Profile Assessments of Motivations to Gamble The GMAP: Treatment Implications Cynthia Dunn B'Psych H

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Profile Assessments of Motivations to Gamble (The
G-MAP) Treatment ImplicationsCynthia Dunn
(B.Psych Hons)Dr D Graham Dr N Caltabiano
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Abstract

• A recent evaluation of evidence based problem
  gambling treatment reveals considerable
  limitations to treatment efficacy. Considerable
  evidence exists to support the efficacy of
  individualised, client-directed, outcome informed
  practice. Decades of research indicate that the
  client is the single most potent contributor to
  successful outcome in counseling/therapy
  (Saggese, 2008). The G-MAP is an Australian
  assessment measure developed specifically for
  understanding and evaluating problem gamblers
  motivations to gamble. The measure was designed
  as an interactive map which collaboratively
  involves the client, assists in treatment
  planning, and provides measurable outcomes. This
  study presents a number of G-MAP profiles of
  high-frequency gamblers who vary in gender, form
  of gambling activity, SOGS scores and
  psychosocial variables. The participants took
  part in a larger study and were selected on the
  basis of both unique and common factors. Issues
  such as the seductiveness of poker machines,
  the stages of change model, and the hindrance
  of labelling are explored. Implications of a
  client-focused, outcome-informed treatment
  approach to problem gambling, the importance of
  motivation, and the limitations of case studies
  are discussed.

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Aims and significance

• Investigate the multidimensional nature of
  gambling behaviour and treatment implications.
• The punters' view' explores motivation for
  gambling, levels of involvement, psychosocial
  variables and gender.
• Profiles were selected on the basis that they
  were all community participants with both unique
  common factors.

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Introduction

• Recent evaluation of evidence based Problem
  gambling treatment reveals considerable
  limitations (Westphal, 2008).
• There is considerable evidence to support
  individualised, client-focused, outcome informed
  practice (Miller, Mee-Lee, Plum Hubble, 2005).
• The client is the single most potent
  contributor to successful outcome in
  counselling/therapy (Sagesse, 2005, p.560).

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Measures (1) A 44-item semi-structured interview
(Blaszczynski, 1998). (2) The South Oaks Gambling
Screen (SOGS) (Lesieur Blume, 1988). (3) The
Maroondah Assessment Profile for Problem Gambling
(G-MAP) (Loughnan, Pierce Sagris-Desmond,
1999). (4) The Positive and Negative Affect
Schedule (PANAS) (Watson, Clark Tellegen,
1988). (5) The Scale of Gambling Choices (Baron,
Dickerson Blaszczynski, 1995). (6) The Gambling
Expectancy Effects Questionnaire (GEEQ) (Walters
Contri, 1999).
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The G_MAP

• The Maroondah Assessment Profile for Problem
  Gambling (G-MAP) (Loughnan, Pierce
  Sagris-Desmond, 1999).
• 85 item Questionnaire which corresponds to 5
  groups of 17 factors. Scores are transposed onto
  a profile which provides a graphic
  representation.
• Takes about 20 minutes to complete, 10 min to
  score and about 10 minutes to analyse. This can
  also be sensitively done in collaboration with
  the client.

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Profiles

• Jack
• Is a 59 yr old regular/heavy gambler who gambles
  on the horses most days although he scores 0 on
  the SOGS (social category) Gambles to supplement
  pension every week, despite no reported problems,
  he bets on trebles trifectas , 6 days a wk and
  6/ bet and spends 30/wk not include winnings.
• No AOD or Psych problems reported. Never sought
  Gambling Treatment. PA 38, NA 10, G MAP
  groups (1), 25 (2), 17 (3), 8 (4), 4 (5) 2.
  G MAP factors Uninformed (12) Control (11),
  Scale of Gambling Choices Always controls/Able to
  stop Expected gambling outcomes (Mode
  Descriptors) Excited, Expert (3). Urge-6,
  Preoccupation-6, Control-9.
• His qualitative comment was that he gambles to
  supplement his pension (only horse racing), he
  has gambled since childhood. He believes people
  with gambling problems lack self-discipline.

