The National Resources
The National Council on Problem Gambling operates the National Problem Gambling Helpline at 1-800-522-4700. The service is free, confidential, and available 24 hours a day. Counselors trained in problem gambling treatment answer calls and connect callers to local treatment providers.
The NCPG also maintains a website (ncpg.org) with a directory of treatment facilities, support groups, and self-help resources organized by state. The directory lists 1,200 plus treatment programs in the United States.
Gambler's Anonymous is a peer support organization modeled on Alcoholics Anonymous. There are approximately 600 meetings per week across the country. Like AA, the organization is free and based on a twelve-step model.
The National Institute on Drug Abuse (NIDA), part of the NIH, funds research on gambling disorder and publishes clinical guidelines for treatment. NIDA's research shows that cognitive-behavioral therapy and motivational interviewing are evidence-based treatments for problem gambling.
State-Level Programs
New Jersey operates the Council on Compulsive Gambling, with offices in Trenton, Atlantic City, and Newark. The council provides counseling, referrals to treatment, and education.
Nevada has the Council on Compulsive Gambling (no relation to the New Jersey council, though they coordinate). Nevada's program is integrated into the Department of Health and Human Services.
California runs the Problem Gambling Addiction Counseling and Referral Network (PGACR), which operates treatment centers in major cities.
Every state with legalized gambling is required by federal law (part of the Indian Gaming Regulatory Act, extended to all gaming) to fund problem gambling treatment. The level of funding and the quality of services vary dramatically by state.
The Screening Tools
The most widely used screening tool is the PGSI (Problem Gambling Severity Index), a nine-question questionnaire administered by counselors or self-administered online. Scores range from zero to twenty-seven. A score of three or higher indicates disordered gambling.
The DSMB (Diagnostic and Statistical Manual of Mental Disorders) criteria for gambling disorder were updated in DSM-5 (2013) to align with other addictive disorders. A person meets the diagnostic criteria if they display four or more of nine symptoms over a twelve-month period.
These tools are used by treatment providers to assess severity and determine appropriate levels of care.
Treatment Modalities
Cognitive-behavioral therapy (CBT) focuses on identifying and changing patterns of thought and behavior that reinforce gambling. A person might have a belief ("I am due for a big win") that leads to a behavior (continued gambling). CBT targets the belief.
Motivational interviewing is a technique where a counselor helps the client develop their own motivation for change rather than imposing external pressure.
Family therapy addresses the impact of gambling disorder on spouses and children. Problem gambling is not an individual problem; it is a family problem.
Medication (naltrexone, topiramate) may be prescribed to reduce cravings or manage co-occurring depression or anxiety.
Inpatient treatment is available at specialized facilities in major metropolitan areas. The treatment typically lasts thirty days and includes individual counseling, group counseling, family meetings, and education.
Financial Resources
The National Endowment for Financial Education (NEFE) provides free financial counseling to people dealing with gambling-related debt. NEFE counselors help develop budget plans and negotiate with creditors.
Non-profit credit counseling agencies (affiliated with the National Foundation for Credit Counseling) offer similar services.
The Barriers
Stigma is the largest barrier. Problem gambling is often seen as a moral failure rather than a disorder. A person struggling with gambling might not seek help because they believe they should simply "try harder" or "have willpower."
Access is another barrier. Many rural areas have no treatment facilities. A person in rural Montana might have to travel five hours to access an outpatient counselor.
Cost is a barrier for uninsured people, though many programs offer sliding-scale fees or accept uninsured clients. Insurance coverage for gambling disorder treatment is inconsistent. Some policies cover it; others do not.
Wait times can be long. A person calling the NCPG helpline might be connected to a treatment program with a three-month wait list.
The Evidence
Treatment is effective. A meta-analysis of forty-eight studies showed that people who complete cognitive-behavioral therapy have significantly lower rates of gambling behavior and better financial and social outcomes compared to untreated groups.
The longer a person remains in treatment, the better the outcomes. People who complete thirty-day inpatient programs have better outcomes than those who attend outpatient counseling only.
The resources exist. The barrier is the first call. After that, the system can help.
