Compulsive Gambling

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Compulsive Gambling

• University of Detroit Mercy
• HLH 532
• Julie Bruce
• Caroline Daneshvar
• Chasity Falls
• Heather Hatfield
• William Schram

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Detroit, MI
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Fun timesor troubled times?
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More than just casinos..
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How many are affected?

• Over two and a half million adults are
  pathological gamblers and another three million
  are problem gamblers (Gerstein et al 1999).
• Percentage wise, problem gambling effects 1-3 of
  the population (Sharpe et al 1995)

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The four types of gamblers

• Social gamblers
• Compulsive gamblers
• Professional gamblers
• Problem gamblers

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The life of the problem gambler

• Received welfare
• Declared bankruptcy
• Having been arrested
• Divorce rates for pathological gamblers were
  53.5, problem gamblers were 39.5, other
  gamblers 29.8, and non-gamblers 18.2 (Gerstein
  et al 1999).

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DSM-IV Diagnostic Criteria

• Preoccupation
• Reliving past experiences
• Handicapping
• Planning next gambling trip
• Tolerance
• More money same excitement

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DSM-IV Diagnostic Criteria

• Withdrawal
• Unable to quit, cut back, or stop
• Loss of control
• Restless or irritable when trying to quit
• Escape
• Helplessness, guilt, anxiety, depression

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DSM-IV Diagnostic Criteria

• Chasing
• Returns to get even on losses
• Lying
• Conceals gambling from family, others
• Illegal acts
• Forgery, fraud, theft, embezzlement

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DSM-IV Diagnostic Criteria

• Risked relationships
• Personal relationships / marriage
• Employment
• Education
• Bailouts
• Relies on others for money

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Two Types of Gamblers

• Action seekers
• Usually male
• Competitive
• Start at a young age
• Big tippers
• High rollers
• Narcissistic personality

• Escape seekers
• Female
• Gamble for long hours
• Late onset
• Relationship issues

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Study Comparison

• Problem Gamblers Help Network of West Virginia
• Gamblers Anonymous

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Government Sponsored/Run Gaming Venues

• -VLT's in bars/restaurants
• -Daily Lottery and Powerball
• -BINGO and Tip Boards
• -Two horse race tracks with slots and VLT's
• -Two Dog Race tracks with Slots and VLT's

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Solution

• First Choice Health Systems, Inc, established in
  1995 as a statewide network of behavioral health
  providers, manages various state contracts
• Answered RFP in December 1999 to design and
  implement a statewide gamblers help program

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The Current Program Basics

• Provide 30 hours of clinical training and
  continuing education to licensed counselors,
  social workers and psychologists
• Provide two hours of clinical supervision for
  these clinicians
• Provide outreach so that gamblers and their
  family can self-identify to the help-line
• Answer help line 24/7 by trained clinician

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Outreach

• Brochures at race tracks
• Stickers on some slot machines at tracks
• Billboards
• Radio Newspaper ads
• Exhibits at Professional conferences

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Outreach

• WVU Medical School Addictions Institutes
• WV Counseling Association Conference
• WV Psychologists Association conference
• WV Social Workers Association Conference
• WV Drug and Alcohol Counselors

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Program Basics

• Offer Gamblers a free two-hour assessment (or
  consultations for family) within 30 miles of
  residence and 72 hours of call
• Mail all callers printed information
• Refer appropriate callers to GA, Gam-anon, and
  consumer credit Services
• Provide support for the creation of new Gamblers
  Anonymous and Gam-Anon meeting where needed

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Program Basics

• Conduct six month and one year follow-up calls
• Share demographic and outcome data with West
  Virginia Lottery West Virginia DHHR officials
• Exchange of info with clinician allows for
  accurate evaluation of progress and
  recommendation of other interventions/services

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Components of Gamblers Anonymous

• Founded in 1957 by two men struggling with
  obsession of gambling
• 20 Question survey
• 12 Step Recovery Program

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Summary of Recovery Program

• Meetings which are peer driven
• Meetings provide fellowship and support
• Success built upon the persons acknowledgement
  of their problem
• No fees for attending meeting-non-profit
  organization
• No discrimination
• Convenient-meetings are held several nights of
  the week

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12 Step Program

• 1. The individual must realize they are powerless
  over gambling
• 2. Come to believe that a Power greater than
  ourselves could restore us to a normal way of
  thinking.
• 3. Make a decision to turn our will over to the
  care of this power of our own understanding.
• These first 3 steps get the gambler in a mental
  frame of mind to approach recovery-spiritually
  sound

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• 4. Make a searching a fearless moral and
  financial inventory of ourselves
• 5. Admit to ourselves and to another human being
  the exact nature of our wrongs.
• 6. Be entirely ready to have these defects of
  character removed.
• The above steps require the individual to look
  at past wrongs and identify them.
• 7. Humbly ask God to remove shortcomings.
• 8. Make a list of all persons we have harmed and
  become willing to make amends to them all.
• 9. Make a direct amends to such people wherever
  possible, except when doing so would injure
  others.

