Guidance Document for the
Implementation of Problem Gambling
Treatment Services
January
2024
www.oasas.ny.gov
Guidance Document for the Implementation of Problem
Gambling Treatment Services
I. Introduction
OASAS is issuing this resource guidance document which intends to support OASAS certified
treatment providers who have a gambling designation on their operating certificate to provide
problem gambling treatment services as both an individual and co-occurring disorder. Additional
Resources and applicable links can be found on page 6.
II. Background and Intent
Data and research indicate that there are many New York State residents that are currently at
risk for or are affected by a gambling disorder both as a primary issue and as a co-occurring
disorder that are not currently receiving services. In addition, there are family, friends and
communities who are also affected who are not seeking assistance.
In May 2019, OASAS announced expanded opportunities for all certified treatment providers to
provide problem gambling treatment at all levels of care. OASAS issued an adopted Part 857
Regulation, LOCADTR for Gambling, Billing Guidance and a Local Services Bulletin for a
Gambling Free Environment to assist providers who have an interest in providing problem
gambling services.
Any OASAS certified treatment provider can apply for a problem gambling designation on their
operating certificate. Designated providers are subject to all regulations applicable to their
operating certificate in addition to Part 857 Problem Gambling Treatment and Recovery
Services regulations. If terms of such regulation conflict with corresponding terms of the
approved designation plan related to the provision of gambling-only services, the terms of the
designation plan and the provisions of this Part applicable to gambling-only services shall
govern. OASAS certified programs may not provide problem gambling treatment services as a
primary or secondary issue nor bill for this service without a gambling designation on their
operating certificate issued by OASAS.
Billing for Problem Gambling Outpatient Services
The Part 857 Problem Gambling Treatment and Recovery Services regulation allows for
provisions to admit without a full Gambling Disorder diagnosis as outlined in the Diagnostic
Statistical Manual -V -TR (DSM V-TR ). People who meet the full DSM-V-TR criteria for a
gambling disorder should be diagnosed with F63.0.This should be on the first position of the
claim. If they do not meet the criteria for gambling disorder and the focus of treatment is for
difficulty experienced due to gambling, the diagnosis should be a mental health diagnosis that
reflects the distress with Z72.6, Gambling and Betting, in the second or subsequence place on
the claim.
Effective January 1, 2023, New York State (NYS) Medicaid fee-for-service (FFS) and
Medicaid Managed Care (MMC) Plans will begin covering Gambling Disorder treatment
provided to individuals admitted for and receiving gambling only services from those
Office of Addiction Services and Supports (OASAS) certified outpatient, inpatient and Part
820 stabilization and or rehabilitation programs 2that are have the OASAS Gambling
Designation. For further information please refer to the Ambulatory Patient Group (APG)
Manual Policy and Medicaid Billing Guidance.
III. Resources for Person Centered Care
Promoting person centered care is an important component in providing any type of treatment
service. OASAS has issued a guidance document for Person Centered Care that include
principles and practices for all treatment providers.
Problem Gambling treatment interventions should minimize the harmful consequences of
gambling, avoid or reduce the risks associated with gambling behaviors, assist in coping with
negative mental status including but not limited to suicidal ideation, anxiety, depression, and
stress by adapting positive coping strategies and skills and understanding the cognitive-
behavioral processing that happens when one gambles. Guiding principles in providing problem
gambling treatment should always include services that are readily available to the individual,
that include a culturally relevant assessment and treatment plan that is developed with the client
and continually re-evaluated based on the client’s identified needs. The treatment of co-
occurring disorders should be integrated into the services provided.
Treatment Models:
A review of literature suggests Cognitive-Motivational Behavioral Therapy (CMBT) as a positive
approach to treatment and has been supported through several clinical trials funded by the
National Institute of Mental Health. Cognitive Behavioral therapy is intended to change the
thoughts and behaviors that are intrinsic to maintaining a behavior. The goal is to identify and
change the gambler’s cognitive distortions and errors that are associated with excessive
gambling behaviors. 1,2,3,4,5 It also includes developing problem-solving skills, social skills and
relapse prevention strategies. However, it is important to develop clinical interventions which
are based on a comprehensive person-centered assessment and treatment plan that may
include but not limited to a spectrum of care including self-help, psycho-education, individual,
couples and family therapy, medication assisted treatment and relapse prevention.
There is some empirical research6,7 that demonstrates utilizing the Community Reinforcement
and Family Training (CRAFT), a comprehensive treatment program for concerned significant
others of substance abusers. This model has shown to be effective with CSO’s of those with
gambling problems. The CRAFT is successful at reducing the CSO distress and capitalizes on
the well-documented fact that family members have considerable influence on the person who
is addicted decision to enter treatment.
