Psych CASC / OSCE · Addiction psychiatry — behavioural addictions
Explain gambling disorder, CBT, and naltrexone — CASC communication station
MRCPsych/FRANZCP-style communication station: explain GD as a medical behavioural addiction, CBT and harm reduction first-line, realistic off-label naltrexone counselling, suicide-debt risk, and collaborative work with family without collusion or moralising.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry/addiction registrar. The examiner may play the patient and/or partner. [1]
Candidate instructions. Explain gambling disorder in plain language. Outline why CBT, motivational work, and financial safeguards are first-line. Discuss naltrexone honestly (off-label, not a magic injection cure). Assess suicide and alcohol risk sensitively. Negotiate a collaborative plan without shaming or colluding in either total control-by-partner or pure willpower myths. [2][3]
Candidate scenario
He meets severe GD criteria, has passive suicidal thoughts since the debt reveal, drinks more than he admits, and fixates on medication. Partner is angry and frightened about further losses. [1]
Marking domains
- Empathy, structure, non-stigmatising language
- Accurate plain-language model of GD as behavioural addiction
- CBT and harm-reduction explanation (self-exclusion, bank tools)
- Honest naltrexone evidence and monitoring caveats
- Suicide/debt and alcohol risk enquiry
- Partner involvement without coercive control collusion
- Teach-back and agreed next steps [2][3][4]
Reveal assessor key
Open. Name role/time; ask patient and partner top concerns (control of money, shame, craving for a medical fix). [1]
Explain GD. “This is a recognised brain-and-behaviour condition where betting takes priority despite harm — not simple greed. Your brain’s reward and habit systems get locked into chase cycles.” Avoid moral lecture.[1]
Explain first-line care. “The treatments with the best evidence start with structured psychological therapy — CBT — that targets the thoughts that drive chasing, builds urge skills, and pairs with practical money safeguards and self-exclusion. Mutual-help groups can support that work.” [2][4]
Naltrexone. “Some people with strong urges benefit from naltrexone tablets studied in trials, but it is off-label for gambling, needs liver blood tests, is not a guaranteed cure, and works best with therapy — there is no single injection that permanently deletes betting desire for everyone.” Correct magical XR expectations; oral off-label framing is enough at lay level.[3]
Risk. Gently explore suicidal thoughts, safety, alcohol quantity, and crisis contacts. Validate partner fear; propose agreed financial controls that preserve dignity and safety rather than punitive total takeover without consent where avoidable.[1]
Close. Summarise plan: safety, CBT referral, self-exclusion/bank blocks, LFT if medication pathway pursued, alcohol review, early follow-up, teach-back. [1][2]
References
- [1]Potenza MN, et al. Gambling disorder Nat Rev Dis Primers, 2019.PMID 31346179
- [2]Petry NM, et al. Cognitive-behavioral therapy for pathological gamblers J Consult Clin Psychol, 2006.PMID 16822112
- [3]Grant JE, Kim SW, Hartman BK A double-blind, placebo-controlled study of the opiate antagonist naltrexone in the treatment of pathological gambling urges J Clin Psychiatry, 2008.PMID 18384246
- [4]Cowlishaw S, et al. Psychological therapies for pathological and problem gambling Cochrane Database Syst Rev, 2012.PMID 23152266