Intro & Prevention
A definition of gambling
What is… risking something of value on the outcome of an event when the probability of winning is less than certain.”
2 screening tools for PG?
What are
South Oaks Gambling Screen – SOGS
Problem Gambling Severity Index
Brief Biosocial Gambling Screen – BBGS
NODS/NORC
Lie/Bet Questionnaire
Name some of the co-occurring rates between SU & MH & PG?
What are: Substance Use 75% had an alcohol disorder; 38% had a drug use disorder; 60% were nicotine dependent
Mental Health 56% PG’s diagnosed with a mood disorder; 60% PG’s diagnosed with an anxiety disorder
42% PG’s diagnosed with substance use disorder; 57-82% the other disorder was diagnosed first
While almost half (49%) of those with lifetime PG received treatment for mental health or substance use disorder, NONE reported treatment for gambling problems.
MI - A strategy that involves listening carefully to clients and then making a reasonable guess as to what they are saying.
What is Reflective Listening
Define Recovery Capital
What is Recovery capital (RC) is the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from severe AOD problems.
2 warning signs of problem gambling
What are : Continually talking about gambling
Spending more money or time gambling than you can afford
Gambling more in order to win back losses
Borrowing, stealing, or selling things to get money for gambling or to pay gambling debts
Having financial difficulties such as not being able to pay bills due to gambling
Gambling to escape problems or boredom, or to relieve anxiety or depression
Being criticized by others for your gambling
Hiding signs of gambling activities such as lottery tickets or betting slips
Missing work, school or other commitments due to gambling
Name some DSM 5 Gambling Disorder Criteria
What are: Is preoccupied with gambling (relives past experiences…)
Needs to put increasing amounts to get the same excitement
Has repeated, unsuccessful attempts to control, cut back, or stop
Becomes restless or irritable when trying to stop gambling
Gambles as a way to escape problems or deal with dysphoric mood
After losing money gambling, often returns another day to get even
Lies to family/friends/coworkers to hide the extent of gambling losses
Has jeopardized, or lost, a significant relationship, job, educational, or career opportunity because of gambling
Relies on others to provide the money to relieve a desperate financial situation caused by gambling
Name some Similarities of Gambling Disorder and Substance Abuse Disorders?
What are:Emotional difficulties; Stress ; Preoccupation with activity; Intense cravings; Increase tolerance; Continue usage despite negative consequences; Impulsivity; Significant withdrawal symptoms
MI – A strategy associated with successful outcomes by eliciting reasons for behavioral change from clients.
What is Change Talk
List the 3 types of Recovery Capital
What are:
Personal Recovery Capital
Family/Social Recovery Capital
Community Recovery Capital
2 gambling risk factors that are specific to gambling?
What are: Emotional difficulties
Stress
Distorted expectations about winning
Social pressure to gamble
Risky gambling behavior
Attention deficits
Impulsivity
Illusion of control over outcomes
Addiction history
Family history of gambling problems
Name some questions to ask when assessing?
What are
What do you like to do for fun?
Ever win anything?
What impact has gambling had on your recovery?
What impact has gambling had on your relationship/s?
What impact has gambling had on your finances?
How long have you been gambling?
Name some Negative Consequences of PG and Impact of Gambling w/ SU & MH Disorders
What are: Problem Gambling is Associated w/ Higher Rates of:
Debt – on average in excess of $30,000
Legal Problems - illegal Activity-25% of problem gamblers will commit a crime to further their gambling
Employment problems-1 in 4
Depression
Alcohol-related Problems
Utilization of Mental Health TX
Suicide Attempts
Name the Context for Stages of Change
What is: Views change as a process, rather than an event.
● Involves cognitive and behavioral processes.
● Relapse is an expectation and not penalized.
3 resources to refer a problem gamblers to other than TX with a MA PGS clinician?
What are GA; In the Rooms; GA Phone meeting; SMART; Phone app supports; online supports
Exposure to early childhood (THIS) has consistently been associated with disordered gambling later in life.
(What is trauma?)
Elements of a CBT Session
What are: Mood check: The therapist asks about the client’s mood since the previous session.
Bridge: The focus of the previous session is reviewed to create a bridge to the current session.
Agenda: The therapist and client identify issues to address in the current session, which will act as the agenda.
Homework review: Homework from the previous session is reviewed to note progress and troubleshoot any difficulties.
Agenda items: Agenda issues are addressed using cognitive and behavioral strategies.
New homework: Exercises and tasks for the upcoming week are assigned.
Summary and client feedback: The session is wrapped up.
According to the DSM 5 approximately what % of those in tx for PG had considered suicide & what % has attempted it?
What are:The DSM-5 states that up to half of individuals in treatment for a gambling disorder have suicidal ideation and about 17% have attempted suicide.
Describe Cognitive Restructuring
What is : Work with the client to identify Cognitive Distortions by exploring their thought processes in depth; Identify Facts from Fiction
When these thoughts are brought to the surface, the client can begin to challenge their thinking
Identify new ways of thinking and strategies to overcome Cognitive Distortions
List the SAMHSA- 4 major dimensions that support a life in Recovery?
What are:
Health: Overcoming or managing one’s disease(s) or symptoms, for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem and, for everyone in recovery, making informed, healthy choices that support physical and emotional well-being
Home: Having a stable and safe place to live
Purpose: Conducting meaningful daily activities, such as a job, school volunteerism, family care taking, or creative endeavors, and the independence, income, and resources to participate in society
Community: Having relationships and social networks that provide support, friendship, love, and hope
The name of responsible gambling programs that are within Massachusetts casinos.
(What is GameSense?)
List reasons why CBT is effective
What are: CBT has been identified as the most effective Evidence Based Model for Treating Gambling Disorder.
Clinicians utilize CBT to help their clients shift their gambling related attitudes, beliefs and behaviors and deal with their urges in a more productive way.
CBT enables clients to identify faulty thinking (cognitive distortions) and develop new techniques and strategies to adopt and maintain healthy behaviors.