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• Steps 7-9 guide the individual through the repair
  of all damage that gambling has caused.
• 10. Continue to take personal inventory and when
  wrong promptly admit it.
• 11. Seek through prayer and meditation to
  improve a conscious contact with God.
• 12. Having made an effort to practice these
  principles in all affairs, try to carry this
  message to other compulsive gamblers.
• The last three steps are maintenance steps, to be
  carried for the rest of the individuals life.
• Daily inventory sheets are recommended to help
  the person to self-reflect on their progress

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West Virginia

• Strengths
• Free 24/7 hotline
• 2-hr. assessment
• Free consultation with a trained counselor for
  gambler family (30 hrs.)
• Check-ups (6 mo. 1yr.)
• Record keeping to determine how detrimental
  gambling is becoming

• Weaknesses
• Consultation/assessment could be up to 30 miles
  away
• Over the phone, no one-on-one interaction
• An authority figure

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West Virginia

• Improvements
• More contact time
• Decrease time between follow-up calls
• Counselors more readily available

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Gamblers Anonymous

• Strengths
• Free meetings
• Available transportation
• Weekly meetings on a variety of days, times,
  locations
• Peer support
• Honesty
• Pressure relieve meetings with a sponsor

• Weaknesses
• Low success rate
• High relapse rates
• Not therapy

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Gamblers Anonymous

• Improvements
• Intimate sessions amongst gamblers

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Healthy People 2010

• Goal increase quality of life
• Usually have no support
• Wondering where to get money to support their
  addiction, shelter, eat

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The Health Belief Model (HBM)

• Variety of Constructs
• Used to help gambler over-come addiction
• 1. Perceived susceptibility severity the
  notion that the gambler is in population to have
  an addiction behavior
• at this pt. the gambler will reach out for
  help (Cues to Action)
• 2. Perceived threats the thought of having no
  money
• 3. Perceive benefits the idea that forgiveness
  will be given all family friend issues
  resolved
• 4. Self-efficacy is needed once in the life
  of gambler, he/she can work on continuing with
  their treatment begin to set future goals

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Outcomes-Effectiveness of GA

• Stewart and Brown(1988) describes difficulty in
  measuring
• -no case histories kept (anonymity)
• -cant get a representative sample b/o changing
  nature of attendees
• -self-selected membership leads to sample bias
• -no control group

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Outcomes of GA

• Stewart and Brown(1988)
• -232 GA attendees 8 were abstinent after 1 year,
  7 after two years
• -problem may be because of nature of program as a
  peer-oriented program, unable to provide special
  psychological needs
• -Argued that the most severe gamblers attend GA
  need for individual therapy

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Outcomes of GA

• Lesier and Blume(1991)
• -outcomes for patients in individual and group
  inpatient programs plus GA
• -Of 72 patients interviewed after 14 months, 64
  achieved abstinence and gambling problems had
  decreased significantly
• -indication for simultaneous professional
  programs plus GA

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Effectiveness of WV program

• 47 clients were able to be contacted
• -6 months after program, 57 were abstinent(43
  were still gambling)
• -gambling related debt was significantly
  decreased in 19 of the abstinent group
• -68 of the 160 abstinent clients had completed
  initial assessment and referral

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Effectiveness of WV

• -data is being collected on the of people who
  go to first assessment, but also engage in
  therapy, but this data is not yet available.

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References

• Cooper-Moran, Mia Kruedelbach, N. The Problem
  Gamblers Help Network of West Virginia. 17th
  National Conference on Problem Gambling. June
  19-21, 2003.
• Ferentzy, P. Skinner, W. (2003). Gamblers
  Anonymous A critical review of the literature.
  The Electronic Journal of Gambling Issues.
  www.camh.net
• Gamblers Anonymous Website. 2004.
  www.gamblersanonymous.org
• Gamblers Anonymous Brochures and Publications.
  October 2003.
• Gamblers Anonymous Michigan Department of
  Community of Health presentation. University of
  Detroit Mercy. Monday, June 14, 2004.
• Glanz, K., Rimer, B.K., Lewis, F.M. (2002).
  Health behavior and health education Theory,
  research, and practice (3rd ed.). San Francisco
  John Wiley Sons, Inc.
• Healthy People 2010 (2004). A systematic approach
  to health improvement. www.healthypeople2010.gov
• Lesieur, H.R. Blume, S.B. (1991). Evaluation of
  patients treated for pathological gambling in a
  combined alcohol, substance abuse, and
  pathological gambling treatment unit using the
  Addiction Severity Index. British Journal of
  Addiction, 86, 1017-1028.
• Stewart, R.M. Brown, R.I.F. (1998). An outcome
  study of Gamblers Anonymous. British Journal of
  Psychiatry, 152, 284-288.