Background: With the legalization of new forms of gambling there are increasing numbers of individuals who appear to have gambling related problems and who are seeking help. Consequently quality research into gambling treatment is crucial.

Objectives: To complete a systematic review and meta-analysis of all randomised controlled trials (RCTs) of psychological and pharmacological treatments for pathological gambling. Data collection and analysis: Published and unpublished RCTs of treatments of pathological gambling were identified. The data was entered into the Cochrane Review Manager software. Relative risk analyses were conducted for the dichotomous outcome of controlled vs. uncontrolled gambling.

Main results: Only four RCTs of psychological treatments were identified. The experimental interventions, behavioural or cognitive-behavioural therapy (BT/ CBT), were more efficacious than the control interventions in the short-term (relative risk 0.44, 95% confidence interval (CI) 0.24-0.81). There was a trend for long-term treatment with BT/CBT to be more efficacious than the control treatments, but the statistical significance of this was sensitive to the statistical model used for meta-analysis. With a fixed effect model the relative risk was 0.56 (95% CI 0.33-0.95); the relative risk with a random effects model was 0.61 (95% CI 0.25-1.47).

Conclusions: This systematic review revealed a paucity of evidence for effective treatment of pathological gambling. As gambling is becoming more accessible in many countries and there is epidemiological evidence of increasing rates of pathological gambling, more rigorous RCTs are required.