Gambling and Violence in a Nationally representative sample of UK men.

A Roberts, JW Coid, R King, R Murphy, J Turner, H Bowden-Jones, K Palmer du Perez, J Landon.

Addiction July 2016

Down and Out in london: Addictive Behaviours in Homelessness

Journal of Behavioural Addictions June 2016
Sharman S, Dreyer,J, Clark L, Bowden-Jones H.

Gender differences in Treatment Seeking Pathological Gamblers

Journal of Behavioural Addictions June 2016

Ronzitti S, Lutri V, Clerici M, Smith N,Bowden-Jones H.

Treatment Provision for Gambling Disorder in Britain: call for an integrated treatment and commissioning model

BJPsych Bulletin Vol 40 Issue 3 June 2016

George S & Bowden-Jones H

Brain Emotion Systems,Personality,Hopelessness,Self/Other Perception and Gambling Cognition: A Structural Equation Model .

Illiceto P, D’Antuono A,Bowden-Jones H,Giovani E, Giacolini T, Candilera G.

J of Gambling Studies32(1):157-169MARCH 2016

Blunted Endogenous Opioid Release Following an Oral Amphetamine Challenge in Pathological Gamblers

Inge Mick Jim Myers Anna C Ramos Paul Ra Stokes David Erritzoe Alessandro Colasanti Roger N Gunn Eugenii A Rabiner Graham E Searle Adam D Waldman Mark C Parkin Alan D Brailsford Jos Cf Galdurz Henrietta Bowden-Jones Luke Clark David J Nutt Anne R Lingford-Hughes

Neuropsychopharmacology . Advance online publication Dec 2015 doi 10.1038/npp 2015.340

HenriettaBowden-Jones : extrovert, optimistic, driven. British Medical Journal.

BMJ Confidential 2015; 350:h1444 18 March 2015

DOI: 10.1007/s10899-015-9543-0

Smoking and Gambling Disorder: Does Tobacco Use Influence Treatment Outcome?

Ronzitti S, Lutri V, Meleck S, Smith N, Bowden-Jones H.

J of Gambling Studies 31,N3 (1107-1117),2015

Textbook: Gambling: Cultural attitudes, motivations and Impact on Quality of Life.

Ed: G.Martinotti & H.Bowden-Jones

Published April 2015 by Nova Publishers New York.

Textbook: A Clinician’s Guide to Working with Problem Gamblers.

Ed: H.Bowden-Jones & George S.

Feb 2015 Published by Routledge .

Using Naltrexone in the Treatment of Pathological Gambling

Suchde R & Bowden-Jones H.

Research and Advances in Psychiatry 2014;1(1):6-11

Internet addiction: A Qualitative Overview

Perera A, George S, Bowden-Jones H

Research and Advances in Psychiatry 2014 1(1) 32-37

Internet Gaming Addiction:a Novel Approach, The Lindberg & Bowden-Jones Model

Lindberg A & Bowden-Jones H

Canadian Journal of Addiction Vol 5 Number 2 June 2014

Gambling:The Hidden Addiction.April 2014

Faculty Report Royal College of Psychiatrists. FR/AP/01

George S& Bowden-Jones H

Amphetamine induced endogenous opioid release in the human brain detected with [11]C carfentanil PET: replication in an independent cohort

Mick I, Myers j,Stokes P, Erritzoe D, Colasanti A,Bowden-Jones H, Clark L, Gunn R, Rabiner E.

The International Journal of Neuropsychopharmacology 05/14


Rates of Problem gambling in a British Homeless sample: A preliminary Study.

Sharman S, Dreyer J, Aitken M, Clark L,Bowden-Jones H.

Journal of GamblingStudies Jan 2014DOI 10.1007/s10899-0149444-7

Using Naltrexone in the treatment of pathological gambling.

Suchde R & Bowden-Jones H

Research and Advances in Psychiatry 2014; 1 (1): 6-11

Internet Addiction: A Qualitative Overview

Perera A, George S, Bowden-Jones H.

research and Advances in Psychiatry 2014; 1(1):32-37

Pathological Gambling: A clinical overview.

Kaspar P, Mitter S,Bowden-Jones H.

Clinical Focus Primary Care. 2013, Vol 7, Issue 3 145-216

Book review of Women and Problem Gamblingby L Karter..

Bowden-Jones H

Addiction and Treatment British Journal of PsychiatryAugust 2013203:157;doi:10.1192/bjp.bp.113.131870

Experiencing gambling related cognitive biases in motor behaviour: rolling dice to win.

Authors:Lim M,Bowden-Jones H,Rogers R.

J of Gambling Studies Vol 29 N1 2013

Proposed changes for substance use and gambling disorders in DSM-5: Impact on assessment and treatment in the UK

Authors: Petry N,Bowden-Jones H,George S

The Psychiatrist ( Feb 2013) 37: 41-43

Problem gambling: What can psychiatrists do?

Authors: George S,Bowden-Jones H, Orfeord J, Petry N.

The Psychiatrist (Jan 2013) 37: 1-3

Gamblers Anonymous:overlooked and underused?

George S, Ijeoma O,Bowden-Jones H.

Advances in Psychiatric Treatment (2013) 19: 23-29

Commentary on Petry et al (2013): Actus Reus- why it matters to pathological gambling treatment.

AuthorBowden-Jones H.Addiction vol 108, Issue 3, 582-583, March 2013

Pathological gambling among men: an overview

Authors: J. Dhillon &H.Bowden-Jones

Trends in Urology and Men”s health. November/December 2012

Book Chapterin Forensic Psychiatry. B. Puri and I. Treasaden ( in publication)

H.Bowden-Jones& S.George ”Pathological gambling and Crime”

Hodder Arnold Publishers.

Pathological Gambling: A clinical review.

Kaspar P, Mitter S, Bowden-Jones H.

Clinical focus: Primary care. 2012

Striatal dopamine D2/D3 receptor binding in pathological gambling is correlated with mood-related impulsivity.

Authors: Clark, L, Stokes, P, Wu K, Michalczuk R, Benecke A, Watson B, Egerton A, Piccini P, Nutt D,Bowden-Jones H,Lingford-Hughes A.

Neuroimage 63 (2012) 40-46.

Decision making, impulsivity, and addictions: Do Parkinson”s disease patients jump to conclusions?.

Djamshidian, A., O”Sullivan, S. S., Sanotsky, Y., Sharman, S., Matviyenko, Y., Foltynie, T., Michalczuk, R., Aviles-Olmos, I., Fedoryshyn, L., Doherty, K. M., Filts, Y., Selikhova, M.,Bowden-Jones, H.,Joyce, E., Lees, A. J. and Averbeck, B. B. (2012),

Mov. Disord.. doi:10.1002/mds.25105

Affective forecasting in problem gamblers.

Willmer -Reed J, Smith N, Bowden-Jones H,MacLeod A K

International Gambling Studies March 2012.

doi: 10.1080/14459795.2012.671841

Chapter :Drugs and Alcohol misuse in the Workplace.

Authors:Bowden-Jones H, Brown D.

in ”Fitness For Work: The Medical Aspects”, Fifth Edition
Edited by Keith T. Palmer, Ian Brown, and John Hobson
Oxford University Press
ISBN 9780199643240 In press. Publication date Jan 2013.

Editorial: The Medical Management of Problem Gamblers

Authors:Bowden-Jones, H& Smith, N.

British Medical Journal (BMJ) March 2012 344: e 1559

Gambling, the Family and You: a self-help handbook for Family members.

Copello A,Bowden-Jones H, Cousins J, George S, Orford J.

CNWL publications 2012.

Addictions. Encyclopediaof quality of life research

NY: Springer Publishing. 2012

Authors:Temcheff, C.,Bowden-Jones, H., & Derevensky, J.

A patient”s Journey: Gambling addiction

British Medical Journal (BMJ) Dec 2011; 343 do7789

Authors: patient,Bowden-Jones H, George S.

Impulsivity and Cognitive Distortions in pathological gamblers attending the UK National Problem Gambling Clinic: A preliminary report.

Psychological Medicine Dec 2011 41 pp 2625-2635

Authors: Michalczuc R,Bowden-Jones H, Verdejo-Garcia A, Clark L.

Problem Gambling Leaflet for Royal College of Psychiatrist: Updated

Royal College of Psychiatrists Public Education Editorial Board.

Authors:Bowden-Jones H,George. S.2011

Pathological gambling in Parkinson”s disease-a review of the literature

Movement Disorders, September 2011, vol./is. 26/11(1976-1984), 0885-3185;1531-8257 (September 2011)

Authors:Djamshidian A., Cardoso F., Grosset D.,Bowden-Jones H., Lees A.J.

Abstract:The prevalence of pathological gambling is 3.4% to 6% in treated Parkinson”s disease, which is higher than the background population rate. In this review we discuss current evidence to indicate that dopamine agonists are much more likely to trigger this behavior than either L-dopa or selective monoamine oxidase B inhibitor monotherapy. New insights from recent behavioral and functional imaging studies and possible treatment approaches are also covered. A PubMed literature search using the terms “gambling” and “Parkinson”s disease,” “impulse control disorder,” “impulsive compulsive behaviour,” “dopamine agonist,” of individual dopamine agonists, and of ongoing drug trials, using, was carried out for the period up to January 2011. 2011 Movement Disorder Society.

Pathological gambling and the treatment of psychosis with aripiprazole: Case reports

British Journal of Psychiatry, August 2011, vol./is. 199/2(158-159), 0007-1250;1472-1465 (August 2011)

Authors:Smith N., Kitchenham N.,Bowden-Jones H.

Abstract:This paper details three case reports that suggest that pathological gambling activity may have been adversely modified following treatment for psychosis with the antipsychotic aripiprazole. These reports are discussed in the context of previous observations of the potential impact of aripiprazole on impulse control and the implications such observations could have for clinical practice and future research.

Pathological gambling: A neurobiological and clinical update

British Journal of Psychiatry, August 2011, vol./is. 199/2(87-89), 0007-1250;1472-1465 (August 2011)

Authors:Bowden-Jones H., Clark L.

Abstract:A proposed merging of pathological gambling with the drug addictions in the forthcoming DSM-5 prompts an overview of the neurobiological data showing similarities between these conditions, as well as an update on national trends in gambling behaviour and current treatment provision.

”You never told me I would turn into a gambler”: a first person account of a dopamine agonist- induced gambling addiction in a patient with restless legs syndrome.

BMJ Case Reports 2011: doi;10.1136/bcr

Authors:H.Bowden-Jones, S. George.

Gambling Addiction in Women

Women”s Health,Vol 6, N2,2011

Authors: S.George, H.Ekhtiari,H.Bowden-Jones

Once upon a time…’. Article on the development of the National Problem Gambling Clinic.

Addiction Today: Jan 2010


Win-win treatment. Interview by Lynne Wallis

Nursing standard (Royal College of Nursing (Great Britain) : 1987), February 2009, vol./is. 23/23(22-23), 0029-6570 (2009 Feb 11-17)

Authors:Bowden-Jones H., Frayne C.

Abstract:Addiction to gambling tends to be a hidden problem but now the UK”s first NHS-funded treatment unit is attempting to tackle it.

Problem Gambling Leaflet for Royal College of Psychiatrists

Royal College of Psychiatrists Public Education Editorial Board.

Author:Bowden-Jones H.2009

2008 Cambridge Textbook of Effective Treatments in Psychiatry.

H.Bowden-Jones:Co-author of Cannabis chapter.

Editor Prof Peter Tyrer and K. Silk.

Harm Reduction Canadian Style

Scanbites Summer 2006: vol 3 issue 2.


Neurobehavioural characteristics and relapse in addiction [11]

British Journal of Psychiatry, May 2006, vol./is. 188/MAY(494), 0007-1250 (May 2006)

Authors:Bowden-Jones H., McPhillips M., Joyce E.M.

Risk-taking on tests sensitive to ventromedial prefrontal cortex dysfunction predicts early relapse in alcohol dependency: A pilot study

Journal of Neuropsychiatry and Clinical Neurosciences, 2005, vol./is. 17/3(417-420), 0895-0172 (2005)

Authors:Bowden-Jones H., McPhillips M., Rogers R., Hutton S., Joyce E.

Abstract:Twenty one patients in a residential rehabilitation program fulfilling International Classification of Diseases-10 (ICD) criteria for alcohol dependence syndrome were recruited. On neuropsychological tests, alcohol dependent patients relapsed early if they made choices governed by immediate gain irrespective of later outcome, which is consistent with dysfunctional ventromedial-prefrontal cortex mediating the inability to resist the impulse to drink.

Neural substrates of cue reactivity and craving in gambling disorder

Translational Psychiatry 7 (1):e992 January 2017

EH Linbrick-Oldfield,I Mick,RECocks, J McConigle,SP Sharman,AP Goldstone,PRA Stokes, A Waldman, D Erritzoe,H Bowden-Jones, D Nutt, A Lingford-Hughes, L Clark.

The benefits of using the UPPS model of impulsivity rather than the Big Five when assessing the relationship between personality and problem gambling

Natale Canale · Alessio Vieno · Henrietta Bowden-Jones · Joël Billieux

Addiction January 2017

Barriers to Treatment for Female Problem Gamblers: A UK Perspective
Anna Kaufman · Jessica D Jones Nielsen · Henrietta Bowden-Jones
Journal of Gambling Behaviour Dec 2016

Gambling disorder and suicidality within the UK: an analysis investigating mental health and gambling severity as risk factors to suicidality

Kathryn J. Roberts · Neil Smith · Henrietta Bowden-Jones · Survjit Cheeta

International Gambling Studies December 2016

Do High School Students in India Gamble? A Study of Problem Gambling and Its Correlates

Jaisoorya TS,Beena KV,Beena M,Ellangovan K, Thennarassuk K,Bowden-Jones H, Benegal V, George S.