Pharmacological Approaches
While understanding the biological underpinnings for a Gambling Disorder is in its infancy, there
are some studies that have looked at the neurobiology of a Gambling Disorder that indicate the
specific roles for neurochemicals such as norepinephrine (arousal and excitement), serotonin
(behavioral initiation and impulse control) dopamine (regarding and reinforcing behaviors) and
opioids (pleasure and urges)8,9
There are currently no FDA approved medications for treatment of Gambling Disorder.
However, there is some preliminary research that supports utilizing opioid receptor antagonists
(specifically Naltrexone and Nalmefene) in the treatment of gambling disorder.8,9,10
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Screening
The first step in identifying a person who may have a gambling disorder, is to conduct a
preliminary screening to identify if an individual should receive a more comprehensive
assessment as it relates to their gambling behaviors. Utilizing a brief screen is required for all
OASAS certified Part 822 clinics and recommend for all other OASAS treatment providers that
serve clients who present with a SUD, co-occurring disorder, and other mental disorders such
as (mood disorders, anxiety disorders, posttraumatic stress disorder, attention deficit
hyperactivity disorders)
Not all those who seek support will screen positive. If they do gamble recreationally, they may be a
low risk gambler who can benefit from reducing their risks of harm when they do gamble. Lower
risk gambling guidelines and support can be beneficial in preventing someone from increasing their
risk of harm and from using gambling as a replacement from substance use.
Assessment
The first step as you begin an assessment is to listen carefully to what the person is saying
and to skillfully work with the person to a mutual understanding of the problem the person has
presented, the outcome that is desired and some initial steps to begin developing the roadmap
to those outcomes. A person-centered assessment focuses on what the person is saying and
their framing of the problems surrounding their gambling and potential solutions. The counselor
is active in guiding, reframing, raising discrepancies, offering compassion and hope by taking
what the person is saying and translating that to a plan of action that the person recognizes as
their own.
A comprehensive assessment for a gambling disorder should address the following
components:
1. Presenting problem and history
2. Current gambling use and history of use
3. Diagnostic Impressions
4. Current and past medical history and symptoms
5. Substance abuse and mental health screening, past and current symptoms,
6. Suicide assessment including ideations, attempts and contracting if applicable
7. Legal
8. Employment
9. Family/Social
10. Housing
11. Financial
12. Client strengths
Assessment Considerations
Suicide
Because of the hidden nature of a gambling addiction, many people suffer from an elevated risk
of suicidal thoughts and attempts.11,12,13 It is imperative that the clinical work with those affected
by problem gambling include ongoing suicide risk screening using the Columbia-Suicide
Severity Rating Scale (C-SSRS) and evidence-based Suicide Safer Care protocol that
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implements appropriate clinical follow up based on the level of risk. The prevention of suicide
involves screening, assessment, intervention, treatment and monitoring for at-risk individuals.
The Columbia Protocol, also known as the C-SSRS screening version can be completed
licensed clinician trained to use the C-SSRS assessment tool and working within his/her scope
of practice. Implement Suicide Safer Care Protocol as indicated by assessment. (See page 6 for
Additional Resources)
Financial
Financial issues are often a primary concern when someone seeks help. When gambling
behaviors become uncontrollable, a person with a gambling problem will often spend more and
more money in an attempt to win back their losses, believing “one more” big win will solve all
their challenges. Significant financial consequences can occur that may include overdue bills,
not providing for basic needs including food, shelter and clothing, credit cards maxed out and/or
poor credit, relying on others for financial bailouts, selling personal and household items and/or
stealing money.
Because of the financial destruction that a gambling problem often causes, an important
component of the treatment process includes treatment planning around addressing financial
issues. This may include addressing skills around managing money, limiting access to money,
dealing with creditors and/or loan sharks/bookies, developing a debt repayment plan and
limiting access to opening credit cards or other ways to access money to gamble with.
Clinicians should be comfortable in dealing with financial strategies and issues throughout the
course of treatment and have community linkages to assist the client that may include credit
counseling services and Gamblers Anonymous Pressure Relief Groups.
Diagnosis
As outlined in the DSM V-TR, Gambling Disorder can be viewed on a spectrum of severity and
varies depending on the client’s history and cultural influences. Early intervention with those
who have mild symptoms is important from a prevention perspective and therefore it is OASAS’
policy that clients do not need a full diagnosis for a Gambling Disorder to be admitted to
treatment. If a patient does not meet the full criteria for a Gambling Disorder, they may be
admitted with a primary mental health diagnosis that reflects the distress.
