Pathological gambling is serious problem, with significant psychological, financial, and public health consequences. Nevertheless, controlled trials examining the efficacy of therapeutic interventions for pathological gamblers are sparse, and many pathological gamblers recover on their own, or with only minimal interventions. In this initial study of a SMART design for pathological gamblers, we will offer a brief intervention to all (n = 100), and subsequently randomize individuals based upon their initial treatment response to varying intensities of additional care from none to 8 sessions of individual cognitive behavioral therapy (CBT) plus 14 weeks of Aftercare. Gambling outcomes will be assessed pre-treatment and at about weeks 10, 24, 36 and 52.

• Behavioral: Motivational Enhancement Therapy (MET)
• Behavioral: Cognitive-Behavioral Therapy (CBT)

• Experimental: Following 2 sessions of MET intervention received by all patients, patients in Condition 1 receive no further intervention.
• Experimental: Patients in Condition 2 will receive 8 sessions of the CBT (Cognitive Behavioral Therapy) intervention.
• Experimental: Patients in Condition 3 will receive 8 sessions of CBT plus aftercare treatment.

Inclusion Criteria:

• age > 18 years old, DSM-IV criteria for pathological gambling
• >2 gambling episodes in past 60 days
• spent >$100 wagering in the past 60 days
• willingness to accept random assignment after the brief intervention.

Exclusion Criteria:

• Reading level below 5th grade
• uncontrolled psychiatric conditions (e.g., active suicidal intention, psychosis, bipolar disorder)