The Gambling Disorder Treatment Handbook

CHAPTER 1: GAMBLING IS EVERYWHERE, (and it doesn't appear to be going away anytime soon) 11 Global Gambling Market................................................................................................... 12 Gambling Expansion and New Horizons.......................................................................... 14 Online and Internet Gambling........................................................................................... 15 Social Gaming.................................................................................................................... 17 Sports Betting..................................................................................................................... 20 Consumer Protections and Harm Minimization to Promote Safe Gambling Use......... 22 Self-Exclusion.................................................................................................................... 23 Game Features and Structural Characteristics................................................................... 24 Gambling Behavior Characteristics................................................................................... 26 Setting Limits..................................................................................................................... 27 Training Employees who Interact with Gamblers.............................................................. 28 CHAPTER 2: Understanding Gambling Disorder: Pathways towards Etiology, Prevalence, and Comorbid Determinants of Health 30 Etiological Predictors and Risk Factors for Developing Gambling Disorder................ 32 Biological/Neurological Implications................................................................................ 34 Psychological Implications................................................................................................ 37 Social-Cultural Implications.............................................................................................. 38 Spiritual Implications......................................................................................................... 41 Pathways Model of Problem Gambling............................................................................. 43 Considerations for Special Populations and Gambling.................................................... 48 Adolescents......................................................................................................................... 48 Older Adults....................................................................................................................... 49 Diverse Communities......................................................................................................... 50 Military............................................................................................................................... 51 Trauma and Survivors Issues............................................................................................. 52 Co-Occurring Disorders..................................................................................................... 53 CHAPTER 3: Models of Intervention................................................................................... 55 Transtheoretical Model....................................................................................................... 56 Treatment Approaches and Stance of Therapy................................................................ 58 Cognitive Therapy............................................................................................................. 58 Behavior Therapy.............................................................................................................. 59 Cognitive-Behavior Therapy............................................................................................. 59 Third-Wave Behavior Therapy.......................................................................................... 61 Motivational Interviewing................................................................................................. 63 Pharmacological Therapy.................................................................................................. 65 Treatment Considerations: Modality, Duration, and Targeting Relapse....................... 66 Online Modalities.............................................................................................................. 67 Brief Treatment.................................................................................................................. 68 Relapse Prevention............................................................................................................. 69 CHAPTER 4: Models of Intervention Applied..................................................................... 71 Closing the Doors................................................................................................................. 73 Addressing Gambling Symptoms....................................................................................... 77 Cognitive Distortions......................................................................................................... 77 Habituation......................................................................................................................... 78 Chasing Losses and Wins................................................................................................... 82 Session Considerations......................................................................................................... 83 Treatment Selection............................................................................................................ 83 Mindfulness in Session....................................................................................................... 84 Relapse Prevention............................................................................................................. 85 Terminating Therapeutic Relationship............................................................................... 88 CHAPTER 5: Where to Start and What to Ask in the Beginning...................................... 90 Gambling Screens, Assessments, and Diagnostic Tools.................................................... 90 Lie-Bet Questionnaire........................................................................................................ 91 Brief Biosocial Gambling Screen (BBGS)........................................................................ 91 GBIRT................................................................................................................................ 92 Gatekeeper Question.......................................................................................................... 92 Simply Asking Open-Ended Questions (Fun Assessment)............................................... 94 Diagnostic Statistical Manual-5 (DSM-5)......................................................................... 95 International Statistical Classification of Diseases and Related Health Problems (ICD-10)96 South Oaks Gambling Screen (SOGS).............................................................................. 97 Problem Gambling Severity Index (PGSI)........................................................................ 97 Gambling Pathways Questionnaire (GPQ)........................................................................ 97 Gambling Functional Assessment II (GFA-II).................................................................. 98 The Chicken or the Egg: Which Came First.................................................................... 98 Depression and Anxiety..................................................................................................... 98 Traumatic Brain Injuries (TBI).......................................................................................... 99 Drugs, Alcohol, Nicotine/Tobacco and Cannabis............................................................ 100 Suicide Risk Assessment................................................................................................. 101 Gambling Problem or Gambling Solution...................................................................... 101 Closing the Doors............................................................................................................ 102 It's a Control Thing.......................................................................................................... 103 Creating a Safe Place....................................................................................................... 