Vers une prise en charge intégrative des joueurs pathologiques

The purpose of this article is to provide an integrative model of treatment of this disorder based on the typology of pathological gamblers. Many studies have tried to understand this pathological behaviour by exploring motivational, psychological, biological and ecological correlates of gambling to explain the aetiology. An approach integrating various orientations, at the same time cognitive-behavioural, motivational, psychoanalytical and bodily-centred is the most relevant for this behavioural disorder. On the one hand, treatment should focus on the similarities displayed by the gambler. On the other hand, treatment should evaluate and focus on the specificities of each subtype of pathological gamblers. This last point refers to the question of the role played by the game for the gambler. All pathological gamblers present similar symptoms. Concerning those common points, professionals should evaluate and treat comorbidities, wrong perceptions/cognitions, motivation to change, gambling behaviour and social aspects of the gambling behaviour. Concerning the specificities, professionals should evaluate to which subtype or pathway the gambler corresponds, and then adapt the treatment. For example, for emotionally vulnerable problem gamblers gambling to escape painful emotional experiences and presenting alexithymia components, specific psychotherapeutic techniques improving affect identification and differentiation should be applied. Thus, add-on individual psychoanalytical oriented sessions and relaxation sessions should be included in the treatment.