Pathological Gambling, Comorbidities and Treatment Outcome: Is the Bronze Standard Good Enough? A Case Study Nady el-Guebaly Foothills Hospital Addiction Centre and University of Calgary, Calgary, Alberta The paper presents a case study of our attempt to design an outcome package for a program including pathological gamblers and their comorbidities. The clinical intri- cacies involved highlight the limitations of the clinical trial and the need for alter- nate designs aimed at assessing effectiveness. KEY WORDS: pathological gambling; treatment outcome; alternate designs. Mr. A, a 39 year old construction manager, was referred by his family physician to our Centre having incurred a debt of some $50,000 playing video lottery machines (VLT’s) reportedly 3–4 days a week. His wife of 11 years was seeking divorce, the couple had 3 young children. His gambling began about 5 years ago following a sports neck injury resulting in his switching his leisure activity from hockey to attending bars with friends and being introduced to the local gam- bling machines. Currently, playing the VLT’s had become a solitary activity and he tried to limit his gambling to $100 per sitting. He denied, during the initial assessment, any associated alcohol problem but reported symptoms meeting criteria for a Generalized Anxiety Disorder which he attributed to his worries about debts. His Please address correspondence to Dr. Nady el-Guebaly, Foothills Hospital Addiction Centre, 1403 – 29 Street NW, Calgary AB T2N 2T9, Canada. E-mail: nady.el-guebaly@calgaryhealthre- gion.ca, the critical contributions of Dr. David Hodgins in developing our program’s outcome monitoring is hereby gratefully acknowledged. Journal of Gambling Studies, Vol. 21, No. 1, Spring 2005 (Ó 2005) DOI: 10.1007/s10899-004-1922-x 43 1050-5350/05/0300-0043/0 Ó 2005 Springer Science+Business Media, Inc.