A CASE STUDY OF COMPREHENSIVE TREATMENT ON GAMBLING DISORDER IN ADOLESCENTS: NOVEL CHALLENGES IN LOW MIDDLE INCOME COUNTRY

Abstract Background Gambling disorder is growing extensively in Indonesia, with the estimated prevalence in 2021 is around 1%. This figure is in line with the global prevalence, which is in the range of 0.1% to 5.8%. Recent years have seen a rise in the availability of gambling activities, particularly online gambling during the COVID- 19 pandemic and easily approved online loans. Furthermore, this issue became more complicated due to a lack of effective regulation and public awareness, impacting not just individuals but also families and society as a whole. There have been documented negative impacts of gambling disorder, such as damaged relationships, loss of employment, financial hardships, and a greater chance of mental health problems like anxiety and depression. However, treatment options and support services for people with gambling disorder are still limited in Indonesia. Adolescents with gambling disorders are particularly difficult to manage because they are still connected to their peers and find it difficult to cut back on technology use that encourages online gambling. Additionally, adolescents with immature prefrontral cortex also have poorer decision making skills and are more impulsive, thereby raising their risk of developing a gambling disorder. Aims The aim of the present study was to manage gambling disorder using a multi-modal approach including pharmacological and psychotherapy Case-description A 18-year-old male, was brought by his parents to an out-patient psychiatric clinic because his online gambling had gotten worse over the past five months. He also had premorbid antisocial personality disorder and tobacco use disorder, along with a family history of substance abuse that included his father and paternal grandmother. He had the background of progessively increasing engagement in online gambling for the past one year with consequent financial difficulties, school problems and relationship problems. His primary goal when playing online roulette, slots, and black jack was to win money, thus he could go out with friends. The patient took online loan and embezzled funds from the mosque savings, parents, uncle, and aunt. According to DSM-V, he was diagnosed with gambling disorder. He received cognitive behavioral therapy and motivational enhancement therapy at first. Subsequently, he was prescribed 50 mg of sertraline and 10 mg of clobazam for his mood irritability brought on by the limitations of his gadget, which he also attempted to manipulate his parents in order to gain access to the gadget. Additionally, contingency management was added to improve the course of treatment. Conclusion The management of gambling disorders should involve a thorough treatment plan that uses a multimodal approaches. The patient has responded well and promptly to the therapeutic approaches used. Specific tailor-made therapeutic approaches for each individual need to be developed.