This programme is a treatment manual written for mental health professionals. It assumes clinical training, experience in addiction treatment or access to specialist advice, and a supervision framework. It replaces neither your clinical judgement nor your professional responsibility. Diagnostic criteria are reformulated in our own words and never reproduced: refer to the original manuals for the wording itself. It is written neither for the people concerned nor for those close to them. A warning specific to this indication: suicide risk is high in people with gambling disorder, particularly at the time of a major loss or when debts are discovered. It is asked about explicitly from the first session, and section 5 says how. If a person is in immediate danger, contact your country's emergency services.
1. The programme at a glance
Indication. Gambling disorder in adults, from mild to severe, in outpatient care, whatever the form of gambling: sports betting, casino games online or in a venue, machines, poker, lotteries and scratch cards, horse-race betting. Speculative trading falls within scope when it works the same way — section 4.
Reference model. A cognitive behavioural therapy for addictions adapted to gambling: motivational interviewing at the start, functional analysis of episodes, control of access to gambling and to money, cognitive work on erroneous beliefs about chance and on chasing losses, management of urges and emotions, work on debts and secrecy, and relapse prevention.
Format. Twelve 50-minute sessions, one a week; the first lasts 75 minutes. Two sessions can include someone close chosen by the person: the fifth, on money, and the tenth, on debts and secrecy. Three booster sessions, at one month, three months and six months.
Mechanism targeted. Making gambling hard to get to while the person learns to stop responding to it. Cutting the link between a loss and the next stake. And replacing the conviction that one can win it back with the reality of a game built so that the gambler loses over time.
| Session |
Focus |
Session output |
| 1 |
Assess and make safe |
Suicide risk assessed, emergencies identified, one barrier in place |
| 2 |
Decide |
Balance sheet written, goal set and dated |
| 3 |
Analysing the episodes |
Four episodes taken apart |
| 4 |
Closing off access |
Inventory of access points, barriers scheduled |
| 5 |
Protecting the money |
Written plan for access to money |
| 6 |
Chance |
Beliefs listed, one experiment carried out |
| 7 |
Winning it back |
Chasing losses calculated on the person's own figures |
| 8 |
Urges and triggers |
One urge got through, a card written |
| 9 |
Emotions and freed-up time |
One response per emotion, evenings scheduled |
| 10 |
Debts and secrecy |
Complete inventory, first contact dated |
| 11 |
The lapse and getting back on track |
What to do, written down before it happens |
| 12 |
Review and prevention |
Maintenance plan, measures repeated |
What the person takes away. Ten printable worksheets, listed in section 40: my record, my balance sheet, my episodes, my barriers, my money, what I believe about chance, my urge, my debts, the corner for those close, my plan for what comes next.
What distinguishes this programme from the other manuals on this site. Three things. Suicide risk, placed before everything else and looked for at every moment when money moves. The order of the work: access is closed off and the money protected before the thoughts are worked on. And two sessions devoted to beliefs about chance, which are specific to gambling and have no equivalent in substance addictions.
2. Before you begin
Who this programme is for
This text is written for psychologists, psychiatrists, psychotherapists, doctors and nurses trained in cognitive behavioural therapy, working in liaison with a doctor and, where possible, with a social work service or a budget adviser. It assumes that you can talk about money precisely — amounts, accounts, loans, due dates — without embarrassment and without judgement. That is less obvious than it seems: many clinicians talk more easily about sex than about money.
It is written neither for the people concerned nor for those close to them.
The four preliminary decisions
Is there current suicide risk? This is the first question, before any other. Section 5. It is asked at the first session, and again each time a loss, a discovery or a due date occurs.
Is there a financial emergency? A payment that cannot be met in the coming days, a threat of eviction, a seizure, money taken that is about to be discovered. These situations come before the protocol, because they are at once triggers for gambling — the temptation to win quickly to cover the gap — and moments of suicide risk.
Is gambling the main problem? A manic episode, treatment with a dopamine agonist, a neurocognitive disorder or a severe alcohol use disorder changes the approach. Sections 9 and 10.
And who is in on the secret? Nobody, a partner who knows everything, a partner who thinks they know. The answer changes the place of those around the person and the timing of session 10.
What this programme does not treat
It does not treat an acute suicidal crisis. That calls for emergency management, described in section 5, and the protocol resumes afterwards.
It does not settle debts. It helps the person to look at them, to disclose them and to turn to the right people. Dealing with over-indebtedness is a matter for budget professionals, voluntary organisations or public schemes that vary from country to country. Section 35.
