(c) 2005

Foundation of Treating Addictive Illness

2013

Mike Schiks, MS ACATA Executive Director/CEO

Vanguard - Project Turnabout

(c) 2005

…Problem Pathological Gamblers

(c) 2005

Problem/Compulsive Gambling

Society’s big secret………..

(c) 2005

Jon E. Grant, JD, MD, MPH Professor

University of Minnesota School of Medicine Minneapolis, MN

*Core Features and Common Qualities of Problem Gambling

(c) 2005

Characteristics of Problem Gambling

• Ultimately defined by loss of control

• Evidence that Problem Gambling is an addictive illness with physiological basis

• Physiological basis

(c) 2005

Residential/Inpatient

• Safe harbor needed

• Isolation

• Co-morbidity Issues – Self harm issues

• History of non-compliance with less intense services

(c) 2005

Residential/Inpatient Options

• Integrate Problem Gamblers with other addictions

• Integrate Problem Gamblers into Mental Health Systems

• Separate inpatient/residential services for Problem Gamblers

(c) 2005

Vanguard Information…..

• Separate Problem Gambling Unit

• Patient Profile of Vanguard Patients from 2008 to

2010 • 292 Compulsive Gamblers without substance abuse

diagnosis – Note: We have collected data for people with substance

abuse as well however we wanted data that more directly reflected impact of Problem Gambling.

(c) 2005

Physical Health Information

Vanguard life areas impacted….

(c) 2005

Neglect of Health Issues Directly Related to Compulsive Gambling

15%

85%

Yes

No

(c) 2005

Taking Prescription Meds as Prescribed Directly Related to Compulsive Gambling

12%

88%

Yes

No

(c) 2005

Number Without Health Insurance

77%

23%

Yes

No

(c) 2005

Diagnosed Psychological Problems Directly Related to Problem Gambling

35%

65% Yes

No

(c) 2005

Suicide Attempts Directly Related to Compulsive Gambling

32%

68% Yes

No

(c) 2005

Hospitalized For Suicide Attempt Directly Related to Compulsive Gambling

15%

85%

Yes

No

(c) 2005

Family Relationships

(c) 2005

71%

29%

Alienation of Most Family Members

Yes

No

(c) 2005

69%

31%

Conflict Over Lost Family Funds

Yes

No

(c) 2005

Financial Consequences

Directly Related to Compulsive Gambling

(c) 2005

92%

8%

Spent Living Expenses

Yes

No

(c) 2005

99%

1%

Depletion of Savings

Yes

No

(c) 2005

24%

76%

Spent Pension Early

Yes

No

(c) 2005

32%

68%

Loan Default

Yes

No

(c) 2005

Uninsured Vehicles

7%

93% Yes

No

(c) 2005

68%

32%

Remortgage/car

Yes

No

(c) 2005

30%

70%

Filed Bankruptcy

Yes

No

(c) 2005

54%

46%

Theft of Money, Check or Credit Cards

Yes

No

(c) 2005

Housing Problems

Directly Related to Problem Gambling

(c) 2005

Unpaid Rent

57%

43%

Yes

No

(c) 2005

68%

32%

Behind on Utility Bills

Yes

No

(c) 2005

Loss of Home Mortgage Default

16%

84%

Yes

No

(c) 2005

Homeless

14%

86%

Yes

No

(c) 2005

Vocational

(c) 2005

Vocational

• Doesn’t consider number who consider “gambling” a vocation

• Or those who are unemployable

(c) 2005

Job loss Related to Compulsive Gambling

24%

76%

Yes

No

(c) 2005

(c) 2005

The Solution…to Problem Gambling and Other Addictions

(c) 2005

NOT EVERYONE VIEWS PROBLEM GAMBLING ADDICTION THE SAME

……Not Quite That Simple

(c) 2005

Perspectives of Addictive Behavior

• Moral View • Sin, weak, willpower, bad

• Causation View – Problem Gambling symptom of underlying problems

• Behavioral View – Learned habit….reinforced behavior

• Social View – Protect society from those effected – Focus on prevention

• Illness View – Can be diagnosed, predictable, can be treated – Chronic Illness…..Remission not cure oriented

(c) 2005

Perspectives of Addiction

(c) 2005

………….again……….

(c) 2005

……Not quite that simple…..

Chronic Illness Model

(c) 2005

“I have stopped insert addiction thousands of times…its not starting again that is the tricky part”

(c) 2005

Change related to addictive behavior

• Direct impact of the addiction

• Neglect of life areas

– Problem Gambling takes over life

– Consequence of lost focus

– Consequence of navigating consequences….

• Stop the decline

• Build a foundation of recovery

(c) 2005

Continuum Model

• Addiction has been referred to as “Life and Death Issue.

• More helpful for people with addictive illness to think in terms of a progression “living and dying” in all life areas….

(c) 2005

Progression of Addiction and

Recovery Related to Life Areas

Healthy

Dead

In

touch

Numb

Up to

ability

Damaged

Thriving

Alone

Capable

Incapable

Part of

Disconnected

Managed

Chaos

P

h

y

s

i

c

a

l

F

e

e

l

i

n

g

s

C

o

g

n

i

t

i

v

e

F

a

m

i

l

y

I

n

t

i

m

a

c

y

S

p

i

r

i

t

u

a

l

F

i

n

a

n

c

e Other life

areas….

