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The Gambling Disorder Treatment Handbook

A Guide for Mental Health Professionals
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This handbook provides mental health professionals with a thorough understanding of the biopsychosocial nature of disordered gambling and shares current evidence-based theories, interventions and strategies to use in clinical practice. It provides guidance for working with individuals of any age and covers different gambling modes, activities and subtypes, including new forms of gambling through online and virtual platforms. Drawing on the authors' substantial experience working with and researching gambling addiction, it considers how treatment can be specialized for particular client groups, including trauma survivors, military, older adults, adolescents and diverse communities. It provides detailed diagnostic and screening resources and includes important information on the financial and legal aspects. This is essential reading for any therapist treating clients with gambling disorder.
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
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