Cognitive Behavioral Therapy for Pathological Gambling

The purpose of the study is to evaluate a new form of counseling for pathological gambling and to see if the counseling is more effective than attending Gamblers Anonymous.

Subjects will be assigned to counseling or be given a referral list of available Gamblers Anonymous meetings at the first visit based on answers to questions. Assignment to counseling or Gamblers Anonymous will be randomly selected (i.e. chance) with an equal chance of receiving either one. For those assigned to counseling, you will meet with the therapist for 60 minutes weekly. You will receive 5 sessions of counseling.

All subjects will be assessed with gambling questionnaires twice during the 5-week period and again at 3 and 6 months following the 5-week period.

For those assigned to Gamblers Anonymous, they will be offered 5 weeks of counseling at the end of the 6-month follow-up.

• Behavioral: Cognitive Behavioral Therapy
  5-weeks of Cognitive Behavioral Therapy
  Other Name: CBT
• Behavioral: Wait-list
  subjects assigned to wait-list condition for six-weeks

• Active Comparator: Cognitive Behavioral Therapy
  Weekly Cognitive Behavior therapy
  Intervention: Behavioral: Cognitive Behavioral Therapy
• Wait-list
  Subjects in wait-list for six-weeks
  Intervention: Behavioral: Wait-list

Inclusion Criteria:

1. Outpatient men and women age 18 to 75
2. Presence of current DSM-IV pathological gambling for at least 6 months duration
3. PG is the most problematic psychiatric disorder (in the patient's and clinician's opinion) and the primary reason for seeking treatment
4. Minimum score of >5 on the South Oaks Gambling Screen which reflects gambling severity consistent with pathological gambling

Exclusion Criteria:

1. Current clinically significant suicidality, severe depression (a score of ≥ 19 on the Hamilton Rating Scale for Depression, 17-item version)(30) or any other disorder requiring immediate intervention
2. Presence of any clinical features requiring a higher level of care than outpatient treatment
3. Cognitive impairment that interferes with the capacity to engage in CBT or to provide informed consent
4. DSM-IV substance abuse or dependence within the past 3 months (see Screening Visit)
5. Current Axis I diagnosis of bipolar disorder or psychotic disorder
6. Previous treatment of CBT for PG (duration of at least 6 sessions); because CBT is not widely used for PG, a minimum of 6 treatments will be rare.
7. Current use of psychotropic medications or within 2 months prior to study entry.
8. Current participation in Gambler's Anonymous (GA).