Gambling Disorder Treatment Handbook

Jody Bechtold has been treating individuals with gambling disorder since 2006. She is a clinical social worker, counselor, professional coach and CEO of The Better Institute. Her public speaking, conference presentations, training and journal publications are focused on gambling addiction. She is an International Gambling Counselor Certification Board Member and sits on the Membership Committee of the National Council on Problem Gambling. She is based in Pittsburgh, PA, USA.Alyssa N. Wilson is Associate Professor and Department Chair of the Applied Behavior Analysis Program at The Chicago School of Professional Psychology in Los Angeles. She is a Board Certified Behavior Analyst Doctoral (BCBA-D), and a Licensed Behavior Analyst in the state of Missouri. Dr. Wilson's research focuses on biopsychosocial aspects of problem gambling, including assessment and treatment provision. She is based in Los Angeles, CA, USA.

• CHAPTER 1: GAMBLING IS EVERYWHERE, (and it doesn't appear to be going away anytime soon) 11Global Gambling Market................................................................................................... 12Gambling Expansion and New Horizons.......................................................................... 14Online and Internet Gambling........................................................................................... 15Social Gaming.................................................................................................................... 17Sports Betting..................................................................................................................... 20Consumer Protections and Harm Minimization to Promote Safe Gambling Use......... 22Self-Exclusion.................................................................................................................... 23Game Features and Structural Characteristics................................................................... 24Gambling Behavior Characteristics................................................................................... 26Setting Limits..................................................................................................................... 27Training Employees who Interact with Gamblers.............................................................. 28CHAPTER 2: Understanding Gambling Disorder: Pathways towards Etiology, Prevalence, and Comorbid Determinants of Health 30Etiological Predictors and Risk Factors for Developing Gambling Disorder................ 32Biological/Neurological Implications................................................................................ 34Psychological Implications................................................................................................ 37Social-Cultural Implications.............................................................................................. 38Spiritual Implications......................................................................................................... 41Pathways Model of Problem Gambling............................................................................. 43Considerations for Special Populations and Gambling.................................................... 48Adolescents......................................................................................................................... 48Older Adults....................................................................................................................... 49Diverse Communities......................................................................................................... 50Military............................................................................................................................... 51Trauma and Survivors Issues............................................................................................. 52Co-Occurring Disorders..................................................................................................... 53CHAPTER 3: Models of Intervention................................................................................... 55Transtheoretical Model....................................................................................................... 56Treatment Approaches and Stance of Therapy................................................................ 58Cognitive Therapy............................................................................................................. 58Behavior Therapy.............................................................................................................. 59Cognitive-Behavior Therapy............................................................................................. 59Third-Wave Behavior Therapy.......................................................................................... 61Motivational Interviewing................................................................................................. 63Pharmacological Therapy.................................................................................................. 65Treatment Considerations: Modality, Duration, and Targeting Relapse....................... 66Online Modalities.............................................................................................................. 67Brief Treatment.................................................................................................................. 68Relapse Prevention............................................................................................................. 69CHAPTER 4: Models of Intervention Applied..................................................................... 71Closing the Doors................................................................................................................. 73Addressing Gambling Symptoms....................................................................................... 77Cognitive Distortions......................................................................................................... 77Habituation......................................................................................................................... 78Chasing Losses and Wins................................................................................................... 82Session Considerations......................................................................................................... 83Treatment Selection............................................................................................................ 83Mindfulness in Session....................................................................................................... 84Relapse Prevention............................................................................................................. 85Terminating Therapeutic Relationship............................................................................... 88CHAPTER 5: Where to Start and What to Ask in the Beginning...................................... 90Gambling Screens, Assessments, and Diagnostic Tools.................................................... 90Lie-Bet Questionnaire........................................................................................................ 91Brief Biosocial Gambling Screen (BBGS)........................................................................ 91GBIRT................................................................................................................................ 92Gatekeeper Question.......................................................................................................... 92Simply Asking Open-Ended Questions (Fun Assessment)............................................... 94Diagnostic Statistical Manual-5 (DSM-5)......................................................................... 95International Statistical Classification of Diseases and Related Health Problems (ICD-10)96South Oaks Gambling Screen (SOGS).............................................................................. 97Problem Gambling Severity Index (PGSI)........................................................................ 97Gambling Pathways Questionnaire (GPQ)........................................................................ 97Gambling Functional Assessment II (GFA-II).................................................................. 98The Chicken or the Egg: Which Came First.................................................................... 98Depression and Anxiety..................................................................................................... 98Traumatic Brain Injuries (TBI).......................................................................................... 99Drugs, Alcohol, Nicotine/Tobacco and Cannabis............................................................ 100Suicide Risk Assessment................................................................................................. 101Gambling Problem or Gambling Solution...................................................................... 101Closing the Doors............................................................................................................ 102It's a Control Thing.......................................................................................................... 103Creating a Safe Place....................................................................................................... 103The First Few Sessions...................................................................................................... 