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Joint Session - Dr. Sally Gainsbury, Ken Winters, and Alfonso Fernandez

Horizons RG
Horizons RG
Horizons RGResponsible Gambling Conference at BCLC

Joint Session: Dr. Sally Gainsbury - Time to get off the Couch? Alternative Treatments for Problem Gambling Ken Winters - SBIRT to Address Problem Gambling Alfonso Fernandez - ControlGam: An Innovative Virtual Therapy Tool Presented at the New Horizons in Responsible Gambling Conference in Vancouver, February 2-4, 2015

Joint Session - Dr. Sally Gainsbury, Ken Winters, and Alfonso Fernandez

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Joint Session - Dr. Sally Gainsbury, Ken Winters, and Alfonso Fernandez
Joint Session - Dr. Sally Gainsbury, Ken Winters, and Alfonso Fernandez
Dr. Sally Gainsbury, Dr. Ken Winters and
Mr. Alfonso Fernandez
Senior Lecturer, Centre for Gambling Education & Research
Department of Psychiatry, University of Minnesota
CEO, AMS Media
Alternative treatments for
problem gambling
Sally Gainsbury
Centre for Gambling Education and Research, Southern Cross
University
Presentation at New Horizons in Responsible Gambling
Vancouver, February 4, 2015
Achieving treatment & responsible gambling objectives
Internet & mobile technology:
1. Assist people with gambling-related problems
2. Facilitate responsible gambling
• A comprehensive system
• Customisable for specific needs and populations
• Country/Province-wide access
• Evaluation & updates
 Evidence-based
 Value for money
Constant connectivity
Ad

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Joint Session - Dr. Sally Gainsbury, Ken Winters, and Alfonso Fernandez

  • 3. Dr. Sally Gainsbury, Dr. Ken Winters and Mr. Alfonso Fernandez Senior Lecturer, Centre for Gambling Education & Research Department of Psychiatry, University of Minnesota CEO, AMS Media
  • 4. Alternative treatments for problem gambling Sally Gainsbury Centre for Gambling Education and Research, Southern Cross University Presentation at New Horizons in Responsible Gambling Vancouver, February 4, 2015
  • 5. Achieving treatment & responsible gambling objectives Internet & mobile technology: 1. Assist people with gambling-related problems 2. Facilitate responsible gambling • A comprehensive system • Customisable for specific needs and populations • Country/Province-wide access • Evaluation & updates  Evidence-based  Value for money
  • 7. Internet & mobile technology • Online screening with automated feedback • Self-directed online CBT • With therapist support (email, chat, phone, face-to-face) • Brief interventions & prevention resources • Online • SMS
  • 8. Online treatment options Face-to-face counselling e.g., video conferencing Online counselling: Email, video conferencing, chat Treatment with therapist support Self-directed interventions Structured online CBT Customized SMS Brief interventions Online peer-support forum Peer support Support: GP, counsellors, telephone or online chat
  • 9. Treatment and responsible gambling principles Build capacity & sustained solutions tailored to community needs • Integrated treatment and prevention options • Allow individuals to seek help in the way they wish • Help-seeking is cyclical Promote innovation through technology & leveraging existing programs • New online interventions • Working with existing support services
  • 10. Promote simple pathway to support • One entry point, many options • Customised support recommendations • Province-wide access • Value for money • Time efficient • Greater uptake • Builds on existing programs
  • 11. Early intervention Prevention isn’t about ‘help’ • Evidence gap – encouraging uptake of responsible gambling resources and tools • Brief online tools • Stay in control • Integrated into wider support services
  • 12. Options to suit users Layer low, medium, and high intensity interventions Communication is key Integrate with professionals, community and local organisations
  • 13. Best practice • Preliminary research support • Efficacy of funding • Program evaluation • Demonstrate performance & value for money • Incorporate best practice • Build research capacity
  • 14. Conclusions • Face-to-face treatment is still important • But support can be more inclusive • Full range of options to suit diverse needs • Ongoing funding needed for development, evaluation & updates • Continue to build capacity to improve ongoing support services
  • 15. Thank you, questions? Dr Sally Gainsbury Senior Lecturer, Centre for Gambling Education & Research Southern Cross University Email: sally.gainsbury@scu.edu.au Website: http://works.bepress.com/sally_gainsbury/ @DrSalGainsbury
  • 16. Screening, Brief Intervention and Referral to Treatment (SBIRT) To Address Problem Gamblers Ken Winters, Ph.D. Department of Psychiatry University of Minnesota winte001@umn.edu New Horizons in Responsible Gambling Conference Vancouver, BC February 4, 2015 Source: Linda Sobell
  • 17. Who Am I? • Problem gambling researcher since early 1990’s – Applied research projects include treatment outcome studies and development of GAMTOMS • SBIRT researcher in the last decade
  • 18. • At the risk of being over-simplistic, the keys to treating a problem gambler: • Develop a therapeutic alliance with the person. • Help him/her to break the functional value of their gambling. General Views of Any Counselling Program to Address Problem Gambling
  • 20. Gambling Involvement and Response Intensive Treatment Adapted from Broadening the Base of Alcohol Treatment (IOM) Prevention Brief Intervention ~85-90% ~1%~5-10%
  • 21. SBIRT Screening, Brief Intervention, Referral to Treatment Prob Identif. Next step Referral Screening Probable? BI or More Assess Treatment? Assessment Definitive? Treatment Continuing Care?
  • 22. SBIRT Screening, Brief Intervention, Referral to Treatment Prob Identif. Next step Referral Screening Probable? BI or More Assess Treatment? Assessment Definitive? Treatment Continuing Care?
  • 23. SBIRT Screening, Brief Intervention, Referral to Treatment • Many favorable screening tools available (good resource: www.ncrg.org) • Lie/Bet • BBGS • MAGS • NORC Diagnostic Screens (4- and 17-item versions) • PGSI (screen of the CPGI) • SOGS
  • 24. SBIRT Screening, Brief Intervention, Referral to Treatment
  • 25. BI “Sweet Spot” Intensive Treatment Adapted from Broadening the Base of Alcohol Treatment (IOM) Prevention Brief Intervention ~85-90% ~1%~5-10%
  • 26. SBIRT-T Common Elements of Brief Interventions • Motivational interviewing • Normative feedback • Decisional balance • Negotiated goals
  • 27. DECISIONAL BALANCE EXERCISE Pros “What do you like about gambling? What are the good things about ugambling? What else?” (Ask again until nothing else.) Cons “What don’t you like as much about gambling? What are the not-so-good things ? What else?” (Ask again until nothing else.)
  • 28. DECISIONAL BALANCE EXERCISE More probing “If you were to stop gambling, what would be the good things that might happen? What would be the bad things? “ “If you were to continue to gamble, what would be the good things that might happen? What would be the bad things? “
  • 29. SBIRT Screening, Brief Intervention, Referral to Treatment • Efficacy: Small body of research • Effect sizes in the “moderate range” (singles and doubles, not home runs) • Not clear if harm reduction effective over the long term
  • 30. SBIRT Favorable outcome Minimal/no change Problem worsens Support recovery Refer more services Conduct booster or refer more services Multi-screen red flags Refer more assessment
  • 31. Summary • The SBIRT approach is an emerging and promising set of tools to address those with a gambling problem. • Evidence-based and evidenced- informed models from the drug abuse literature can be harnessed for the PG field. • Apply a PG-focused SBIRT to clients in drug treatment and mental health clinics. Screening Brief Intervention Referral to Treatment
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