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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Gambling disorder and behavioural addiction

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Gambling-related suicide risk can be immediate

Gambling harm can be a dominant driver of suicidal thinking even without another mental disorder, and risk may be highest immediately after a gambling episode, disclosure, major loss, debt discovery or relapse.

Action: Ask directly about suicidal thoughts, intent, plan, means and recent losses; if risk to self or others is considerable or immediate, involve specialist mental-health or crisis services through emergency services when necessary. Make a collaborative safety plan, mobilise appropriate support and reduce immediate access to gambling and money.

Synopsis

Identify gambling-related harm without stigma, assess suicide, financial, family and safeguarding consequences directly, implement practical access barriers, and sequence motivational work, gambling-specific CBT, peer support and specialist naltrexone according to NICE NG248.

  • Ask directly and neutrally, especially when someone presents with self-harm, depression, anxiety, psychosis, bipolar disorder, ADHD, substance dependence, homelessness, financial concern or criminal-justice contact.
  • Assess product and environment, frequency and duration, money and time spent, chasing losses, borrowing, concealment, failed attempts to stop, craving, triggers and impact on affected others.
  • A validated measure such as the Problem Gambling Severity Index can structure severity, but any score is interpreted with current harm, volatility and suicide risk.
  • Immediately discuss self-exclusion, blocking software and marketing, bank gambling blocks, payment limits, important bills on payday and supported restriction of money where the person agrees.
  • Consider motivational interviewing when confidence or commitment is uncertain, and offer peer support to people who want it as part of treatment.
  • NICE recommends gambling-specific group CBT soon after diagnosis, usually 8–10 sessions; offer individual CBT, usually 6–8 sessions, if group work is declined, unavailable or unsuitable, and include relapse prevention.
  • Naltrexone is not first-line: consider it only after an adequate psychological course has not achieved the desired outcome or after repeated relapse, started by or under an appropriately experienced specialist.
  • The NICE off-label regimen is naltrexone 25 mg orally once daily for 3 days, then 50 mg once daily for 4–6 months after confirming normal liver and kidney function and no opioid use.

Key red flags

A suicide plan, intent, rehearsals, access to lethal means or inability to remain safe after gambling requires immediate crisis intervention.

A major loss, relapse, concealed debt, relationship rupture, criminal allegation or imminent eviction can sharply increase risk even if the person appeared settled earlier.

Domestic abuse, economic coercion, theft, fraud, dependent children lacking essentials or threats from creditors requires safeguarding and practical action.

Mania, psychosis, severe depression, substance dependence, intoxication or withdrawal may drive or amplify gambling and needs concurrent urgent treatment.

New gambling after a dopamine agonist or aripiprazole starts or increases suggests a medicine-related impulse-control problem requiring prescriber review.

Investigation priorities

01
Direct gambling historyFirst step

Map products, access, frequency, duration, expenditure, chasing, concealment, control and consequences.

Management branches

IdentificationAsk and assess the whole harm

A person presents with mental-health, substance, financial, safeguarding or justice problems associated with elevated gambling risk.

  1. Ask directly about gambling and use a validated measure when acceptable, without making a threshold the gate to support.
  2. Assess suicide, recent loss, debt, housing, relationships, employment, crime, affected others, mental illness, substances and contributing medicines.
  3. Provide hope, explain treatment and agree urgent safety, safeguarding and practical financial actions before longer-term therapy.

Key medicines

Naltrexone for gambling that harmsAfter an adequate psychological treatment course has failed to achieve desired outcomes or repeated relapse has continued, a specialist may start naltrexone 25 mg orally once daily for 3 days, then 50 mg once daily for 4–6 months, usually alongside continued psychological therapy.Confirm normal kidney and liver function and no opioid use before starting; warn that opioid analgesics will be blocked and opioid dependence risks precipitated withdrawal. Agree regular liver tests and review efficacy, nausea, mood, chest pain or palpitations under specialist supervision.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG248 gambling-related harms recommendationsIdentification, suicide safety, practical blocks, CBT and specialist naltrexone regimen.
  • NICE NG248 gambling-related harms overviewScope and current status of the 2025 national guideline.
  • NICE NG248 rationale and impactEvidence interpretation for suicide, psychological and pharmacological recommendations.
  • NHS help for problems with gamblingPublic self-assessment, NHS clinics, self-referral and immediate practical support.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom