Psychological Phenotypes in Glambling Disorder: A case study using the Pathway Model

Background: Twenty years ago Blaszczynski and Nower (2002) formulated an integrative model of problem gambling and postulated three distinct pathways that lead to problem gambling: the conditioned behavioral pathway (1), the emotionally vulnerable pathway (2) and the antisocial-impulsive pathways (3). These pathways or phenotypes would share common dimensions such as accessibility to gambling, but would present specific characteristics: sociodemographic, vulnerability and psychological processes involved in the development and maintenance of the disorder. In the model revision (Nower & Blasxczynski, 2022)  the authors empirically confirmed the three phenotypes of the original model using a sample of 1168 participants. Researchers interested in the model have focused on how the Pathway Model (PM) can be used to develop individualized treatment approaches for type of gambler (Bonnaire et Billieux, 2022, others). A case study is presented and the usefulness of PM to understand and treat gambling disorder is reviewed within the Behavioural Addictions Program of the Addiction Unit of the Psychiatry and Psychology Service of the Hospital Clínic of Barcelona, ​​Spain.
Clinical case: Male, 37 years old. He attended the Behavioural Addictions Program in October 2022 to treat a gambling problem (slot machines) that began 4 years earlier. The patient was linked to the program with a psychodiagnostic interview followed by individual follow-up visits. The patient met 6 of 9 DSM-5 diagnostic criteria for Gambling Disorder, with a diagnosis of: "Persistent Gambling Disorder, in early remission, of moderate severity." Following the PM, the patient is identified as pathway 1, with the onset of the problem in adulthood after having obtained a high income after the first gambling episode and where erroneous cognitive distortions and economic repercussions (debts) predominate. There is no premorbid psychopathological history of interest, there was no suicidal ideation or behaviour, there is no substance consumption, with good perceived physical and mental health, good psychosocial, socio-familial, socio-occupational and socio-economic adjustment. An individual psychotherapeutic intervention has been carried out with a motivational and cognitive-behavioural approach, taking into account the phenotype, vulnerability factors and identified psychological processes. The patient remains linked to the program and does not play slot machines during the entire follow-up (1 year), in sustained remission. The PM appears to be a useful treatment model to integrate the heterogeneity associated with gambling disorder.