Gambling Addiction Treatment: Therapy, Medications, Care

01Gambling Addiction Treatment: Therapy, Medications and Levels of Care

People searching for gambling addiction treatment are often looking for help in a hurry and finding material written for something else. Plenty of what ranks borrows the structure of substance use treatment wholesale: detox, rehab, twelve steps. Gambling disorder shares some features with substance use disorders, and it differs from them in ways that matter for care. The evidence base is smaller, no medication is approved for it, and the usual structure of substance use care doesn't map neatly onto it.

This guide walks through what the diagnosis is called, what the research says about therapy for gambling addiction, which medications have been studied and how strong that evidence is, why co-occurring conditions deserve attention, and how outpatient and residential settings compare. It's educational. It can't say what any individual needs or predict what any plan will pay.

02Quick answers

What does gambling disorder treatment usually include? Counseling is the core, often CBT, sometimes with peer support, family sessions, and treatment for co-occurring conditions. Residential care exists but is less common.

What is the clinical name? Gambling disorder, the term used in the DSM-5 and in ICD-11.

Is it treated like a substance use disorder? Not identically. Some approaches overlap, and the settings, evidence and medications differ. A clinician with experience in gambling disorder can explain what applies to a given person.

Where do people start? The National Problem Gambling Helpline, operated by the National Council on Problem Gambling (NCPG), connects callers with local resources. Call or text 1-800-MY-RESET (1-800-697-3738), or use the online chat.

03What Gambling Disorder Is, and How It Differs From Substance Use Disorders

The DSM-5 moved gambling disorder, formerly called pathological gambling, out of the impulse control disorders and into the chapter on substance-related and addictive disorders. It became the first recognized non-substance behavioral addiction. A diagnosis requires four or more of nine criteria within a 12-month period, with severity rated mild (four to five criteria), moderate (six to seven) or severe (eight to nine). The earlier DSM-IV threshold was five of ten criteria. ICD-11, the World Health Organization's classification, also lists gambling disorder (code 6C50), describing a pattern of persistent or recurrent gambling marked by impaired control, increasing priority given to gambling, and continuation despite negative consequences.

A 2016 review in Substance Abuse and Rehabilitation lays out where the two conditions overlap and where they don't:

• Overlap: preoccupation, loss of control, negative consequences, high rates of other psychiatric conditions, shared features in brain reward and stress systems, and some overlapping treatment approaches.
• Differences: gambling disorder has no craving item, and its threshold and severity bands differ (substance use disorders use two or more of eleven symptoms, with mild, moderate and severe bands set at different counts). Its criteria also cover fewer areas of life consequence, and include features with no substance counterpart, such as chasing losses.

Why this matters for treatment: a program built entirely around substance use may not address the financial, legal and relationship consequences that often come with problem gambling, and a gambling program may not be equipped to manage a substance use disorder. Programs differ, so the questions at the end of this guide are worth asking directly.

04Gambling Disorder Treatment: Where the Evidence Stands

The honest summary is that the research is real but modest. The two most useful recent syntheses are a Cochrane review of psychological therapies and a network meta-analysis of medications.

05Therapy for Gambling Addiction: What the Research Shows

The Cochrane review of psychological therapies for pathological and problem gambling (Cowlishaw and colleagues, 2022) pooled 14 randomized trials with 1,245 participants. Its main findings:

• Cognitive behavioral therapy (CBT): In the shorter term, up to about three months after treatment, CBT was associated with benefits that ranged from medium to very large depending on the outcome measured. Only one study followed people for 9 to 12 months, and the effects there were smaller and not statistically significant. The authors wrote that the durability of therapeutic gain is unknown.
• Motivational interviewing (MI): Studies were mostly of people with less severe gambling. At up to three months, MI reduced financial losses but had close to zero effect on symptom severity. At 9 to 12 months, it reduced gambling frequency.
• Other approaches: Evidence for integrative therapies and for a twelve-step-facilitated group therapy was limited, with very small samples.
• Quality: The authors rated the overall evidence as low to very low quality and said results may overestimate how well treatment works.

CBT for gambling generally works on the thoughts and behaviors around betting, such as beliefs about luck and chance, responses to urges and triggers, and relapse planning. The Cochrane review doesn't prescribe a format, and programs deliver therapy individually, in groups, or both. Counseling for gambling is also described by the American Psychiatric Association as covering control, family relationships, urges, stress, finances and relapse prevention, alongside psychodynamic, group and family approaches.

Peer support. Gamblers Anonymous and Gam-Anon (for family and friends) are the best-known peer groups, and the American Psychiatric Association lists them among available supports. Research on peer groups is thinner than for therapy, so they're usually described as a complement to professional care rather than a replacement.

06Medications for Gambling Disorder: What Has Been Studied

No medication is approved by the FDA for gambling disorder, according to the American Psychiatric Association. Medication, where it comes up, is usually either an off-label option a prescriber discusses or a treatment for a co-occurring condition such as depression or anxiety.

A 2025 systematic review and network meta-analysis in Comprehensive Psychiatry (Ioannidis and colleagues) identified 22 double-blind randomized trials, with 16 trials and 977 participants in the network analysis. Compared with placebo:

• Nalmefene showed the largest reduction in gambling severity, with moderate certainty of evidence by the authors' rating, along with more dropouts due to side effects.
• Naltrexone showed a trend toward reduced severity that didn't reach statistical significance, and it also had more dropouts due to side effects.
• Olanzapine and topiramate weren't more effective than placebo.

