Craig Johnson, LADC

MN Gambling Treatment Provider

LET’s GET READY TO GAMBLE Ice Breaker

Why Beyond the 12 Steps • Peer support will not address underlying problems

• Mental Illness and Personality Disorders must be addressed (MacKillop, et al.,

2014)

• All addictions disrupt the balance of life, but Disordered Gambling has deeper psychological affect (Savage, Slutske and Martin, 2014)

Hit or Miss: The Bottom

• It actually does not exist, and leads to “comparison” of the disorder

• Consequences alone will not stop the disordered gambler

• Devastating loss not essential to getting help

• “the bottom” will often delay treatment (Dodes, 2014)

Not Counting Your Days A return to use is a stand alone event, not an eraser

Failure is an option, not an excuse

A window into the personal and chronic nature of this disease

Develop the “instance of use” as a basis for empowerment, not disenchantment , do over's are possible and encouraged (Dodes, 2014)

One size does not fit all Addicts are not defined by their DOC (Drug of Choice) but their BOC

(Behaviors of Choice)

One’s character is not flawed, behaviors are flawed, so change the behavior

One’s individual identity must re restored (Dodes, 2014)

Gamblers Dissociative Experience Desire to escape reality, fueled by illusion and fantasy

The gambler loses control of their escape (Rambeck, 2014)

Gambling experiences last too long and occur too often (Rambeck, 2014)

Time and Reality distortion (Grecuuci, et al., 2014)

Motivated by the chase

Pathological Nature of Gambling (PG) Understand Four Phase of PG; Winning, Losing, Desperation, Terminal

Gambling is substitute to satisfy unmet needs

Identify rituals in the gambling process (Rambeck, 2014)

Biopsychosocial Model of Gambling Psychological consequences of gambling

Suicide and Familicide (Moghaddam et al., 2015 & Anderson, Sisak and Varnik, 2011)

Affects on the brain

Social aspects of the disease

Understanding the progression of the disease

Psychodynamic Concepts of Gambling Insecurity, compulsivity, and stress as the basis of disordered gambling

Changes in personality which correlate to PG (OCEAN) (Miller, 2013)

Openness

Conscientiousness

Extraversion

Agreeableness

Neuroticism

Stages of Treatment Address the Crisis of Quitting Gambling

Integration of New Attitudes and Skills

Learn to meet One’s Own Needs (Rambeck, 2014)

Visualize your Future Stay in the moment, remove the blinders, and help the client look ahead

“Back to the Future” letter

……everyone, take out a piece of paper

To move beyond…. Acceptance and Commitment Enhance self awareness

Develop Communications

Increase self confidence

Improve ability to live in the present, but see the future

Disrupt negative thought/behavior patterns (Savage, Slutske, Martin, 2014)

Moving Evan Further Beyond Develop comprehensive aftercare plan

Develop client’s “new” understanding of money

Explore what still needs to change about money

Who/How will their money be controlled

Family and Recovery Emotional meaning of money

Did one’s family of origin discuss/argue about financial issues

Regarding gambling; when did money loose it’s value?

What barriers exist to enable a healthy discussion of problem gambling and money management in the future

Moving into Recovery Decrease amount of time/frequency of gambling

Meeting financial obligations

Absence of impaired control and engaging in cross addictions

Absence of negative consequences and improved quality of life

QUESTIONS

References COTE, D., CARON, A., AUBERT, J., DESROCHERS, V., & LADOUCEUR, R. (2003). Near wins

prolonged gambling on a video lottery terminal. Journal of Gambling Studies, 19, 433–438. doi:10.1023/A:1026384011003

LUCE, C., KAIROUZ, S., NADEAU, L., MONSON, E., (2016) Life events and problem gambling severity: a prospective study of adult gamblers. Psychology of Addictive Behaviors, 30, 922-930. doi: 10.1037/adb0000227

BREVERS, D., KORITZKY, G., BECHARA, A., NOEL, X. (2014), Cognitive processes underlying decision-making under uncertainty in gambling disorder. Addictive Behaviors, 39, 1533-1536. doi: 10.1016/jaddbeh.2014.06.004

