WHAT EVERY ADDICTION COUNSELOR SHOULD KNOW ABOUT GAMBLING WHAT ARE WE MISSING?

Transcription

1 WHAT EVERY ADDICTION COUNSELOR SHOULD KNOW ABOUT GAMBLING WHAT ARE WE MISSING?

2 Rules of the Road

3 Comments

4 Questions This is for you. If you have a question, please ask it. Don t be embarrassed the guy next to you probably has the same question and is afraid to ask

5 Don t Worry About Interrupting My Train of Thought. As you will soon see, no Thought went into this at all. My only goal is to you the information that you need. You are the best person to determine what that is.

6 Participate The more you take part the more you and everyone else learn.

7 Equal Opportunity Embarasser Volunteer early and get it over with. In the next four hours I will be sure to get to each of you. Besides you probably will never have to see any of these people again.

8 About Me

9 What do you need? Who are you? What do you want to put in your cart for this workshop?

10 GAMBLING, A HIDDEN ADDICTION MANY PATIENTS HAVING OTHER ADDICTIONS ARE ALSO ADDICTED TO GAMBLING.

11 You won t find it if you don t look!

12 HOW MANY PEOPLE GAMBLE RECREATIONALLY? MANY PEOPLE GAMBLE FOR FUN

13 HOW DO YOU FEEL ABOUT GAMBLING

14 What about Alcohol?

15 Is Gambling Really an Addiction?

16 Gambling was an accepted pass time in ancient Rome

17 The bible speaks of gambling in the old Testament.

18 The Pilgrims held lotteries to determine land holdings

19 Betting on horse racing has been a pass time since we have had horses

20 Games of Chance Every culture has their own games of Chance. American Indians would gamble With bones in games similar to dice.

21 Asians among others have a high Pathological Gambling Addiction Potential

22 Gambling was a Desecration of the First Temple.

23 Gambling For Jesus Clothing

24 It is a pretty good guess that as early as prehistoric times, gambling existed

25 Is Pathological Gambling An Addiction or Just a Bad Habit.

26 Pathological Gambling Prevalence Rates General Population Last Year 0.2%-0.3% Life Time: 0.4%-1.0%

27 Female Gamblers The life time prevalence rate of gambling disorder for females is about.0 2%

28 Prevalence Rate for Male Gamblers For male gamblers it is about.06%

29 Gambling As An Addiction Gambling Addiction Gambling addiction is a condition that affects approximately two to five percent of Americans. A variety of risk factors can predispose someone to compulsive gambling, but the gambling addict s brain appears to respond to the act of gambling in the same way the alcoholic brain responds to a drink.

30 Finally Arrived! The American Psychiatric Association in the DSM-5 has classified

31 What is the boundary between Recreational Gambling and Pathological Gambling?

32 DSM-5 criteria for Compulsive Gambling

33 Diagnostic Criteria A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more of the following over a 12 Month Period.

34 Criteria Continued 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 2. Is restless or irritable when attempting to cut down or stop gambling 3. Has made repeated unsuccessful efforts to control, cut back or stop gambling 4. Is often preoccupied with gambling (eg. Having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble.

35 Criteria Continued 5. Often gambles when attempting to cut down or stop gambling. 6. Often gambles when feeling distressed (e.g. helpless, guilty, anxious, depressed. 7. Lies to conceal extent of involvement with gambling 8 Has jeopardized or lost a significant relationships, jobs, or educational or career opportunities 9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

36 B. The Gambling Behavior is not better explained by a manic episode. Criteria Continued

37 Specify if Episodic Episodic: Meeting the diagnostic criteria at more than one time point, with symptoms subsiding between periods of gambling. Persistent Persistent Experiencing continuous symptoms, to meet diagnostic criteria for gambling disorder for multiple years.

38 Specify if. Early remission After full criteria for gambling disorder were previously met, not of the criteria for gambling disorder have been met at least 3 months but for less than 12 months. Sustained remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met during a period of 12 months or longer.

