Problem Gambling Handbook June 2015

7/23/2019 Problem Gambling Handbook June 2015

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National Certifed Gambling Counselor (NCGC -I)

Dr. Matthew Bruhin will be the instructor for this course. Dr. Matthew J. Bruhin is President of

Matthew Bruhin & Associates, a boutique mental health and addiction treatment practice. He is

also Eecuti!e Director of APE" #eco!er$, a cuttin% ed%e, holistic, and inte%rati!e residentcial

substance abuse treatment pro%ram.

Dr. Bruhin is passionate about his wor with addiction and famil$ therap$. Dr. Bruhin is a 'tate

of (alifornia Board of Beha!ioral 'ciences, )icensed Marria%e and *amil$ +herapist and an

Addiction 'pecialist, re%istered and certified b$ both the Breinin% nstitute and the American

Academ$ of Health (are Pro!iders. Dr. Bruhin earned his Doctorate in Addiction Ps$cholo%$

and also earned his MA'+E#' DE-#EE (ounselin% Ps$cholo%$ and holds a Bachelors

de%ree in Ps$cholo%$, with a Minor in Addicti!e Disorders.

-amblin% addiction, also nown as compulsi!e %amblin%, is a t$pe of impulse control/disorder.

(ompulsi!e %amblers can0t control the impulse to %amble, e!en when the$ now that the%amblin% is hurtin% themsel!es or their lo!ed ones. -amblin% is all the$ can thin about and all

the$ want to do, no matter the consequences.

(ompulsi!e %amblers eep %amblin% whether the$0re up or down, broe or flush, happ$ or

depressed. E!en when the$ now the odds are a%ainst them, e!en when the$ can0t afford to lose,

people with a %amblin% addiction can0t 1sta$ off the bet.2

-amblers can ha!e a problem, howe!er, without bein% totall$ out of control. Problem %amblin%

is an$ %amblin% beha!ior that disrupts $our life. f $ou0re preoccupied with %amblin%, spendin%

more and more time and mone$ on it, chasin% losses, or %amblin% despite serious consequences,

$ou ha!e a %amblin% problem.


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(ourse (ontent

3 )earnin% How to Asses (lients for Problem -amblin%

A. )earnin% how to en%a%e and build a collaborati!e relationship for future

session

B. Pro4ectin% to clients that %amblin% is 1learned beha!ior2

(. nstillin% hope & moti!ation that chan%e is possible

D. (ompletin% assessment for problem %ablin%

E. (reatin% clients treatment plan

*. (reatin% & En%a%in% clients into homewor

3 +eachin% (lient0s (onsequences Associated with -amblin%

A. Assessin% etent of dama%e caused b$ beha!ior

B. 5orin% to maintain client throu%h treatment

(. Moti!atin% client to wor towards reco!er$

D. mportance of re!iewin% past wee e!ents

3 dentif$in% (o%niti!e Distortions

A. How to identif$ & correct co%niti!e distortions about %amblin%

6. 1e%ati!e #ate of #eturn2

7. +he 1ndependence of E!ents2 phenomenon

8. 1llusions of (ontrol2

9. 'uperstitions

:. (hasin% )osses

;.


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3 Dealin% with =r%es & +ri%%ers

A. How to identif$ techniques to deal with ur%es to %amble

B. How to identif$ techniques to deal with tri%%ers to %amble

3 (opin% with 'tress in #eco!er$

A. )earnin% to identif$ life stressors

B. +eachin% wa$s to deal with stressors

6. A!oidin% A!oidance

7. 5a$s to (ope

8. Buildin% Positi!e Acti!ities

3 Dealin% with 'lip/ups & #elapse

A. Main% relapse plan for mana%in% relapse

B. )earnin% difference between slip & relapse

(. )earn about barriers to continuin% success

3 )earnin% about -A & How it (an Help

A. 5hat is the difference between AA & -A>

B. How can a counselor use -A with treatment>

3 5orin% with *amilies of Problem -amblers

A. How to handle families in treatment?

B. 5a$s families can help process

(. ssues that counselors can run into with families and how to cope

D. How to help famil$ sessions sta$ producti!e


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Problem -amblin% 'tudent Handboo

The first purpose of this student handbook is to provide you with an

easy reference to the primary concepts regarding Problem Gambling, the

diverse yet complimentary theories of how and why Problem Gambling

develops, and the various treatment approaches for individuals, the family,

and the community at large.

The second purpose of this handbook is to stimulate your interest for

further reading, research and understanding. We will pose challenging

questions that require serious thought, and not all questions have definite

answers.

We are going to discuss the concepts, techniques and methodologies

that are of significant value to the individual and family seeking recovery

from problem gambling and to those professionals and peer counselors and

coaches who wish to help facilitate the recovery process.

Academic Addiction is dedicated to accuracy and reliability of

information. We endeavor to avoid completely any hints of fear

mongering, e!aggeration of conditions, or e!ploitation of social issues to

advance any agenda other than to provide superior training by continually

striving to be the standard of e!cellence. " #url #arer


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ntroductionProblem gambling is characterized by difficulties in limiting

money and/or time spent on gambling which leads to adverse

consequences for the gambler, others, or for the community."


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5e use the term @problem %amblin%2 for %amblin% which %i!es rise

to an$ problems for the indi!idual, his or her famil$, friends, worplace or

the communit$ at lar%e whether or not the problems are se!ere enou%h for

a person to be labelled usin% dia%nostic criteria as a 1problem %ambler2 or

1patholo%ical %ambler.2

'ome eperts sa$ there are four t$pes of %amblers

Social, Professional, Problem, Pathological

ther eperts epand sli%htl$ on those t$pes, notin% that there are

three t$pes of %amblers who, formin% the ma4orit$, don$t have problemsas

a result of %amblin%. +he recreational pla$er, the serious pla$er, and the

professional pla$er.

+he recreational pla$er %ambles for fun, doesn0t thin about it much

ecept when doin% it, has a %ood time pla$in% the %ames, and usuall$ will

show financial loss that is not problematic C it is simpl$ the cost of

entertainment.

+he serious pla$er is disciplined, strate%ic, and is not in the %ame for

fun, stimulation, or ecitement. +hese pla$ers are seriousl$ proficient at

%ames such as poer and blac4ac. +he$ ha!e a particular 1s$stem2 for

pla$in%, stop when not winnin%, and show a financial %ain for their efforts

at the end of the $ear.


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+he professional is eactl$ what the name implies. +he$ are the

more ad!anced !ersion of the serious pla$er, and strate%ic disciplined

%amesmanship, coupled with eceptional nowled%e of their %ame of

choice has %i!en them a lucrati!e career.

And then $ou ha!e the : of pla$ers who manifest 1problem

%amblin%.2

he term Problem !ambling covers a wide spectrum of

situations from easily corrected gambling related problems to severe,

even life#threatening problems requiring medical, psychiatric and/or

psychological intervention.

)et0s eep this simple, direct and eas$ to understand.

+he !ast ma4orit$ of people who %o to a casino, a card room, pla$

blac 4ac, poer, %in rumm$, ld Maid, %o to the race trac, or bu$ a

lotter$ ticet ne!er ha!e an$ problems related to %amblin%. f those who

do ha!e problem %amblin% issues, 8 percent prefer pla$in% slot machines,

and 8 percent prefer card %ames. )ess than one percent of problem

%amblers are into lotter$ %ames, dice %ames, and %ames of sill.

t is not the amount of time someone %ambles, or the amount of

mone$ the$ bet when %amblin% that defines someone as ha!in% mo!ed into


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the realm of Problem -amblin%. Perhaps the$ ha!e the free time, and

plent$ of mone$ to do with as the$ please.

People who donthave problem gambling issues never gamble

what they can$t afford to lose, they never go chasing after losses

trying to win them bac%, don$t borrow money to gamble, don$t miss

wor% because of it, and there is never any negative impact on their

family life, their &obs, relationships or finances because of gambling.

+hose who ha!e no %amblin% related problems ha!e a !er$ difficult

time understandin% how someone could become so attached or obsessed or

to use the 1A 5ord2/ Addicted to %amblin%.

As reflected in the definition of addiction pro!ided b$ the American

'ociet$ of Addiction Medicine the concept of addiction has epanded in

recent $ears to include man$ t$pes of ecessi!e beha!iors that people

compulsi!el$ continue despite ne%ati!e consequences.

ndi!iduals stru%%lin% with ecessi!e, immoderate, obsessi!e or

compulsi!e beha!iors are too embarrassed, ashamed or proud to as for

help. t is estimated that FG of people with problem %amblin% issues

ne!er see help, and we will discuss the reasons for that. But first of all,

let0s tae a loo at what ma$ be basic indicators of someone ha!in%

problem %amblin% issues.


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The %ieet 'creening (nstrumentconsists of two questions

6. Ha!e $ou e!er felt the need to bet more and more mone$>

7. Ha!e $ou e!er had to lie to people important to $ou about how

much $ou %ambled>

A 1$es2 response to one of these questions indicates that we should

mo!e on to a more detailed questionnaire.

Here is a simple self/assessment !ersion of a Dia%nostic 'creen for

-amblin% Disorders. t was desi%ned to assist indi!iduals in e!aluatin%

whether to modif$ or see help for their %amblin% beha!ior. t is based on

the American Ps$cholo%ical Association0s criteria for patholo%ical

%amblin%.

