Discusses the basics counselors need to know when treating people with gambling issues

1. Gambling Problems: An
Introduction
Instructor: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs.com Counselor Education & Training
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2. Objectives
 Define Pathological Gambling, Gambling Disorder,
and Problem Gambling
 Explore the Prevalence of Gambling Issues
 Identify Who Has a Gambling Problem
 Identify Links Between Gambling Problems and
Other Behavioral Health Conditions
 Identify Tools for Screening, Assessing, or
Diagnosing Gambling Problems
 Identify Treatment Issues and Strategies
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3. Intro
 Gambling problems can co-occur with other
behavioral health condition
 Only about 10 percent of people with a gambling
problem seek treatment
 a variety of other problems can be related to
gambling, including victimization and
criminalization; social problems; and health
issues, including higher risk for contracting
sexually transmitted diseases and HIV/AIDS
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4. Definitions
 Gambling is defined as risking something of value,
usually money, on the outcome of an event decided at
least partially by chance
 Action gamblers are typically men and gamble because
it is stimulating
 Action gambling requires some type of skill or
knowledge (poker, sports…)
 Relief gamblers are often female, gamble for the
escape and often gamble using games of chance (bingo,
lottery, slot machines…)
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5. Definitions
 In the DSM V
 “Pathological Gambling” was renamed “Gambling
Disorder.”
 Gambling disorder is categorized under Substance
Related and Addictive Disorders
 Problem gambling does not meet the criteria for
pathological gambling.
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6. Diagnostic Criteria
 Problematic gambling behavior leading to clinically significant impairment or
distress, as indicated by four (or more) of the following in a 12-month period:
 1. Gambles with increasing amounts of money 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 cut back, or stop gambling.
 4. Is often preoccupied with gambling
 5. Often gambles when feeling distressed
 6. After losing money gambling, often returns another day to get even
 7. Lies to conceal the extent of involvement with gambling.
 8. Gambling as jeopardized or lost a significant relationship, job, or career
 9. Relies on others to provide money to relieve financial problems.
 B. The gambling behavior is not better accounted for by a manic episode.
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7. Warning Signs
 Financial problems exist despite an adequate income.
 Money has gone missing from a bank account or wallet, or valuables
have disappeared.
 There is a lot of borrowing, cash advances, living off credit cards, etc.
 Retirement, insurance plans, etc., are cashed in or allowed to lapse.
 The person avoids family functions or other social events
 Neglects responsibilities or makes excuses
 Drops other leisure activities to focus on gambling
 Arrives late for work or other commitments
 Disappears for large blocks of time
 Appears deceptive/secretive about behavior, particularly re: money
 Seems edgy, reactive or defensive
 Changes sleep, eating or sexual behaviors
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8. Warning Signs in Adolescents
 Can’t account for missing money
 Skips school
 Borrows or steals money from friends or family
 Sometimes has large amounts of unexplained cash
 Has a fake ID, casino entry card, or gambling
receipts among belongings
 Is preoccupied with video arcades, internet
gambling sites or day trading
 Has left a trail of internet visits or credit card
charges to gambling sites.
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9. Prevalence
 Roughly 1.5 million Americans have experienced pathological
gambling
 An estimated 6 million Americans struggle with problem
gambling.
 Men are more likely than women to have gambling problems
 People diagnosed with pathological gambling, 73.2% had an
additional addictive disorder, 50% had a mood disorder, and 61%
percent had a personality disorder
 People who have both an SUD and pathological gambling have
high rates of attention deficit disorder
 The level of gambling involvement may be seen on a
continuum:
 No gambling - casual social gambling - serious social gambling -
risky gambling - problem gambling - pathological gambling
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10. Screening
 Screening for gambling problems is important because few
people seek treatment for these problems and instead seek
help for other complaints (e.g., insomnia, stress-related
problems, depression, anxiety, interpersonal issues)
 Tools
 South Oaks Gambling Screen (SOGS). The SOGS consists of 16 items
and differentiates between no gambling problems, some problems,
and probable pathological gambling (freely available)
 National Opinion Research Center’s Diagnostic Screen for Gambling
Problems. This is a questionnaire based on DSM-IV criteria
 Other Tools
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10

11.  3 major routes to gambling problems
 “Normal” Healthy, functioning adults who fall victim to easy
access, poor judgment and misunderstanding of odds. Mood
disorders are often the result of the gambling not the cause.
 “Emotionally Vulnerable” People who gamble to escape from
negative moods.
 “Biologically Based Impulsivity”
 Tend to be action gamblers
 As many as 20 per cent of those with gambling problems have
ADHD
 Likely to have a number of concurrent problems, such as
addiction, emotional lability, chronic boredom, and inadequate
social skills
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12. Risk Factors
 A big early win
 Susceptibility to boredom
 A poor understanding of randomness
 A tendency to use escape as a way of coping
 A stressful life with a lack of support and
direction around the time that gambling began
 History of a mood (anxiety, depression or bipolar
disorder), substance or process addiction,
intermittent explosive disorder, ADHD.
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13. Protective Factors
 Financial security
 Supportive friends
 Having hopes and dreams for the future
 Doing well at work
 Using support or other coping skills rather than
escape to deal with distress
 Knowledge of randomness
 Setting limits on betting
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14. Services
 Provide information and resources to assist clients with
 Financial difficulties
 Debtors Anonymous can help people learn how to budget their
money and rein in their spending
 Marital and family issues
 Contributes to chaos and dysfunction within the family, can
contribute to separation and divorce, and is associated with child
and spousal abuse
 Disclosing the gambling secret can be devastating to relationships,
leading to resentment and loss of trust
 Refer the client to Gamblers Anonymous, and family members and
loved ones to Gam-Anon
 Legal Issues
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15. Treatment Strategies
 Motivational Interviewing
 Brief, solution focused counseling
 Cognitive Behavioral Therapy
 CBT to treat gambling disorder usually involves identifying
and changing cognitive distortions about gambling,
reinforcing nongambling behaviors, and recognizing positive
and negative consequences
 Cognitive restructuring
 Relapse Prevention
 Learning to identify and avoid risky situations that can
trigger or cue feelings or thoughts that can lead to relapse
to gambling
 Learning to prevent vulnerabilities
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16. Summary
 Gambling is a large problem for millions of people
 Gambling not only impacts finances, but also relationships,
health and mental health
 People gamble for two main reasons—excitement or escape
 Money is not always the end goal for gamblers, although it is a
potent reinforcer.
 Gamblers often have distorted cognitions about the likelihood
they will win
 Adolescents who develop a problem with gambling are more
likely to develop pathological gambling issues in adulthood.
 Protective factors include: Social support, healthy coping skills,
setting limits on bets and having other hobbies/interests/goals
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