39 Associated Features Supporting Distortions in thinking Superstitions Diagnosis Sense of power and Control over outcome of chance events. Over Confidence Magical Thinking

40 Money is the cause and answer to problems.

41 Impulsive

42 Competitive

43 Restless and Easily Bored

44 Restless, agitated

45 Overly Concerned With Approval of Others

46 Depressed, Lonely, lack of Self Esteem

47 Characteristics of the Compulsive Gambler What are some characteristics of a person who is a compulsive gambler? 1. INABILITY AND UNWILLINGNESS TO ACCEPT REALITY. Hence the escape into the dream world of gambling. 2. EMOTIONAL INSECURITY. A compulsive gambler finds he or she is emotionally comfortable only when "in action". It is not uncommon to hear a Gamblers Anonymous member say: "The only place I really felt like I belonged was sitting at the poker table. There I felt secure and comfortable. No great demands were made upon me. I knew I was destroying myself, yet at the same time, I had a certain sense of security." 3. IMMATURITY. A desire to have all the good things in life without any great effort on their part seems to be the common character pattern of problem gamblers. Many Gamblers Anonymous members accept the fact that they were unwilling to grow up. Subconsciously they felt they could avoid mature responsibility by wagering on the spin of a wheel or the turn of a card, and so the struggle to escape responsibility finally became a subconscious obsession. Also, a compulsive gambler seems to have a strong inner urge to be a 'big shot' and needs to have a feeling of being all powerful. The compulsive gambler is willing to do anything (often of an antisocial nature) to maintain the image he or she wants others to see.

48 Characteristics Continued Then too, there is a theory that compulsive gamblers subconsciously want to lose to punish themselves. There is much evidence to support this theory. What is the dream world of the compulsive gambler? This is another common characteristic of compulsive gamblers. A lot of time is spent creating images of the great and wonderful things they are going to do as soon as they make the big win. They often see themselves as quite philanthropic and charming people. They may dream of providing families and friends with new cars, mink coats, and other luxuries. Compulsive gamblers picture themselves leading a pleasant gracious life, made possible by the huge sums of money they will accrue from their 'system'. Servants, penthouses, nice clothes, charming friends, yachts, and world tours are a few of the wonderful things that are just around the corner after a big win is finally made. Pathetically, however, there never seems to be a big enough winning to make even the smallest dream come true. When compulsive gamblers succeed, they gamble to dream still greater dreams. When failing, they gamble in reckless desperation and the depths of their misery are fathomless as their dream world comes crashing down. Sadly, they will struggle back, dream more dreams, and of course suffer more misery. No one can convince them that their great schemes will not someday come true. They believe they will, for without this dream world, life for them would not be tolerable. Isn't compulsive gambling basically a financial problem?

49 Characteristics Continued No, compulsive gambling is an emotional problem. A person in the grip of this illness creates mountains of apparently insolvable problems. Of course, financial problems are created, but they also find themselves facing marital, employment, or legal problems. Compulsive gamblers find friends have been lost and relatives have rejected them. Of the many serious difficulties created, the financial problems seem the easiest to solve. When a compulsive gambler enters Gamblers Anonymous and quits gambling, income is usually increased and there is no longer the financial drain that was caused by gambling, and very shortly, the financial pressures begin to be relieved. Gamblers Anonymous members have found that the best road to financial recovery is through hard work and repayment of our debts. Bankruptcy, borrowing and/or lending of money (bailouts) in Gamblers Anonymous is detrimental to our recovery and should not take place. The most difficult and time consuming problem with which they will be faced is that of bringing about a character change within themselves. Most Gamblers Anonymous members look upon this as their greatest challenge, which should be worked on immediately and continued throughout their lives. Who can join Gamblers Anonymous?

50 Simply Put

51 Treating the Compulsive Gambler Identification: Lie Bet Questionnaire 20 Questions of GA SOGS Screening It is essential that we determine if gambling is a co-existing disorder. Many addicts suffer from dual addictions.

52 Withdrawal

53 Gamblers go Through Real Withdrawal 1. The Gambler feels agitated. He/she is often irritable, angry and jumpy. 2. The gambler often is pre-occupied by his/her past behavior, and consequences. (Financial, legal etc.) 3. Craving. When faced with the discomfort of treatment, the gambler may have selective recall and want to return to gambling to reduce his/her emotional pain.

54 THE WORLD OF THE PATHOLOGICAL GAMBLER

55 The first thing that the therapist must do with the compulsive gambler is to slow them down. Slow Down This is the essential first step in getting the gambler ready for treatment.