MP#+A+ this self/assessment will help $ou fi%ure out if there

is a problem,but onl$ a professional can dia%nose what type of problem.


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t mi%ht be a problem %amblin% issue, or it mi%ht be somethin% else, or

both or none at all.

6. Ha!e there e!er been periods lastin% two wees or lon%er when

$ou spent a lot of time thinin% about $our %amblin% eperiences, plannin%

out future %amblin% !entures or bets, or thinin% about wa$s of %ettin%

mone$ to %amble with>

Ies o

7. Ha!e there e!er been periods when $ou needed to %amble with

increasin% amounts of mone$ or with lar%er bets than before in order to %et

the same feelin% of ecitement>

Ies o

8. Ha!e $ou e!er felt restless or irritable when tr$in% to stop, cut

down, or control $our %amblin%>

Ies o

9. Ha!e $ou tried and not succeeded in stoppin%, cuttin% down, or

controllin% $our %amblin% three or more times in $our life>

Ies o

:. Ha!e $ou e!er %ambled to escape from personal problems, or to

relie!e uncomfortable feelin%s such as %uilt, aniet$, helplessness, or

depression>


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Ies o

;. Has there e!er been a period when, if $ou lost mone$ %amblin%

one da$, $ou would often return another da$ to %et e!en>

Ies o

. Ha!e $ou lied to famil$ members, friends, or others about how

much $ou %amble, andor about how much mone$ $ou lost on %amblin%, on

at least three occasions>

Ies o

F. Ha!e $ou e!er written a bad chee or taen mone$ that didn0t

belon% to $ou from famil$ members, friends, or an$one else in order to pa$

for $our %amblin%>

Ies o

K. Has $our %amblin% e!er caused serious or repeated problems in

$our relationships with an$ of $our famil$ members or friends> r, has

$our %amblin% e!er caused $ou problems at wor or $our studies>

Ies o

6G. Ha!e $ou e!er needed to as famil$ members, friends, a lendin%

institution, or an$one else to loan $ou mone$ or otherwise bail $ou out of a

desperate mone$ situation that was lar%el$ caused b$ $our %amblin%>

Ies o


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f $ou ha!e a famil$ member, friend or emplo$ee who would answer

$es to one or more of those questions, the$ ma$ indeed ha!e problem

%amblin% issues. *riends and famil$ alwa$s as 15h$>2 +hen the$ as

1(an the person be helped, or can the$ help themsel!es>2

+he second question is easier to answer that the first. +he 15h$2 is

a comple combination of factors that !ar$ from indi!idual to indi!idual,

and the relationships between different factions of societ$ who ha!e some

sort of interest in %amblin% are comple and multi/faceted as well.

+o use an ob!ious %amblin% analo%$, man$ different %roups

Lstaeholders ha!e a do% in this race.

Public health researchers and social scientists want to minimiNe the

riss of le%al %amblin%.

Economists, financial institutions and law enforcement are more

about the relationship between le%al %amblin% and banruptcies, and crime.

+reatment professionals, %o!ernment a%encies and not/for/profit

or%aniNations are worried about resource allocation for the pre!ention and

treatment of %amblin% problems, // in other words, the$ want their share of

%rants and fundin%.


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+hen $ou ha!e %roups who are opposed to le%al %amblin%, and these

fols want to pre!ent an$ further epansion and would lie to repeal the

laws that ha!e made %amblin% le%al.

Man$ of these people share the paranoid delusion that the %amin%

industr$ is intentionall$ culti!atin% or eploitin% 1problem %amblers.2

)et0s clear that one up ri%ht now.

+he %amin% industr$ is an industr$ built on prudent conser!ati!e

business plans and pro!en maretin% principles. (ostbenefit ratios are

continuall$ anal$Ned, and when it comes to the business of %amblin%,

nothin% is left to chance.

+he %amin% business, lie the entertainment business, is strictl$

business. -amin% industr$ leaders realiNe that the industr$ as a whole must

act in a sociall$ responsible manner, lie an$ other business that desires to

be !iable in the lon% run

+he %amin% industr$ has in!ested si%nificantl$ in research to identif$

those who ma$ ha!e %amblin% problems, and encoura%e their reco!er$. f

that sounds contradictor$ to the industr$0s best interests, it isn0t.

K9 of their customer base will ne!er ha!e %amblin% problems, and

K9 is more than sufficient for maintainin% and increasin% profit. (asino

owners and operators are more concerned with maintainin% or increasin%


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maret share than in culti!atin% income from people with problematic

%amblin% issues which ma$ in!ol!e, on the far end of the spectrum,

dan%erous patholo%ies.

1Moral Entrepreneurs2Opeople who mae their li!in% or increase

their public profile b$ 1cashin% in2 on threats to the public morals, will

alwa$s ea%%erate the se!erit$ of social issues if doin% so leads to them

%ettin% mone$ to address the 1crises,2 or le%islation fa!orable to their

%roup or or%aniNationCa word of caution, there are certain buNN words that

are used to create moral panics that precede restricti!e and puniti!e

le%islation, or to foster pre4udice a%ainst a se%ment of the population.

+he two most common are 1e!il2 and 1epidemic.2 +he onl$ real

epidemics are conta%ious ph$sical diseases such as t$phoid fe!er, or small

po. An$time social issues are described as an 1epidemic2 such as a

1compulsi!e %amblin% epidemic,2 watch out C that means someone is

worin% an a%enda of either seein% mone$ to fi%ht that 1epidemic,2 or is

promotin% le%islation appealin% to their political base.

'onest and ethical professionals have no reason to lie,

e(aggerate or mislead the public. )e rely on proven, factual, well

researched methodologies.


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5hen the famil$ of the person dealin% with the issue of problem

%amblin% ha!e their heads filled with misinformation and unwarranted

suspicions, it creates problems C sometimes more problems than the

%amblin%.

Allow me to %i!e $ou an eample. 'ome of $ou ma$ ha!e read, or

heard politicians or special interest %roups repeat with alarm the results of

research b$ the American nsurance nstitute that found that 9G of white

collar crime is caused b$ %amblin%.

here is no such thing as the *merican +nsurance +nstitute, and

there is no such study. +t is a complete fabrication. Iet this complete

falsehood has been repeated o!er and o!er, e!en in testimon$ before the

=nited 'tates 'enate. 'omeone heard it, and accepted it as fact without

botherin% to fact chec it. As it turns out, there were no facts to chec. +he

entire thin% is fae.

5here do these fae studies come from> *rom people who 4ust mae

them up nowin% that their audience will belie!e whate!er the$ sa$, and

not bother to chec if it is true or not.

+here is, howe!er, a comprehensi!e research stud$ )White collar

crimes and casino gambling* looking for empirical links to forgery,

embe++lement, and fraudb$ Ja$ '. Albanese, published April 78, 7GGF


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that !alidated pre!ious studies that showed that %amblin%, dru%s, 1another

lo!er2, or an$ other situation are + the actual cause of financial crimes

such as embeNNlement. he true cause is that the person$s problem was

one that could not be shared.

+f you can$t share the problem, you %eep it a secret, you don$t

get help.

As with recreational dru%s, people are ashamed to come forward and

%et help for a problem arisin% from participatin% in an ille%al acti!it$.

+he more %amblin% is defined as le%itimate leisure acti!it$, the

easier it ma$ be for those who %amble ecessi!el$ to share their problem

and see help, ultimatel$ a!oidin% the need to pursue 1solutions2 to

financial problems such as embeNNlement. f an indi!idual belie!es that he

is @not supposed to0 %amble, an$ problem arisin% from %amblin% would be

considered as non/shareable.

+f you have to hide it, you$re not going to share about it.

+f you %now you don$t have to hide it, you will share it, and get

help for it.

he more taboo the problem, the more people hide it instead of

getting help for it.


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Problem !ambling and Problem rug/*lcohol -se

here is a significant correlation between problem gambling and

problem alcohol and drug use.

Accordin% to the ational Epidemiolo%ic 'ur!e$ on Alcohol and

#elated (onditions, of people dia%nosed with patholo%ical %amblin%, 8.7

percent had an alcohol use disorder, 8F.6 percent had a dru% use disorder,

;G.9 percent had nicotine dependence, 9K.; percent had a mood disorder,

96.8 percent had an aniet$ disorder, and ;G.F percent had a personalit$

disorder. +hese facts lead us to .

Problem !ambling and ental 'ealth

+ndividuals with problem gambling issues often are found to

have various, easily treated mental health concerns. Amon% these are

Attention Deficit Disorder, bsessi!e (ompulsi!e Disorder, -enetic

Depression and -eneraliNed Aniet$ Disorder C all of which respond !er$

fa!orabl$ to a combination of medication and e!idence based therap$

techniques.

+he aniet$ disorders share features of ner!ousness, inhibition,

a!oidance, compulsion and se!ere stress often accompanied b$ !arious

bodil$ s$mptoms such as palpitations, sweatin%, shain%, shortness of


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breath, chest pain, nausea, numbness or tin%lin% sensations in the hands,

and diNNiness, etc.

-eneraliNed Aniet$ Disorder has more to do with bein% ecessi!el$

anious and worried about thin%s that are be$ond one0s control, and

s$mptoms include restlessness, unusual fati%ue, difficult$ concentratin%,

irritabilit$, muscle tension and sleep problems.

