Relapse in disordered gambling: a systematic review from a biopsychosocial perspective

Background
Relapse is common among individuals undergoing treatment for gambling disorder (GD). Understanding the biological, psychological, and social (biopsychosocial (BPS)) factors that influence relapse in GD is important to guide clinical practice and improve treatment efficacy. However, evidence synthesis in this area is warranted to provide clarity and cohesion to the literature.

Method
A systematic review of empirical research (2015–2026) was conducted. Included studies focused on factors that either predicted relapse in GD, or those that offered protection against relapse. Findings were synthesized according to the BPS model (PROSPERO ID: CRD42024521445).

Results
Twenty-six studies were included in the review. Overall, studies lacked heterogeneity, with most conducted in Spain (n = 19) and deriving from the same participant groups (n = 14). Biological factors such as younger age were associated with higher rates of GD relapse. Psychological predictors encompassed alcohol/substance use, personality traits (higher harm avoidance and lower self-directedness), cognitive factors (cognitive distortions, low cognitive flexibility, impulsivity), and poor psychopathological state. Social factors such as marital status (being single, divorced, or separated), lower education levels, involvement in crime, and exposure to gambling advertising also contributed to relapse risk. Relatedly, familial support, engaging in meaningful activities, and attendance at self-help meetings were protective against relapse.

Conclusions
Overall, a broad range of BPS factors influence GD relapse. Despite the lack of heterogeneity in the included studies, these findings may contribute to better therapeutic understanding and practice. Expanding this research area is crucial for improving long-term recovery outcomes in GD.