It does not treat gaming disorder. The principles partly carry over, but that disorder has its own presentation. Section 4.
It does not on its own treat a severe alcohol or other substance use disorder. The combination is common; when alcohol use is heavy, it is treated in parallel, and the manual Alcohol use disorder: a therapist's manual describes that work, including the question of withdrawal.
And it takes no position on legal matters. When gambling has led to embezzlement or fraud, the person needs a lawyer, and you do not play that role.
How to use it
Read the whole text before the first session, in particular sections 5, 6, 32, 33 and 34: suicide risk, what maintains the disorder, barriers, money, and beliefs about chance. These are the five places where the treatment is won or lost.
Each session is described using the same framework: the aim, the steps, what you say, common errors, and the criterion for moving on.
Three warnings specific to this presenting problem.
Secrecy is the rule, not the exception. Gambling cannot be seen or smelt, and it leaves no mark on the body. Many people have led a double financial life for years, and the amounts given at the first session are almost always lower than the real amounts. That corrects itself with time and with the way of asking, not with suspicion.
The consultation often follows a catastrophe. An emptied account discovered, a debt revealed, a partner threatening to leave, a legal complaint. The person arrives at the moment when suicide risk is highest and motivation strongest: both are taken into account in the same session.
And the question "are you still gambling?" is not enough. You need to ask what was staked, where, with which means of payment, and where the money came from.
3. Four situations not to be confused
1. Recreational gambling
What you observe. Occasional stakes, decided in advance, within a budget the person can lose without consequence, with no chasing of losses and no secrecy.
What points the way. The money lost is experienced as the price of entertainment, not as a sum to be recovered.
What it implies. Nothing, other than information if the person asks for it.
2. At-risk gambling
What you observe. Rising stakes, sessions that grow longer, a few episodes of chasing losses, the beginnings of concealment, but without established loss of control or major consequences.
What points the way. The person is worried themselves, or someone is worried about them, and they can still stop when they decide to.
What it implies. A brief intervention: measure, give information on how gambling works, set limits in figures, review. Brief formats have data in this population — section 12.
3. Gambling disorder
What you observe. Loss of control, a growing place for gambling, chasing losses, lying, borrowing, and financial, relational or occupational consequences.
What points the way. The person no longer stops on a decision, but when there is no money left.
What it implies. The programme described here.
4. Gambling secondary to something else
What you observe. Gambling that occurs only during an episode of elevated mood. Gambling that appeared after the start of dopaminergic treatment, in a person with Parkinson's disease or restless legs syndrome. Gambling that appeared with a neurocognitive disorder, particularly one affecting frontal functions.
What points the way. The chronology. Gambling that starts suddenly at sixty or seventy, in someone who had never gambled, should raise the question of medication and of the brain before any other.
What it implies. A medical opinion, and treatment of the cause. Section 9.
The three sorting questions
"When you lose, what happens next?" The question that isolates chasing losses, the most characteristic mechanism of the disorder.
"Who knows how much you have gambled?" It isolates secrecy.
"Where does the money you gamble today come from?" It isolates borrowing, loans and embezzlement, and it measures the urgency.
4. The forms of gambling today
Why the form matters
The disorder is the same, but the speed is not. What most distinguishes forms of gambling from the point of view of risk is event frequency: the time between the stake and the result, and between the result and the next stake. The shorter that time, the more the game lends itself to loss of control. A weekly draw and a machine that produces a result every few seconds do not have the same potential.
The other big difference is access. A gaming venue closes, it is far away, and you are seen there. A phone never closes.
Sports betting
What has changed. In-play betting during the match, on ever finer events — the next goal, the next point, the next corner — which turn a match into a series of rapid bets. The option to cash out before the end. Welcome offers and free bets. And a massive advertising presence around competitions.
What is specific to this form. The conviction, stronger here than elsewhere, that knowledge of the sport gives an advantage. It gives a little, never enough to offset the operator's margin over time. Session 6 works on this point directly, using the person's own accounts.
Online casino games
Slot machines, roulette, card games, accessible day and night from a phone, with no witnesses, at a speed that venues do not allow. This is the form that has most changed clinical practice: people gamble in bed, at work, on public transport, and a deposit takes a few taps. Legality varies from country to country, and many people gamble on sites that are not licensed in their own country, which no self-exclusion scheme covers.
Casinos and gaming venues
Machines and tables, in places often designed so that time passes unnoticed. Machines have one feature worth knowing about: they announce, with sounds and lights, "wins" smaller than the stake, which are in reality losses. The person has the impression of winning often, while their balance goes down.