People with aniet$ problems often %amble to escape aniet$, or as a

replacement for an old compulsion. +here is ample research e!idence that

%amblin% acti!it$ is often preceded b$, and is a response to, stress and

aniet$.

)-ver a lifetime, pathological gamblers had a threefold increase in

an!iety disorders in general, and a si! fold increase in obsessive

compulsive disorder #land et al., /0012//'amuel )aw, Problem

-amblin% nstitute of ntario.

escription of *n(iety isorders

+here are people with problem %amblin% issues who suffer from

bsessi!e (ompulsi!e Disorder C a condition treated much as one would

treat depression C anti/depressants plus education and pro!en therap$.


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Affecti!e disorders such as (D, Bi/Polar, Aniet$, ADD, and

Depression are more common amon% %amblers who pla$ slot machines and

other %ames where there is little or no sill factor.

0ou light up my 1rain2

#ecent studies ha!e shown that the brains of some compulsi!e

%amblers 1li%ht up2 in the eact same area and the eact same wa$ as the$

would if the %ambler had taen a central ner!ous stimulant such as

methamphetamine.

Don0t let the word 1methamphetamine2 scare $ou C people often

for%et that amphetamines and methamphetamines are le%al prescription

medications deemed safe for children as $oun% as si $ears of a%e when

prescribed as part of appropriate medical treatment, primaril$ for Attention

Deficit Disorders or narcoleps$.

here is considerable research strongly lin%ing compulsive

gambling to attention#deficit disorder 3*4. And what is the treatment

for ADD> Either amphetamines or methamphetamine, b$ prescription, plus

therap$.

*or some people with undia%nosed ADD, %amblin% is a both a

s$mptom and a self/medication as it stimulates that same areas of the brain

as would the medication.


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+n some cases, the problem gambler is self#medicating their *

by gambling 5 a method far more e(pensive than a doctor$s

prescription.

ot all people with problem %amblin% issues ha!e those related

mental health issues or correspondin% problematic relationships with

recreational dru%s, includin% alcohol.

Problem !ambling and Suicide

-amblers who contemplate suicide ha!e had suicidal thou%hts on

a!era%e ten $ears before the$ e!er started %amblin%, and the suicidal

thou%hts are related to pre/eistin% mental health disorders, lon% standin%

substance use disorders and or problem drinin%, rather than %amblin%.

There are three theories of Problem Gambling:

he isease odel, the Social 6earning/ 7ognitive 1ehavioral

odel, and the Psychodynamic odel.

he isease odelis the one fa!ored b$ -amblers Anon$mous

and b$ the -amin% ndustr$. Iou will find the phone numbers of the local

-amblers Anon$mous prominentl$ posted throu%hout casinos, encoura%in%

people eperiencin% %amblin% problems to call -amblers Anon$mous.

he basic concepts of the isease odel is thatproblem

gambling in a condition that you either have or do not have. +t is not


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something caused by the presence of casinos, slot machines or race

trac%s. he disease is progressive and will only get worse, and there is

no way to reverse it.

f $ou ha!e it, $ou will lose control, tr$ to quit on $our own but fail,

and e!entuall$ hit bottom. +he onl$ wa$ out of this condition is to ne!er

e!er %amble no matter what because if $ou do, all the s$mptoms will come

bac full force.

n the Disease Model, treatment is often a combination of medication

to treat compulsions and impulsi!e beha!ior, or anti/depressants for those

dealin% with depression and suicidal tendencies, plus therap$ with a trained

professional ps$cholo%ist and the support of -amblers Anon$mous, a 67/

'tep pro%ram based on the 67/'teps of Alcoholics Anon$mous.

-.A. is not treatment for an$thin%, nor does it claim to treat an$

medical or ps$cholo%ical condition. +reatment for problem %amblin% is

considered an 1outside issue2 upon which -.A. has no opinion. +reatment,

accordin% to -.A. is the realm of doctors and scientists.

*or those of us who treat clients with problem %amblin% issues,

and de!elop appropriate treatment plans, it is important for us to

understand how the indi!idual sees the problem. f their !iew is consistent

with the Disease Model, the$ will embrace it and benefit from it.


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f the indi!idual seein% help does not thin of the problem in the

same terms, he or she is liel$ to resist participation. +hat means that the

disease model approach is + %oin% to be of !alue to them.

)hen developing a treatment plan we must match the

individual to the appropriate approach.+he counsellor, coach or

therapist must ha!e an understandin% of whether the %ambler thins about

his or her problem in a wa$ that matches the disease model. f not, don0t

use it.

5hile the disease model is the most widel$ used model in the =nited

'tates of America, and has been around lon%er than an$ other model, it also

has the least amount of research !alidation.

t is of interest that almost e!er$ web site or treatment center dealin%

with Problem -amblin% sa$s that it is 1pro%ressi!e2 C it will %o from bad

to worse to horrible, that there is no wa$ to re!erse it, and $ou are doomed,

more or less, unless $ou abstain.

'a$in% somethin% o!er and o!er a%ain doesn0t mae it true, and there

is si%nificant research indicatin% that problem %amblin% does not always

follow a pro%ressi!e pattern.

#ather, it tends to be episodic in nature, and 1problem %amblin%2

ma$ manifest itself in a sudden e!enin% of financial ris tain%, or %o on an


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uncharacteristic %amblin% bin%e, and then %o bac to non/obsessi!e, non/

compulsi!e, completel$ responsible %amin% beha!ior. And then, alon%

comes another 1episode2 of irresponsibilit$. n that case, we should

endea!or to find out what tri%%ers that irresponsibilit$. n this situation, it

is ob!ious thatgambling is a symptom, not the problemthat needs to be

dealt with.

he Social 6earning 8 7ognitive 1ehavioral odel asserts that

%amblin% is leaned and reinforced beha!ior. (ounsellors worin% within

the social learnin% model focus on empowerment and solutions rather than

past or hidden problems.

+he co%niti!e/beha!ioral model is based on the theor$ that

beha!ior is initiated, maintained Lor discontinued, based on principles of

learnin%, and what people interpret and belie!e about e!ents that %o on

around them.

7ognitive 1ehavioral therapy is the most research validated and

proven effective method of helping people with problem gambling

issues.

he Psychodynamic odelproposes that personal problems

such as problem %amblin% are an attempt at self/healin% or a strate%$ of

resol!in% unconscious emotional conflicts be$ond the person0s control.


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+he indi!idual %ambles to ease their emotional pain, and the$ ha!e an

unconscious desire to lose C in fact, for the problem %ambler, it0s all about

loss, not winnin%.

=nder this admittedl$ non/scientific theor$, problem %amblers wish

to be punished, the$ feel inadequate and create, while %amblin%, a fantas$

world in which the$ are important and respected. +his ma$ sound a bit far

out, in$ or peculiar, but there are plent$ of in$, far out and peculiar

people in this world C and $ou ma$ be one of them,

A related concept of this model is that the person has mood swin%s

from arousal to depression, and that %amblin% is an attempt to re%ulate

mood swin%s.

+his theor$, despite soundin% 1wa$ out2 has made a si%nificant

contribution to problem %amblin% treatment because there reall$ are man$

%amblers dealin% with the emotional impact of loss, and the fantas$ of

importance, respect and power that people with %amblin% problems often

confirm that the$ ha!e when %amblin%.

)Problem gambling is simply a means of acting out one$s deeper

emotional addiction to painful, unresolved inner conflict. (f, for some

reason, problem gamblers weren$t able to gamble, they would act out their


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inner conflict in other ways, perhaps through substance abuse, 3ob failures,

or relationship problems. PETER MICHAELSON

5hat we are %oin% to do in this seminar, is discuss the techniques

and methodolo%ies that are of si%nificant !alue to those who see reco!er$

from problem %amblin%.

As a matter of public polic$ and professional ethics, therapist,

counsellors, doctors and reco!er$ coaches are more concerned with

formin% alliances with clients that empower them to effecti!el$ o!ercome

%amblin% problems than we are in the ori%ins of the condition. .

n the topic of problem %amblin%, the !ast ma4orit$ of research

stud$ and treatment ideas came from the =nited 'tates. +he ='A is not the

onl$ countr$ in the world, nor the onl$ culture.

Australian research now defines problem %amblin% as a broadl$

social and public health issue rather than an addiction or disordered

beha!ior ori%inatin% in the indi!idual.

+he medical model used in the ='A defined problem %amblin% b$

the beha!ior of the indi!idual +he Australian Model defines problem

%amblin% b$ the consequences of the beha!ior.

n the Australian model,2it is generally accepted that gambling

related problems are situated in a broader conte!t of environmental, social,


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political and economic factors, and that problem gambling can emerge as

a result of a confluence of factors incorporating both the individual

gambler and the wider gambling and social environment. The risk factors

associated with problem gambling have been identified as a combination of

many factors. Problem -amblin% and Harm C -amblin% #esearch,

Australia 7GG:

ne of those factors bein% that %amblin% policies and decisions

made b$ %o!ernmental bodies were all dri!en b$ re!enue imperati!es at the

epense of consumer protection.

'tate and local %o!ernments ha!e introduced a ran%e of harm

reduction measures, includin% re%ulations re%ardin% certain aspects of

%ame desi%n that ma$ be decepti!e re%ardin% odds of winnin%, as well as

treatment and rehabilitation of indi!iduals.

