States. We also identify priorities for further research, including treatment effectiveness, cost-effectiveness, how patients should be matched to treatments, and prevention strategies.

Defining Treatment and Challenges to Treatment

In the committee's view, the definition of treatment needs to be a broad one. We define treatment as: (1) activities directed at individuals for the purpose of reducing problems associated with problem or pathological gambling and (2) activities aimed at groups of individuals (e.g., communities) to prevent gambling problems from arising in the first place. Comprehensive treatments move through three stages: acute intervention, followed by rehabilitation, and ending with maintenance. These three stages can vary according to the philosophy of the providers, the settings in which treatment takes place, and the specific approaches employed. No systematic compilation of treatment services for pathological gambling has been made in the United States. Treatment is provided in many ways and in many settings, although outpatient treatment is probably the most common; no single treatment approach dominates the field. In fact, it appears to be common for approaches to be combined in most clinical settings. It is important, as well, to recognize that recovery from pathological gambling can take place without formal treatment. Such individuals have been classified by various descriptors, for example, so-called spontaneous recovery and natural recovery (Wynne, personal communication, 1998). Although the subject of natural recovery from psychoactive substances, such as alcohol and opiates, has received some attention in the professional literature (McCartney, 1996), no such attention has been given to gambling.

Functionality of Addictive Behaviors

All addictions, by their nature, pose special problems to treatment providers. Like other purposive human behavior, addictive behaviors have adaptive or functional value, with the result that efforts to change these behaviors often fail.



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