Author: Professor Nicki Dowling, PhD, MAPS, Deakin University.
Psychologists are well placed to recognise and respond to gambling harm. Some clients seek psychological support specifically for gambling-related difficulties. For others, gambling harm may emerge during assessment for common co-occurring concerns such as depression, anxiety, substance use, relationship or financial difficulties, family violence, and suicidal thoughts or behaviours.
To help psychologists screen and respond to gambling harm, the Australian Psychological Society (APS), with funding from the NSW Office of Responsible Gambling, has developed the Psychological Care for People Experiencing Gambling Harm (APS, 2026a) Practice Guide. The Practice Guide brings together accessible, evidence-informed clinical guidance and is complemented by a webinar (APS, 2026b) and a community information sheet (APS, 2026c). Together, these resources address harms experienced by both people who gamble and their family members and friends.
Language matters in gambling care
Importantly, no single term is right for every clinical context. Gambling disorder is the diagnostic term for persistent or recurrent gambling associated with adverse consequences and clinically significant impairment or distress. Problem gambling has been widely used to describe difficulties controlling gambling that result in adverse consequences but has increasingly fallen out of favour because of concerns about stigma and its focus on individual rather than broader social, cultural, environmental, economic and industry-related determinants. Gambling harm focuses on adverse consequences, including financial, emotional, relationship, health, occupational, cultural and other harms.
The Practice Guide recommends humanising, non-stigmatising, person-first language, while also attending to each client’s preferred terminology. This article therefore uses harmful gambling when referring to gambling associated with adverse consequences, and gambling disorder where formal diagnosis is relevant.
Recognition starts with asking
Gambling harm may not always be apparent at initial presentation, particularly when clients present with mental health, substance use, financial or relationship concerns. Screening may be especially relevant in mental health, alcohol and other drug, and family violence services where common presentations often co-occur with gambling harm.
Validated screening and assessment tools are available and can help identify gambling-related difficulties and clarify their severity. The guideline outlines screening options available and emphasises the importance of matching the measure to its purpose and population it was developed for.
A positive screen is only the beginning
A positive screen is a prompt for a more detailed assessment. The aim is to understand the client’s gambling behaviour, factors that inform formulation, gambling-related harms and urgent concerns, for example:
- Gambling behaviour. Clarify what the person gambles on, whether gambling occurs online or in land-based venues, and its frequency, expenditure and duration.
- Factors that inform formulation. Consider gambling history and motivations, gambling-related cognitions, urges, readiness to change, self-efficacy, coping, social support, high-risk situations, and treatment expectations and goals. These domains can inform formulation and identify processes to monitor during treatment.
- Gambling-related harm. Assess the consequences of gambling separately from symptom severity. Consider the use of scales designed to assess harm where appropriate such as the Gambling Harms Scale-10 or Domain-General Gambling Harm Scale.
- Urgent issues. Identify concerns requiring immediate treatment, safety planning, or referral, particularly suicidal ideation or behaviour and family violence. Screening for hazardous alcohol use, other drug use, gaming, depression and anxiety is also recommended.
Diagnosis is a separate task
Screening and symptom-severity measures do not establish a diagnosis of gambling disorder. Where a formal diagnosis is required, the preferred approach is a clinician-administered structured diagnostic interview, such as the Structured Clinical Interview for Gambling Disorder. Psychologists should also distinguish gambling disorder from non-disordered gambling and consider differential diagnoses, including manic episodes, personality disorders and medical or medication-related causes.
Formulation connects assessment to treatment
A comprehensive assessment can then be brought together in an individualised formulation of the factors contributing to harmful gambling and supporting recovery. Formulation may consider vulnerabilities, gambling motivations and cognitions, mental health or substance-use concerns, social and financial influences, access to gambling, and protective factors such as social support and coping skills. Psychologists should also consider how culture, language, family and community context, stigma and help-seeking may shape the client’s experience.
Formulation is an important tool for guiding collaborative goals, treatment targets and strategies.
Treatment goals are negotiated, not imposed
Treatment goals may not always be focussed on abstinence. Australian gambling services frequently use a harm-minimisation approach in which clients may aim to stop gambling, stop particular activities associated with harm, or reduce gambling frequency, expenditure or duration.
Importantly, goals may change over treatment and should be set collaboratively with the client. Meaningful, measurable goals can provide a positive foundation for treatment. Imposing goals may undermine engagement and progress.
CBT and MI have the strongest evidence
Cognitive-behaviour therapy (CBT) and motivational Interviewing (MI) have the strongest evidence base for harmful gambling. Clinical guidelines therefore recommend individual or group CBT and/or MI. In practice, these approaches can be complementary: MI can strengthen motivation, engagement, readiness to change, and confidence to change, particularly where ambivalence is present. This is important given that around one-third of clients disengage from treatment, often early. CBT can then target the cognitive, behavioural and situational processes that maintain gambling by challenging gambling-related beliefs, managing urges and high-risk situations, developing alternative coping strategies, and preparing for relapse.
