What are the recommended first-line treatment options for patients diagnosed with gambling disorder?

Recommended first-line treatment options for patients diagnosed with gambling disorder include psychological interventions, specifically gambling-specific cognitive behavioural therapy (CBT). Group CBT is recommended to reduce gambling severity and frequency and should ideally be delivered by two practitioners with gambling-specific CBT training over 8 to 10 sessions. If group therapy is not suitable or the patient prefers, individual CBT is an alternative, typically delivered over 6 to 8 sessions by a practitioner with gambling-specific CBT competence. Both forms of CBT should include a relapse prevention component addressing triggers and relapse responses.

Motivational interviewing may be considered to enhance the person's confidence and commitment to change or to encourage those hesitant about starting treatment.

Peer support should be offered as an integral part of treatment for those who wish to engage with it, providing opportunities for shared experiences and encouragement.

Pharmacological treatment, such as naltrexone, is not first-line but may be considered if psychological therapy does not achieve desired outcomes or if there are repeated relapses despite appropriate psychological treatment. Naltrexone should be started and supervised by a specialist and combined with ongoing psychological therapy.