Objective: Gambling is a common activity that becomes problematic in some vulnerable individuals, with gambling disorder (GD) now recognised as a bona fide mental/brain disorder. Several factors are associated with vulnerability to developing GD, including other mental disorders and pathological personality traits like high impulsivity. This clinical condition, referred to as Dual Gambling Disorder (GDD), better captures the broader psychopathological spectrum of GD.
Methods: This narrative review addresses recent advances in neuroscience and psychiatry that can help design more effective prevention strategies for GD. After establishing the current state of the art regarding GD/GDD from a biopsychosocial perspective, we assess the scientific evidence supporting approaches to GDD prevention.
Results: Following an overview of GD/GDD, we examine how precision psychiatry can not only shape therapeutic interventions but also, evidence-based prevention strategies for GD, and how these strategies align with advances in clinical neuroscience and precision psychiatry. Prevention is analyzed across multiple levels: primordial, primary, secondary, and tertiary. Finally, we outline key elements to be considered when designing scientifically grounded prevention strategies for specific target populations.
Conclusions: The development of preventive strategies for GD, particularly when arising alongside other mental disorders, must be grounded in scientific evidence from neuroscience and precision psychiatry.
Keywords: Dual Disorder; Evidence–based prevention; Gambling; Precision psychiatry.
Gambling disorder is a mental, and therefore a brain disorder, that is becoming an increasingly important problem worldwide, in part due to the widespread development of online gaming platforms.Like many addictive disorders, people with gambling disorder often have some other mental disorder (in up to 96% of cases), which is why it is proposed to use the term gambling dual disorder.According to scientific evidence, brain dysfunctions precede the appearance of gambling dual disorder and must be evaluated from the biological, psychological and social perspective, in that order. Prevention must be based on the identification of populations at high risk.The phenotypic diagnosis of gambling disorder should be completed with a precision diagnosis that identifies endophenotypes or biotypes, such as high impulsivity or the presence of other mental disorders, not only categorical but also dimensional.Treatment should be biological, psychological and social, in that order. A clear barrier is the lack of neurobiological treatments approved by regulatory agencies (FDA, EMA) for gambling disorders. However, a diagnosis of gambling dual disorder that includes other symptoms, phenotypes, or mental disorders may allow us to use effective biological treatments.We propose that, to adequately manage gambling dual disorder, it is necessary to design and implement evidence-based prevention strategies that incorporate recent advances in clinical neuroscience, addressing different levels (primary, secondary and tertiary) and involving all stakeholders (e.g., patients/families, clinicians/clinicians, social workers, etc.).