Background and AimsConsiderable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross‐study evaluations and hindered the development of best‐practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery.MethodsA systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6‐month follow‐up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) were adhered to.ResultsThirty‐four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty‐three different outcome measures were identified: 25 (39.7%) assessed gambling‐specific constructs, 36 (57.1%) assessed non‐gambling specific constructs, and two instruments were used across both categories (3.2%). Self‐report instruments ranged from psychometrically validated to ad‐hoc author‐designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing.ConclusionsIn research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder‐specific symptoms and behaviours suggests a multi‐dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.

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Self-exclusion is an important harm minimization strategy implemented by gambling operators to restrict a problem gambler’s access to gambling opportunities. Aspects of self-exclusion, including low uptake and non-compliance, limit the effectiveness of programs. Research that considers the consumer perspective is needed to enhance the perceived utility of self-exclusion in the target audience. Twenty interviews were conducted with current (n = 13) and former (n = 7) participants of a multi-venue self-exclusion program for land-based gaming machine venues in New South Wales, Australia. Participants were asked open-ended questions about their experiences and opinions of the program, including its strengths and weaknesses, and suggested improvements for future consumers. Overall, participants found self-exclusion beneficial. However, several shortcomings of the program were expressed, including lack of available public information and overly complicated registration processes. Participants lacked confidence in venues’ willingness and ability to identify non-compliant gamblers and highlighted the need for vastly improved detection systems. The quality of interactions with venue staff in relation to self-exclusion were mixed; counsellor support, however, was perceived as important from beginning to end of a self-exclusion period. Results suggest that gambling operators should increase marketing efforts to promote the availability and benefits of self-exclusion. Investigation of strategies to streamline registration processes and to augment detection systems with new technologies was supported. Venue staff may benefit from training in appropriate self-exclusion facilitation procedures. Gambling operators should aim to foster strong links between self-exclusion programs and professional gambling counselling services.Résumé L’auto-exclusion est une importante stratégie de minimisation des méfaits mise en œuvre par les exploitants de jeux d’argent afin de limiter l’accès des joueurs pathologiques aux occasions de jeu. Certains aspects de l’auto-exclusion, notamment la faible participation et la non-conformité, limitent toutefois l’efficacité des programmes. Des recherches tenant compte de la perspective du joueur sont nécessaires pour renforcer l’utilité perçue de l’auto-exclusion auprès du public cible. Vingt entretiens ont été menés auprès de participants actuels (n = 13) et anciens (n = 7) d’un programme d’auto-exclusion multi-sites pour les salles de jeux de hasard en Nouvelle-Galles-du-Sud, en Australie. On a posé aux participants des questions ouvertes sur leurs expériences et leurs opinions sur le programme, y compris ses forces et ses faiblesses, et sur des améliorations à apporter pour les futurs participants. Dans l’ensemble, les participants ont trouvé le programme d’auto-exclusion bénéfique. Toutefois, plusieurs lacunes du programme ont été signalées, notamment le manque d’informations disponibles dans le public et des processus d’inscription excessivement compliqués. Les participants manquaient de confiance en la volonté et la capacité des propriétaires de sites d’identifier les joueurs non conformes, et ils ont souligné la nécessité d’améliorer considérablement les systèmes de détection. La qualité des interactions avec le personnel des lieux concernant l’auto-exclusion était mitigée; le soutien des conseillers a toutefois été perçu comme important du début à la fin de la période d’auto-exclusion. Les résultats laissent croire que les exploitants de jeux d’argent devraient intensifier leurs efforts de publicité pour promouvoir la disponibilité et les avantages de programmes d’auto-exclusion. La recherche de stratégies visant à rationaliser les processus d’inscription et à améliorer les systèmes de détection par de nouvelles technologies a été encouragée. Les membres du personnel des sites peuvent bénéficier d’une formation sur les procédures appropriées de facilitation pour l’auto-exclusion. Les exploitants de jeux devraient s’efforcer d’établir des liens étroits entre les programmes d’auto-exclusion et les services de conseillers professionnels en matière de jeu.

Background:There is no consensus on how to best define recovery in gambling disorder. This minimizes clinicians' abilities to apply optimal treatment goals and contributes to inconsistency in the use of outcome variables to evaluate interventions. Current understanding of recovery is largely based on professional opinion and theoretical models of gambling disorder. This study aimed to examine core features of recovery identified by service users with lived experiences.Methods: Thematic analysis was applied to qualitative data from 32 face-to-face interviews.Interviewees were at various stages of help-seeking for gambling problems mostly related to electronic gaming machines via self-exclusion and/or specialized gambling counseling. Results: Recovery was perceived by the participants as a continuous process that encompasses periods of improvement and decline. Several key themes of recovery emerged; participants highlighted the importance of developing insight into the psychological and environmental processes that contribute to their gambling problem. Insight helped participants feel empowered to successfully manage their gambling urges and behavior. Recovery extended to building a meaningful life beyond gambling, which involved engagement in alternative activities and fostering strong social relationships. It included stabilization of personal finances and achieving general psychological health and wellbeing. Conclusions: Findings challenge acute symptom-focused models of recovery by broadening the definitional boundaries to include sustained improvements across multiple psychosocial dimensions. Greater emphasis should be given to service user-defined elements of recovery in treatment and research. The long-term perspective of the recovery process has implications for extending standard follow-up assessment intervals in gambling treatment studies. 3

There is considerable conceptual debate about how hoarding disorder (HD) and buying-shopping disorder (BSD) can be best classified. In this article, we reason that these disorders may represent behavioral addictions by mapping evidence to the Components Model of Addiction and the Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors. Our review identifies phenomenological, psychological, and neurobiological evidence to support both disorders as behavioral addictions. However, limitations of the extant literature prevent strong conclusions from being made about the conceptual status of HD and BSD as behavioral addictions. By applying addiction theory to HD and BSD, we generate testable predictions for future research and open potential new avenues for psychological treatment advances. Public Health Significance StatementThe classification of hoarding disorder and buying-shopping disorder as behavioral addictions has significant implications for how these mental disorders are understood and treated. This review article highlights potentially fruitful new areas for research and novel applications of addiction treatments that could improve outcomes for individuals suffering from these debilitating and chronic conditions.