Lotteries, scratch cards and horse-race betting
Scratch cards are fast and sold everywhere, which brings them close to machines. Lotteries with widely spaced draws are, for the same spending, less conducive to loss of control — without being exempt from it, particularly when the person multiplies tickets to "increase their chances". Horse-race betting combines the conviction of expertise with races that are now almost continuous.
Poker
It involves a real element of skill, and a minority of players win over time. That makes the illusion of control hard to work on: the argument "it is a game of skill" is partly true. What matters is not to settle that debate, but to look at the person's accounts over twelve months, and at the way their sessions end.
Speculative trading, at the boundary
Very rapid transactions, leveraged products, cryptocurrencies, very short-term options. This is not gambling in the sense of the classifications, and the point is not to treat all risky investment as a disorder. But some of the people who consult describe functioning identical to that of gambling: positions taken for the excitement, chasing losses through ever riskier positions, secrecy, borrowing, nights spent in front of the charts.
What it implies. When that is the case, the programme applies, with the same episode analysis and the same barriers. The useful question is not "is it gambling?" but "does it work like gambling for you?". Section 36.
Video games, and what brings them close to gambling
Gaming disorder is a different disorder. It concerns time spent on and engagement in gaming, not money. ICD-11 makes it a diagnosis in its own right, built on the same model as gambling disorder; DSM-5-TR places it among the conditions requiring further study. This manual does not treat it.
Loot boxes in video games. Chests, card packs, draws of characters or items, paid for with real money or with purchased virtual currency, whose content is determined at random. Their structure is that of gambling: a stake, a random outcome, rewards of variable value, staged near-misses. Their psychological kinship with gambling has been highlighted (Drummond and Sauer, 2018), and a large survey of more than seven thousand video game players showed an association between spending on them and the severity of problem gambling, clearer than for other in-game purchases (Zendle and Cairns, 2018).
What is not established. The direction of the relationship: do these purchases lead to gambling, or are vulnerable people simply drawn to them? The available data do not allow a conclusion. Some countries have classed them as gambling, others have not.
What it implies in practice. Systematically asking a young gambler what they spend on video games and since when. When a person consults for heavy spending on loot boxes, with chasing losses and secrecy, the episode analysis and barriers of this programme apply. And the sites that allow people to bet virtual items, which exist around certain games, are gambling without any ambiguity.
5. Suicide risk: what comes before everything
Why this section is placed here
Because gambling disorder is associated with a suicide risk markedly higher than in the general population. A Swedish study covering everyone who received this diagnosis in specialist care between 2005 and 2016 found suicide mortality about fifteen times that of the general population; nearly one person in five had received, during the period, a diagnosis of suicide attempt, and comorbid depression predicted death by suicide (Karlsson and Håkansson, 2018). And because this risk has a particular structure: it does not only follow mood, it follows money. It rises at the time of a big loss, when a debt becomes impossible to hide, when the secret comes out, when proceedings begin.
The moments of risk
The major loss, particularly one involving money that did not belong to the person.
Discovery, by the partner, the family, the employer or the bank.
Disclosure, including disclosure made in session. The relief of disclosure is real; the shame that follows it is real too.
The impossible due date. Rent, a loan, a promised repayment, money taken that has to be given back.
Proceedings. A letter from a bailiff or a debt collection agency, a summons, a complaint, a dismissal.
And separation, or the threat of it, which often comes at the same time.
What is asked, and when
At the first session, systematically, with the same frankness as with any patient. "Do you ever think you would rather not be here any more?" then, if so, "do you ever think about taking your own life?"
At every session, as long as the risk has not been ruled out, and again at each of the moments above — including when they occur between two sessions and you learn of them afterwards.
A question specific to gambling. The idea that one's death would settle the debt — through insurance, through an inheritance, or simply because "without me, they will not have to pay any more" — is a thought found in heavily indebted people, and it is not voiced spontaneously. It has to be asked about: "Have you ever thought that your disappearance would solve the money problem?"
What is explored when the answer is yes. Frequency, intent, plan, access to means, preparatory acts, personal and family history, hopelessness, and what holds the person back. The manual Suicidal behaviour in adults: a therapist's manual details this assessment; it applies here without modification, and the course of action is described there in full.
What makes it worse, and can be treated
Debt, and even more its secrecy. Shame. Alcohol, common in this population, which lowers inhibition. Comorbid depression. Isolation, often produced by gambling itself. And the insomnia of nights spent gambling or doing sums.