56 Dr Lesieur s Turtle

57 Detoxification is Real

58 It is too far off to look in the future

59 It is far too early to look for the end of the Journey.

60 The Compulsive Addicts Initial View of the World.

61 And it hits hard

62 Client is:

63 Client is:

64 And without protection

65 Resistance

66 ACCEPTANCE

67 The typical client has Denial not accepted the fact that they have a problem.

68 The clients often battle with themselves regarding the reality of the problem

69 The Client Views his Problems as being small

70 Testing

71 The Lie Bet Lie/Bet Questionnaire The Lie/Bet Questionnaire1 is a two question screening tool for pathological gambling. The two questions were selected from the DSM-IV criteria for pathological gambling because they were identified as the best predictors of pathological gambling. The Lie/Bet Questionnaire is useful in determining if a longer screening tool or further assessment is appropriate.

72 Questions to Ask Lie/Bet Questionnaire: 1. Have you ever had to lie to people important to you about how much you gambled? 2. Have you ever felt the need to bet more and more money?

73 Quick and Dirty This is probably the quickest way to determine if you should proceed further.

74 SOUTH OAKS GAMBLING SCREEN SOUTH OAKS GAMBLING SCREEN (SOGS) Name: Date: 1. Please indicate which of the following types of gambling you have done in your lifetime. For each type, mark one answer: "Not at All," "Less than Once a Week", or "Once a Week or More." Please Check one answer for each statement: NOT AT ALL Less than once a week Once a week or more. Played cards for money. b. Bet on horses, dogs, or other animals (at OTB, the track, or with a bookie). c. Bet on sports (parlay cards, with bookie, at Jai Alai. d. Played dice games, including craps, over and under or other dice games. e. Went to casinos (legal or otherwise). f. Played the numbers or bet on lotteries. g. Played bingo. h. Played the stock and/or commodities market. i. Played slot machines, poker machines, or other gambling machines. j. Bowled, shot pool, played golf, or some other game of skill for money. k. Played pull tabs or "paper" games other than lotteries. l. Some form of gambling not listed above (please specify):

75 Continued 2. What is the largest amount of money you have ever gambled with on any one-day? Never Gambled More than $ up to $1,000 $ 1.00 or less More than $1,000 up to $10,000 More than $1.00 up to $10.00 More than $10,000 More than $10.00 up to Check which of the following people in your life has (or had) a gambling problem. Father Mother Brother/Sister My spouse/partner My child(ren) Another relative A Friend or someone important in my life 4. When you gamble, how often do you go back another day to win back money you have lost? Never Most of the time Some of the time Every time that I lose (less than half of time I lose). 5. Have you ever claimed to be winning money gambling, but weren t really? In fact you lost? Never Yes, less than half the time I lost Yes, most of the time 6. Do you feel you have ever had a problem with betting or money gambling? No Yes Yes, in the past, but not now. 7. Did you ever gamble more than you intended to? Yes No 8. Have people criticized your betting or told you that you had a problem, regardless of whether or not you thought it was true? Yes No 9. Have you ever felt guilty about the way you gamble, or what happens when you gamble? Yes No 10. Have you ever felt like you would like to stop betting money on gambling, but did not think that you could? Yes No

76 South Oaks Gambling Screen Continued 11. Have you ever hidden betting slips, lottery tickets, gambling money, IOUs, or other signs of betting or gambling from your spouse, children or other important people in your life? Yes No 12. Have you ever argued with people you live with over how you handle money Yes No 13. (If you answered "yes": to question 12) Have money arguments ever centered on your gambling? Yes No 14. Have you ever borrowed from someone and not paid them back as a result of your gambling? Yes No 15. Have you ever lost time from work (or school) due to betting money or gambling? Yes No 16. If you borrowed money to gamble or to pay gambling debts, who or where did you borrow from (check "Yes" or "No" for each): a. From household money Yes No b. From your spouse/partner Yes No c. From relatives or in-laws Yes No d. From banks, loan companies, or credit unions Yes No e. From credit cards Yes No f. From loan sharks Yes No g. You cashed in stocks, bonds or other securities Yes No h. You sold personal or family property Yes No i. You borrowed on your checking accounts (passed bad checks) Yes No j. You have (had) a credit line with a bookie Yes No k. You have (had) a credit line with a casino Yes No The SOGS may be reproduced as long as the language is used as printed and the scored items are not revised without permission of the author. Click here to see learn about your score: SOGS Scoring Click here to go to the DSM-IV questionnaire: DSM IV

