Background on evidence-based guidelines

Learn more about evidence-based guidelines for "Practice Guidelines for Treating Gambling-Related Problems".

Table of Contents

Why use evidence-based guidelines?

Evidence-based practice guidelines help treatment providers deliver scientifically supported clinical services that are best suited to patient needs. Scientific support for treatment strategies is essential to ensuring that treatment services are safe and effective. In short, evidence-based practice guidelines can help providers deliver the best treatments based upon the best evidence for each patient.

These guidelines are for treatment providers who are involved with clients/patients who are struggling with gambling-related health problems or Gambling Disorder. Whether you are a psychologist, a family practitioner, a social worker, or some other type of health service provider, if you have patients who might be affected by gambling, these guidelines are for you.

Evidence-based practice in context: the EBP triad

The Institute of Medicine defines evidence-based care as “the integration of best research evidence with clinical expertise and patient values.” In other words, the research evidence we present in this resource is just one pillar of evidence-based care. Clinicians should begin with research and then integrate their own expertise and their individual patients’ characteristics, culture, and preferences.

In an ideal situation, these three pillars will converge. However, individual patients might require unique decisions and interventions not addressed within the existing literature base.

The EBP Triad requires that patients be actively involved in assessment, case formulation, prevention, therapeutic relationship, treatment, and consultation. [Source: Norcross, Hogan, Koocher, & Maggio, 2017]

Evidence base for these guidelines

The Guidelines for Treating Gambling Disorder rest upon a systematic search of scientific evaluations of treatment approaches. Different search and inclusion parameters could lead to different outcomes. As more publications become available, the Guidelines will be updated.

The systematic search for gambling treatment evidence included reviewing the following sources:

These Guidelines only include scientific evaluations relevant to the treatment of gambling-related problems that are published in peer review journals. There is less certainty of methodological quality for publications that are not peer reviewed. These Guidelines are limited to English-language publications. Currently, these Guidelines represent an analysis of 134 peer reviewed publications. We coded these publications for a variety of characteristics, such as treatment type, methodology, treatment outcomes, and more. These publications are available for review.

Categorizing strength of evidence & research design

High Quality Evidence

“High Quality Empirical Evidence” refers to treatment approaches that have two or more robust Randomized Clinical Trials (RCTs) from independent sources that show favorable clinical changes, such as a reduction in experienced symptoms or gambling behavior. We included trials in this categorization only if in key analyses the study authors compared participants in the treatment group against participants in a control condition (e.g., referral to Gamblers Anonymous, waitlist control), rather than against themselves at baseline. The latter design is best considered a case series study rather than an RCT. Treatment approaches that are absent from this section might be effective for treating gambling. However, at the time of this review, there is insufficient scientific evidence to label those treatments as High Quality, evidence-based practices.

Developing Empirical Evidence

Developing Empirical Evidence refers to treatments that have shown favorable effects in one randomized clinical trial related to gambling disorder. We specified that the treatment under consideration was not combined with another treatment.  These treatments also might have been tested using other, less rigorous study designs, as well as the clinical trial. Some of these treatments are well studied for other expressions of addiction, such as substance use disorders. For those expressions of addiction, those treatments might be considered to have High Quality Empirical Evidence. However, there is insufficient empirical evidence to do this for gambling. Therefore, we have categorized treatment types that only have a single focused trial that shows a positive clinical outcome for gambling disorder as Developing – even well known treatments with proven efficacy for other expressions of addiction.

Limited Empirical Evidence

“Limited Empirical Evidence” is a category for treatment approaches that have been evaluated using relatively weak methods. This might include study designs without randomization or control/comparison groups, or it might include small samples or inadequate follow-up periods. Certain medications have limited empirical evidence for treating gambling disorder. These include bupropion, fluvoxamine, olanzapine, sertraline, nefazodone, memantine, carbamazepine, ecopipam, citalopram, and acamprosate. Other treatments that fall in the “limited empirical evidence” for gambling disorder category are acceptance and commitment therapy, behavioral therapy (e.g., exposure therapy), eye movement desensitization and reprocessing (i.e., EMDR), mindfulness, hypnosis, meditation, multifaceted inpatient/outpatient, and deep transcranial magnetic stimulation. By categorizing treatments having “limited empirical evidence” we do not mean to imply that these treatments are not, or will not, be proven useful for treating gambling disorder. However, this classification does reveal that there is currently an absence of rigorous scientific studies of these treatments and their impacts upon gambling behavior and symptoms. To read more about these and other studies, click below to access the full bibliography.

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