Providers should access the LOCADTR for Gambling by logging into LOCADTR 3.0 and clicking
on the gambling module. Providers DO NOT need a separate log in to access the LOCADTR for
Gambling.
Treatment Planning
Treatment planning begins at the first conversation with an individual about their gambling
concerns. It is important to support an individual’s personal motivation to seek treatment and
assure treatment planning remains non-judgmental and free from bias. Using a person’s own
words in identifying what elements of their gambling they find problematic, and prioritization of
their main goals helps to align the treatment plan to the person. Harm Reduction strategies
should be considered if that is a client centered goal.
With the consent of the individual engaged in care, families and significant others are
encouraged to engage in treatment to support the individual and receive support for their own
recovery. This can be done through family treatment sessions where the family can learn skills
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to support their loved one while establishing an open line of therapeutic communication.
Sample forms including comprehensive evaluations, treatment planning, progress notes,
discharge planning, consent forms, can be found below.
IV.Additional Resources
OASAS Certified Provider Information
Application for Gambling Designation on OASAS Operating Certificate
https://www.oasas.ny.gov/system/files/documents/2019/09/PPD-17.pdf
Problem Gambling Treatment and Recovery Services Regulation
https://www.oasas.ny.gov/system/files/documents/2019/05/Part857.pdf
Level of Care for Alcohol and Drug Treatment Referral for Gambling
https://www.oasas.ny.gov/system/files/documents/2019/10/LOCADTRManualGD_FINAL9Apr2019.pd
f
Ambulatory Patient Group (APG) Manual Policy and Medicaid Billing Guidance
https://oasas.ny.gov/system/files/documents/2023/12/apg-manual.pdf
Problem Gambling Medicaid Billing guidance
OASAS Local Services Bulletin Gambling Free Environment
https://www.oasas.ny.gov/legal/gambling-free-services
Person Centered Care Guidance Document for OASAS Certified Providers
https://oasas.ny.gov/person-centered-care
OASAS approved screening and assessment tools:
https://oasas.ny.gov/system/files/documents/2022/09/approved-gambling-screening-and-
assessment-tools.pdf
Lower Risk Gambling tool https://gamblingguidelines.ca/
Sample treatment forms TAG forms
https://www.oasas.ny.gov/search/provider_forms_?f%5B0%5D=filter_term%3A461 (then use the
refine with “gambling” as key search word)
Abstinence Recovery Plan
https://portal.ct.gov/-/media/DMHAS/PGS/Abstinence-Plan-Template.pdf
Harm Reduction Recovery Plan
https://portal.ct.gov/-/media/DMHAS/PGS/Harm-Reduction-Template.pdf
Suicide Prevention Resources
The Columbia Lighthouse Project: This online resource includes information on The Columbia-
Suicide Severity Rating Scale (C-SSRS), the most evidence-supported tool of its kind, is a
simple series of questions that anyone can use anywhere in the world to prevent suicide.
http://cssrs.columbia.edu/
Suicide Prevention Resource Center: The Suicide Prevention Resource Center (SPRC) is the
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only federally supported resource center devoted to advancing the implementation of the
National Strategy for Suicide Prevention. SPRC is funded by the U.S. Department of Health and
Human Services' Substance Abuse and Mental Health Services Administration. It includes
resources for clinicians that include a patient safety plan template.
http://www.sprc.org/
Zero Suicide: The Zero Suicide framework is a system-wide, organizational commitment to safer
suicide care in health and behavioral health care systems. https://zerosuicide.sprc.org/
Suicide Prevention Center of New York: SPCNY is an education and resource organization that
provides resources and training on suicide prevention. https://www.preventsuicideny.org/
Anyone who works for an OASAS-certified program is eligible to the Center for Practice
Innovations Learning Community which includes free trainings on suicide safer care.
https://practiceinnovations.org/Learning-Community-Login
Problem Gambling Financial Resources
Problem Gamblers Finances-A guide for Treatment Professionals:
https://ipgap.indiana.edu/documents/problem-gambling-toolkit.pdf
Personal Financial Strategies for Loved Ones:
https://www.mdproblemgambling.com/wp-
content/uploads/2023/01/loved_ones_guide_ncpg_booklet.pdf
Recovery Support
Smart Recovery
SMART Recovery is the leading, evidence-informed approach to overcoming addictive behaviors
and leading a balanced life. SMART is stigma-free and emphasizes self-empowerment.
https://smartrecovery.org/
Gambler’s Anonymous (GA)
GA is a twelve- step fellowship for those who have a gambling problem. For more information,
contact the local GA meetings in your area visit http://www.gamblersanonymous.org/ga/. Some
GA meetings offer Pressure Relief sessions where financial and legal issues are addressed and
strategies are developed.
