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Gambling Problems: An Introduction
Instructor: Dr. Dawn-Elise Snipes
Executive Director: Counselor Continuing Education & Training

CEUs/OPD/CPDs are available for this presentation at for clinicians in the US and for clinicians in Australia.

~ Define Pathological Gambling, Gambling Disorder, and Problem Gambling
~ Explore the Prevalence of Gambling Issues
~ Identify Wo 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

~ 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
~ 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…)
~ 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.
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.
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
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.
~ 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

~ 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

~ 3 major routes to gambling problems
~ “Normal” Healthy, functioning adults who fall victim to easy access, poor judgement 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

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) or impulse control disorder (substance or process addiction, intermittent explosive disorder, ADHD)

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
~ 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
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
~ 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