Gambling addiction treatment in the United States has experienced decades of stability, but recent pandemic-induced closures have upset the balance. Dr. Nathan Smith, director of the Kindbridge Research Institute, discusses the efficacy of telehealth as a treatment in a world still reeling from the effects of Covid.

Gambling disorder is a serious mental illness and the only behavioral addiction currently recognized by the American Psychiatric Association.

Decades of stability in the treatment of this disorder has been disrupted by covid-induced lockdowns, with populations isolating themselves for months and succumbing to the subsequent stresses.

The pandemic has created a seismic shift in the social factors influencing gambling disorder and treatment availability: underlying risk factors intensified, gambling availability changed dramatically, and access to treatment was reduced.

Several studies have been conducted to consider the impact that closures have had on online gambling consumption, with the shift from retail to online gambling, reduced access to treatment options, and decreased quality of mental health.

Reduced access to treatment is a clear problem, which must be addressed to prevent further deterioration in the conditions of those most at risk. The areas of effectiveness that have suffered most have been aspects such as group therapy, which has not been offered in recent years because it does not meet social distancing guidelines.

Research findings suggest that traditional treatment for pathological gambling is not adequate due to its rigid structure and fragmentation in marginalized populations, meaning that more emphasis needs to be placed on newer, alternative treatments such as telehealth.

However, U.S. state regulations currently make it difficult to transition to telemedicine services for gambling. With the closures still relatively fresh in the minds of most, patients remain leery of seeking treatment for medical conditions and hospitals are more focused on reducing the spread of viruses, even at the cost of reducing social support for patients.

"As in many aspects of life, the pandemic has made us rethink our thinking moving forward."

In the treatment of gambling addiction, telehealth has emerged as one of the leading candidates for solving the problems that have arisen. Telehealth offers a way to overcome the many increases in social risk factors for gambling disorder by offering remote therapy that allows access to care when isolated.

Kindbridge is pioneering new online treatment centers, as well as different approaches to traditional treatment, which can be moved online temporarily or permanently.

For example, during a shutdown, an addiction recovery service that used self-management groups and recovery training successfully moved from face-to-face treatment to telephone consultations with no change in the quality of treatment.

Care for non-opioid addictions is often poor, which has been exacerbated since the pandemic. A review of country-level briefing notes produced six months after the global Covid-19 outbreak found that eight countries advocated for increased telehealth solutions to addiction care.

Although the problems of social isolation and increased screen time remain, online delivery, as a treatment modality, increases overall efficiency and administrative compliance.

Another potential benefit of telehealth treatment is the possibility of integrating other app-based tools for the treatment of pathological gambling in combination with more traditional methods.

One such tool is ecological momentary intervention, which delivers brief interventions electronically to a person's phone. In a feasibility trial, the use of follow-up ecological intervention techniques on smartphones was able to reduce gambling episodes by 71%, craving occurrences by 72%, and craving intensity by 5.4%.

We are traversing uncharted territory in many respects. The availability of gambling in the U.S. is now greater than ever, while access to new types of treatment is also at a higher level than previously seen.