Most gambling addicts that arrive in treatment programs are eventually diagnosed with another underlying mental health problem, or comorbidity. Gambling addiction rarely develops alone.
A new partnership between Kindbridge Behavioral Health and Axis Integrated Mental Health is addressing all facets of the problem simultaneously, for the first time using FDA-cleared deep TMS non-invasive magnet therapy and esketamine, an FDA-approved nasal spray drug used for depression in patients being treated initially with gambling disorder.
In a state that ranks 41st for prevalence of mental illness, Colorado is providing the proving ground of the new joint approach.
“People come to their mental health journeys in a lot of different ways,” said Axis Chief Growth Officer Liesl Leary-Perez, who founded the Colorado-based clinic with her husband six years ago. “A lot of times we won’t know someone has a gambling addiction, because they don’t think they have an addiction. It’s not like heroin, or alcohol. There’s not really immediate side effects or a smell on the breath, or they’re not missing work right away.
“It’s a very insidious kind of disease. We have patients we have seen for years and all of a sudden they’re like, ‘Oh, I might not be able to see you next month because I may not be able to afford the appointment.’ And it turns out that they’re going to go [gamble] so they can win some money back so they can make ends meet a little bit more. And it still doesn’t occur to them that their depression and anxiety is part of that.”
From Kindbridge’s 2024 treatment outcomes data:
- 70% of individuals entering gambling disorder treatment reported a prior diagnosed mental health condition, most commonly depression, anxiety, ADHD, or trauma-related disorders.
- At intake, 47% met criteria for major depression and suicidality.
- 42% met criteria for inattention/hyperactivity/impulsivity.
- 40% met criteria for generalized anxiety disorder.
Kindbridge reported major improvements in mental health measures when treatment focused on both the gambling and co-occurring conditions:
- Depression scores decreased 65.2% over 12 weeks
- Anxiety (GAD-7) scores decreased 76.5%
How the Kindbridge-Axis partnership works
Patients can seek the deep TMS and esketamine treatments either after a consultation with Kindbridge counselors or contacting them directly. Axis also refers patients back to Kindbridge if it becomes clear after an initial hour-long assessment that they would be better served starting with therapy.
“Some people really need some medical intervention before they can get into therapy and have therapy be effective,” Leary-Perez said. “I think the longest amount of time it takes for us to talk to a patient is really about the cost. The first thing someone asks me isn’t if it’s effective, isn’t if it’s safe. The first thing people want to know is ‘can I afford this?’
“And when we’re talking about gambling addiction, that becomes even more important.”
The two-hour treatment sessions for the spray and much shorter sessions for deep TMS are often covered by insurance with as little as a $10 co-pay.
“We have all of the safety protocols and you can only get it in-clinic,” Leary-Perez said. “You cannot get this delivered to your house. You cannot pick it up at Walgreen’s. It’s a very tightly controlled process, which is why there’s not that many interventional psychiatry practices that do it.”
Deep TMS patients require more, but quicker, visits.
“We have the latest-generation technology. It has an 82 percent efficacy rate and 65 percent remission rate from depression,” Leary-Perez said. “The first four weeks, it’s five days a week for about 20 minutes a day. You can drive afterwards. No big deal. You put a helmet on, we have mapping to figure out what frequency we need to put you on. It’s very customized to the patient’s brain. They do that for four weeks, and then after that it’s twice a week for eight weeks. So 12 weeks all together, but only four weeks that are intense.”
Addressing a need in Colorado
Around 70% that seek help for gambling for the first time have previously engaged with a clinician for another mental health-related issue.
Depression is the most common comorbidity, but research has shown that patients with ADHD are two to three times more likely to develop gambling addiction.
“When we go through the diagnostics and start crafting care plans, it is really evident that there’s a lot of mental health issues that are co-occurring alongside of the gambling-related harms issue,” said Daniel Umfleet, Kindbridge’s founder and chief executive officer.
Those seeking help — they can contact Kindbridge by text message or online chat — are immediately directed to an initial screening call before being connected with a clinician for “a deeper dive,” Umfleet said. Counseling is virtual at Kindbridge, but those deemed in need of a greater level of care are referred to in-person counseling and remedies.
“So Axis fills the gap,” he said. “Spravato [the brand name of esketamine] and TMS are really showing a lot of strong evidence time and time again in clinical research, and having a massive impact on major depressive disorder.”
In some cases, he said, they take effect within 24 hours.
Untangling issues, formulating treatment
More than 50% of Kindbridge patients with gambling-related health issues present with major depressive disorders as the top co-morbidity. Sometimes, Umfleet said, progress is possible in virtual outpatient settings, usually in nine to 12 sessions.
“It’s preferential for the care provider and the individual to make a decision on what it is that they want to do,” Umfleet said, “but Spravato has got a lot of strong clinical evidence that within a week, you’re really starting to see a downward trend in major depressive disorder. And TMS is following the same sort of pathway in there.”
Umfleet said knowing which disorder to treat first is not a linear process. Each patient differs, he said, but the initial goal is to help a patient prioritize their health.
“It’s not an easy thing to do. A lot of times gamblers present because somebody made them come in,” he said. “When a person comes in who is there because there’s a gambling-related health issue, a lot of times, and I would say the majority of times in the beginning, those folks are not prioritizing their health in any way, shape, or form.
“So it’s very typical, and this is why it’s really important that we continue to build systems that are no-cost solutions for individuals to get into care, because even if you have a deductible on your plan, or if you have a co-pay on your health insurance plan, and your co-pay is $25, at that particular point in time, they’re prioritizing that $25 to go spend it somewhere else. So the first hurdle is getting them in the mindset of we need to prioritize your own health.”
