Problem Gambling and Therapy: Clinical Interventions and Public Health Perspectives

Gambling harm in Australia is a pressing public health issue, with losses per adult exceeding those of any other country. While historically understood through the narrow lens of “problem gambling,” contemporary practice recognises a broader framework of gambling-related harm that affects individuals, families, and communities. This article critically examines gambling behaviour through a biopsychosocial lens, exploring the interplay of neurobiology, psychological vulnerabilities, and social determinants. It draws on Blaszczynski and Nower’s Pathways Model (2002), the Problem Gambling Severity Index (PGSI), and therapeutic strategies such as the Lifeline exercise to demonstrate evidence-based approaches for clinical practice. It also explores the importance of challenging cognitive distortions, addressing comorbidities, and embedding trauma-informed care. Finally, it calls for integration between micro-level therapeutic work and macro-level systemic strategies, positioning counsellors not only as clinicians but also as advocates for public health reform.

Gambling is deeply embedded in Australian culture, from lottery tickets to sports betting. While participation is normalised, the consequences are disproportionate. Australians lose approximately $24.88 billion annually, averaging $1,635 per adult, the highest per capita losses worldwide (Productivity Commission, 2010; updated sector reports). For counsellors, this is not merely an issue of individual behaviour but one that intersects with mental health, trauma, family systems, and socioeconomic stressors. The challenge for the counselling profession is to balance effective individual interventions with a recognition of gambling harm as a systemic issue requiring a public health response.

The first pathway is that of the behaviourally conditioned gambler, whose problems often emerge through repeated exposure and reinforcement. These clients may not present with significant underlying vulnerabilities, but are drawn into harmful patterns through the accessibility of gambling products and the powerful reinforcement schedules that underpin them. For counsellors, treatment may involve cognitive-behavioural strategies that help clients recognise triggers, challenge distorted beliefs, and develop new patterns of behaviour.

The second pathway describes the emotionally vulnerable gambler, for whom gambling is often a means of coping with psychological distress, trauma histories, or unresolved grief. These clients may present with co-occurring conditions such as depression, anxiety, or substance use, and gambling becomes a maladaptive escape from overwhelming emotions. For practitioners, this group requires a trauma-informed and integrative approach that addresses both the gambling behaviour and the underlying mental health concerns. Counselling may focus on building safer coping strategies, processing traumatic experiences, and strengthening social supports.

The third pathway captures the antisocial–impulsivist gambler, who is characterised by traits such as impulsivity, risk-taking, and, in some cases, antisocial behaviours. Neurological or personality vulnerabilities may be present, and these clients often struggle with broader difficulties in regulating behaviour across multiple domains. Interventions for this group may be more challenging and require highly structured, skills-based approaches that incorporate impulse control, emotional regulation, and in some cases, coordination with forensic or justice-based services.

Alongside theoretical frameworks, screening and assessment tools play an important role in clinical practice. The Problem Gambling Severity Index (PGSI) (Ferris & Wynne, 2001) remains the most widely validated instrument for categorising gambling risk and guiding initial intervention. Used in combination with broader measures such as the Kessler Psychological Distress Scale (K10), the DASS-21, or the AUDIT, the PGSI allows practitioners to identify not only the severity of gambling problems but also the presence of co-occurring issues. This integrated assessment is critical, as many clients do not present with gambling as their only concern. Instead, gambling is often entangled with financial stress, relational conflict, trauma, and other mental health challenges.

Cognitive Behavioural Therapy (CBT) remains one of the most widely researched interventions for gambling. In practice, this often involves working with clients to challenge specific gambling-related cognitions such as the illusion of control, beliefs in “lucky streaks,” or the gambler’s fallacy. Behavioural strategies may include setting financial and time limits, identifying high-risk situations (such as being paid on payday), and developing alternative leisure activities to reduce reliance on gambling for stimulation.

Motivational Interviewing (MI) is particularly effective with clients who are ambivalent about change. Many gamblers experience powerful urges to stop but also hold hope that the next win will resolve their problems. MI techniques help explore this ambivalence without judgement, guiding clients toward articulating their own reasons for change. For example, discussions might highlight the discrepancy between the desire to provide financially for children and the impact of gambling losses on family wellbeing.

Trauma-Informed Practice is essential given the high rates of trauma histories among people who present with gambling issues. For some clients, gambling serves as an escape from distressing memories or overwhelming emotions. Trauma-informed counselling requires creating safety, avoiding re-traumatisation, and acknowledging that gambling may have functioned as a survival strategy. In these cases, supporting clients to build healthier coping mechanisms and gradually processing trauma is central to sustainable recovery.

Family-Inclusive Practice recognises that gambling rarely affects the individual alone. Partners may be managing hidden debt, children may experience neglect or anxiety, and extended families often carry the stress of financial or relational breakdown. Involving family members where appropriate can support repair, build accountability, and create a stronger system of support around the client. It also allows practitioners to validate and support those harmed by gambling behaviour in their own right.

Finally, partnerships with financial counsellors are often crucial. Unlike other forms of addiction, gambling harm almost always carries financial consequences that directly impact wellbeing. Counsellors may collaborate with financial specialists to help clients address debt, negotiate with creditors, or implement strategies such as voluntary self-exclusion from betting accounts. Integrating therapeutic and financial interventions ensures clients are not left addressing psychological recovery while still trapped in cycles of unmanageable debt.

One of the core counselling tasks is to dismantle the myths sustaining gambling. Persistent beliefs that skill, luck, or persistence will eventually lead to a win reinforce harmful play. Research consistently shows that gambling systems are designed to favour the house. Using psychoeducation, experiential exercises, and reflective dialogue, counsellors can help clients critically examine these beliefs. Addressing myths is not only cognitive work but also emotional work, as clients may need to grieve the loss of hope in “beating the system.”

By blending clinical interventions with public health advocacy, counsellors position themselves as both practitioners and change agents. At a public health level, several initiatives have shown promise. Federal restrictions on online gambling advertising during children’s television hours and live sporting events represent one step toward reducing young people’s exposure. Some states, including Western Australia, have implemented tighter controls on electronic gaming machines, with restrictions on note acceptors and pre-commitment systems to help players limit losses. Voluntary self-exclusion schemes, where individuals can bar themselves from venues or online platforms, provide an additional harm-reduction measure, although their effectiveness depends on robust enforcement.

Evidence from tobacco and alcohol regulation demonstrates that cultural change is possible when public health strategies combine policy, education, and treatment support. In the gambling field, campaigns such as BetStop - the National Self-Exclusion Register (launched in 2023) illustrate movement toward coordinated national approaches. At the same time, advocacy groups continue to push for stronger reforms, including a ban on gambling advertising during prime-time sport broadcasts, warning labels similar to tobacco packaging, and improved access to financial and therapeutic support services.

Problem Gambling and Therapy: A Clinical and Public Health Perspective