Pathological Gambling A Critical Review (1999) / Chapter Skim
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6: Treatment for Pathological Gamblers
6: Treatment for Pathological Gamblers
Pages 192-236
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From page 192... ...
We then discuss what is known about the characteristics of those who seek treatment for pathological gambling. We then turn to treatment models that have been applied for helping pathological gamblers, what is known about treatment effectiveness, whether treatment is warranted, and issues related to treatment availability, utilization, funding, and treatment providers in the United 192
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From page 193... ...
It is important, as well, to recognize that recovery from pathological gambling can take place without formal treatment. Such individuals have been classified by various descriptors, for example, so-called spontaneous recovery and natural recovery (Wynne, personal communication, 1998~.
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The key to change comes when those addicted begin to realize that the costs of their addiction exceed the benefits, as when pathological gamblers identify gambling as a destructive agent in their life. It is at this point that addicted people often ask those who they trust to help them stop, and they take the first steps to seek professional help.
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From page 195... ...
The majority tend to be in their 30s and 40s and have graduated from high school and attended some college (Blackman et al., 1989; Moore, 1998; Yaffee et al., 1993; Stinchfield and Winters, 1996~. Gambling Severity Most clinical studies indicate that, before pathological gamblers come in for treatment, they gamble either every day or every week (Moore, 1998; Stinchfield and Winters, 1996~.
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Comorbidity As discussed in Chapter 4, a number of studies have found significant rates of cooccurring mental disorders and psychiatric symptoms among pathological gamblers. Studies have indicated evidence of pathological gambling cooccurring with substance use disorders, depression, suicidal thoughts and attempts, and various personality disorders.
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Wildman, personal communication to the committee, 1998~. A table summarizing the literature on treatment outcome studies reviewed by the committee appears in Appendix D
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From page 198... ...
Although several others have noted the value of psychodynamic treatment for addictive behaviors (Boyd and Bolen, 1970; Kaufman, 1994; Khantzian, 1981; Shaffer, 1995; Wurmser, 1978) , there have been no controlled or randomized studies exploring the effectiveness of this approach for treating pathological gamblers.
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Behavioral Behavioral treatment methods actively seek to modify pathological gambling behavior on the basis of principles of classical conditioning or operant theory. Several variations of behavioral treatment methods are used today, often in combination.
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However, findings from these limited studies are not consistent enough to reach conclusions about treatment effectiveness. Early studies of effectiveness on behavioral forms of treatment for pathological gamblers focused on aversion treatment.
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Larger outcome studies have been undertaken and provide more evidence for treatment effectiveness. In a study of 110 German pathological gamblers, Iver Hand (1998)
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Also of significance are the study's findings pertaining to the controlled gamblers. The pattern of gambling suggested that controlled gambling is not necessary a temporary response followed by a relapse to heavier gambling (Blaszczynski et al., 1991:299~.
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and adult pathological gamblers (Bujold et al., 1994; Sylvain et al., 1997~. The Sylvain study (1997)
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fluvoxamine study. Of 19 pathological gamblers, 9 dropped out during the placebo phase.
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The effectiveness of the drug in treating pathological gamblers is currently being investigated under controlled conditions by Suck-Won Kim at the University of Minnesota (Kim, 1998~.
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believes that pathological gamblers are deficient in the number of coping skills they have available and in their ability to flexibly choose the skill most appropriate to the stressful, or potentially relapse-triggering, situations they face. In a comparison with nongambling substance abusers, he found that substance abusers with a gambling problem utilize significantly more avoidance and impulsive coping styles.
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From page 207... ...
loins or family therapy is another therapeutic component of addiction-based treatment. This element is important when dealing with pathological gamblers, because families are often loath to forgive the gambler.
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Of the 26,8 were abstinent and the others showed less gambling compared with the period prior to treatment. However, the gamblers contacted at the four-year follow-up represented only about one-third of the original treatment sample of 99 pathological gamblers.
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Other Self-Help Related to the Gamblers Anonymous approach is the use of self-help and psychoeducational literature for pathological gamblers. Dickerson et al.
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If we assume some rate of natural recovery among pathological gamblers, the social costs of gambling will be lower than estimates that assume no possibility of natural recovery. Since Winick (1962)
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HEALTH CARE SERVICES AND PREVENTION Although the effectiveness of various treatment approaches is not well substantiated in the literature, it is the committee's view that treatment for most, but perhaps not all, pathological gamblers is warranted. This position is based on three assumptions: First, pathological gambling is a serious disorder associated with several negative consequences.
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From page 212... ...
Many approaches have been employed in the service of pathological gamblers, although most of the treatment is probably delivered on an outpatient basis. Inpatient care is generally limited to patients with severe acute crises, treatment failures, and severe comorbid disorders, particularly depression (Lesieur, 1998; Blume, 1986~.