Putting CBT and MI to work
Clinicians working with clients experiencing gambling harm in Australia recommend the following set of techniques to support change. These techniques can be selected and combined according to the formulation rather than delivered as a fixed sequence.
Information gathering. Throughout treatment, psychologists might explore when gambling first became a concern, how it has changed over time, previous attempts to change, what has helped in the past, and experiences of seeking support or treatment.
Motivational enhancement. When ambivalence is present, psychologists can strengthen readiness, confidence and commitment by eliciting clients’ own reasons for changing gambling and linking change with personal values and priorities. Readiness or confidence ratings and personalised feedback on gambling patterns may support this process. The emphasis is on autonomy and eliciting rather than directing change.
Decisional balance. Psychologists can help clients consider the perceived benefits of continuing to gamble, such as excitement, escape, social connection or the possibility of financial gain, alongside costs such as financial losses, distress and relationship difficulties. They can also explore the benefits of change, such as greater financial security, improved wellbeing or relationships, and more time for valued activities, alongside perceived costs, such as losing a source of enjoyment, escape or social connection, or giving up hope of recovering losses.
Goal setting. Psychologists can help clients collaboratively translate intentions into specific behavioural goals without assuming abstinence is the only acceptable outcome. Goals might include stopping gambling altogether, stopping the activities associated with greatest harm, or reducing gambling frequency, expenditure or duration. Goals may change over time and should be reviewed regularly to ensure they remain realistic, sustainable and aligned with broader treatment aims.
Information provision. Psychoeducation can help clients understand how gambling products work, including house advantage and expected loss, randomness and independence of events, variable reinforcement, rapid or continuous play, near misses and other structural features. It may also cover common gambling cognitions, chasing losses and sunk-cost thinking; the functions gambling may serve, such as excitement, escape or social connection; and how urges can be triggered by mood, money, alcohol, sporting events, advertising or gambling environments. Contemporary risks such as mobile access, inducements, notifications and frictionless payments may also be relevant. Information should be tailored to the client’s gambling activities and formulation.
Cognitive restructuring. Psychologists can target gambling-related cognitions relevant to the formulation, including the gambler’s fallacy (“I’ve lost several times, so a win must be due”), illusions of control (“I have a system that gives me an edge”), selective recall of wins, interpretations of near misses, and beliefs that further gambling can recover losses. Other targets may include anticipatory thoughts (“gambling will help me feel better”) and permissive thoughts (“I’ll only spend $50”). Strategies such as Socratic questioning and behavioural experiments can be applied to these beliefs.
Financial regulation. Psychologists can work with clients to identify practical safeguards that reduce access to money for gambling, such as spending or withdrawal limits, changes to banking arrangements, budgeting strategies, payment-blocking features, self-exclusion and pre-commitment limits. These strategies, which can interrupt cycles of loss, financial pressure and chasing losses, provide immediate protection while broader skills develop. Referral to financial counselling may be appropriate where more specialist support is required.
Problem solving. Problem-solving strategies can be applied to difficulties that trigger or maintain gambling; for example, developing alternatives when gambling is used to manage boredom, anxiety or distress. Problem solving can help to address financial, relationship, legal, family, employment, or social problems resulting from gambling.
Planning social support. Psychologists can help clients identify trusted people who may provide encouragement, assist during high-risk situations or support agreed goals, as well as peer or online supports where appropriate. Clients may also spend more time with non-gambling people and activities, strengthening supportive connections while reducing exposure to gambling-oriented environments or relationships. Involvement of others should reflect client preference and safety, particularly where family violence is present.
Relapse prevention. Psychologists can help clients identify warning signs and high-risk situations, including urges, distress, boredom, substance use, access to money, gambling cues and opportunities, chasing thoughts, or renewed confidence in controlling gambling. Plans may combine coping strategies, practical barriers such as limiting access to money or gambling, and people to contact when risk increases. Rehearsing responses to urges and planning for lapses can reduce escalation. Distinguishing lapse from relapse, reviewing lapses non-judgementally to identify triggers and refine the plan, and framing recovery as nonlinear may support continued engagement.
Matching other therapies to the formulation
CBT and MI remain the best-supported approaches to gambling treatment. However, clinical consensus in Australia points to a range of other therapies that may have a role in practice. This includes mindfulness-, acceptance- and skills-based approaches, along with solution-focused brief therapy, interpersonal psychotherapy and narrative therapy. Couple or family interventions may be useful where gambling and relationship functioning are closely intertwined.
