101–103These findings mirror evidence from the treatment of alcohol dependence.104Although CBT for gambling is very similar to CBT for substance abuse treatment, cognitive therapies that focus explicitly on the distorted cognitions related to gambling are more unique in content. These therapies often involve more therapist contact (eg, up to 20 sessions) and demonstrate robust benefits relative to wait-list controls.105,106However, these results will need to be replicated using larger sample sizes and using intent-to-treat analyses, as these studies105,106excluded individuals who dropped out of treatment resulting in inflated treatment effects. Similar to other studies finding few differences among gambling treatments,101an RCT107that compared cognitive therapy to other active therapies (eg, motivational interviewing, behavioral therapy) and used intent-to-treat analyses found no significant differences in gambling outcomes among the therapies.Overall, AUD/DUD and gambling treatment research to date suggests that no one format or approach is ideal. Rather, it appears that most treatments are beneficial, with few differences found between active treatments when pit-ted against one another. Thus, persons with addictions who desire treatment have a wide range of options available to Substance Abuse and Rehabilitation downloaded from by 220.127.116.11 on 16-Aug-2018For personal use only.1 / 1
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Substance Abuse and Rehabilitation 2016:7submit your manuscript | Dovepress Dovepress10Rash et althem based on preferences, needs, and perhaps severity of their disorder. Moving forward, therapies may need to increas-ingly incorporate content that addresses the high comorbid-ity between GD and other psychiatric disorders, including, anxiety, mood, personality, alcohol, and drug disorders.22Evidence suggests that psychiatric symptoms are responsive to and improve during gambling treatment.108However, room for further improvement in psychiatric symptoms remains among those with more severe presentations,109suggesting that these individuals need specialized and integrated content to address comorbid conditions.ConclusionA major challenge in comprehensively delineating links and risks across GD and AUD/DUD pertains to the asymmetrical nature of research on addiction-related disorders in which GD is a nascent field of inquiry with a dearth of funding in comparison to other addictions.110Nevertheless, recent investigations have begun to elucidate the developmental progression of GD,111suggesting that the etiology of GD is complex, epigenetic, and includes a multitude of both proximal and distal predictors. Moreover, these models are similar in nature to developmental psychopathology models of AUD/DUD, suggesting significant overlap and common risk factors. As evidence accumulates, we are able to integrate decades of research into broad, inclusive models of addic-tion37that incorporate behavioral addictions such as GD.
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