Craig Johnson, LADC
MN Gambling Treatment Provider
LET’s GET READY TO GAMBLE Ice Breaker
Why Beyond the 12 Steps • Peer support will not address underlying problems
• Mental Illness and Personality Disorders must be addressed (MacKillop, et al.,
2014)
• All addictions disrupt the balance of life, but Disordered Gambling has deeper psychological affect (Savage, Slutske and Martin, 2014)
Hit or Miss: The Bottom
• It actually does not exist, and leads to “comparison” of the disorder
• Consequences alone will not stop the disordered gambler
• Devastating loss not essential to getting help
• “the bottom” will often delay treatment (Dodes, 2014)
Not Counting Your Days A return to use is a stand alone event, not an eraser
Failure is an option, not an excuse
A window into the personal and chronic nature of this disease
Develop the “instance of use” as a basis for empowerment, not disenchantment , do over's are possible and encouraged (Dodes, 2014)
One size does not fit all Addicts are not defined by their DOC (Drug of Choice) but their BOC
(Behaviors of Choice)
One’s character is not flawed, behaviors are flawed, so change the behavior
One’s individual identity must re restored (Dodes, 2014)
Gamblers Dissociative Experience Desire to escape reality, fueled by illusion and fantasy
The gambler loses control of their escape (Rambeck, 2014)
Gambling experiences last too long and occur too often (Rambeck, 2014)
Time and Reality distortion (Grecuuci, et al., 2014)
Motivated by the chase
Pathological Nature of Gambling (PG) Understand Four Phase of PG; Winning, Losing, Desperation, Terminal
Gambling is substitute to satisfy unmet needs
Identify rituals in the gambling process (Rambeck, 2014)
Biopsychosocial Model of Gambling Psychological consequences of gambling
Suicide and Familicide (Moghaddam et al., 2015 & Anderson, Sisak and Varnik, 2011)
Affects on the brain
Social aspects of the disease
Understanding the progression of the disease
Psychodynamic Concepts of Gambling Insecurity, compulsivity, and stress as the basis of disordered gambling
Changes in personality which correlate to PG (OCEAN) (Miller, 2013)
Openness
Conscientiousness
Extraversion
Agreeableness
Neuroticism
Stages of Treatment Address the Crisis of Quitting Gambling
Integration of New Attitudes and Skills
Learn to meet One’s Own Needs (Rambeck, 2014)
Visualize your Future Stay in the moment, remove the blinders, and help the client look ahead
“Back to the Future” letter
……everyone, take out a piece of paper
To move beyond…. Acceptance and Commitment Enhance self awareness
Develop Communications
Increase self confidence
Improve ability to live in the present, but see the future
Disrupt negative thought/behavior patterns (Savage, Slutske, Martin, 2014)
Moving Evan Further Beyond Develop comprehensive aftercare plan
Develop client’s “new” understanding of money
Explore what still needs to change about money
Who/How will their money be controlled
Family and Recovery Emotional meaning of money
Did one’s family of origin discuss/argue about financial issues
Regarding gambling; when did money loose it’s value?
