One of the considerable challenges in effectively treating those with any kind of addiction, whether alcohol, drugs or gambling, is the degree to which professional helpers receive adequate training in addictive illness. At present, only a small amount of the curriculum for psychologists, social workers, physicians, psychiatrists, chaplains and nurses includes addiction.
While there’s been an increase in the availability of specialty training in addiction as it relates to alcohol and drugs, attention to pathological gambling has not been at the same level. Part of this is related to the general lack of public awareness about problem gambling, and part relates to the stigma that affects individuals’ and family members’ willingness to come forward and seek help.
Gambling activity, like the use of alcohol and chemical substances, comes in several forms. On one end of the spectrum, there is the occasional participant whose “use” may be more experimental or social in nature. In other cases, the activity may be more episodic and a function of opportunity or the response to a particular time or event in a person’s life. Beyond that, the activity may cross into addictive illness and essentially consume a person’s existence, creating considerable limitations in other aspects of life.
For individuals considered to be addicted to gambling, the goal of therapy is to have them abstain from all gambling activities. That is often a difficult message to swallow in a society bombarded by media messages communicating gambling as harmless entertainment.
Not surprisingly, current treatment approaches for gambling addiction essentially mirror those employed for chemical and alcohol abuse. “Effective treatment for problem gambling has a lot to do with matching the individual with the appropriate level of care,” says Mike Schiks, executive director of Project Turnabout/Vanguard, an organization that offers residential treatment programs for those with addictions to alcohol, drugs and gambling.
Depending on the severity of a person’s gambling problem, different approaches are appropriate or practical at each stage. As with the treatment of other addictions, treatment approaches include prevention, counseling, outpatient programs and inpatient programs, as well as aftercare programs.
Providers who counsel prevention are limited. Their efforts deal predominantly with decisions related to experimentation and infrequent use. Prevention messages tend to be part of the alcohol and drug prevention curriculum.
Discussion about gambling behavior may take place in a counseling session under several scenarios. The first is when gambling is discussed in the context of counseling for another purpose, such as relationship, marriage and family therapy, or avocation counseling. The second is when the focus is more directly on the gambling behavior.
Private counselors and therapists often address periodic gambling “abusers” in conjunction with other life problems. Therapy may or may not focus on gambling, and it may be accompanied by the suggestion that an individual curtail or possibly discontinue gambling, particularly as it relates to other problems or mental health issues a person may be experiencing (i.e., depression, anxiety, family and marital issues, etc.). Treatment providers at this level may include a physician, psychologist, psychiatrist or licensed counselor. Compulsive gamblers may be counseled by generalist private practitioners either individually, in couple or family settings, or in group therapy when there are enough clients.
While this type of counseling is often referred to as “outpatient,” it lacks the educational process and support dimensions of an actual outpatient program. Although one-to-one counseling can be effective for various kinds of issues, without a group component it may not be as effective for gamblers who are further along in their addiction.
Outpatient programs. There are outpatient programs that specialize in problem gambling. Such programs employ a treatment plan that is based on a comprehensive assessment, and typically include group therapy (exclusively for problem gamblers), an educational aspect, and a continuing care plan.
Intensive outpatient treatment typically consists of two-to-four days of treatment per week in a program attended by a relatively homogeneous group of fellow compulsive gamblers at various stages of treatment. Treatment consists of a combination of education, therapy and practice with peer support. The length and duration of the program varies depending on the individual’s progress.
The goals of this treatment are to personalize the addiction and the consequences in a manner so that participants understand the stakes of recovery. “It is hard for many compulsive gamblers to accept that they cannot go back to any kind of social or recreational gambling,” says Mike.
Another goal is to instill a sense of hope. “Often, problem gamblers have suffered serious emotional pain and anguish, had difficulties with their family, and sustained extreme financial hardship,” says Mike. “They can feel a sort of “morning after” franticness once they’re honest with themselves, and they need support.”
Beyond that, the process follows the Prochaska and DiClemente’s Stages of Change Model, a model of behavior change that assesses an individual’s readines to act on a new healthier behavior, and provides strategies or processes to guide the individual through the stages of change to action and maintenance. The treatment focus moves on to help problem gamblers understand the need to commit to the recovery process, to learn about themselves, to identify coping skills and develop a sense of ongoing responsible behavior through monitoring their progress. They are also encouraged to commit to the ongoing use of support around them and, ultimately, to create a sense of self worth in knowing that their experience and recovery can benefit others.
“The model of treatment is comprehensive and in many ways more complex than most people understand,” says Mike. “It’s about engaging people to change their lives.”
Inpatient programs. The most intense program treatment takes place at residential facilities geared for compulsive gamblers. In Minnesota, the Vanguard Compulsive Gambling Treatment Center in Granite Falls is the only residential program in Minnesota and one of only a few in the nation.
Such programs are designed and built exclusively for individuals and families experiencing problems due to gambling. The program includes a full array of services from psychological evaluation to a medical physical.
By the time gamblers require inpatient treatment at a residential facility, they’re at an acute stage and their problems are severe. Some statistics gathered by Vanguard suggest the dire circumstances of gamblers who reach this stage: 99 percent have depleted savings; 77 percent are without health insurance; 88 percent have stopped taking prescribed medications; 84 percent are in mortgage default; and 82 percent have had suicidal thoughts related to their gambling behavior.
One of the first priorities upon patient admission is addressing the overall health of the patient. “When people reach the addiction stage of problem gambling, they often neglect their health,” says Mike. Therefore, the inpatient treatment process begins with a medical physical and a psychological assessment. The assessment is important because many people come in with varying degrees of emotional distress, including some who have received a mental health diagnosis and have stopped taking medication.
“From this process we develop a treatment plan designed to educate the patient about the impact that gambling has had on their life and the lives of others. We then work with them in finding real-time approaches and solutions to deal with their compulsive gambling. There is also an inpatient/residential peer group that provides a training ground for patients to learn how to reach out to other compulsive/problem gamblers.
Continuing care programs and services, sometimes called aftercare, generally begin immediately following an inpatient/ residential and or intensive outpatient treatment. They often include an array of services based on the individual’s needs. Some services focus directly on helping the problem gambler refrain from gambling. These services often include group therapy meetings led by specialized gambling counselors or individual sessions to help them transition into a “gambling-free lifestyle.” Self-help groups such as Gambler’s Anonymous, which are independent of all treatment and counseling agencies, are available to provide lifetime support at minimal to no cost.
Addictive gambling often impacts all areas of an individual life. Continuing care programs may also include recommendations for counseling on a myriad of issues including marriage, family, emotional, financial, vocational and/or medical care for co-occurring disorders.
Success of Gambling Treatment
Addictive gambling is often hidden and invisible. It can be equally hard to find individuals who have received treatment, and who have gone back to the business of being productive citizens and family members. Anonymity, in fact, is a tradition that’s espoused in most support groups. Yet, one of the most important factors in raising the visibility and effectiveness of problem gambling therapy is to highlight those who have benefited from treatment. Problem gambling is very real, yet so is successful recovery.