Gambling in Brazil: a call for an open debate.

AIMS: To provide an overview of gambling in Brazil, including historical background, past and current legislation, gamblers' profile, treatment and research initiatives.
METHODS: Review of the published literature and research reports.
RESULTS: Gambling is deeply rooted in Brazilian history and culture, but gambling regulation historically alternates between legalization and banning. Currently, only state lotteries, horse betting and poker-playing are allowed. There is pressure to widen the games repertoire, but efforts at full legalization and commercial exploration of gambling have receded. Despite the barriers to gambling access, Brazil has prevalence rates similar to other countries: 1.0 and 1.3% life-time prevalence for pathological and problem gambling. A faster progression from regular to problem gambling was found among middle-aged women in clinical samples and for adolescent male gamblers in a population-based sample. Youth gambling is associated with severe forms of gambling and other risk-taking behaviours. Treatment options are scarce, and the public health system is unprepared to support gambling patients. Ongoing incipient efforts are being made to establish a treatment model combining psychotherapy and psychiatric comorbidity treatment with promotion of quality of life.
CONCLUSION: Life-time incidence of pathological gambling in Brazil appears similar to many other countries, at approximately 1%. Arguably, there is a need to develop a more coherent regulatory and treatment response to this societal problem.