Recovery extends beyond gambling reduction
Treatment outcome monitoring is not only about whether gambling has reduced, but also what is changing in treatment and how recovery is unfolding more broadly.
Intended outcomes may include changes in gambling behaviour frequency, expenditure and duration, and gambling symptom severity.
Changes in gambling processes such as cognitions and urges, readiness, self-efficacy, coping and social support should also be monitored. In addition to recovery outcomes such as functioning, wellbeing, relationships, managing urges and building a meaningful life beyond gambling are important to consider.
Gambling harm is less suitable as a treatment outcome because harms may lag behind changes in gambling behaviour and persist after gambling has reduced or ceased.
Relapse is common - and requires planning
Harmful gambling can follow a fluctuating and episodic course, making relapse planning an important part of treatment and recovery. Recent evidence provides a clearer picture of relapse in harmful gambling (Dowling et al., 2026). Relapse estimates increase during treatment from 17% at one month to 27% at four months, while post-treatment estimates average 14% at six months and 33% at 12 months.
Gambling cognitions show the strongest evidence as a risk factor of relapse, with alcohol use problems, psychological distress, gambling severity and functional impairment also implicated, while family and social support appear protective. Structured relapse prevention interventions, adjunctive treatments and digital supports appear promising. However, post-treatment aftercare remains largely unexamined, which reinforces the importance of follow-up and rapid re-access to support where needed.
Every psychologist can play a role
Psychologists do not need to work in a specific gambling service to help reduce gambling harm. Asking about gambling during assessment, particularly when clients present with common co-occurring concerns, may identify harm that would otherwise remain hidden.
Psychologists already possess many of the core clinical skills needed to respond, including assessment, formulation, motivational interviewing skills, cognitive and behavioural intervention, risk management and relapse prevention. The Practice Guide helps psychologists translate those clinical skills into gambling-specific care.
RESOURCES TO SUPPORT YOUR PRACTICE
APS Practice Guide: Psychological care for people experiencing gambling harm: The APS Practice Guide is the starting point for psychologists wanting more detailed guidance on assessment and diagnosis, treatment options, vulnerable groups, harm reduction, relapse and ongoing support, and referral pathways; the guide also provides a starting point for the psychological care of family members and friends affected by gambling harm (APS, 2026).
APS webinar: The accompanying APS webinar explores how psychologists can apply the Practice Guide in everyday psychological practice relating to people who gamble and their family members and friends (APS, 2026b).
APS community information sheet: The accompanying APS community information resource is designed to help support conversations with clients and their family members and friends about gambling harm (APS, 2026c).
For professional guidance and resources: Gambling Help Online and NSW GambleAware provide professional guidance and resources for recognising gambling harm, screening and assessment, intervention, and referral, as well as support for clients affected by someone else’s gambling (Gambling Help Online, 2026a; NSW Office of Responsible Gambling, 2026a).
For professional development and training: NSW GambleAware provides online learning, webinars and workshops to strengthen the knowledge and skills of professionals in identifying, assessing and responding to gambling harm (NSW Office of Responsible Gambling, 2026b).
For information on screening and assessment: Freely available, open-access articles provide the exact item wording, response options and scoring instructions for each brief screening measure (Dowling et al., 2019); practical guidance for the selection of measures for screening, assessment, diagnosis, and treatment outcome monitoring (Aslan et al., 2026; Dowling & Rodda, 2025).
For session-by-session treatment guidance: Gambling-focused CBT therapist manuals (Ladouceur & Lachance, 2007, Raylu & Oei, 2010).
For online information and self-help resources: Gambling Help Online and NSW GambleAware provide information, self-assessment tools, practical self-help strategies and resources for people experiencing gambling harm and their family members and friends (Gambling Help Online, 2026b; NSW Office of Responsible Gambling, 2026c).
For online counselling and peer support: Gambling Help Online provides free, confidential, 24/7 live-chat counselling, email support, and online peer support forums for people experiencing gambling harm and their family members and friends (Gambling Help Online, 2026c).
For telephone counselling and support: The Gambling Helpline (1800 858 858) provides free, confidential, 24/7 counselling, information and support for people experiencing gambling harm and their family members and friends (Gambling Help Online, 2026d).
For digital supports: Evidence-based digital supports provided by Australian state and territory governments can complement psychological treatment between sessions and provide ongoing support as part of aftercare for people seeking to reduce their gambling: GamblingLess: In-The-Moment, Gambling Habit Hacker, and Reset (NSW Office of Responsible Gambling, 2026d; Victorian Government, 2026).
