Transcript Massachusetts Council on Compulsive Gambling

Problem Gambling:
The Hidden Addiction (Part 2)
Victor Ortiz, MSW, LADC I, CADC II
Presentation for:
Residential Substance Abuse Treatment (RSAT)
January 21, 2015
Acknowledgement
o Harvard Medical School Division on Addiction
o National Center for Responsible Gaming
o Dr. Eunice Aviles
Learning Objectives
 Participants will be able to identify three effects of




disordered gambling on mental health functioning
Participants will be able to identify two theories of
gambling addiction
Participants will be able to identify two complementary
services to gambling addiction treatment
Participants will be able to identify two self help guide
resources.
Participants will be able to identify three common
triggers experienced by problem gamblers in recovery
Problem Gambling: The Hidden Addiction
Part I
Main Points
The association of gambling disorders and psychiatric disorders
Changes in the DSM-5 – Substance-Related Disorders
Addiction Syndrome Model
4
Evidence Based Practice
Evidence Based Practice
o
Applying the best available research results
(evidence) when making decisions about
health care. Health care professionals who
perform evidence-based practice use
research evidence along with clinical
expertise and patient preferences.
6
Evidence Based Practice
EVP
+
clinical expertise
+
patience values
=
positive outcomes
7
The Field of Gambling Disorders
o It was not until 1972 that Dr. Robert Cluster, a physician
working at the Veterans' Administration hospital in
Brecksville, Ohio, first proposed a clinical entity, which
he termed compulsive gambling.
o In 1980, the American Psychiatric Association
incorporated "pathological gambling" into its diagnostic
and statistical manual (American Psychiatric Association,
1980) and thus legitimated this entity within the
mainstream mental health field.
The Field of Gambling Disorders
o The development of clinical strategies for the effective
treatment of disordered gambling is in its very early
stages (Korn, Shaffer, 2004)
o The technological growth has added an additional
dimensions to gambling.
The Gambling Environment is Evolving
o Gambling has become more convenient and accessible.
o Gambling is coming out of gambling environments and is
converging with other technologies.
o Gambling is becoming more anonymous and "asocial”.
o Gambling is perceived as an ever more important source
of public revenues.
Sources include: Griffiths, M. (2012) Technological trends, behavioral tracking, and implications for social
responsibility tools in gambling. [PowerPoint presentation] Retrieved from
http://www.responsiblegambling.org/docs/discovery-2012/technology-trends-behavioural-tracking-andimplications-for-social-responsibility-tools-in-gambling.pdf?sfvrsn=8
Problem Gambling:
A Public Health Perspective
11
Framework for Public Health Action
Range of Gambling Problems
Range of Behaviors
none
mild
moderate
Non
Gambling
severe
Healthy
Gambling
Unhealthy
brief
Treatment
Harm Reduction
Health Promotion
Primary prevention
Secondary prevention
Tertiary prevention
Range of Interventions
intensive
Public Health Approach to
Gambling Problem
o For example, the classic public health model for
communicable disease that examines the
interaction among host, agent, environment and
vector can be instructive for gambling.
o A public health viewpoint also can lead to the
design of more comprehensive and effective
strategies for preventing and treating gambling
related problems.
Clinical Practice
The Case of Rita
o
o
o
o
o
o
o
48 years old woman
First started gambling when she was 30
Gambling intensified after her first divorce
Was previously diagnosed with a mood and
anxiety disorder
6 months free from a bet
Married with two children
Occasionally drinks, but has never used drugs
15
Rita
Gambling of Choice
Treatment/Services
o Casino Gambling
o Mental Health Counseling
o Scratch tickets
o Gambler Anonymous
17
Jose
18
The Case of Jose
o
o
o
o
o
o
o
40 years old
First started using drugs at 12 years old
Drug of choice is heroin
Was previously diagnosed with a mood and anxiety
disorder
9 months of sobriety
Married with two children
Currently resides in a Substance Abuse residential
program
19
Jose
Substance of Choice
Treatment/Services
o Heroin
o Substance Abuse Counseling
o 12 Step Programs
Rita & Jose
o
o
o
o
Missed Opportunities
Connecting mental health disorders, SUD, and/or
symptoms to gambling behaviors
Education and awareness within clinical practice
Strengthen referrals and support services
Incorporating evidence within policy and practice
21
A Clinical Perspective
o People with gambling disorders are hesitant to enter
treatment.
o None of the participants in the National Comorbidity
Survey Replication (Kessler & Merikangas 2004) with
a PG diagnosis ever received treatment for a
gambling problem; however, 49% were treated for
other mental disorders (Kessler et al. 2008).These
studies indicate that about half of the PGs received
treatment for other psychiatric disorders. However,
neither they nor their treatment providers recognized
that their disordered gambling required treatment
22
Ranked Treatment Interventions
Strong Evidence
· Cognitive Behavioral Therapy
· Behavioral Therapy
Moderate Evidence
· Relapse Prevention
Weak Evidence
· Psychodynamic Psychotherapy
· Self Exclusion
· Gamblers Anonymous
Cognitive Behavioral Therapy
 Research has demonstrated that cognitive factors are an
important part of the development and maintenance of
problem gambling (Lupu, 2008).
 Many pathological gamblers remember important
winnings during their first gambling experiences. An
individual absorbed by gambling loses sight of the
hazardous dimension and concentrates on the possibility
of controlling and influencing the game to his/her favor
(Lupu, 2008).
Cognitive Behavioral Therapy
 Cognitive Behavioral Therapy (CBT) has proven to be
an effective way of treating problem gamblers (Fortune &
Goodie, 2012).
 Positive outcomes of CBT can be seen as much as two
years after termination of treatment (Gooding & Tarrier,
2009 in Fortune & Goodie, 2012).
Cognitive Behavioral Therapy
 Experts have agreed that cognitive distortions play a key role in
triggering and maintaining gambling behaviors despite negative
outcomes. (Jacobsen, Knudsen, Krogh, Pallesen, & Molde, 2007 in
Fortune & goodie, 2012).
 The purpose of CBT with pathological gamblers is to “identify
negative thoughts, cognitive distortions and erroneous perceptions
about gambling that are responsible for continued gambling”
(Tavares, Zilberman, el-Guebaly, 2003 in Fong, 2005).
 In doing so the aim is to correct cognitive distortions about gambling
to achieve complete abstinence (Fong, 2005).
Principles of Drug Abuse Treatment
for Criminal Justice Population
7. Treatment should target factors that are associated with criminal behavior
o “Criminal thinking” is a combination of attitudes and beliefs
that support a criminal lifestyle and criminal behavior, such
as feeling entitled to have things one’s own way, feeling
that one’s criminal behavior is justified, failing to accept
responsibility for one’s actions, and consistently failing to
anticipate or appreciate the consequences of one’s
behavior.
o This pattern of thinking often contributes to drug use and
criminal behavior. Treatment that provides specific
cognitive skills training to help individuals recognize errors
in judgment that lead to drug abuse and criminal behavior
may improve outcomes.
28
Screening Tools
29
Screening Tools




