Comparative Effectiveness of Therapies for Problematic Gambling: A Network Meta-analysis and Systematic Review of Psychosocial and Pharmacological Intervention
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Abstract
Introduction: Gambling has emerged as a significant behavioral addiction worldwide, presenting serious challenges to both the economic sector and public health.
Objective: To compare pharmacological and psychological interventions for problematic gambling marked by Diagnostic and Statistical Manual for Mental Disorders Fourth Editions (DSM-IV) ≥3.
Method: A systematic search was conducted with six databases. Quality appraisal and certainty grades were performed with Cochrane RoB 2.0 and GRADE. A frequentist network meta analysis was conducted in R using a random-effects model with standardized mean differences (SMD) and 95% confidence interval (CI) to compare the interventions based on South Oaks Gambling Screen (SOGS) score, Pathological Gambling-Yale-Brown Obsessive-Compulsive Scale (PG-YBOCS) score, and frequency of gambling. Additionally, Surface Under the Cumulative Ranking Curve (SUCRA) was employed to summarize and rank the comparative performance of interventions.
Results: Face-to-face Group Cognitive Behavioral Therapy (CBT) demonstrates the most notable reduction in the SOGS compared to control groups (SMD −3.44, 95% CI: −4.83 to −2.05). Pharmacological treatments exhibit a moderate effect size (SMD −1.00, 95% CI: −1.39 to −0.62), while Self-Help CBT provides a small but significant benefit (SMD −0.73, 95% CI: −1.28 to −0.17). Motivational interviewing (MI) produced the largest reduction in gambling behavior, significantly lowering monthly gambling frequency versus control (SMD −2.88, 95% CI: −3.64 to −2.12). A combined imaginal desensitisation plus MI (IDMI) therapy also substantially improved gambling severity on the PG-YBOCS scale compared to waitlist (SMD −1.27, 95% CI: −2.48 to −0.05).
Conclusion: Psychological intervention produces larger and more consistent improvement in gambling severity than pharmacological intervention. Group CBT effectively reduces symptom severity, while MI is most effective in decreasing gambling frequency. IDMI also improves severity scores on the PG-YBOCS. Conversely, current evidence does not support stand-alone pharmacological monotherapy.
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