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Profiles

• Joe
• Is a 52 yr old regular/heavy gambler who gambles
  on the pokies and raffles at the Club Thurs night
  and RSL on Friday nights, attending for
  membership draws. He scores 4 on the SOGS
  (regular category) and has gambled since he was
  16, he works as a labourer and reports no
  problems. He bets on mainly pokies (keno lotto
  to a lesser degree, 2 days a wk and 80/ session
  and loses 60/wk.
• No AOD or Psych probs. Never sought Gambling Rt.
  PA 21, NA 10.
• G - MAP Groups (1), 12 (2), 26 (3), 10 (4),
  23 (5) 17. G MAP factors Relaxation (9) Oasis
  (9), Entrenchment (10) Shyness (10)
• Scale of Gambling Choices Mostly able to
  control/Doesnt try to resist, Expected outcomes
  (Mode) Excited, Reckless (3). Urge-7,
  Preoccupation-5, Control-5.
• His qualitative comment was that he gambles when
  he goes for dinner at his Club. He also attends
  the RSL Friday nights for the raffles
  membership draws.

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Profiles

• Jim
• Is a 57 yr old regular/heavy gambler who gambles
  on the horses and is a He scores 4 on the SOGS
  (regular category) and has gambled since he was
  16, he works as a company director and reports
  no problems. He bets on mainly horses, less than
  once a week, and report 3000 per bet, and
  claims not to lose.
• No AOD or Psych probs. Never sought Gambling Rt.
  PA 35, NA 14.
• G - MAP Groups (1), 24 (2), 5 (3), 12 (4),
  13 (5) 0. G MAP factors Control (15) Winner
  (9).
• Scale of Gambling Choices Mostly able to
  control/Doesnt try to resist, Expected outcomes
  (Mode) Excited, Important, In Control (3).
  Urge-1, Preoccupation-2, Control-9.
• He made no qualitative comment.

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Profiles

• Jill
• Is a 45 yr old regular/heavy gambler who gambles
  on the pokies, and scores 10 on the SOGS (heavy
  category) and has gambled since she was 18.She
  works as an administrator and gambles on poker
  machines horses, but reports problems with
  only poker machines for 5 yrs. She gambles on
  pokies twice a week, for 4 hr sessions spending
  200 each time she plays, and she reports losing
  250/wk.
• No AOD or Prescription problems. She reports
  having schizophrenia. (with some suicidal
  ideation, no attempts) Never sought Gambling Rt.
  PA 20, NA 20.
• G - MAP Groups (1), 0 (2), 60 (3), 8 (4),
  16 (5), 8. G MAP factors Good Feelings (16)
  Numbess (20) Relaxation (16), Entrenchment (12).
• Scale of Gambling Choices Failure to control/
  makes little attempt to resist, Expected outcomes
  (Mode) Broke, A Nobody, Forgets Problems, loser
  (5). Urge-10, Preoccupation-10, Control-1.
• Her qualitative comment made reference to her
  grandmother being a heavy gambler and that she is
  of an Aboriginal and Irish bloodline. Her
  gambling loses are bothering her less less.

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Profiles

• John
• Is a 56 yr old heavy gambler who gambles on the
  pokies, and scores 14 on the SOGS (heavy
  category) and has gambled since he was 10, he is
  on a TPI pension and reports problems with
  gambling having sought help from everyone. He
  gambles on mainly pokies, twice a week, and
  reports gambling for 8 hrs/session, losing approx
  1000 and claims to lose 500/wk.
• No AOD problems, but is on prescription
  medication for PTSD. Has sought Gambling Rt. PA
  11, NA 36. Possible at- risk for suicide, as
  has attempted for reasons related to gambling.
• G - MAP Groups (1), 12 (2), 35 (3), 39 (4),
  39 (5) 11. G MAP factors Entrenchment (19)
  Desperation (16) Good Feelings (10) Numbness
  (10) Oasis (10). Scores across all domains but
  zero on Control.
• Scale of Gambling Choices Unable to
  control/Doesnt try to resist, Expected outcomes
  (Mode) Miserable, Bored, Loser, Broke (5).
  Urge-10, Preoccupation-10, Control-1.
• He made no qualitative comment, but has sought
  treatment from multiple sources has had a
  gambling-related offence.

