambling issues. A study by Wendy Slutske of the University of Missouri concluded one-third of pathological gamblers overcome it by natural recovery. Additionally, for patients with both pathological gambling and a comorbid bipolar spectrum condition, sustained-release lithium has shown efficacy in a preliminary trial. In general, behavior analytic research in this area is growing There is evidence that the SSRI paroxetine is efficacious in the treatment of pathological gambling. As to behavioral treatment, some recent research supports the use of both activity scheduling and desensitization in the treatment of gambling problems.
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However, no one treatment is considered to be most efficacious and, in the United States, no medications have been approved for the treatment of pathological gambling by the U.S. Most treatment for problem gambling involves counseling, step-based programs, self-help, peer-support, medication, or a combination of these. The most common instrument used to screen for “probable pathological gambling” behavior is the South Oaks Gambling Screen (SOGS) developed by Lesieur and Blume (1987) at the South Oaks Hospital in New York City.
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