104Where to Start and What to Ask...................................................................................... 104Presence of Suicidal Ideation........................................................................................... 105Motivation and Consequences of Gambling.................................................................... 105Games/Gambling............................................................................................................. 106Development of Gambling Habits................................................................................... 106Current Gambling Problem.............................................................................................. 106DSM-5 Diagnostic Criteria and Other Assessments........................................................ 106Finances........................................................................................................................... 107Current Living Conditions............................................................................................... 107Other Compulsive or Addictive Behaviors...................................................................... 107Prior Mental Health and Health Problems....................................................................... 108Personal Strengths and Resources.................................................................................... 109Steps Taken Prior to Seeking Treatment.......................................................................... 109Summary of Initial Recommendations............................................................................. 109Clinical Impressions......................................................................................................... 110Gambling Bio-Psycho-Social-Spiritual Evaluation......................................................... 112Chapter 6: Harm Reduction Approaches Across the Continuum.................................... 123Harm Reduction to Self-Exclusion: A Shared Continuum............................................ 124Using Harm Reduction with Clients................................................................................ 12510 Rules of Responsible Gambling................................................................................... 127Using Harm Reduction with Specific Populations......................................................... 131Self-Exclusion as Harm Reduction................................................................................... 134Case Examples of Harm Reduction on a Continuum..................................................... 137Case 1: Susan...................................................................................................................... 137Case 2: Joe.......................................................................................................................... 138Chapter 7: On Finances........................................................................................................ 140Real Money and Gambling Money................................................................................... 141Why Bankruptcy Is Not an Option.................................................................................. 141Money Protection............................................................................................................... 143Financial Inventory for Restitution Plan......................................................................... 144Clarifying Debt and Expenses.......................................................................................... 144Debt Repayment / Financial Restitution Plan................................................................... 146Involving Family Member................................................................................................. 147Asset Protection Plan for Partner/Spouse and Children................................................ 148Case Examples for Implementing Finance Strategies.................................................... 151Case 1: Eva......................................................................................................................... 151Case 2: Noah....................................................................................................................... 153CHAPTER 8: Family Involvement...................................................................................... 155Family Systems Theory Review........................................................................................ 155First and Second Order Change....................................................................................... 156Provide Education About Suicide.................................................................................... 159Provide Education About Gambling Disorder................................................................. 159Working with the Family : Spouse/Partner and Gambler............................................. 163Working With the Family : Family Only........................................................................ 165Protect Family Member's Financial Assets..................................................................... 165Core areas of conflict....................................................................................................... 166Enabling as a form of bailout........................................................................................... 167Setting limits and boundaries........................................................................................... 167Trust, anger/love, confidence........................................................................................... 167Expectations of new lifestyle........................................................................................... 168Working with the Family: Parents and the (Adult) Gambler........................................ 168Working with the Family : Parents and (Adolescent) Gambler.................................... 169Working with the Family : Final Stage of therapy.......................................................... 171CHAPTER 9: Self-Help and Peer Supports........................................................................ 173Self-Help Programs............................................................................................................ 17312-Step Programs............................................................................................................... 174Gamblers Anonymous...................................................................................................... 174Celebrate Recovery............................................................................................................ 176SMART Recovery............................................................................................................... 177Peer Supports...................................................................................................................... 177Having the Conversation................................................................................................... 179Understanding the Younger Generations......................................................................... 180Other Online Supports..................................................................................................... 180CHAPTER 10: Gambling and the Law............................................................................... 182Gambler or Criminal Profile............................................................................................. 183Legal Involvement: Before & During............................................................................... 185The 5 Rs' of Treatment and Documentation.................................................................... 186Act As If You Are Already in Front of the Judge............................................................ 188Clinical Report Sections..................................................................................................... 189Legal Involvement: After................................................................................................... 193Providing Expert Testimony.............................................................................................. 194Example Report Evaluation to inform and educate sentencing.................................... 195Full Report to an attorney on behalf of your client - example....................................... 203REFERENCES 206

Not all addictions are the same, so treating them should address the unique features of the addiction, in this case gambling disorder. Bechtold and Wilson highlight aspects of gambling disorder that differ from other addictions and provide concrete ideas for therapists and other professional helpers to improve their practice, whether they treat the gambling or refer someone for treatment. The rich details are rooted in up-to-date evidence, and case examples illustrate how to tailor and use core therapeutic skills in treating persons with gambling disorder and their families. They explain how boundary setting, addressing suicidal thoughts and behaviors, addressing finances, and interacting with and documenting for the judicial system are critical and different for people facing gambling problems. It highlights key screening and assessment tools and provides resources that can supplement therapy and increase the likelihood of recovery. This book offers insights for both new and seasoned professionals.