Treatment Of Pathological Gambling A Critical Review Of The Literature

By Nancy M. Petry. (2005). Washington, DC: American Psychological Association, 417 pp., ISBN: 1-59147-173-7. Price: $59.95 USD.

In the early 1980s, gambling research was championed by only a few pioneers and appeared infrequently in mainstream psychology and psychiatry journals. As gambling became more widely available and accepted, the topic began to draw the attention of a greater number of researchers. A study of gambling citations from 1903 through 2003 (Shaffer, Stanton, & Nelson, 2006) reveals that the frequency of scholarly journal articles increased rapidly beginning in the mid- to late 1980s. Furthermore, as of 2006 almost a third of all gambling-related citations that have ever been published appeared in print between 1999 and 2003, meaning that much of our knowledge about gambling problems has only recently been published.

For many reasons 1999 was a seminal year in problem gambling literature. Among that year's gambling publications were two that especially stand out. For example, the Shaffer, Hall, and Vander Bilt (1999) meta-analysis on the prevalence of problem and pathological gambling appeared in the American Journal of Public Health. The National Research Council (1999), having secured the expertise of some of the top gambling researchers, published an important book entitled Pathological Gambling: A Critical Review. These two publications made important connections between problem/pathological gambling problems and the broader psychological and psychiatric literatures. In addition, these publications provided a conceptual framework for researchers. As a result, sound estimates of the prevalence of problem and pathological gambling were empirically established. The knot of terminology was untangled. The promise of interventions and a matrix of potential etiological factors were brought to light.

In 2002, Dr. Petry started work on this book by following up on a period of tremendous growth in the scholarly information about gambling. She took on the challenge of compiling a comprehensive review of the etiology, comorbidity, and treatment of gambling problems. Interestingly, at the start of the project she feared that there was “not enough research to conclude much” (p. ix). Her fear was mistaken. In reality she took on a project greatly needed by clinicians and researchers alike. Fortunately for us, she was the right person to take on this task. While establishing herself as an important voice in the gambling literature, Dr. Petry competently organized the incoming flood of information on problem and pathological gambling literature. Her book makes a significant contribution to the framework that was launched in 1999.

Dr. Petry states two objectives for this book. The first was to inform clinicians and treatment providers seeking a more in-depth knowledge about pathological gambling and its treatment. She is well qualified for this task, for her team at the University of Connecticut has evaluated and treated several hundred individuals with gambling problems. The second objective was to provide a comprehensive source of information about gambling problems. To accomplish these objectives, the book presents a balance between delivering detailed information needed by researchers and informative clinical vignettes to facilitate a clinician's application of the research findings. The book is organized into five sections: foundational issues, etiology, interventions, a treatment model, and some concluding thoughts.

The opening, or foundations, section of the book orients the reader to issues central to problem gambling. In defining the problem, Dr. Petry adopts the conceptual model that gambling involvement and gambling problems exist on a continuum, with the end of the continuum representing those who meet the diagnostic criteria for pathological gambling. She discusses issues related to prevalence rates and at-risk populations before moving to a chapter that focuses on methods for screening and assessing an individual's level of gambling problems. This section of the book might be considered by some as too detailed, but these details should be seen as essential for someone who needs to understand the issues of defining and describing gambling problems. Dr. Petry also gives the reader access to many of these assessment and measurement tools. The chapter on assessment measures is thorough and useful for both clinicians and researchers.

The three chapters in the etiology section give a detailed discussion of demographic correlates, comorbidity issues, and possible biological bases for gambling problems. As a researcher, this reader was particularly impressed with the volume of research that Dr. Petry was able to review. The text is detailed, informative, and highly balanced in its presentation. I do wonder whether some clinicians reading this section might be frustrated by the lack of consensus or definitive conclusions that can be drawn from this literature. This presentation of the research, however, is accurate.

In the third section, Dr. Petry reviews the research on interventions, including natural recovery. Other intervention approaches included in these chapters are pharmacotherapies, family interventions, psychoanalytic approaches, behavioral interventions, and cognitive therapies. This section provides the therapist with a detailed overview of each of these literatures. Clinical case information is included where appropriate. I was surprised to see the chapters on family intervention and psychoanalytic approaches, for the empirical literature on these topics is meager. Dr. Petry communicated this point, but I wonder if a more general chapter that addresses general treatment issues might have been more helpful to readers.

The fourth section of the book is a detailed presentation of Dr. Petry's cognitive-behavioral treatment model and brief motivational interventions. In my opinion, these chapters contain the most important information for most clinicians and treatment providers. Dr. Petry has become a leading clinician for treating gambling problems. In these chapters, she gives away all of her secrets, providing all the information needed to deliver a treatment grounded in substantial empirical findings. Well-chosen clinical vignettes add richness to the detailed session-by-session description of treatment. In addition, all of Dr. Petry's session handouts and homework exercises are given in the appendices. The addition of these clinical tools provides the clinician with everything needed to implement Dr. Petry's treatment protocol.

The concluding section of the book covers two distinct topics. The first chapter, which covers prevention with adolescents, is well done but a bit out of place. My opinion is that youth gambling is a very complicated issue that probably needs another 300-page book to be fully addressed. In the final chapter, Dr. Petry identifies some of the issues currently being discussed in the problem gambling and pathological gambling literature. For example, her comments about the criteria for understanding the threshold for those experiencing gambling problems, but not meeting diagnostic criteria for pathological gambling, are very much on target.

In summary, I would highly recommend this book to both treatment professionals and researchers. Dr. Petry has done an impressive job of providing a readable and useful summary of the immense amount of research that has appeared since 1999. The book includes information, clinical details, and both assessment and treatment tools that the clinician will value. Also included are accurate and concise reviews of the etiological, assessment, and treatment literatures, which researchers should find very useful.