77 Continued 11. Have you ever hidden betting slips, lottery tickets, gambling money, IOUs, or other signs of betting or gambling from your spouse, children or other important people in your life? Yes No 12. Have you ever argued with people you live with over how you handle money Yes No 13. (If you answered "yes": to question 12) Have money arguments ever centered on your gambling? Yes No 14. Have you ever borrowed from someone and not paid them back as a result of your gambling? Yes No 15. Have you ever lost time from work (or school) due to betting m

78 Scoring the SOGS SOUTH OAKS GAMBLING SCREEN-SCORE SHEET Scores on the SOGS are determined by scoring one point for each question that shows the "at risk" response indicated and adding the total points. 5 or more shows at risk behavior Question 1 Not counted Question 2 Not counted Question 3 Not counted Question 4 Most of the time I lose, or Yes, every time I lose Question 5 Yes, less than half the time I lose or Yes, most of the time Question 6 Yes, in the past but not now or Yes Question 7 Yes Question 8 Yes Question 9 Yes Question 10 Yes

79 Question 11 Yes Question 12 Not counted Question 13 Yes Question 14 Yes Question 15 Yes Question 16a Yes Question 16b Yes Question 16c Yes Question 16d Yes Question 16e Yes Question 16f Yes Question 16g Yes Question 16h Yes Question 16i Yes Question 16j Not counted Question 16k Not counted Total SOGS Scoring Continued

80 What it Means (maximum score = 20) Interpreting the score: 0 No problem with gambling 1-4 Some problems with gambling 5 or more Probable Pathological Gambler Remember: The SOGS may be reproduced as long as the language is used as printed and the scored items are not revised without permission of the author.

81 DSM IV CHECK LIST FOR Dx The following list of ten questions are used to make a diagnosis of Pathological Gambling. This list is typically used by mental health professionals determine, based on the what the patient is saying, how many of the criteria fit. It can be difficult for a person to make a "self-diagnoses" because someone can manipulate the questions in a manner that is not accurate. Below is the list of questions and afterward I have provided some discussion of some of the common questions people ask. This information is intended for educational purposes only. Conclusions about whether a person is or is not a Pathological Gambler CAN NOT be based only on their score. In addition, there is an exclusionary diagnosis, Bipolar Disorder. This means that if someone has Bipolar Disorder than making a diagnosis of Pathological Gambling would be dependent on additional assessment information. This has been adapted from the American Psychiatric Association (APA) and is available with expanded information in the book: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV ) DSM IV CHECKLIST (312.31) 1. Are you preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)? 2. Do you need to gamble with increasing amounts of money in order to achieve the desired excitement? 3. Have you made repeated unsuccessful efforts to control, cut back, or stop gambling? 4. Are you restless or irritable when attempting to cut down or stop gambling?

82 DSM IV Check List Continued 5. Do you gamble as a way of escaping from problems or of relieving feelings of helplessness, guilt, anxiety, or depression? 6. After losing money gambling, do you often return another day to get even? 7. Do you lie to family members, therapists, or to others to conceal the extent of involvement with gambling? *** 8. Have you committed illegal acts such as forgery, fraud, theft, or embezzlement to finance gambling? 9. Have you jeopardized or lost a significant relationship, job or educational or career opportunity because of gambling? 10. Do you rely on others to provide money to relieve a desperate financial situation caused by gambling? ***Removed in DSM V

83 DSM IV Scoring Unfortunately there is no real scoring key for the DSM-IV assessment tool. No objective criteria but 4-5 is considered by most experts pathological Gambling

84 DSM-5 Criteria Scores Mild criteria met Moderate 6-7 criteria met Severe 8-9 Criteria met.

85 Simply Put Social Gambling Social gamblers consider gambling to be a valid form of recreational activity, and maintain full control over the time, money and energy they expend on gambling. They consider the cost of gambling to be payment for entertainment.

86 Types of Gambling ( Continued) Problem Gambling Problem gambling involves the continued involvement in gambling activities, despite negative consequences. All gambling addicts are problem gamblers, although not all problem gamblers have a gambling addiction.