What is specific to gambling and can be treated quickly. A money situation is almost never without a way out, even when it looks like one. Knowing that there are budget professionals, that a creditor can agree to a repayment schedule, and that most countries provide procedures for people who can no longer meet their debts lowers hopelessness faster than any argument. That is why section 35 is part of the course of action for suicide risk, and not a separate social chapter.
The safety plan
It is written with the person, in session, as soon as risk is present. Its usual headings: my warning signs, what I can do on my own, the people and places that take my mind off things, the people I can tell that things are not going well, the professionals and emergency numbers in my country, and what makes my environment safer.
Here a heading specific to gambling is added: what I do on the evening of a big loss. Do not stay alone. Do not gamble again to wipe it out. Call a person named in advance. Decide nothing important before the next day. This heading also appears on worksheet 10.
A safety plan is not a contract. Nobody is made to promise anything: things are organised.
Restricting access to means
It applies here as it does elsewhere: what is available at home, what can be entrusted to someone else, by whom and when. An agreement in principle is not enough; it is checked at the next session.
When to refer or admit to hospital
Active intent with a plan, means available, inability to engage with a safety plan, concurrent intoxication, severe agitation, a complete absence of people around at the time of a crisis. The referral is organised within the session, not afterwards: you make the call in front of the person, you do not let them leave alone when they cannot, and you write down what you have done.
What you must have ready
The emergency numbers and the suicide prevention line for your country, the details of a gambling help service if one exists, and those of a social work service or an organisation that helps people in debt. And an answer to this question: what do you do if a person tells you, on a Friday evening, that they have lost the rent money and that their partner will find out on Monday?
Frequently asked questions
The patient says he will stop once he has won it back.
That is the disorder talking, and it is very common. Do not argue with it at the first session: note the sentence, put a first barrier in place, and keep the calculation for session 7, where the person will do it themselves on their own figures.
Does self-exclusion really work?
It is a useful barrier against impulsive gambling, which can be got round when the urge is strong and which does not cover unlicensed sites. The data are mainly observational. Always propose it, never on its own. Section 32.
Should you insist that the partner be told?
No. You work on the question of the secret, you prepare what is said, and you help the person to decide. When the partner's money is involved, it is difficult to protect their finances without their knowing, and this is said frankly. Session 10.
Someone close wants to pay off all the debts.
It is an act of love and a moment of risk. Suggest that the help go through a plan, with an adviser, paying the creditors directly, and at the same time as barriers and an organisation of the money. Section 35.
The patient plays poker and says it is a game of skill.
He is partly right, and denying it loses the discussion. Look together at his real accounts over twelve months, and at the way his sessions end. Section 34.
Is trading gambling?
Not in the sense of the classifications. But when it works like gambling — excitement, chasing losses, secrecy, borrowing —, the programme applies. Sections 4 and 36.
A young adult spends a lot on loot boxes in a video game.
The structure of these purchases is that of gambling, and the episode analysis and the barriers apply. The link with later gambling is documented by associations, not established as a cause. Section 4.
Is there a medication?
None has a specific official indication in most countries. Opioid antagonists have the most favourable data, with heterogeneous results, and prescribing them is a matter for the doctor. Section 14.
The gambling started at sixty-five, in a man who had never gambled.
Ask about his medication, particularly dopaminergic drugs, and consider a neurocognitive disorder. Talk to the doctor before any protocol, and protect the money in the meantime. Section 9.
He has taken money from his employer.
Assess suicide risk within the session, refer to a lawyer, and know what your professional confidentiality covers. Do not express a view on how to deal with the legal side. Section 35.
He gambled again and has not come for a month.
Write or call, without reproach, offering an appointment, and ask how he is — including in terms of suicide risk. It is shame that keeps people away, not lack of interest.
Can controlled gambling be the aim?
In some people, with a mild disorder, on slow forms, with no significant debts, and with figures. The fast forms stay closed. Section 13.
Should you refer to Gamblers Anonymous?
Inform, suggest going once to see, work on the concrete obstacles, and ask how it went. Controlled data are limited, and many people find support there. Section 12.
The person drinks while gambling.
Ask systematically, treat alcohol as a trigger in the episode analysis, and, if drinking is heavy, draw on the manual Alcohol use disorder: a therapist's manual. Section 10.
How long should treatment last?
Twelve sessions and then spacing out, with booster sessions up to at least six months, and particular vigilance around self-exclusion end dates and influxes of money.