Therapeutic approaches related to pathological gambling: an integrative literature review

Abstract

Background: Pathological gambling, or gambling disorder, is characterized by persistent and recurrent behavior that causes significant harm, involving loss of control, constant preoccupation with gambling and continuity despite negative consequences. According to the DSM-5, the diagnosis is made when the individual presents at least four specific criteria in 12 months. Epidemiology indicates a prevalence of between 0.5% and 3% of the global adult population, being more common in young men and in people with psychiatric comorbidities. The etiopathogenic mechanism involves dysfunctions in the brain circuits of reward, impulse control and decision-making, with the mesolimbic dopaminergic system and prefrontal cortex standing out. Clinically, the disorder is manifested by symptoms such as increased tolerance, abstinence, failed attempts at control and social and financial losses. Aim: To carry out an integrative review on therapeutic approaches to pathological gambling. Method: The search was carried out on the PUBMED database using the strategy: “gambling”[title] OR “games of chance”[title] AND treatment[title], including clinical trials and observational studies published in the last five years. Results: The  references search was carried out in June 2025, and 8 articles were identified that responded adequately to the previously established search strategy. After reading the titles and abstracts of the papers, one study was excluded because it discussed strategies for reducing cocaine consumption and not gambling addiction. The remaining 7 studies were then included for full reading, as they met the eligibility criteria defined for the review. Conclusion: The review shows that gambling disorder involves multiple domains-neurobiological, cognitive, emotional and social-requiring integrated interventions. Awareness-raising and emotional regulation strategies show promise, while pharmacological treatments have so far failed to outperform placebo. Furthermore, approaches that combine comorbidities, such as smoking, and couple therapies broaden the options without proving superiority. Finally, the need to customize protocols based on neurocognitive profiles was highlighted. Furthermore, future trials should integrate biological and psychosocial markers to optimize individualized treatments.