Journal of Gambling Behavior · November 2016

Types of gambling and levels of harm: A UK study to assess severity of presentation in a treatment-seeking population

Silvia Ronzitti · Emiliano Soldini · Vittorio Lutri · Neil Smith, Massimo Clerici ,Henrietta Bowden-Jones
Journal of Behavioural Addictions Sept 2016

The experience of gambling problems in British professional footballers: a preliminary qualitative study

Lim MS, Bowden-Jones H,Salinas M,Price J, Goodwin G, Geddes JR, Rogers R.

Addiction Research and Theory August 2016



Dr Henrietta BOWDEN-JONES, Consultant Addiction Psychiatrist, National Problem Gambling Clinic, Central and North West London NHS Foundation Trust, London

Professor Colin DRUMMOND, Chair, Addictions Faculty, Royal College of
Psychiatrists and Professor of Addiction Psychiatry, King’s College London.

Professor Shane THOMAS, Professor of Primary Care Research, Monash University, Australia.


The Royal College of Psychiatrists’ Faculty of Addictions has been asked by the Department of Health in England to provide a rapid review of evidence-based treatment for gambling disorder in the UK to inform policy considerations on matters such as the future level of NHS involvement in the delivery of care for this disease, and the potential need for psychotropic medication for the hundreds of thousands of people affected by the illness.


The rates of Gambling disorder in the UK have been reported as ranging from between 0.5 to 0.9 per cent over the last decade (British Gambling Prevalence Survey 2007 and 2010 and Health Survey for England 2012).

This figure amounts to there being about 300,000 problem gamblers in the UK at any one time.

From the work conducted by GambleAware there is now evidence that of the 300,000 people gambling pathologically, 8,000 (2.7%) are in treatment at any one time, although this figure does not include any patients treated in the private sector. This compares to around six per cent of problem drinkers and 50 per cent of class A drug misusers in treatment in England (Public Health England, 2016).

Despite gambling disorder being recognised internationally as a mental disorder, it has not as yet become a core NHS mental health service responsibility. Problem gambling issues often present with both physical and psychiatric comorbidities, pointing to a need for the illness to be seen as both a physical and mental health issue, and also a social issue.


In England, gambling policy is overseen by the Department for Culture, Media and Sport rather than the Department of Health or Public Health England. At present there is little formal NHS involvement in the field of pathological gambling, either in apportioning funds or in overseeing treatment provision.

The primary role in determining national treatment provision rests with GambleAware (formerly known as The Responsible Gambling Trust). This is the charity set up by the gambling industry to apportion funds to treatment, research and prevention at national level, rather than this being the role of a government body, such as NHS England.

There are 19 treatment services in England and one national helpline providing interventions for the treatment of problem gamblers. The geographical distribution of services is informed neither by the prevalence rates of problem gambling, nor by a needs assessment to guide strategic commissioning. Access to services is therefore highly variable across England.

GamCare is the largest non-statutory treatment provider, with a London base and 17 partner agencies across the UK. Gordon Moody is the only residential treatment service for pathological gamblers.

The National Problem Gambling Clinic is currently the only designated NHS provider of treatment for gamblers, supported by both GambleAware and Central and North West London NHS Foundation Trust.

Data from all the treatment providers is collected by GambleAware. This information reflects not only the demographics of the treatment-seeking population but also the type of treatment they receive, as well as drop-out rates and non-attendance data.


Up until 2010 the evidence base for treatment of problem gambling at international level was outlined in the Australian National Health and Medical Research Council (NHMRC) guidelines developed by Monash University: Guideline for screening, Assessment and treatment in problem gambling, published in 2011. The principal author of these guidelines is Prof Shane Thomas. (See Appendix).

The process was scientifically rigorous and the results have informed clinical practice across the world, and continue to do so. There is not yet an equivalent publication for the period 2010 to 2016, but the most relevant studies have been included here. The Monash Guidelines are currently being updated to take into account any new research published since the original guidelines were published. The current guidelines based their recommendations on 34 randomised controlled trials reported in 37 articles.

There are currently no NICE guidelines for the treatment of pathological gambling which is why in the UK, as elsewhere, clinicians and services have been referring to the Monash Guidelines.