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It may be that nonspecialized providers deliver the majority of addiction treatment services. As an adjunct or alternative to primary treatment, treatment providers often refer gamblers to Gamblers Anonymous and Gam-Anon (Lesieur, 1998; Stinchfield and Winters, 1996~.
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, only 34 have a council. Without a good estimate of the number of pathological gamblers in the United States and the actual number of patients in treatment for this disorder, it is nearly impossible to reliably estimate the gap between the need for and use of treatment services.
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counselors (although several help lines lack a professional staff and are concerned about liability issues) , information (e.g., about Gamblers Anonymous, GamAnon, problem gambling research)
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Some help lines have developed information systems about calls and clients. The variability between them is considerable; they ask different questions, do not necessarily ask all questions of all callers, and report data using different summary categories.
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The mean score was about 8, which is considerably higher than the standard cutoff score of 5 for defining probable pathological gamblers (Lesieur and Blume, 1987) , although it is lower then the mean score obtained from a Minnesota sample of treatment seekers (Stinchfield and Winters, 1996~.
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the National Council on Problem Gambling, an association formed in 1972 to provide information on problem gambling, began certifying gambling counselors in 1989; and (3) the American Compulsive Gambling Counselor Certification Board, affiliated with the Council on Compulsive Gambling of New Jersey, Inc., and formed in 1989, began offering its credential on a national basis in 1993.
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From page 219... ...
A clear challenge for developing effective ways to prevent problem gambling is the lack of awareness of the dangers of excessive gambling. In one sense, programs to prevent substance abuse have it easy; the dangers of illicit drug use are relatively easy to identify.
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This lack of rigorous research is aggravated by the fact that adequate research funding for pathological gambling treatment has not been made available in substantial amounts by the federal government. In contrast, the substance abuse field, which has benefited from treatment research made possible by expansion of research funding by the National Institute on Drug Abuse (NIDA)
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From page 221... ...
The prevailing sentiment among experts in the substance abuse field, backed by two decades of well-funded research, is that for substance abusers, some treatment is better than no treatment (Institute of Medicine, 1996~. At this juncture, there appears to be no compelling evidence in the pathological gambling literature to reject the notion that some treatment is better than none.
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, women constitute one-third of the population of pathological gamblers but are underrepresented in treatment study samples. And there is increasing recognition of the need to set up and evaluate treatment programs designed specifically for women and adolescents.
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Matching patients to optimal treatment approaches is an ongoing area of research in the substance abuse treatment field. Limited independent research on matching patients to treatment settings suggests that outcomes are improved when patients were matched to settings that address their
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From page 224... ...
a means of facilitating movement through a continuum of treatment services (Substance Abuse and Mental Health Services Administration, 1995~. Because the gambling treatment field does not contain an adequate knowledge base pertaining to these three elements, matching patients to treatments cannot be adequately studied until the basic research regarding assessment and placement criteria has first been conducted.
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Research persuasively demonstrates that one of the most reliable predictors of treatment outcome for substance abuse addiction is the patient's readiness to change, regardless of treatment strategy (Prochaska et al., 1992~. Consequently, the pathological gambling treatment field should direct research attention to studying the patients' overall readiness to change and the specific stage of change as predictors of treatment outcome.
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Journal of Substance Abuse Treatment 3~2~:131-133.
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Boisvert 1994 Treatment of pathological gamblers: An experimental study. Journal of Behavior Therapy and Experimental Psychiatry 25:275-282.
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Pp. 135-146 in Compulsive Gambling: Theory, Research and Practice, H.J.
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Politzer 1989 Family, marital, and occupational satisfaction for recovering pathological gamblers. Journal of Gambling Behavior 5:201-210.
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Dumont 1994 Cognitive-behavioral treatment for adolescent pathological gamblers. Behavior Modification 18:230-242.
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Lopez Viets, V.C., and W.R. Miller 1997 Treatment approaches for pathological gamblers.
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British Journal of Psychiatry 142:366-372. 1988 Behavior completion versus stimulus control in compulsive gambling: Implications for behavioral assessment.
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Lindner 1992 Inpatient treatment of male pathological gamblers in Germany. journal of Gambling Studies 8:93-109.
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Winters 1996 Treatment Effectiveness of Six State-Supported Compulsive Gambling Treatment Programs in Minnesota. Minneapolis: Department of Psychiatry, University of Minnesota.
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Ramirez 1987 Follow-up of pathological gamblers after treatment. American Journal of Psychiatry 144:757-761.
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Edmonton: Alberta Alcohol and Drug Abuse Commission. Yaffee, R., V
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