87 Many Addicts have Dual Addictions and/or may Switch Addictions

88 For Many Clients Switching Addictions

89 Thus the counselor must be aware of Two issues 1 Existing problem of pathological gambling. 2. Potential to change addictions. 3. Do not ignore

90 Types of Gamblers and Comparison to Substance Abusers

91 The Action Gambler The action gambler is addictive gambling in which he takes high risks

92 Characteristics of the Action Gambler The action gambler is Euphoric during the Thought process Planning Process Actually while playing the game

93 Wants to be Seen as a Winner Prefers to play in groups or with other people. If is very important to him to be recognized as a winner by his/ her peers as a person who is able to win.

94 More Common in Men Males are most likely to be action gamblers. Gambling is viewed As Macho. Action Gambling also can occur in Females tough less likely

95 The thinking process does not work. Usually highly intelligent people High IQ s Enjoy Games Usually Sports Oriented Like to play skill oriented games Dice, Poker Black Jack Sports Betting

96 Personality Characteristics of the Action Gambler Appearance of very high self esteem but contradictory to that have low self esteem and eventually become liars. Outgoing Anarchistic Domineering

97 ESCAPE GAMBLERS As implied by the term Escape gamblers are hiding from something in their life which causes both mental and physical pain

98 Depression Always expect Depression in Escape Gamblers. The escape gambler is not Looking for the rush, but instead Is looking to be numbed to the Physical and/or Emotional Pain.

99 Unlike the Action Gambler The Escape Gambler: Does not like to hunt in packs Play games with other people around because they want to be left alone. They want to focus on the game to make them numb

100 Sex Prevalence Females are more likely to become escape gamblers than males They are more likely to take up the habit late in life, i.e. after age 30. Often onset coincides With retirement, being Widowed or other major Life change.

101 Escape Gamblers Games of Choice Slot Machines Video poker Bingo Lottery On line Gambling Other Machine Gambling Games

102 Characteristics of Escape Gambler Introverted Quiet Manipulative Viewed as being responsible by Others who do not know about Their illness

103 Characteristics of Escape Gambler Continued With escape gambler often history of abuse Desperate seeking Empowerment Avoiding Confrontation Like the action gambler they also have low self esteem.

104 Let s Talk Treatment

105 Step One Gamblers are usually agitated when they are detoxifying from gambling

106 Be patient

107 Master Problem List What are the areas that need to be addressed Clearly gambling Dual Diagnosis Mental Health issues Stressors Family issues Finances OTHER ISSUES OF IMPACT

108 REMEMBER THE GOAL IS TO PUT ALL THE PIECES OF THE PUZZLE TOGETHER

109 MEET THE PATIENT WHERE THEY ARE AT!

110 Proceed by addressing each of the problems in the Master Treatment Plan

111 Going Home When Treatment Is Completed, patient will go home:

112 The End Product of Treatment is Abstinence in the Real World Family will be a crucial part of the patient s recovery, however; they have not had the benefit of Treatment.

113 Preparing the Family

114 Helpful Hints Get the family involved early and often.

115 Address Pressure Relief Issues Remember the debt has been caused by the gambler not the family. None the less the debt will probably affect every family member. The family may have some very justified resentments Frequently the recovering gambler will return to gambling to try to cover their debts.

116 Encourage Gamanon It helps the family to know they are not alone

117 The Addict is Responsible for their Recovery

118 Family Addiction

119 Instant acceptance: NOT In God We Trust. The gambler is not God and has taught those around him/her to expect the worst

120 Control of Money Prepare the gambler for the fact that Another person will be controlling his/her money. It is important that this person be someone who has been selected in cooperation with the gambler. Remember, no one likes to be controlled

121 Meetings, Meetings and More Meetings Twelve Step Meetings are essential for both the Compulsive Gambler and The Family.

122 Advice The Family needs to understand that they are not the best Source for advice. Best advice: Sponsors Therapists 12 Step Group

123 Suggestions for Far Families Telephone Counseling (including conference calls with family and client) Skype Face time on Smart phones Intensive family therapy weekends. Written communications and e mail assignments Provision of referrals to outside sources for therapy.

124 Questions

125 Want to bet you can treat the Correct Answer: compulsive gambler.