Gambling is an Addiction: treatment strategies
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1 Gambling is an Addiction: treatment strategies Michael H. Rosen, MSW, LGSW Network Development Coordinator Maryland Center of Excellence on Problem Gambling Problem Gambling Helpline Number:
2 Difference Between DSM V & DSM IV Renamed Gambling Disorder Maintained Reclassified into: Substance Related & Addiction Disorder Reduced to 9 Criteria from 10 with the elimination of illegal acts criterion Diagnostic cut-off lowered to 4 from 5 Addition of time frame: Symptoms must be present within a 12 month period (as with SUDs) Funded by DHMH/ADAA
3 DSM V Severity Criteria Gambling Disorder Severity Rated 9 vs 10 Criteria (Illegal activities may be dropped) 2-3 Criteria will be indicative of a Mild Disorder 4-5 Criteria will be indicative of a Moderate Disorder 6 or More will be indicative of a Severe Disorder (The threshold for diagnosis (DSM-5) is two or more criteria in contrast to one or more criteria for DSM-4)
4 Remaining Questions Effect on reimbursement Effect on SAMHSA recognition Effect on research funding And remember: We are treating people with gambling problems, not problem gamblers
5 Problem Gambling Among SMI Clients What Defines a Problem Gambler among the Mentally ill Often Someone Who Gambles Very Little Money But Whose Self-Esteem And Self- Worth are Compromised by the GAMBLING
6 Problem Gambling among SMI clients Money is often controlled by someone in the person s life, either a mental health agency or family member, so financial damage may be minimal. Basic bills are being paid and there may be no access to credit cards because of limited income However may cause conflicts around money with family, peers within treatment and group living settings. Cognitive deficits may cause serious impairments in judgment
7 Pathological Gambling: Comparison to Substance Abuse Similarities Loss of Control Preoccupation Negative impact on major life areas Tolerance
8 Pathological Gambling: Comparison to Substance Abuse Similarities Withdrawal Symptoms Self-help groups Biopsychosocial/spiritual disorders Family involvement
9 Pathological Gambling: Comparison to Substance Abuse Differences Unpredictable outcome Fantasies of success No biological test Easier to hide
10 Pathological Gambling: Comparison to Substance Abuse Differences Greater financial problems Intensity of family anger Less public awareness and acceptance
11 Significance of Co-Occurring Disorders Individuals with Co-Occurring PG and SUDs Experience More Severe Symptoms Than Those With SUDs Alone (Kaplan & Davis, 1997) - Increased Rates of Admission for Detoxification (> Two-Fold Rate) - Increased Rates of Admission for Psychiatric Stabilization (> 50% Increased Rate) - More Suicidality (Federman et al, 1998)
12 Lifetime Co-morbidity Kessler et al., 2008 (National Comorbidity Survey Replication) Although nearly half (49%) of those with lifetime pathological gambling received treatment for mental health or substance abuse problems, none reported treatment for gambling problems.
13 Problem Gambling Treatment Begin with a thorough assessment: Screen ALL clients for gambling disorder: gambling screens SOGS - SOGS-RA - PERC Integrate assessment questions and ask them over the course of treatment Involve family if possible as soon as possible Offer facts and brief education on gambling problems to clients and colleagues Know local resources: / GA
14 Screening What questions about gambling can you incorporate into each part of your interview? Biological/Medical Substance Use/Abuse Psychological Social Leisure Activities Spiritual
15 Family Screening Does Family Have Significant Financial Problems Are Financial Problems Related to Gambling (Either causing them or seen as solution) Have You Been Concerned About Extent of Gambling of Family Member?
16 Instruments South Oaks Gambling Screen (SOGS) PERC-(NODS)instrument Gambling Severity Index GA-20 Questions Lie-Bet 2 Question Brief Screen SOGS-R A- Adolescent Screen Mass. Adolescent Gambling Screen
17 The NODS-PERC NODS 1 NODS 8 NODS 10 NODS 14 Have there ever been periods lasting 2 weeks or longer when you spent a lot of time thinking about your gambling experiences or planning out future gambling ventures or bets? Have you ever gambled as a way to escape from personal problems? Has there ever been a period when, if you lost money gambling one day, you would return another day to get even? Has your gambling ever caused serious or repeated problems in your relationships with any of your family members or friends?
18 Continuing Care in Comorbid Pathological Gamblers Parallel process of gambling and mental health/substance abuse treatment Make connections continuously May need multiple support groups Educate and address motivation for all disorders Family education on full diagnostic picture Remember both/all can be recurring, progressive disorders Learning from relapses
19 Problem Gambling Resources Gamblers Anonymous Patterned after Alcoholics Anonymous Founded 1957 (recovering alcoholics) Abstinence Club Vs. Recovery Program War Stories vs. Recovery skills 1800 US Groups ( 19 Meetings in Maryland ( gambling.com)
20 Gamblers Anonymous Meeting Structure and Programs Meeting types Traditional (closed) Open Step Cross Comment Financial pressure and budget relief groups
21 Gamblers Anonymous Benefits Peer support No dues or fees Structure for recovery Means of reducing shame and guilt Encourages active participation in own recovery Long term maintenance
22 Gamblers Anonymous Comparison to AA GA meetings longer and smaller GA everyone can speak Often GA and Gam-Anon held at same place and same time Few step meetings or lead meetings
23 Gam-Anon Goal: support and strategies for participants who are related to a problem/compulsive gambler Steps and Tools to help take control of their lives Build inner strength and maturity Stop enabling the gambler 2 meetings of Gam-Anon in Maryland
24 20 questions GA-: Are you a Compulsive Gambler? Gam-Anon: Are you living with a Compulsive Gambler? Could your child be a Compulsive Gambler?
25 Resources GA - GAM-AON - Maryland Center of Excellence on Problem Gambling: Problem Gambling Helpline Number:
26 Resources for Problem Gamblers The Maryland Center of Excellence on Problem Gambling is a resource center. Our Helpline operates 24/7 for referrals for problem gamblers and their families at: Visit the webpage at:
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