For referrals to specialist services: The Gambling Helpline (1800 858 858) facilitates referrals to free specialist therapeutic gambling counselling and financial counselling across all Australian states and territories, for both people who gamble and affected family members and friends. Psychologists can also contact the service for referral advice and assistance (Gambling Help Online, 2026d).
References
Aslan, I. H., Dowling, N. A., Ioannidis, K., Flett, K., Solly, J., Watts, S., Bowden-Jones, H., Kaar, S. J., Gaskell, M. J., Howard, J. I., Grant, J. E., & Chamberlain, S. R. (2026). Evidence-based measurement of Gambling Disorder: A rapid review of instruments for different purposes. Neuroscience and Biobehavioral Reviews, December 2026. https://www.sciencedirect.com/science/article/pii/S0149763426004288
Australian Psychological Society. (2026a). Psychological care for people experiencing gambling harm. Australian Psychological Society: Practice guide. https://psychology.org.au/for-the-public/psychology-topics/gambling-harm/gambling-harm-resources-for-psychologists/gambling-harm-resource-psychologists
Australian Psychological Society. (2026b). Psychological care for people experiencing gambling harm. Australian Psychological Society: Webinar. https://psychology.org.au/for-the-public/psychology-topics/gambling-harm/gambling-harm-resources-for-psychologists/webinar
Australian Psychological Society. (2026c). Psychological care for people experiencing gambling harm. Australian Psychological Society: Community information sheet. https://psychology.org.au/for-the-public/psychology-topics/gambling-harm/resource-for-people-impacted-by-gambling/community-resource-guide
Dowling, N. A., Hawker, C. O., Merkouris, S. S., Dias, S. E., Gandhi, M. N., Craigie, G. F., Ioannidis, K., Solly, J. E., Grant, J. E., Thomas, A. C., & Chamberlain, S. R. (2026). Breaking the cycle: A rapid evidence review of gambling relapse. Clinical Psychology Review. Manuscript under review.
Dowling, N. A., Merkouris, S. S., Dias, S., Rodda, S. N., Manning, V., Youssef, G., Lubman, D. I., & Volberg, R. A. (2019). The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis. Clinical Psychology Review, 74, 101784. doi: 10.1016/j.cpr.2019.101784. https://pubmed.ncbi.nlm.nih.gov/31759246/
Dowling, N. A., & Rodda, S. N. (2025). Pragmatic, brief, free, and validated: Standardised treatment outcome measurement for gambling treatment services. Cognitive and Behavioral Practice. https://www.sciencedirect.com/science/article/pii/S1077722925000987
Gambling Help Online (2026a). Gambling Help Online: How professionals can help. https://www.gamblinghelponline.org.au/support-yourself-or-others/taking-action/information-for-professionals
Gambling Help Online (2026b). Gambling Help Online: Tools and resources. https://www.gamblinghelponline.org.au/tools-resources
Gambling Help Online (2026c). Gambling Help Online: Free online support for anyone affected by gambling. https://www.gamblinghelponline.org.au/
Gambling Help Online (2026d). Gambling Help Online: How the Gambling Helpline can help. https://www.gamblinghelponline.org.au/support-yourself-or-others/taking-action/telephone-support
Ladouceur, R., & Lachance, S. (2007). Overcoming your pathological gambling: Workbook. Oxford University Press. https://academic.oup.com/book/1126
NSW Office of Responsible Gambling (2026a). GambleAware: For professionals. https://www.gambleaware.nsw.gov.au/for-professionals
NSW Office of Responsible Gambling (2026b). GambleAware: Training for health and community workers. https://www.gambleaware.nsw.gov.au/for-professionals/for-health-and-community-workers/training-for-health-and-community-workers
NSW Office of Responsible Gambling (2026c). GambleAware: I need support. https://www.gambleaware.nsw.gov.au/i-need-support
NSW Office of Responsible Gambling (2026d). Free apps to manage your gambling. https://www.gambleaware.nsw.gov.au/i-need-support/i-want-to-help-myself/use-apps-to-manage-your-gambling
Raylu, N., & Oei, T. P. (2010). A cognitive behavioural therapy programme for problem gambling: Therapist manual. Routledge. https://www.routledge.com/A-Cognitive-Behavioural-Therapy-Programme-for-Problem-Gambling-Therapi/Oei-Raylu/p/book/9780415548168?_gl=1*qnwdvt*_gcl_au*MjA2MTA0MjA3OC4xNzg5MDI0MDg4*_ga*MTgwNTAyNzA2Ny4xNzg5MDI0MDkw*_ga_0HYE8YG0M6*czE3OTE4NTU1NzYkbzIkZzAkdDE3OTE4NTU1NzYkajYwJGwwJGgw
Victorian Government (2026). Reset how you think about gambling. https://resetapp.com.au/