103 The First Few Sessions...................................................................................................... 104 Where to Start and What to Ask...................................................................................... 104 Presence of Suicidal Ideation........................................................................................... 105 Motivation and Consequences of Gambling.................................................................... 105 Games/Gambling............................................................................................................. 106 Development of Gambling Habits................................................................................... 106 Current Gambling Problem.............................................................................................. 106 DSM-5 Diagnostic Criteria and Other Assessments........................................................ 106 Finances........................................................................................................................... 107 Current Living Conditions............................................................................................... 107 Other Compulsive or Addictive Behaviors...................................................................... 107 Prior Mental Health and Health Problems....................................................................... 108 Personal Strengths and Resources.................................................................................... 109 Steps Taken Prior to Seeking Treatment.......................................................................... 109 Summary of Initial Recommendations............................................................................. 109 Clinical Impressions......................................................................................................... 110 Gambling Bio-Psycho-Social-Spiritual Evaluation......................................................... 112 Chapter 6: Harm Reduction Approaches Across the Continuum.................................... 123 Harm Reduction to Self-Exclusion: A Shared Continuum............................................ 124 Using Harm Reduction with Clients................................................................................ 125 10 Rules of Responsible Gambling................................................................................... 127 Using Harm Reduction with Specific Populations......................................................... 131 Self-Exclusion as Harm Reduction................................................................................... 134 Case Examples of Harm Reduction on a Continuum..................................................... 137 Case 1: Susan...................................................................................................................... 137 Case 2: Joe.......................................................................................................................... 138 Chapter 7: On Finances........................................................................................................ 140 Real Money and Gambling Money................................................................................... 141 Why Bankruptcy Is Not an Option.................................................................................. 141 Money Protection............................................................................................................... 143 Financial Inventory for Restitution Plan......................................................................... 144 Clarifying Debt and Expenses.......................................................................................... 144 Debt Repayment / Financial Restitution Plan................................................................... 146 Involving Family Member................................................................................................. 147 Asset Protection Plan for Partner/Spouse and Children................................................ 148 Case Examples for Implementing Finance Strategies.................................................... 151 Case 1: Eva......................................................................................................................... 151 Case 2: Noah....................................................................................................................... 153 CHAPTER 8: Family Involvement...................................................................................... 155 Family Systems Theory Review........................................................................................ 155 First and Second Order Change....................................................................................... 156 Provide Education About Suicide.................................................................................... 159 Provide Education About Gambling Disorder................................................................. 159 Working with the Family : Spouse/Partner and Gambler............................................. 163 Working With the Family : Family Only........................................................................ 165 Protect Family Member's Financial Assets..................................................................... 165 Core areas of conflict....................................................................................................... 166 Enabling as a form of bailout........................................................................................... 167 Setting limits and boundaries........................................................................................... 167 Trust, anger/love, confidence........................................................................................... 167 Expectations of new lifestyle........................................................................................... 168 Working with the Family: Parents and the (Adult) Gambler........................................ 168 Working with the Family : Parents and (Adolescent) Gambler.................................... 169 Working with the Family : Final Stage of therapy.......................................................... 171 CHAPTER 9: Self-Help and Peer Supports........................................................................ 173 Self-Help Programs............................................................................................................ 173 12-Step Programs............................................................................................................... 174 Gamblers Anonymous...................................................................................................... 174 Celebrate Recovery............................................................................................................ 176 SMART Recovery............................................................................................................... 177 Peer Supports...................................................................................................................... 177 Having the Conversation................................................................................................... 179 Understanding the Younger Generations......................................................................... 180 Other Online Supports..................................................................................................... 180 CHAPTER 10: Gambling and the Law............................................................................... 182 Gambler or Criminal Profile............................................................................................. 183 Legal Involvement: Before & During............................................................................... 185 The 5 Rs' of Treatment and Documentation.................................................................... 186 Act As If You Are Already in Front of the Judge............................................................ 188 Clinical Report Sections..................................................................................................... 189 Legal Involvement: After................................................................................................... 193 Providing Expert Testimony.............................................................................................. 194 Example Report Evaluation to inform and educate sentencing.................................... 195 Full Report to an attorney on behalf of your client - example....................................... 203 REFERENCES 206