varying treatments, is required if a truly nondiscriminatory financing policy is to be realized. Research that identifies what keeps pathological gamblers from undertaking treatment and that informs clinical services about how best to locate, attract, and retain patients through treatment is also important.

It is also important to study the effects of managed care contracts and health insurance policies that place severe limits on services for those with a pathological gambling disorder. The extent to which gamblers are shortchanged because of limited access to health care has not been well documented. Furthermore, it is not known to what extent treatment for pathological gambling has been carved out from treatment services for other disorders associated with pathological gambling. It is also not clear if the trend by some states to require separate licensing for pathological gambling counselors will have counterproductive results for clients seeking treatment. Some states offer separate licensing for drug abuse and mental health services and the administration of drug abuse treatment independent of psychiatric, medical, family, and other related services. The results of partitioning these practices may result in less service delivery (McClellan et al., in press) and may defeat the principle of matching patients to the most effective treatments.

As noted by Rosenthal (1992), women constitute one-third of the population of pathological gamblers but are underrepresented in treatment study samples. And there is increasing recognition of the need to set up and evaluate treatment programs designed specifically for women and adolescents. Results from such studies will enable the development of programs targeted at these groups. Other client characteristics that require research attention include outcomes for adolescents (only one study to date has reported outcomes for them), as well as outcomes for members of different ethnic groups. Client characteristics may predict differential responsiveness to various treatment approaches, and this line of investigation could be linked to evaluation of community-based response systems.

In the area of gambling counseling certification and services, the committee sees a need for policy research examining controversial issues and viable options. Such research should describe the extent of certified counseling services, the number of counse-

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement