In the last decade there has been an expansion in gaming activities, with more states allowing the building of new casinos and Internet gambling. This expansion coincides with an increase in the prevalence of pathological gambling either as a primary diagnosis or as a comorbidity with an existing psychiatric disorder.

The adult psychiatry training requirements of the American Board of Psychiatry and Neurology are designed to prepare all residents to be competent general psychiatrists, but many residency programs may not be exposing their residents to enough cases of pathological gambling to prepare them to treat patients with this disorder. Thus, I believe it is time for adult psychiatry programs to emphasize pathological gambling training and perhaps add it as a board requirement.