What barriers exist to enable a healthy discussion of problem gambling and money management in the future
Moving into Recovery Decrease amount of time/frequency of gambling
Meeting financial obligations
Absence of impaired control and engaging in cross addictions
Absence of negative consequences and improved quality of life
QUESTIONS
References COTE, D., CARON, A., AUBERT, J., DESROCHERS, V., & LADOUCEUR, R. (2003). Near wins
prolonged gambling on a video lottery terminal. Journal of Gambling Studies, 19, 433–438. doi:10.1023/A:1026384011003
LUCE, C., KAIROUZ, S., NADEAU, L., MONSON, E., (2016) Life events and problem gambling severity: a prospective study of adult gamblers. Psychology of Addictive Behaviors, 30, 922-930. doi: 10.1037/adb0000227
BREVERS, D., KORITZKY, G., BECHARA, A., NOEL, X. (2014), Cognitive processes underlying decision-making under uncertainty in gambling disorder. Addictive Behaviors, 39, 1533-1536. doi: 10.1016/jaddbeh.2014.06.004
GRECUCCI, A., ET AL. (2014). Time devours things: how impulsivity and time affect temporal decisions in pathological gamblers, ,Plos One, 9(10)
References SAVAGE, J., SLUTSKE, W., MARTIN, N.G., (2014). Personality and gambling involvement: a
person-centered approach. Psychology of Addictive Behaviors, 28, 4, 1198-1211. doi: 10.1037/a0037413
MAPLES, J., ET AL. (2014). An examination of the correlates of fearless dominance and self-centered impulsivity among high-frequency gamblers. Journal of Personality Disorders, 28(3), 379-393
MacKILLOP, J., ET AL. (2014). Multidimensional examination of impulsivity in relation to disordered gambling. Experimental and Clinical Psychopharmacology, 22(2), 176-185. doi: 10.1037/a0035874
RAMOS-GRILLE, I., ET AL. (2015). Predicting treatment failure in pathological gambling: the role of personality traits. Addictive Behaviors, 43, 54-59. doi: 10.1016/j.addbeh.2014.12.010
MOGHADDAM, J., ET AL. (2015). Suicidal Ideation and suicide attempts in five groups with different severities of gambling: findings from the national epidemiologic survey on alcohol and related conditions. American Journal on Addictions, 24: 292-298, 2015. doi: 10.111/ajad.12197
References BLACK, D.W., ET AL. (2015). Suicide ideations, suicide attempts, and completed suicide in
persons with pathological gambling and their first-degree relatives. American Association of Suicidology, 45(6) 700. doi: 10.1111/sltb.12162
ANDERSON, A., SIAASK, M., Varnik, A., (2011). Familicide and suicide in a case of gambling dependence. The Journal of Forensic Psychiatry & Psychology, 22(1) 2011, 156-168. Doi: 10.1080/14789949.2010.518244
El-GUEBALY, N., ET AL. (2011). Compulsive features in behavioral addictions: the case of pathological gambling. Society for the Study of Addiction, 107 2011, 1726-1734. Doi: 10.1111/j.1360-0443.2011.03546.x
SMITH, D.P., ET AL. (2015) Cognitive versus exposure therapy for problem gambling: randomized controlled trial. Behavior Research and Therapy, 69(2015) 100-110. Doi: 10.1016/j.brat.2015.04.008
References ASHLEY, L.L., BOEHLKE, K.K. (2012). Pathological gambling: a general overview. Journal of
Psychoactive Drugs, 44(1), 27-37. Doi: 10.1080/02791072.2012.662078
MERKOURIS, S.S., THOMAS, S.A., BROWNING, C.J., DOWLING, N.A. (2016). Predictors of outcomes of psychological treatments for disordered gambling: a systematic review. Clinical Psychology Review, 48 (2016) 7-31. Doi: 10.1016/j.cpr.2016.06.004
CONVERSANO, C. ET AL. (2012). Pathological gambling: a systematic review of biochemical, neuroimaging, and neuropsychological findings. Harvard Review of Psychiatry, 20(1), 130-148. Doi: 10.3109/10673229.2012.694318
RIZEANU, S. (2014) Pathological gambling treatment – review. Procedia- Social and behavioral sciences, 187 (2015) 613-618. Doi: 10.1016/j.sbspro.2015.03.114
MILLER, J.D., ET AL. (2013). Personality correlates of pathological gambling derived from big three and big five personality models. Psychiatry Research, 206 (2013) 50-55. Doi: 10.1016/j.psychres.2012.09.042
References MILLER, J.C., ET AL. (2010). Concurrent validity of gambling functional assessment (gfa):
correlations with the south oaks gambling screen (sogs) and indicator of diagnostic efficiency. Analysis of Gambling Behavior, 2010, 4, 61-75.
GOODIE, A.S., ET AL. (2013). Evaluating the south oaks gambling screen with dsm-iv and dsm-5 criteria: results from a diverse community sample of gamblers. SAGE Publications, 20(5) 523-531. Doi: 10.1177/1073191113500522
LANCE DODES & ZACHARY DODES, The Sober Truth, Beacon Press, Boston Massachusetts 2014.