SOGS-South Oak Gambling Screen
MAGSLie/Bet Screening Tool
BBGS- Brief Biosocial Gambling Screen
30
Screening Tools -LIE/BET
 Have you ever felt the need to bet
more and more money?
 Have you ever had to lie to people
important to you about how much you
gamble?
Resources
33
Gambling Problems: An Introduction for
Behavioral Health Services Providers
www.samha.gov
First Step to Change: Gambling
o Many people are able to change their excessive behavior patterns
without entering formal treatment. The Division on Addiction,
Cambridge Health Alliance, an affiliate of Harvard Medical School has
created a series of self-change toolkits. These toolkits are designed to
do three things: www.basisonline.org/selfhelp_tools
o They will help people gain information about addiction-related
problems.
o They will help people evaluate their own addiction-related behavior.
o They will help people develop change strategies, should they decide
that change is the best course.
36
First Step to Change: Gambling
o Section 1: Facts About Gambling
will explain how gambling works and how it can become a
problem for some people.
o Section 2: Understanding Your Gambling,
will help you think about how you gamble and your reasons
for gambling.
o Section 3: Thinking About Change,
will lead you through the process of change.
37
National Council on Problem Gambling
www.ncpg.org
Massachusetts Council on Compulsive Gambling
www.masscompulsivegambling.org
Harvard School Division on Addiction
www.divisiononaddiction.org
National Center for Responsible Gaming
www.ncrg.org
38
Massachusetts Council on Compulsive
Gambling
Victor Ortiz, MSW, LADC I, CADC II
Sr. Director of Programs and Services
[email protected]
Twitter- @Victor_Ortiz21
617-426-4554
39
Work Cited






Petry, NM, et al. (2005) Comorbidity of DSM-IV pathological gambling and other
psychiatric disorders: Results from the national epidemiologic survey on alcohol and
related conditions. Journal of clinical Psychiatry. 66:564-574
Grant, J.E. J.D. Potenza, M. MD, Weinstein, A. PhD., Gorelick, D. MD, PhD. (2010) The
American Journal of Drug and Alcohol Use, Early Online 1-9. DOI:
10.3109/00952990.2010.491884
Petry, NM, et al. (2013). An Overview of and Rationale for Changes Proposed for
Pathological Gambling in DSM-5. J Gambl Studies.
Howard J. Shaffer, PhD, CAS, Debi A. LaPlante, PhD, Richard A. LaBrie, EdD, Rachel C.
Kidman, BA, Anthony N. Donato, MPP, and Michael V. Stanton, BA; Toward a Syndrome
Model of Addiction: Multiple Expressions, Common Etiology, Harv Rev Psychiatry
2004;12:367–374. 2004
Shaffer HJ, Martin R. Disordered gambling: etiology, trajectory, and clinical
considerations. Annu Rev Clin Psychol. 2011; 7: 483-510.
Shaffer HJ. On the nature and meaning of addiction. Natl Forum 1999;79(4):10–4.67
Work Cited





Shaffer HJ. The most important unresolved issue in the addictions: conceptual chaos. Subst
Use Misuse 1997;32:1573–80.
Shaffer HJ. Rethinking addiction: how gambling and other behavioral addictions are
changing the concept and treatment of alcohol and substance use disorders. Acad News
2003(2):1,3,7.
American Psychiatric Association. DSM-IV: Diagnostic and Statistical Manual of Mental
Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994
American Psychiatric Association. Diagnostic and Statistical Manual
of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013
Grant JE, Potenza MN. Commentary: illegal behavior and pathological gambling. J Am Acad
Psychiatry Law. 2007;35(3):302–305.
Next Presentation
The Neurobiology of Addiction & Effective Treatment
February 18, 2015
2:00 – 3:00 p.m. ET
This webinar will provide an overview of the scientific basis for viewing drug
addiction as a disease that affects the brain and behavior. Evidence-based
interventions and principles for addressing substance use disorders,
including psychosocial treatments and medications will be discussed.
Presenter:
Redonna K. Chandler, Ph.D.