It is now evident that the disturbance gives gioco d’azzardo both a real public health problem both with regard to the international and Italian context. The main causes of this phenomenon are the continuous and rapid growth of game possibilities on the territory and the increase in the use of forms of gioco d’azzardo online.

Recently with the entry of the pathology of Gambling Disorder (ADI) within the Essential Levels of Assistance (LEA) the question of a standardization of care to be addressed to people with the disorder.

Currently, one of the most known and used models that allows to differentiate the treatment pathways based on the evaluation of the path towards the development of addiction is the famous "Pathway Model”By Blaszczynski and Nower. According to this perspective, the path to disturbance can develop in 3 ways:

• individuals who starting with a social gaming activity and subsequently turn over time towards the development of the problem, net of pre-existing psychological problems;
• defined individuals psychologically vulnerable, who use the game as a means to feel relief from personal and relationship issues;
• individuals who show a real propensity to impulsiveness and risk from his youth, to the point that gambling is only one of the activities in which this propensity acts.
  
  These 3 pathways group, in three specific categories, the path towards the disturbance of individuals, placing in the hands of the clinician the possibility of developing a care project consistent with the path subtype.

Here are some thoughts on this:

• The model is a useful simplification, the validity of which is confirmed by a series of studies;
• The model recognizes a category of players not characterized by previous affective, emotional and psychological problems, which for the sole repeated contact with the devices and game activities, tend to develop all those psychological, cognitive and emotional mechanisms typical of the players, including in particular, erroneous beliefs about chance and probability ed illusion of control of gambling.
• The other two categories concern players who gamble for regulate one's own experiences and emotional state, characterized by previous problems.
  
  

The result of these considerations is that the clinician has indications to effectively treat gamblers guaranteeing care paths that adhere to the personal paths of individual players while to the rest of the population, and in particular to those who decide how to manage and regulate this sector, it will be clear that the continuous production of gambling possibilities favors the risk of developing addiction both to individuals who are already vulnerable and to those not yet vulnerable.

Daniel Manasseh 

BIBLIOGRAPHY 

• Casciani O. and De Luca O. (edited by), 2018, "The psychological and psychotherapeutic treatment of gambling disorder in a multidisciplinary perspective", Edizioni Publiedit, Cuneo;
• Blaszczynski A., Nower L., 2002, "A pathways model of problem and pathological gambling", in Addiction, pp. 487-499.

* Notes on the author:
Daniele Manasse is a Psychologist, Psychotherapist specialized in Post-Rationalist Cognitive Psychotherapy.
He deals with individual psychotherapy, intervening with psychotherapy in all those situations in which discomfort and malaise manifest themselves in the form of symptoms or existential problems; deals with research and training on the issues of new addictions and in particular of gambling disorder. Within Psy + Onlus he is the coordinator of the Gambling Area, coordinates and participates in the therapeutic group of pathological gamblers and their families.