It is a widely held view amongst treatment providers and regulators in the problem gambling sphere that if NICE were to produce clinical guidelines on the diagnosis and management of gambling disorders, this would be beneficial for patients across the UK. It would also help to clarify the responsibility of the NHS for treatment provision.


The NHMRC Guidelines state that Cognitive Behavioural Therapy (CBT) was found to be more effective than no intervention, and that treatment either in individual or group delivery should be used to reduce problem-gambling behaviour, problem-gambling severity and distress caused by problem gambling. The CBT should be delivered ideally by CBT-trained professionals and the therapy ideally should be manual-guided.

There was insufficient evidence available at the time to determine whether CBT was superior to other psychological treatment modalities.

Motivational Interviewing and Motivational Enhancement Therapy were also found to be more effective than no treatment intervention in the reduction of gambling problems. Both of these treatment modalities should ideally be delivered by a trained clinician and a manualised structure should be used.

Practitioner-delivered treatment interventions were found to be more effective in reducing problem gambling symptoms than self-help groups.

Group psychological interventions could be used to reduce gambling behaviour and gambling severity in problem gamblers, although the evidence for this is currently limited.

The NHMRC guidelines suggested that studies are needed to assess whether there is evidence for inpatient treatment for gambling disorder. As no studies on this particular topic were included, the NHMRC guidelines could not make any recommendations.

A further area in need of research was linked to whether abstinence-based programmes are more effective than those without a total abstinence goal. However, as with alcohol dependence it is appropriate to continue to work with gamblers who are not currently committed to an abstinence goal rather than denying them access to treatment.

Naltrexone can be used to reduce gambling severity in problem gamblers. It should be prescribed by an experienced practitioner, with appropriate skills and training, and careful consideration must be given within the clinical encounter to contraindications.

Antidepressant medication should not be used to reduce gambling severity in people presenting with problem gambling alone. It is however appropriate to prescribe Selective Serotonin Re-uptake Inhibitors (SSRIs) in people with comorbid depression and gambling disorder, but there is no evidence that this improves gambling outcomes.


The Royal College of Psychiatrists recommends the following:

1. Randomised controlled trials assessing the impact of psychological therapies and medication should be conducted in the UK rather than allowing US-based studies alone to inform clinical practice. The experiences of gambling-related harm and the use of gambling-related products and treatment provision differ widely from country to country, so it would be preferable to base national recommendations on UK-based research.

2. Gambling disorder is a mental disorder that needs to be regarded as an addiction like any other, with significant levels of harm to the individual and to society. Treatment services for problem gambling should have parity of esteem with other mental disorders, in particular alcohol, drug and tobacco addiction, and should be a core element of addictions treatment provision within the NHS.

3. Naltrexone, as the treatment intervention of choice for treatment-resistant pathological gamblers, should be made available to all patients whose lives are affected negatively by their illness.

4. NICE Guidelines for the treatment of gambling disorder are required to address a pathology that affects almost half a million people in England but has not been sufficiently prioritised by the NHS.

5. Training in identifying and treating problem gambling symptoms should be a component of all medical school curricula and the postgraduate psychiatry training curriculum.

December 2016


British Gambling Prevalence Surveys 1997, 2000, 2007 Wardle H et al, NatCen Social Research for the Gambling Commission.

Health Survey for England 2012, Craig R, Mindell, J (eds) The Health and Social Care Information Centre, London.

Public Health England (2016) Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2015 to 31 March 2016. PHE, London

National Health and Medical Research Council (2011), Guidelines for Screening, Assessment and treatment in Problem Gambling. Australian Government publication, available at:


National Health and Medical Research Council (NHMRC) Guidelines

What is the ‘Guideline for Screening, Assessment and Treatment in Problem Gambling’?

This document is the first guideline to address problem gambling in Australia and provides recommendations to guide practice, patient and policy decisions for screening, assessment and treatment of problem gambling. The guideline summarises the research and the current state of knowledge, and has been based on the best available evidence up to March 2010. Several recommendations for practice were made, but only where there was sufficient high-quality evidence available.

What does the guideline recommend?
There are three categories of recommendation in the guideline: evidence-based, consensus-based, and practice points.

There are seven evidence-based recommendations in the guideline, all of which relate to treatment. Each recommendation is associated with a Grade, which indicates the level and quality of evidence upon which it is based. Each recommendation should be read in conjunction with practice points, which are available in the guideline.

For screening and assessment, in the absence of sufficient high-quality evidence, there are three consensus-based recommendations and three practice points.

An electronic version of the guideline (3.1mb) is available here. It can also be obtained from the NHMRC Clinical Practice Guidelines Portal.