Gam-Anon
Gam-Anon is a twelve- step fellowship for those who have been affected by someone’s
gambling behaviors. https://www.gam-anon.org/
Supervision
Clinical supervision is extremely important for practitioners at all levels. Those providing
problem gambling treatment should be receiving clinical supervision on an ongoing basis to
assist in providing the best care to patients as well as providing opportunities for professional
growth. In addition to the clinical supervision provided in your clinic, free monthly group clinical
supervision is provided to those practicing in NYS. For more information and to register, please
visit: www.nyproblemgambling.org/training/counselors/free-clinical-supervision/
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Credentialing Information
OASAS issues several problem gambling credentials including the CASAC-G, CPP-G and CPS-
G. For more information on the credentials, please visit,
https://oasas.ny.gov/credentialing/gambling-specialty-designation-gsd
The International Gambling Counseling Certification Board issues a problem gambling
credentials that are recognized by OASAS as a Qualified Problem Gambling Professional..
Information can be found at https://www.igccb.org/
Provider Training
There are many opportunities to receive initial and advanced training for problem gambling
through the New York Council on Problem Gambling http://nyproblemgambling.org/training/
Education Tools
OASAS Problem Gambling Website: https://www.oasas.ny.gov/talk2prevent/problem-gambling
Know the Odds: Several educational resources, including eBooks, interactive infographics,
PSAs and blog posts that can provide anyone with educational information and support related
to problem gambling. http://nyproblemgambling.org/resources/knowtheodds/
Your First Step to Change: This workbook allows a person to work at their own pace and gain
knowledge and education about their gambling behaviors.
https://www.divisiononaddiction.org/outreach-resources/your-first-step-to-change/
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References
1Increasing the Odds, A series dedicated to Understanding Gambling Disorders, National Center for Responsible
Gambling, Volume 7, What Clinicians Need to Know about Gambling Disorders
2Mayumi Okuda, M.D., Iván Balán, Ph.D., Nancy M. Petry, Ph.D., Maria Oquendo, M.D., and Carlos Blanco,
M.D., Ph.D.(2009) Cognitive Behavioral Therapy for Pathological Gambling: Cultural Considerations. The
American Journal of Psychiatry, 166 (12) 1325-1330
3. Petry NM, Ammerman Y, Bohl J, Doersch A, Gay H, Kadden R, Molina C, Steinberg K. Cognitive-behavioral
therapy for pathological gamblers. J Consult Clin Psychol. 2006;74:555–567. [PubMed
4. Gooding, P., & Tarrier, N. (2009). A systematic review and meta-analysis of cognitive-behavioural interventions
to reduce problem gambling: Hedging our bets? Behaviour Research and Therapy, 47(7), 592–607.
5. Hodgins, D., & Petry, N. (2004). Cognitive and behavioral treatments. In J. E. Grant & M. N. Potenza (Eds.),
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6.Makarchuk, K.. Hodgins, D. C.. Peden, N.. ( 2002). Development of a brief intervention for concerned significant
others of problem gamblers. Addictive Disorders & Their Treatment, 1, 126–134
7.Hodgins, D. C.. Toneatto, T.. Makarchuk, K.. Skinner, W.. Vincent, S.. ( 2007). Minimal treatment approaches for
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8 D Grant J. E., Potenza M. N., Hollander E., Cunningham-Williams R. M., Numinen T., Smits G., et al. (2006).
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Psychiatry 163, 303–312 10.1176/appi.ajp.163.2.303
9 Potenza M. N. (2013). Neurobiology of gambling behaviors. Curr. Opin. Neurobiol. 23, 660–667
10.1016/j.conb.2013.03.004
10 . Potenza M. N., Walderhaug E., Henry S., Gallezot J. D., Planeta-Wilson B., Ropchan J., et al. (2013). Serotonin
1B receptor imaging in pathological gambling. World J. Biol. Psychiatry 14, 139–145
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11 . A Battersby, M., Tolchard, B, Scurrah, M., Thomas, L. – “Suicide Ideation and Behavior in People with
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12 . Wong, P. W., Chan, W. S., Conwell, Y., Conner, K. R., & Yip, P. S. (2010). A psychological autopsy study of
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13 Hodgins, D., Mansley, C., & Thygesen, K. (2006). Risk factors for suicide ideation and attempts among
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