The authors concluded that nalmefene and naltrexone have the most supportive evidence at present and called for more trials. A 2025 narrative review of comorbidity in gambling disorder reaches a similar view: some medications, including naltrexone and nalmefene, show promise, while evidence for others is mixed or preliminary, and antidepressants may help when depression or anxiety is also present, although results vary.

Two cautions belong here.

1. 01Some medications are linked to new gambling urges. The FDA's prescribing information for aripiprazole (Abilify) includes a warning about intense urges, especially to gamble, reported after the medicine was on the market, and notes that urges sometimes stopped after a dose reduction or discontinuation. The same section lists other urges, such as compulsive shopping or eating. Anyone who notices new urges while taking any medication can raise it with the prescribing clinician, because medication changes are made with that clinician.
2. 02Medication decisions belong with a prescriber. This guide doesn't recommend any medication, dose or change.

07Co-Occurring Conditions and Gambling Disorder

People who experience gambling problems often have other conditions too. The 2025 narrative review by Sharma and Weinstein in Dialogues in Clinical Neuroscience summarizes research linking gambling disorder with higher rates of alcohol and substance use disorders, depression and other mood disorders, anxiety disorders, ADHD, and suicidal thoughts. It also notes several things that limit how far those findings stretch:

• Much of the evidence is cross-sectional, so it can't establish cause.
• The direction runs both ways. In some studies another condition came first, and in others gambling did.
• Study designs and populations vary widely, and the review is narrative rather than systematic.

What this means for someone looking at programs: it's reasonable to ask whether a program assesses for depression, anxiety, ADHD, trauma and substance use at intake, and who treats them. Our resources on anxiety, depression, ADHD and trauma, and the guide to dual diagnosis treatment, cover how integrated care works in the context of substance use. Gambling disorder is its own diagnosis, and a program may or may not extend that model to it, so confirm directly.

Suicide risk. Suicidal thoughts are among the co-occurring concerns the research describes. If someone is in immediate danger, call 911. For suicidal thoughts or emotional crisis, call or text 988.

08Outpatient Gambling Addiction Treatment

Most formal gambling addiction treatment happens in outpatient settings. A 2014 report for the Michigan Department of Community Health, prepared by Wayne State University researchers, described the state's publicly funded gambling treatment as outpatient, with intensive outpatient care available only rarely. Details vary by state and have changed since, so treat that as a snapshot rather than a map.

Outpatient options generally include:

• Individual counseling with a clinician, ideally one with training in gambling disorder. NCPG maintains a directory of certified gambling counselors.
• Group therapy or education groups.
• Intensive outpatient and partial hospitalization programs, which offer more hours of structured programming per week while the person lives at home or in other housing. NCPG's facility directory lists programs offering these formats.
• Family or couples sessions, since gambling often affects relationships and finances.

For background on how outpatient levels are generally structured in substance use care, see our guides to outpatient programs and levels of care. Those describe levels as they apply to substance use, and gambling programs may define their own levels differently, so ask each program how it describes what it offers.

09Gambling Rehab: Residential and Inpatient Programs

Residential gambling rehab exists, but it's much less common than residential care for substance use. The 2014 Michigan report cited a 2010 survey finding that nine states offered residential treatment for gambling. NCPG's treatment facility directory today lists a number of residential programs alongside partial hospitalization, intensive outpatient and outpatient ones, with a note that listings come from applicants and aren't guaranteed to be accurate or complete.

The Michigan report offers one description of how residential gambling treatment has been framed and who it was considered for. It defined residential care as live-in treatment lasting up to a month, providing 24-hour structure, stabilization of co-occurring psychiatric conditions, and skills for returning to the community. It identified clients with more severe gambling problems, co-occurring mental health conditions, suicide risk, high relapse risk, or weak support systems as those who might be considered for it. It also stressed that outpatient aftercare has to follow. The comparison programs it described ran from about three weeks to roughly three months of residential care, followed by aftercare.

A few points for readers weighing a residential program:

• Program length varies widely and isn't standardized the way a single named duration might suggest.
• Residential gambling treatment isn't the same as residential substance use treatment. If a person also has a substance use disorder, ask how the program handles that, including any withdrawal care, since capabilities differ.
• Which setting fits a person is a clinical question. A qualified healthcare professional can determine this through a clinical assessment. This guide can't say who needs which level.
• Outcome claims deserve questions. The Michigan report cites a Minnesota study with a higher completion rate for residential than outpatient clients, which says something about staying in a program, not about long-term recovery.

10Insurance and Payment

Payment options and payer participation vary by facility. Our Insurance Coverage Guide explains common coverage terms and plan questions. Reported payer participation does not guarantee coverage for a specific plan. Coverage, network status, authorization requirements, deductibles, and copays vary by plan. Plan-specific information should be confirmed directly with the insurer and facility.

11Finding Help

The National Problem Gambling Helpline offers call, text and chat support at 1-800-MY-RESET and connects people with local resources. NCPG also lists a gambling counselor directory and a state-by-state resource map.

For co-occurring substance use or mental health needs, FindTreatment.gov (SAMHSA's locator) lets users search by location and filter by type of care, and the SAMHSA National Helpline, 1-800-662-HELP (4357), provides free, confidential referrals 24 hours a day. The directory lists dual diagnosis treatment centers, and support resources cover other options.