5e mention what is happenin% in Australia as preface to pointin% out

a current shift in orth America in definin% problem %amblin%, althou%h

the reasons for the shift are entirel$ different.

+here has been a shift in definitions of problem %amblin% awa$ from

problem %amblin% as a medical or mental disorder, and instead focusin% on

the harmful consequences. 5h$ would we do that when medical or mental


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health concerns are pro!en to be a most si%nificant factor affectin% those

consequences>

At first, that wouldn0t seem to mae sense. But a closer eamination

of the situation re!eals a matter of o!erwhelmin% importance *or millions

of people in a !ariet$ of cultures and sub/cultures, the stigma of mental

health issues and/or addiction is so severe that if see%ing help for

gambling related problems labeled them as gambling addicts, the

harm of such labeling would be far worse than the harm from problem

gambling.

'adl$, the$ are correct. Etensi!e research !alidates that the harm of

stigma, social distancing, e!clusion and pre3udice, often combined with so

called )tough love, is more harmful to an individual than even the most

e!treme forms of actual addiction, including 4eroin addiction..

We have a long and tragic history of shaming, blaming,

pushing people with behavioral problems away, isolating

them, and threatening them all things that increase stress,

anxiety and actually make the illness stronger.

+hus, fearful of sti%ma and labelin%, those who would benefit from a

supporti!e and !ictorious therapeutic alliance are denied reco!er$ from


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problem %amblin%. Hence, b$ not usin% terms such as 1-amblin%

Addiction2 and not sa$in% 1problem %amblers are mentall$ ill2 we mae it

eas$ for those eperiencin% problem %amblin% issues to sa$ 1He$, 0m

ha!in% a bit of a problem here2 and not suffer the sti%ma and social

distancin% that is worse than problem %amblin%.

+hose of us who wor with clients who come to us with Problem

-amblin% concerns now that it is the relationship with the client, more

than an$thin% else that determines success. Because a powerful d$namic

collaboration is imperati!e, we need to now how to en%a%e and build that

relationship. +hanfull$, there is cuttin% ed%e research showin% us e!idence

based therap$ relationships

'9 ':99 '+;!S -P


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+he correlation between alliance and outcome increases as treatment

pro%resses o!er time, but b$ the third or fourth session, the stren%th of the

alliance %i!es $ou a reliable indication of how thin%s are %oin% to %o.

he stronger the alliance, the greater the success. he wea%er the

alliance, the more li%ely the client will drop out before completion.

+he client and $ou ma$ ha!e different !iews on the stren%th of the

alliance. t is the client0s !iew that is most important, althou%h $ou ha!e

si%nificant influence on how the$ !iew the stren%th of the collaboration. t

is important to monitor the health and !iabilit$ of $our alliance periodicall$

as $ou ad!ance towards the %oal.

here are things you can do that build and protect the alliance.

Buildin% a stron% alliance requires that $ou full$ inte%rate the

client0s indi!idual stren%ths, epectations, needs, and abilities into the

therap$.

Maintainin% the alliance depends to a critical de%ree on $ou ne!er

becomin% defensi!e should the client manifest ne%ati!it$ or hostilit$.

':99 7


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@. 1e genuine. his is called congruence 1eing your authentic self with

no pretense.

+hese three core conditions foster a stron% therapeutic relationship

and create an atmosphere where the client feels safe, and doesn0t feel

4ud%ed.

5e don0t fi the client. 5e collaborate with them in brin%in% out

their own abilit$ to address and resol!e issues in their own best interest.

+he client is the chan%e/maer, the$ are responsible for main%

chan%es occur, and all wor done b$ the counselor, coach or therapist is

aimed at fosterin% the natural self/actualiNin% capabilities within the client.

9mpathy

9mpathy is defined by famed psychologist 7arl :ogers as the

Asensitive ability and willingness to understand the client$s thoughts,

feelings and struggles from the client$s point of view.

t is important to mae efforts to understand $our clients0

eperiences and to demonstrate this understandin% throu%h responses that

address the client0s needs as the client percei!es them.


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Empath$ is more than parrotin% bac the client0s words, or reflectin%

bac onl$ the content of what the$ sa$. #ather, the idea is to 1tune in2 to

the emotional component as eperienced b$ the client.

Iou epress empath$ in man$ wa$s includin% !er$ direct responses

that let the client now $ou understand their eperience, and responses that

!alidate the client0s perspecti!e of the eperience. +he aim is to help brin%

the client0s inner and outer eperience !i!idl$ 1to life0 // C not 4ust the nuts

and bolts of a past e!ent, but the heart and soul of it as the client

eperienced it then, or eperiences it now, and what influence it has on

their choices and beha!ior..

As Dr. #obert Hare said of those without empath$, 1the$ now the

words, but not the music.2

#emember Just because $ou understand the client, doesn0t mean the

client feels understood. Empath$ is inseparable from all other aspects of the

client relationship. +here is a power in authenticit$, ha!in% an honest hi%h

re%ard for $our client, and ha!in% a sincere and heartfelt interest in their

well/bein%.

he secret of success, said comedian !eorge 1urns, is absolute

authentic sincerity.


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+he basic process used to empower the client is as follows

6. Epression of *eelin%s the client is encoura%ed to discuss what the$

feel is troublin% them.

7. #eflectin% the (lient0s Problem and 'ituation Iou communicate bac to

the client the core messa%e that the$ %a!e $ou, pro!in% that $ou were

pa$in% attention and understand what the$ said. #eflectin% leads to

8. (larification of (lient0s Problem and 'ituation +he client decides what

chan%es to mae to achie!e personal %rowth.

)hen these conditions e(ist, the clients are encouraged to B

> 9(plore their situation

? iscover what concerns them

@ +dentify ways they can ma%e positive changes in their lives.

#emember to as open questions A!oid, if possible, close/ended

questions that lead to limited or one/word responses. =se open/ended

questions that create con!ersation and allow for eploration of issues.

A !aluable technique used in reflecti!e listenin% is to eep the

con!ersation mo!in% throu%h etendin% what people are sa$in% C continue

the sentence or para%raph that the$ started.


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5e want to eep people talin% and epressin% their thou%hts,

feelin%s, attitudes and opinions. n doin% so, and respondin% with sincere

interest and empath$, the clients are assured that $ou are listenin% to them

and understandin% what the$ are sa$in%.

#eflecti!el$ listenin% also implies that $ou are honestl$ interested in

the person and their topic. A!oid sa$in% an$thin% that would shut them

down or embarrass them. Don0t %i!e ad!ice, warnin%s, or a%ree or

disa%ree. Don0t shame them, blame them, 4ud%e them or %i!e them lectures

on moralit$ or show an$ si%ns of disappro!al or appro!al when the$ tell

$ou about the hooers the$ piced up at the casino after hittin% the 4acpot,

rentin% a room, and snortin% hundreds of dollars0 worth of cocaine off their

bacs while ha!in% se with them atop the bureau drawers before

stumblin% home with wide e$es and an empt$ wallet.

Iou can, howe!er, be empowerin%. +hat means $ou !erball$

acnowled%e $our client0s stren%ths. Affirmin% peoples0 stren%ths and

effecti!e strate%ies helps to promote or increase self/efficac$.

3 (onstantl$ summariNe information 'ummariNin% is a technique to

help clients collect information, to lin different pieces of information

presented at different times, and as a transitional summar$ to mar a shift

in focus. 'ummariNin% is a silled technique that helps people b$ framin%


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multiple pieces of information in a coherent and chronolo%icall$ or%aniNed

stor$. +he stor$ is used to help clients reflect on what the$ ha!e said and to

increase awareness of discrepancies and lina%es between destructi!e

beha!iors and outcomes.

he %ey to change is getting clients to initiate self#motivation

statements. People are more li%ely to change if they argue for the

change themselves

An effecti!e technique for elicitin% self/moti!ational statements is to

ha!e indi!iduals discuss and write down the %ood Li.e., pros and bad Li.e.,

cons associated with %amblin%. A partial %oal of this tas is to openl$

acnowled%e some of the benefits, as seen throu%h the clients0 !iew, of

continued %amblin%.

+he other %oal is to compare the costs !ersus the benefits of

continuin% to %amble at their current le!el. +his can be accomplished b$

usin% a simple table Li.e., form with two columns. +he first column is the

pros of the beha!ior, such as the pros or benefits of %amblin%. +he second

column is the cons of the beha!ior, such as the ne%ati!e consequences of

%amblin%.

f the list of pros or benefits is lar%er than the list of cons or ne%ati!e

consequences, the pro beha!iors are more liel$ to occur or continue to


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occur and the opposite will be true if the list of cons or ne%ati!e

consequences is lar%er than the pros. 5ritin% down the lists helps clients to

or%aniNe and !isualiNe the issue the$ are stru%%lin% with.

+here ma$ be times when, despite $our best efforts, $ou space out

or lose $our concentration while a client is tellin% $ou of a si%nificant life

e!ent. +he$ sa$ somethin% that requires a response, and $ou ha!e no idea

what the$ were 4ust sa$in%. 5hat do $ou do>

+hin of the last thin% $ou remember them talin% about before

$ou lost $our connection, and sa$ 1 want to %o bac to what $ou said a

minute a%o about.2 Ha!e them eplain that a bit more, and then

continue.

+his accomplishes three thin%s $ou %et reconnected, the client has

further opportunit$ to clarif$ somethin% of importance, and safe%uardin%

$our alliance.

!ambling is learned behavior

o one is born nowin% how to consciousl$ do an$thin%. 5e learn

4ust about e!er$thin%. As adults, or at least b$ an a%e of supposed

1maturit$2 to one cultural de%ree or another, we de!elop beha!ioral habits

and preferences based on a simple formula that some fols call 1+he

(hinese #estaurant Model.2


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You try it. You like it. You keep going back.

You like it because you have a rewarding experience.


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n fact, the fastest wa$ to destro$ an$ relationship is to i%nore the

other person. +here is nothin% more re4ectin% and hurtful than bein%

i%nored.

-ettin% bac to our (hinese #estaurant Model C

5e tr$ it. f we en4o$ it, the pleasure is our reward, so we %o bac

a%ain. f we tr$ it and don0t lie it. 5e don0t %o bac.

People with %amblin% problems learned that %amblin% was fun

probabl$ the first time the$ pla$ed and won. Accordin% to the principles of

operant conditionin%, rewarded beha!iors will increase. -amblin% is an

acti!it$ where the reward Lwinnin% is immediate.

f $ou hit a 4acpot when $ou first wal into the casino and sit down

at a machine, that instant reward maes a hu%e positi!e impression on $our

brain.

'o what> E!er$one has that same instant reward eperience if the$

pla$ a slot machine and win, so who are those few people who ha!e

%amblin% problems>

he hree Pathways to Problem !ambling

+here are three basic t$pes of fols with %amblin% problems, and

the$ ha!e three separate pathwa$s that %et them to Problem!ille


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. Each be%ins %amblin% for different reasons. nce the$ start, all

three t$pes of %amblers under%o the repetition and reward learnin% process.

HereQs how each pathwa$ wors.

3+he first t$pe of person is reall$ perfectl$ fine. +he$ are not

impulsi!e, compulsi!e, obsessi!e, nor are the$ ADD with an '.=.D or an

'+D. +he$ are 4ust ha!in% %ood clean fun.

5hat sends them on the path to problem %amblin% is that the$ are

superstitious, belie!e in 1luc2 as some sort of independent 1power2 that

can be manipulated, and the$ belie!e that the$ ha!e a deep personal

relationship with the slot machine similar to the relationship that some

(hristians ima%ine the$ ha!e with Jesus.

+hese people are not mentall$ ill nor are the$ idiots C the$ simpl$

belie!e idiotic thin%s. +hese people, howe!er, are the easiest people to

treat because all the$ need to reco!er is to correct their absurd beliefs. n

fact, these fols ma$ reco!er without an$ professional help.

3+he second t$pe starts off with problems C these people are

emotionall$ !ulnerable anious, depressed, ha!e poor problem sol!in%

sills, and are easil$ stressed out. +he$ were unhapp$ ids, and are e!en

unhappier adults. +he reason the$ are depressed and anious could be the

result of childhood trauma, %enetic defects in the brain, of perhaps a brain


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in4ur$ such as mom runnin% o!er their head with the car C it doesn0t much

matter C the point is these are not happ$ people.

+he$ turn to %amblin% for escape, to rela, to feel normal and ali!e.

)ie the first %roup, the$ become conditioned b$ the 4olt of ecitement that

bettin% brin%s. As lon% as the$ are %amblin%, the$ ha!e a respite from the

emotional pain. +hat ma$ be deli%htful and useful, but if the %amblin% is

actuall$ causin% more depression and more aniet$ that in turn requires

more %amblin%, these tra%ic indi!iduals ma$ need more intensi!e

treatment, includin% medications for their depression and aniet$.

3+he final t$pe of impendin% patholo%ical %ambler is a real mess.

+his person is hi%hl$ disturbed, has plent$ of brain problems, most of them

inherited. He or she is also impulsi!e, irritable, probabl$ drun or stoned,

is easil$ bored, h$peracti!e, has difficult$ pa$in% attention, and also has

difficult$ committin% suicide successfull$.

+he fact that the$ ha!e tried to ill themsel!es and failed is not %ood

for their self/ima%e, which is alread$ prett$ mur$. +he$ %amble for thrills

and ad!enture and are probabl$ pissed off that it isn0t all that ecitin%,

despite all the bells whistles and false alarms of thin%s that loo lie the$

1almost won.2


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o one is happ$ when these fols come around, and althou%h the$

%o on wild %amblin% bin%es, casinos would rather the$ sta$ed home

because their attitude and demeanor are a real buNN ill and %i!e

responsible %amin% a bad rap.

Because this %roups0 problems in!ol!e medical, ps$chiatric,

ps$cholo%ical and emotional issues, in addition to sharin% the same t$pe

of sill$ superstitions as the other %roups, these are the most difficult to

treat. ot impossible, onl$ more difficult

+here are two thin%s all three %roups ha!e in common all of them had

to 1learn2 to %amble irresponsibl$. +his learnin% process is often termed

)earnin% b$ reward. +he second thin% all of them in common are

1co%niti!e distortions2 C a fanc$ wa$ of sa$in% the$ belie!e stuff that is

complete nonsense.

6earning by :eward.

*nticipation of a random reward is a delightful treat and

encourages both eagerness and patience.

f the reward is predictable, $ou become complacent. f the reward

ne!er happens, wh$ bother> But if $ou now it0s comin% C the reward, the

4acpot C the free bonus %ames C but $ou don0t now when, that is what


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maes $ou eep on pla$in%... 1ne more2 and 1one more2 and 14ust one

more2 because ma$be the net pull is the one with the reward.

7ognitive istortions.

Patholo%ical %amblers C the fols at the far end of Problem -amblin%

//ha!e more distortions than those who are not Patholo%ical -amblers.

Here are t$pical t$pes of 1(o%niti!e Distortions2 Lbelie!in% nonsense

*!;+=+7*+ 5HI> Here is a simple

eample of -ambler0s *allac$.


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+his coin has landedheads/up nine times in a row. +herefore, the odds

of it landin% tails/up net time are increasin%. n fact, after landin% heads

up nine times in a row, it will probabl$ land tails/up net time it is

tossed. #i%ht> +hat maes sense, doesn0t it> o. t doesn0t mae sense

at all. n fact, that is -ambler0s *allac$.

+he truth is that when a coin is tossed, the odds of it landin% heads or

tails are :G:G. Period. +hat0s it. t doesn0t matter how man$ times the

coin is tossed. 9ach toss is its own event. Past results have nothing

to do with what will happen ne(t.

t is the same for slot machines. Each spin is a sin%ular e!ent with no

ties or relationship to an$thin% that has %one before. +his is not a topic

where opinions differ. +here is onl$ fact and fiction. +he fact is that the

machine has no memor$ of what happened on the pre!ious spin, nor

does it e!en now $ou are pla$in% it. t is a machine. .

6uc%/Perseverance, is a form of ma%ical thinin% that has nothin% to do

with realit$. Problem %amblers ehibit a stron% le!el of belief that sheer

continuation in %amblin% Lluc perse!erance results in success. +he$

also tend to belie!e that 1luc2 is personal rather than a situational

characteristic.
http://www.logicalfallacies.info/relevance/gamblers/http://www.logicalfallacies.info/relevance/gamblers/


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+llusion of 7ontrol,which reflects an indi!idualQs perception that hisher

beha!ior influences chance occurrences, which, of course, it doesn0t.

LDifferences in co%niti!e distortions between patholo%ical and non/patholo%ical %amblers with preferences for

chance or sill %ames.M$rseth H6, Brunbor% -',Eidem M.

perant conditionin% C the reward that conditions $ou C has %i!en

therapists se!eral effecti!e modes of treatment.

+he basic idea is to reward people for main% healthier, reco!er$/

oriented choices. Howe!er, the rewards must have some value, and the

reward must be substantial.

+here was a fellow whose wife came up with operant conditionin% to

%et her husband to stop smoin%. E!er$ time he wanted a ci%arette, she

would perform oral se on him. +he onl$ problem was that after se, he

alwa$s wanted a ci%arette. 5hile he indeed quit smoin%, neither one of

them e!er %ot an$thin% else done.

he Process of 7hange

+he accomplishment of an$thin% depends on a three/part process of

nowled%e, !olition, and action. Snowin% what needs to be done isn0t

enou%h. +hinin% about it isn0t doin% it.


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Most people ne!er %et to the follow/throu%h sta%e of action, especiall$

when it comes to chan%in% lon%/established beha!ior.

+here are man$ theories of beha!ior chan%e, and all of them offer

useful insi%hts. +he 'ta%es of (han%e model shows that beha!ior chan%e

occurs %raduall$, %oin% throu%h pro%ressi!e sta%es. 5hile the process is a

bit more comple in realit$ and the sta%es o!erlap, $ou can %et the basic

idea easil$ enou%h b$ readin% the followin%.

Precontemplation.+he person is uninterested, unaware, or

unwillin% to mae a chan%e. He or she is not e!en thinin% about chan%in%

and ma$ react defensi!el$ to an$ su%%estion that a chan%e in beha!ior is

needed.

n this sta%e, the process of en%a%in% the indi!idual in his or her own

process of chan%e is !er$ important. Enlist their opinion, !alue their !iews.

+he da$s when client0s needs and perspecti!es were i%nored are far behind

us. +he increase in a!ailabilit$ of information, de!elopments in new

technolo%$, and chan%es in public attitudes mean that clients want to

interact differentl$ with their treatment pro!iders. n this sta%e, a simple

friendl$ comment, such as 1perhaps $ou would consider reducin% $our

%amblin% banroll b$ 7: // not losin% that mone$ mi%ht be as rewardin%

as winnin% it.2 L'aid with smile. o recrimination, no ne%ati!it$


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!ontemplation. +he person is considerin% chan%in%, wei%hin% the

pros and cons of the chan%e. f he or she bein% ased to %i!e up somethin%

en4o$able, the sense of loss is an honest consideration.

Preparation.+he$ are preparin% to mae the chan%e. ndicators that

the$ are preparin% to %reatl$ modif$ their %amblin% patterns mi%ht be if

noticed if the$ pla$ penn$ slots instead of dollar machines, and selected

penn$ slot machines with 7G lines of pla$ rather than :G lines.

"ction.An$ action taen toward the desired beha!ior chan%e should

be praised.

#aintenance.f the$ continue the beha!ior chan%e for si months,

that is si%nificant.

+he sta%es of chan%e are not alwa$s linear. +he$ are components of

a c$clical process that !aries for each indi!idual. *or this and man$ other

reasons, indi!idualiNed care is imperati!e.

otivational +nterviewing and Practices

Moti!ational inter!iewin% LM is a non/confrontational, co%niti!e/

beha!ioral inter!ention that is used to help people become more aware of

an$ beha!ior that needs to be modified and to increase internal moti!ation

to address the problem LMiller and #ollnic, 7GG7.


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Moti!ational nter!iewin% was specificall$ desi%ned to help

indi!iduals pro%ress throu%h the first three sta%es of co%niti!e chan%e C

pre/contemplation, contemplation, and determination. +he technique was

desi%ned to help people mo!e into the action phase of chan%e.

A e$ component of Moti!ational nter!iewin% is to show or brin% to

the client0s attention discrepancies between their %amblin% beha!ior and

other more !alued aspects of clients0 li!es.

+he purpose of de!elopin% a discrepanc$ is to illuminate how the

beha!iors, such as irresponsible %amblin%, is at odds with the more !alued

aspects of the persons0 life, such as obtainin% and maintainin% a 4ob.

Man$ indi!iduals in the earl$ sta%es of chan%e are unable to see full$

the connection between problem %amblin% and the consequences Lresults

of their problematic beha!ior.

+o create a discrepanc$, we need to first understand what is

important to clients or what the$ !alue. +he net step is to compare the

two conflictin% %oals for clients usin% their own lan%ua%e and !alue

s$stem. Eamples of potential conflict can include

5antin% to continue bettin% on the horse races while wantin% to

impro!e the relationship with a partner who li!es in fear of financial

de!astation as a result of the client bettin% on horse races.


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wantin% to %amble and also wantin% to sa!e up mone$ for a car.

wantin% to spend all spare time in the casino and wantin% to be

more in!ol!ed in their children0s li!es.

+herapists, counselors, coaches and e!en famil$ members need to

not attempt to impose their !alues on the client. +ae the time to

understand what clients reall$ !alue as opposed to what the$ ha!e been told

to sa$ or report is !aluable.

5hen creatin% discrepancies, present the potential conflict in a

subtle and matter/of/fact manner. 'impl$ hi%hli%ht the conflict as a basic

question for clarification, such as 1 thou%ht $ou wanted to sa!e up some

mone$ to %et a car, will $our on%oin% %amblin% interfere with $ou

achie!in% this %oal2T 1will $our %amblin% *rida$ ni%ht affect $our

depression, or can $ou feed the slots without feelin% sad or ashamed the

net da$>2

he goal is to simply illuminate the discrepancies in the clients$

own thin%ing and planning process. t is helpful to eep a list of %oals

that clients would lie to wor on and to hi%hli%ht these %oals when clients

indicate that the$ would lie to use their time and mone$ to repeat

established patterns of problem %amblin%.


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An important component of Moti!ational nter!iewin% that

differentiates it from more traditional treatment inter!entions is that

confrontation is avoided rather than created.

=se reflection rather than confrontation to deal with, roll, or %o with

resistance. +hrou%h the process of reflection, $ou create opportunities to

further eplore the clients0 reasons for resistance or ambi!alence.

+f we are arguing with clients, we are not using motivational

interviewing. 5e must constantl$ a!oid an$ direct ar%ument. #ollin%

with resistance is a useful technique for eepin% people en%a%ed while the$

wor throu%h their own ambi%uit$. B$ a!oidin% a direct ar%ument, we can

eep people talin% and communicatin%.

Below are three eamples of how this technique can wor while

worin% with clients who are not co%niti!el$ read$ to address their

problems.

)et0s loo at some common client statements, the confrontational

approach, and then the preferred 1#ollin% with #esistance2 approach.

:olling with resistance

(lient statement 1 don0t ha!e a %amblin% problem. E!er$one else is

the problem.2


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(onfrontational approach 1Iou 4ust threw $our entire sa!in%s

account awa$ chasin% after %amblin% losses, $ou were fired from $our 4ob

for missin% worT and $our wife is read$ to lea!e $ou. *ace it //$ou ha!e a

%amblin% problem.2

#ollin% with #esistance approach +t sounds li%e a lot people have

been hassling you about your gambling. 7an you tell me what other

people have been saying or what are some of the issues that led you to

coming into treatmentD

1 don0t want to tae the medicationsT the$ don0t wor and don0t

lie tain% them.2

1Iou ha!e been dia%nosed with ADD and bsessi!e(ompulsi!e

Disorder. Iou need to tae the medication as prescribed b$ the doctorT the

medications will help $ou2

+t sounds li%e your frustrated with the medications and that they

are not wor%ing as you had hopped, can you tell me more about the

medications that you don$t li%e or what is not wor%ingD

+he purpose of rollin% with resistance is to better understand the

clients0 position or perspecti!e. +nstead of challenging clients, e(plore

the issues with them, so that both parties have a better understanding


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50

of the problem and why clients may still be unaware of the severity of

the problem.

he essence of motivational interviewing is to nurture and

promote self#efficacy in the process of change.

(lients are more liel$ to chan%e or to attempt to chan%e if the$ feel

that the$ ha!e the capacit$ and power to do so. 'elf/efficac$ is how people

!iew their own capacities and stren%ths.

M is used to increase self/efficac$ b$ allowin% indi!iduals to

de!elop successful strate%ies for chan%in% their beha!iors. +his can be

accomplished b$ eaminin% clients0 past successes and remindin% them of

these eperiences as the$ tae on new acti!ities and beha!iors.

'elf/efficac$ can also be accomplished b$ helpin% people tae and

achie!e bab$ steps that promote positi!e learnin% eperiences

he %ey theme of motivational interviewing is to wor% with

people where they are in their readiness to change and not where you

thin% they should be.

he Process of 9ffective reatment.

Most people with problem %amblin% issues, often coupled with other

troublesome mental health issues includin% immoderate use of recreational

dru%s feel o!erpowered and helpless. +he$ $earn for hope and a sense of


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empowerment. An important aspect of effecti!e treatment includes

empowerin% patients to see themsel!es in partnership with their ph$sician,

stren%thenin% their ph$sical, emotional, and mental health.

*n important aspect of effective treatment is individualized

cognitive behavioral therapy, also %nown as 71. his therapy is a

form of psychotherapy that emphasizes the important role of thin%ing

in how we feel and what we do.

+here are se!eral approaches to co%niti!e/beha!ioral therap$,

includin% rational emoti!e beha!ior therap$, rational beha!ior therap$,

rational li!in% therap$, co%niti!e therap$, and dialectic beha!ior therap$.

All of these co%niti!e/beha!ioral therapies are based on the idea that

our thou%hts cause our feelin%s and beha!iors, not eternal thin%s lie

people, situations, and e!ents.

9ven if a situation remains unchanged, how we respond to that

situation can change. )e can choose our response, ma%ing a conscious

decision to respond in ways that are in the best interest of our health

and happiness.

n con4unction with (B+, there is another therap$ pro!en !aluable in

treatin% adolescents and substance misuse clients. Moti!ation enhancement

therap$ LME+ has been thorou%hl$ researched in the field of substance


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misuse, most especiall$ with $oun% people, and has pro!en to be

eceptionall$ effecti!e at enhancin% an indi!idual0s moti!ation to mae

positi!e chan%es in beha!ior.

An effecti!e treatment must help clients address, identif$, and

describe the personal meanin% of their beha!ioral problem.

Are the$ self/medicatin%, fillin% up an inner emptiness, numbin%

feelin%s related to a trauma, or all of the abo!e>

-nless clients understand what they are actually doing on a deep

level, they will chronically relapse.

A responsible comprehensi!e treatment pro%ram taes all aspects

into consideration for the on%oin% health and well/bein% of the client.

ealing with riggers for Problem !ambling

nce $oureco%niNethe situations or e!ents that tri%%er a desire to

%amble, $ou can 1outsmart2 the tri%%ers b$ ha!in% a dama%e control plan

in place.

(ommon -amblin% +ri%%ers

-ettin% mone$ Lpa$da$

feelin% bored, restless, an%r$, depressed or lonel$

mone$ worries or risin% debts

drinin% or tain% other dru%s

readin% the sports section and dail$ maret fi%ures

passin% places to %amble, +AB, pubs, clubs, casino

spendin% time with friends who %amblin%


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#e%ular %amblin% times.

nce $ou0!e identified $our tri%%ers, $ou will find it eas$ and rewardin% to

wor out L6 Protection, and L7 Dama%e (ontrol.

*or eample if %ettin% paid is $our tri%%er, $ou outsmart it b$

arran%in% to ha!e $ou pa$ split into two accounts C a sa!in%s account with

no A+M access, and $our re%ular bill/pa$in% account.

'et up automatic pa$ment of $our re%ular monthl$ bills such as %as,

electricit$, telephone, auto pa$ment and rent from $our bill/pa$in%

checin% account. +his wa$ $our bills alwa$s %et paid firstR

5hen $ou %et off wor on pa$da$, the first thin% $ou do is %o

directl$ to the %rocer$ store and bu$ %roceries or those store cards that are

used onl$ at the %rocer$ store. ow $ou now that $ou ha!e $our %rocer$

needs co!ered till net pa$da$, $ou also now $our bills are paid. 5hat a

reliefR

As for the other tri%%ers, there is a simple wa$ to eep them from

ha!in% an impact. t is called D'E/8G. +hat means Do 'omethin% Else

nstead for thirt$ minutes.

+ri%%ers %i!e up after a half hour. 'o, D'E for a half hour, and $ou

usuall$ ha!e the tri%%er defeated.


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+he D'E can be watchin% a mo!ie, %oin% for a wal, or actuall$

doin% some fitness enhancin% eercises. t has been pro!en that ten

minutes of health$ eercise can reduce cra!in%s for dru%s, alcohol or

%amblin% b$ :G.

n the words of fitness epert *elicia )awson, 1Eercise can wor

quicl$ to ele!ate depressed mood in man$ people. Althou%h the effects

ma$ be temporar$, the$ demonstrate that a bris wal or other simple

acti!it$ can deli!er se!eral hours of relief.2

)hen you encounter a trigger, you have power over it 5 no doubt

about it. S9+#@E tric%s the trigger every time.

Another tric when encounterin% a tri%%er is to tae in a slow deep

breath throu%h $our mouth, hold it, and let it out throu%h $our nose. +hat

influ of o$%en to $our brain, and the focus of concentration on $our

breathin%, diffuses the tri%%er. Another !ictor$ for $ouR

)hat about a slip/relapseD

People alwa$s do eactl$ what the$ want to do, sooner or later.

E!en if the result of the action is not pleasant, if the tri%%er to en%a%e in

what $ou en4o$ Lshort term pleasure is stron% enou%h, $ou are %oin% to do

it. +hat last thin% $ou want to do is punish someone for relapsin%. f $ou


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punish someone for %amblin%, the$ will onl$ want to %amble more,

especiall$ if the$ are an adult.

+his relates to a lon%/standin% rule C if a woman disco!ers that her

husband has a mistress, she must ne!er as him to choose between the two

He will almost alwa$s choose the mistress. 5h$> 'imple. f he chooses

the wife, she will fore!er hold the past o!er his head, continuall$ put him in

a subser!ient position to her and he will be miserable. He nows that, and

therefor chooses the mistress as she will not be in a power position o!er

him.

t is the same with an$ beha!ior $ou en4o$ that someone else wants

to curtail. (f you also wish to curtail that activity, stop it completely, or

moderate it, then you are in collaboration, but if someone wants to 1fi2

$ou, 1reform $ou2 then it becomes a %ame as to how outsmart the person

tr$in% to do so.

+he person who wants to not be controlled b$ tri%%ers or

compulsions will, with the help of a therapist or treatment professional,

re%ard the slip or relapse as a learnin% opportunit$, and the$ will de!ise

e!en more cle!er and effecti!e wa$s of circum!entin% the ne%ati!e

potential of a slip or relapse.


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+here are man$ wise people in reco!er$ from Problem -amblin%

who intentionall$ put up beha!ioral fences C real life 1borders2 that eep

them from stra$in% into dan%er Nones. +hese 1fences2 or 1beha!ioral seat/

belts2 include such thin%s as intentionall$ limitin% their access to cash, and

!oluntaril$ requestin% to be placed on a casino eclusion list.

t is important that the cash access limitations and the casino

eclusion be 6GG !oluntar$. f not, the person is liel$ to rebel.

+he


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A casino operator will not cash a chec or etend credit to a pro%ram

participant.

+here are consequences if $ou enroll and do enter a casino. Iou can

be char%ed with trespassin% and $ou will be forced to forfeit an$ winnin%s.

+he


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-amblin% is often used to a!oid or escape from especiall$ painful

feelin%s Lshame, %uilt, helplessness, depression or from some problem in

life that seems unsol!able.

Gambling as "voidance

5hile %amblin%, some people feel the$ are escapin% their

problemse!en temporaril$. 5hile %amblin%, the$ don0t ha!e to thin

about an$thin%. f course, the same thin% can be accomplished much less

epensi!el$ b$ watchin% the (artoon etwor.

Problem Gambling creates problems other than, and in addition to,

the original problems that the person wanted to avoid.

A!oidance, as a wa$ of copin% with problems, is habit/formin%.

People de!elop a repertoire of different wa$s the$ a!oid dealin% with

uncomfortable or difficult situations. =nresol!ed situations do not resol!e

themsel!es. Problems that require personal attention will patientl$ wait for

$ou, quite often %rowin% lar%er and lar%er the lon%er the$ wait.

Howe!er, no problem is as bi% close up as it loos from far awa$.

The sooner you avoid avoidance$ the sooner you deal with the

problem with same dexterity as you deal cards$ the sooner it is resolved.

f $ou ha!e been usin% $our %amblin% to a!oid or escape from some

underl$in% problem, and if $ou ha!e stopped Lor %ained control of $our


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%amblin%, $ou now ha!e a choice Iou can find other wa$s to a!oid or

escape problems, or $ou can confront them, and find health$ wa$s to deal

with them.

'trate%ies

)hich of the following strategies might be helpfulD

+alin% to a friend, famil$ member or therapist

5ritin%, eepin% a 4ournal or diar$

)earnin% to rela, throu%h meditation, $o%a, or breathin%

-ettin% re%ular eercise

Attendin% -amblers Anon$mous or other support %roup meetin%s

)earnin% an%er mana%ement

Ha!in% se e!er$ time $ou want to %amble

1


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=amily +ssues

+he U6 impact on the famil$ with problem %amblin% is financial.

Dependin% upon the actual financial dama%e, or the ea%%eration of

dama%es based on 1what if2 worst case scenarios which has the famil$

upset o!er thin%s that ha!e not happened, is the de%ree to which the famil$

members feel betra$ed, an%r$, suspicious or %et all wound up.

+hese feelin%s mae it harder to sol!e problems. And here is where

one dan%er far eceeds all others C the dan%er that the person who is

dealin% with issues related to problem %amblin% ma$ eperience isolation

from his lo!ed ones.

5i!es or husbands or si%nificant others ma$ not want to be

emotionall$ or ph$sicall$ close to the person who, more than e!er, needs

closeness, acceptance, and lo!e. E!en close friends ma$ turn awa$ o!er

unpaid debts.

'uch erroneous 4ustifications for withdrawin% support and affection

include 1He must eperience the consequences of his actions. He must tae

responsibilit$ and face the music.2

=suall$ this is said b$ people who confuse punishment with

consequences. f $ou stic $our fin%er in a li%ht socet, the consequence

will be a life/threatenin% electric shoc. +hat is cause and effect.


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Punishment is not a natural consequence of beha!ior. (ommittin%

crimes a%ainst societ$ ma$ result in criminal char%es, and there are

consequences to bein% found %uilt$. f !oicin% $our opinion on a

contro!ersial issue results in $ou bein% beaten within an inch of $our life,

that is + a natural consequence of !oicin% $our opinion,

Iour spouse threatenin% to lea!e $ou because $ou pla$ed %in rumm$

last wee and lost ten dollars is + a consequence of %amblin%. t is the

consequence of marr$in% a control frea.

*amilies ma$ ha!e unreasonable epectations of pro%ress or

beha!ior chan%e, and the stress upon the person reco!erin% from problem

%amblin% ma$ be almost unbearable. f there is harsh 4ud%ement and ic$

isolation comin% from those who supposedl$ lo!e $ou, the fact that $ou can

sit in a bar, a dope house or a casino and %et more support and

understandin% from complete stran%ers than $ou do from those who now

$ou, is an ecellent moti!ator to sta$ awa$ from home, do more dope,

drin and %amble.

'elp with *dditional !ambling :elated Problems

*amilies reco!erin% from the harm of Problem -amblin% ma$

require help in practical issues such as financial mana%ement, bud%etin%,


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and other basic aspects of life impacted b$ %amblin%. Part of $our role

ma$ be connectin% them to a!ailable ser!ices.

6ow#:is% !ambling

ot e!er$one who eperiences ne%ati!e effects from %amblin% and

reco%niNes these ne%ati!es is %oin% to commit to abstinence. t ma$ be, for

them, an honestl$ undesirable concept that the$ equate with punishment

rather than healin%. *or those people, if the$ are far from the compulsi!e

%ambler dia%nosis, establishin% low/ris %amblin% protocols ma$ be a

reasonable and !aluable approach.

6ow#ris% gambling means people

)imit how much time and mone$ the$ spend %amblin%

Accept their losses, and don0t tr$ to win them bac

En4o$ winnin%, but the$ now it happened b$ chance

Balance %amblin% with other fun acti!ities Don0t %amble to EA# MEI or pa$ debts

Don0t %amble when their 4ud%ment is impaired b$ alcohol or

other dru%s

e!er borrow mone$ or use personal in!estments or famil$

sa!in%s to %amble

Don0t %amble to escape from problems or feelin%s

Don0t hurt their 4ob, health, finances, reputation or famil$

throu%h %amblin%


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f these standards seem contrar$ to $our usual %amblin% profile, or

that of $our friend or famil$ member, low/ris %amblin% is most liel$ not

%oin% to wor.

*bsolute 'onesty

#ecreational %ame pla$ers do + %amble to mae mone$. +he$

don0t %amble in anticipation of bi% wins. +he$ are simpl$ pa$in% to en4o$

pla$in% a %ame that the$ find fun to pla$. +he$ ma$ en4o$ pla$in% slots

where the$ can win free %ames, e!en thou%h the$ ma$ not win an$ mone$

o!er all. +he recreational %ambler isn0t chasin% losses because the$ didn0t

lose an$thin%. +he$ paid for a fun eperience. f the$ lea!e the casino with

the same amount the$ came in with, the$ are !er$ happ$. f the$ lea!e with

less, the$ are still happ$. on/Problem %amblers are not chasin% wins or

losses.

+f you thin% of gambling as a way to ma%e money, or as a way to

ma%e up for losses, you are not ready to play the game.

Pa$in% mone$ to pla$ a %ame is no different than pa$in% mone$ to

rent a row boat on a little pond. Iou ma$ ha!e fun, $ou ma$ not. Iou ma$

en4o$ the eercise, and if the boat owner %i!es $ou a bit of $our mone$

bac 4ust for the hec of it, that0s nice but not epected. o one rows the


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boat in a circle epectin% the row boat to pa$ their bills or %et bac the

mone$ the$ spent last wee on another row boat.

A slot machine is simpl$ an electronic row boat with flashin% li%hts

and noises. Iou rent it and tae $ourself for a little ride. Iou pa$ for the

eperience of the ride. h, e!er$ so often, for no reason whatsoe!er, some

rower %ets his mone$ refunded. =suall$ the$ use it to rent the row boat

a%ain. +hat0s all there is to it.

Support !roups

!amblers *nonymous

-AMB)E#' AIM=' is a fellowship of men and women

who share their eperience, stren%th and hope with each other that the$

ma$ sol!e their common problem and help others to reco!er from a

%amblin% problem.

+he onl$ requirement for membership is a desire to stop %amblin%.

+here are no dues or fees for -amblers Anon$mous membershipT we are

self/supportin% throu%h our own contributions. -amblers Anon$mous is

not allied with an$ sect, denomination, politics, or%aniNation or institutionT

does not wish to en%a%e in an$ contro!ers$T neither endorses nor opposes


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an$ cause. ur primar$ purpose is to stop %amblin% and to help other

compulsi!e %amblers do the same.2

15e learned we had to concede full$ to our innermost sel!es that we

are compulsi!e %amblers. +his is the first step in our reco!er$. 5ith

reference to %amblin%, the delusion that we are lie other people, or

presentl$ ma$ be, has to be smashed. 5e ha!e lost the abilit$ to control our

%amblin%. 5e now that no real compulsi!e %ambler e!er re%ains control.

All of us felt at times we were re%ainin% control, but such inter!als /

usuall$ brief /were ine!itabl$ followed b$ still less control, which led in

time to pitiful and incomprehensible demoraliNation. 5e are con!inced that

%amblers of our t$pe are in the %rip of a pro%ressi!e illness. !er an$

considerable period of time we %et worse, ne!er better. +herefore, in order

to lead normal happ$ li!es, we tr$ to practice to the best of our abilit$,

certain principles in our dail$ affairs.2

-amblers Anon$mous is an ecellent ad4unct to therap$, and the

support of other people who share $our concerns is wonderful. +he$ are

a!ailable 79, and ha!e online meetin%s and phone support as well.

ot e!er$one, howe!er, is comfortable with 67V'tep pro%rams, and

there are alternati!es to -.A. that ma$ be more to $our client0s liin%.


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#emember, choosin% the appropriate support %roup is up to the client, not

to $ou.

'MA#+ #eco!er$ is an alternati!e to -amblers Anon$mous L-A as

well as other 67/step pro%rams. +his pro%ram usin% concepts of (o%niti!e/

Beha!ioral +herap$ as the essential foundation of their pro%ram of support

and self/help.

'MA#+ #eco!er$0s potential effecti!eness for assistin% indi!iduals

to find relief from problem %amblin% is supported b$ research. 'MA#+

#eco!er$ pro!ides its members with tools and support that the$ can use to

help them reco!er from addicti!e %amblin% beha!iors as well as other

ne%ati!e and unwanted beha!iors.

6. Enhancin% & Maintainin% Moti!ation to Wuit C Helps $ou identif$

and eep up with $our reasons to stop %amblin%. 5h$ do $ou want to stop /

what will eep $ou focused on that %oal>

7. (opin% with =r%es C Dealin% with ur%es is part of reco!er$.

'MA#+ has tools desi%ned to help our members cope with ur%es.

8. Mana%in% Problems C 5e frequentl$ turn to our addicti!e

beha!iors Llie %amblin% addiction to either escape from or a!oid

addressin% problems. 'MA#+ #eco!er$ participants learn problem/sol!in%

tools to help them mana%e challen%es alon% the wa$.


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9. )ifest$le Balance C 'MA#+ %i!e members sills to help balance

both short and lon%/term %oals, pleasures and needs that were once out of

balance.

f $ou would lie to -E+ '+A#+ED ri%ht awa$, $ou can 4oin the

online support communit$ where $ou can read, share and learn from their

worldwide networ of members at an$ time of the da$ or ni%ht. Be sure to

(HE(S out our -amblin% Addiction support forum there.

httpwwwsmartreco!er$.or%

Another resource is -amblin%therap$.or% // an online support

ser!ice for people outside -reat Britain with %amblin% problems and those

affected b$ others %amblin%. +heir online ser!ices include a )i!e Ad!ice

Helpline, *orums, -roup therap$ as well as email support in other

lan%ua%es. +he$ also ha!e a resources database to loo for other options.

*or more details please eplore their website.

www.gamblingtherapy.org

+here is much to learn about obsession and compulsions, the matri

in which the$ de!elop, the role of %enetics, en!ironment and other factors.

n the ='A we continue focusin% on the indi!idual who, for whate!er

!ariet$ of reasons, eperiences harm to themsel!es and those connected to

them because of %amblin%.
http://www/smartrecovery.orghttp://www.gamblingtherapy.org/http://www/smartrecovery.orghttp://www.gamblingtherapy.org/


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n other countries, the focus is not on the indi!idual but on the harm

of problem %amblin% itself with the indi!idual bein% one aspect.

Ad!ancements in medicine, brain ima%in% and on%oin% research in

sociolo%$ and ps$cholo%$ %i!e us %reat hope in alle!iatin% problem

%amblin% if not entirel$, at least %reatl$ reduce it.

E!en thou%h problem %amblin% affects onl$ a small percenta%e of

those who pla$ %ames of chance, that percenta%e is comprised of real

people and their families.

5hile those of us who wor with indi!iduals and families to resol!e

their anieties and despair, renew hope, and encoura%e reco!er$, at least we

now that others are worin% on the bi% picture of sti%ma reduction and

harm minimiNation.

'*: :9-7+


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+o reduce the ne%ati!e social and health consequences

associated with problem %amblers for indi!iduals, their

families and their communities. +o maintain a reasonable le!el of en4o$ment from %amblin%

b$ recreational %amblers.

+o ensure that the li!elihood of those associated with the

%amin% industr$ is not unnecessaril$ compromised.

+he basic assumptions inherent in the harm/minimiNationreduction

approach are that

-amblin% is a recreational acti!it$ that is common amon%

indi!iduals and within the communit$.

Man$ indi!iduals are able to en%a%e in %amblin% without

ne%ati!e consequences to their lifest$le or to the communit$.

A proportion of participants, famil$ members and others

suffer si%nificant harm as a consequence of ecessi!e

%amblin%.

(omplete prohibition is not a realistic option.

Harm reduction in!ol!es indi!iduals at ris reducin%

%amblin% to a safe le!el of the beha!ior.

Harm reduction implies that safe le!els of participation are

possible. Accordin% to Marlatt L6KKF, there are three basic

harm minimiNation strate%ies that can be applied

6. Education of indi!iduals or %roups.

7. Modif$in% the en!ironment.

8. mplementin% chan%es to public polic$


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hrough the combined efforts of all who find gaming of

interest, may it become recognized and appreciated as a

simple recreational pastime rather than a metaphor for any

number of unresolved personal issues.

Sources consulted for the Student 'andboo%, and suggestions

for further study

-amblin% Problems An ntroduction for Beha!ioral Health 'er!ices

Pro!iders. Ad!isor$,


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on the therapeutic worin% alliance ew directions. n A. . Hor!ath & ).

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ther people0s mone$ A stud$ in the social ps$cholo%$ of

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Problem Gambling Handbook June 2015

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