GRECUCCI, A., ET AL. (2014). Time devours things: how impulsivity and time affect temporal decisions in pathological gamblers, ,Plos One, 9(10)

References SAVAGE, J., SLUTSKE, W., MARTIN, N.G., (2014). Personality and gambling involvement: a

person-centered approach. Psychology of Addictive Behaviors, 28, 4, 1198-1211. doi: 10.1037/a0037413

MAPLES, J., ET AL. (2014). An examination of the correlates of fearless dominance and self-centered impulsivity among high-frequency gamblers. Journal of Personality Disorders, 28(3), 379-393

MacKILLOP, J., ET AL. (2014). Multidimensional examination of impulsivity in relation to disordered gambling. Experimental and Clinical Psychopharmacology, 22(2), 176-185. doi: 10.1037/a0035874

RAMOS-GRILLE, I., ET AL. (2015). Predicting treatment failure in pathological gambling: the role of personality traits. Addictive Behaviors, 43, 54-59. doi: 10.1016/j.addbeh.2014.12.010

MOGHADDAM, J., ET AL. (2015). Suicidal Ideation and suicide attempts in five groups with different severities of gambling: findings from the national epidemiologic survey on alcohol and related conditions. American Journal on Addictions, 24: 292-298, 2015. doi: 10.111/ajad.12197

References BLACK, D.W., ET AL. (2015). Suicide ideations, suicide attempts, and completed suicide in

persons with pathological gambling and their first-degree relatives. American Association of Suicidology, 45(6) 700. doi: 10.1111/sltb.12162

ANDERSON, A., SIAASK, M., Varnik, A., (2011). Familicide and suicide in a case of gambling dependence. The Journal of Forensic Psychiatry & Psychology, 22(1) 2011, 156-168. Doi: 10.1080/14789949.2010.518244

El-GUEBALY, N., ET AL. (2011). Compulsive features in behavioral addictions: the case of pathological gambling. Society for the Study of Addiction, 107 2011, 1726-1734. Doi: 10.1111/j.1360-0443.2011.03546.x

SMITH, D.P., ET AL. (2015) Cognitive versus exposure therapy for problem gambling: randomized controlled trial. Behavior Research and Therapy, 69(2015) 100-110. Doi: 10.1016/j.brat.2015.04.008

References ASHLEY, L.L., BOEHLKE, K.K. (2012). Pathological gambling: a general overview. Journal of

Psychoactive Drugs, 44(1), 27-37. Doi: 10.1080/02791072.2012.662078

MERKOURIS, S.S., THOMAS, S.A., BROWNING, C.J., DOWLING, N.A. (2016). Predictors of outcomes of psychological treatments for disordered gambling: a systematic review. Clinical Psychology Review, 48 (2016) 7-31. Doi: 10.1016/j.cpr.2016.06.004

CONVERSANO, C. ET AL. (2012). Pathological gambling: a systematic review of biochemical, neuroimaging, and neuropsychological findings. Harvard Review of Psychiatry, 20(1), 130-148. Doi: 10.3109/10673229.2012.694318

RIZEANU, S. (2014) Pathological gambling treatment – review. Procedia- Social and behavioral sciences, 187 (2015) 613-618. Doi: 10.1016/j.sbspro.2015.03.114

MILLER, J.D., ET AL. (2013). Personality correlates of pathological gambling derived from big three and big five personality models. Psychiatry Research, 206 (2013) 50-55. Doi: 10.1016/j.psychres.2012.09.042

References MILLER, J.C., ET AL. (2010). Concurrent validity of gambling functional assessment (gfa):

correlations with the south oaks gambling screen (sogs) and indicator of diagnostic efficiency. Analysis of Gambling Behavior, 2010, 4, 61-75.

GOODIE, A.S., ET AL. (2013). Evaluating the south oaks gambling screen with dsm-iv and dsm-5 criteria: results from a diverse community sample of gamblers. SAGE Publications, 20(5) 523-531. Doi: 10.1177/1073191113500522

LANCE DODES & ZACHARY DODES, The Sober Truth, Beacon Press, Boston Massachusetts 2014.