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Results (Cases Group 1)
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Results (Cases Group 2)
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Results (Cases Group 3)
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Results (Cases Group 4)
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Results (Cases Group 5)
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The Seductiveness of Poker Machines (Walker, 2004)

• Walkers sociocognitive theory maintains that
  gamblers are motivated by three core beliefs
• It is possible to win through persistence,
  knowledge skill.
• Unlike others who lose, their unrealistic
  optimism fuels the belief that they can win.
• In spite of losses, persistence will eventually
  lead to a pay out.

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The Seductiveness of Poker Machines (Walker, 2004)

• Walker also argues that poker machine players are
  risk averse, conservative and generally unaware
  of the odds.
• High frequency players experience winning
  regularly, will be ahead at some time, and even
  after loosing can recoup these loses with a bonus
  pay out. This reinforces the belief that the
  player can control the machine outcomes (Walker,
  2004).
• Hodgins el- Guebaly (2004) found the major
  reason for relapse was optimism about winning,
  feeling lucky believing that winning were
  possible.

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Motivational Interviewing

• Evidence-based
• Can acknowledge the short-term benefits of
  gambling to gain greater insight
• Commitment talk
• Client-focused
• Emphasis on the role of choice
• Decisions empower client
• Therapuetic alliance

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Stages of ChangeProchaska DiClemente
Determination Decision
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SHIFT

• Substitute Alternatives
• Healthy Supports
• Invest in Self
• Focus on Goals
• Think of Consequences
• Guidebook for Treatment Professionals, Produced
  by CGROWTH

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Gambling Expenditure Queensland 2002-03 (2.48
Billion)
Source Queensland Treasury Annual Report 2002-03
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Gambling Expenditure QLD 2006-2007

• Queensland Household Gambling Prevalence Survey
  (2007) found that 0.47 of adults (approx 14,000)
  had a severe problem as measured by the CPGI
• 1.8 (54,000 people) were at moderate risk of
  having or developing problems
• Therefore, 2.27 (68,000 people) may be at
  risk.
• The ABS reports that in 2006 2007 a total of
  841 M was obtained through taxes on gambling in
  Queensland
• 551M comes from gaming machines.

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The Hindrance of Labelling (Michaleas, 2000)

• Negative labels in the media/news hinder help
  seeking behaviour, create stigma and blame the
  victim.
• Self-fulfilling prophecy of labels such as
  pathological, addictive, disease.
• Undermines the role of social responsibility
  freedom of choice.
• Minimisises support, understanding from friends,
  family and community in general.
• Increases likelihood of shame, guilt, stigma,
  hiding gambling problems reluctance to seek
  help.

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Conclusions

• Motivations to gambles symbiotic with MI
  (commitment to change)
• Use of available simple measures to review client
  progress
• Strong evidence base for client-focused outcome
  approach
• Strong evidence base for natural recovery and
  movement in and out of problems

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Acknowledgements

• A Very Special Thank You to my Supervisors!
• Dr D Graham Dr N Caltabiano
• Structured Interview from Prof A Blaszczynski.
• Kind assistance of Bob Baker GHS Lola Mashado
  Relationships Aust.

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Questions and Discussion
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References

• Delfabbro, P. (2000). Gender differences in
  Australian Gambling A critical summary of
  Sociological and Psychological research.
  Australian Journal of Social Issues, 35,
  (2),145-158.
• Michaleas, T. (2000). Problem Gambling Problems
  of addressing a health issue. Lessons of the
  Past. Proceedings of the 10th National
  Association of Gambling Studies Conference. pp
  116-125. NAGS)
• Miller, S. D. Mee-Lee, D Plum. B Hubble, M.
  A. (2005). Making Treatment Count
  Client-Directed, Outcome-Informed clinical work
  with problem drinkers. Psychotherapy in
  Australia, 11, (4), 42-56.
• Miller, S. D. Hubble, M. Duncan, B. (2008).
  Supershrinks What is the secret of their
  success? Psychotherapy in Australia, 14, (4),
  14-22.

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References

• Saggese, M. L. (2005). Maximizing treatment
  effectiveness in Clinical Practice An
  outcome-informed collaborative approach. Families
  in Society The Journal of Contemporary Social
  Issues, 86, (4), 558-564.
• Walker, M. (2004). The Seductiveness of Poker
  Machines. Gambling Research, 16, (2), 52-66.
• Westphal, J. R. (2008). How well are we helping
  problem gamblers? An update to the evidence base
  supporting problem gambling treatment.
  International Journal of Mental Health and
  Addiction, 6, 249-264.