Evidence based medicine developed to link clinical practice and policy decisions to evidence, so that effective treatments are maximized and ineffective treatments minimized. The objective was to evaluate current status of problem gambling treatment evidence base. The method was literature review of problem gambling treatment articles published from 2003 through 2006. The evidence base for gambling treatment remains limited. No treatment, either psychosocial or pharmacologic fulfills the current standards for efficacy. Articles published in this time period provide more support for the efficacy and effectiveness of cognitive behavioral treatment and use of opioid antagonists. The current evidence base is not sufficient to support the goal of community evidence based treatment. Three types of studies are needed: replication studies of the possibly efficacious treatments by independent investigators, effectiveness studies of the possibly efficacious treatments with community populations and clinicians, and outcome studies of community treatment programs to serve as benchmarks.