(c) 2005

Chronic Illness

• Therapy has more focus on “how to keep in remission”

– Lifestyle change is a critical component

• Goal: Managing the chronic illness….Living with illness in remission

(c) 2005

…..But I digress for a moment

The word “treatment”

(c) 2005

Development of Addiction Treatment over the Years

• Informal experiential process

• Apprentice approach

• Trial and Error

• Engaged patient as part of the team

• Historical lack of codification

(c) 2005

Today a Systematic Approach

Emerging Model of Care

(c) 2005

Treatment Objectives

1. Stop Problem Gambling

2. Change lifestyle to support sustained abstinence from Gambling

(c) 2005

Dimensions of Treatment

• Education – Illness, other conditions, solution/remedies

• Therapy – Individualized

– Apply Solution and remove obstacles

– Match therapy approaches to individual needs

• Fellowship – Caring community – Ongoing support for change

– Self Help

(c) 2005

Treatment processes identified and customized to caregivers circumstance

Residential – Outpatient • Pre-intake

– Information, assist in taking action

• Intake – Orientation – Residential = Entry into a community…

– Peer group dynamics

• Assessment/Plan – Developed process….Treatment plan measurable and agreed upon

• Care – – Combines aspects of Education, Therapy, Support

• Continuing Care – Transition, Re-entry, Help plan in times of need

– Management of money

(c) 2005

Structural Representations

Emerging model

(c) 2005

Pre-intake Intake Assessment

Plan Care

Continued

care

Fellowship - Caring community

Education - Problems & Solutions

Therapy - Application of information

- Holistic capabilities (referral?)

-Individualized and programmatic

-Language that sustains recovery

-12 step as basis for change process

Vanguard Model

(c) 2005

Application of the 12 Steps

But first a bit of background…….

Michael A Schiks MA, ACATA

(c) 2005

Suggestions

• Don’t be put off by the language.

– Look past it…under it

• Remember this was written in the 1930’s by a grass root group (AA) of addicted individuals desperate for a change process.

• This language is the basis of millions of change lives through.

(c) 2005

Why the 12 Steps

• Adaptive to “where the patient is” – Understanding grows with time

• Universal Network – Twelve steps form universal language of support

groups

– Self help groups ARE evidence based

• Under the 12 Steps lies a rich Framework for Change……………….ROADMAP FOR CHANGE

(c) 2005

Problem gambling 12 step change process

Therapeutic Underpinnings

(c) 2005

Therapeutic Underpinnings of 12 Steps

Abbreviated

Admission of Need for Help

Hope from Outside Self

Decide and Commit

Self-Exploration and Reality Testing

Daily Coping Skills

Social Reconciliation

Charting Progress

Strengthening Support System

Acknowledging Change

(c) 2005

Correlation of 12 Steps to Stages of Change Model

Prochaska - DiClimenti

• PRE-CONTEMPLATION – Step 1 – Unaware of the problem, hasn't thought about change – Increase awareness of need for change, personalize information on risks and benefits

• CONTEMPLATION – Steps 1 & 2 – Thinking about change, in the near future – Motivate, encourage to make specific plans

• DECISION/DETERMINATION – Step 3 – Making a plan to change plans, setting gradual goals – Assist in developing concrete action

• ACTION – Steps 4-9 – Implementation of specific action plans – Assist with feedback, problem solving, social support, reinforcement

• MAINTENANCE – Steps 10-12 – Continuation of desirable actions, or repeating periodic recommended step(s) – Assist in coping, reminders, finding alternatives, avoiding slips/relapses (as applies)

(c) 2005

Quality of Life Inventory

(c) 2005

Quality of Life Inventory’s Importance to treatment:

• The Quality of Life Inventory’s Use

– Help screen for mental health and physical problems.

– Help measure a patient’s progress

– People's life satisfaction is based on how well their needs, goals, and wishes are being met in important areas of life.

– Treatment

(c) 2005

A little about the Quality of Life Inventory:

• The Quality of Life Inventory is a psychometric test that is based on the satisfaction of 16 areas of life. – These include the following areas: Health, Self-Esteem, Goals and Values, Money,

Work, Play, Learning, Creativity, Helping, Love, Friends, Children, Relatives, Home, Neighborhood, and Community (Frisch, 1994).

• Satisfaction is weighted from -6 to 6, with a -6 being extreme dissatisfaction and a 6 being complete satisfaction.

• These are recorded and multiplied with a importance value to get weighted satisfaction.

• Total weighted satisfaction is added up, divided by the 16 areas of life, and a raw score is produced.

• We use the raw score to find from the manual the T score and percentile score. This raw score is also how we assess the client’s overall quality of life.

(c) 2005

Average Percentile Scores for Gambling

Overall Quality of Life - Fiscal Year 2012-2013

0

10

20

30

40

50

60

June 12' July 12' Aug 12' Sept 12' Oct 12' Nov 12' Dec 12' Jan 13' Feb 13' Mar 13' Apr 13' May 13' June 13'

Pe

rce

nti

le

Before

After

YEAR 2012 YEAR 2013

*Percentile scores are from 1 to

99

Scores for Percentiles:

Very Low= 1 to 10

Low= 11 to 20

Average= 21 to 80

High= 81 to 99

(c) 2005

Self Esteem Scores for Gambling Fiscal Year 2012-2013

-4

-3

-2

-1

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10 11 12 13

Before

After

*Chart is on a -6 to 6 scale for scoring

Dis

sati

sfa

cti

on

S

ati

sfa

cti

on

(c) 2005

Health Scores for Gambling Fiscal Year 2012-2013

-3

-2

-1

0

1

2

3

4

5

June 12' July 12' Aug 12' Sept 12' Oct 12' Nov 12' Dec 12' Jan 13' Feb 13' Mar 13' Apr 13' May 13' June 13'

Before

After

*Chart is on a -6 to 6 scale for scoring

(c) 2005

Findings:

• Problem Gamblers, whose acuity, is most often higher do respond to inpatient treatment.

Note: This is only one of many measures of care that Vanguard uses. Most important are measures that point it towards opportunities for improvement

(c) 2005

Question / Comments at end of panel

Thank You