The 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) 11
Global Gambling Market................................................................................................... 12
Gambling Expansion and New Horizons.......................................................................... 14
Online and Internet Gambling........................................................................................... 15
Social Gaming.................................................................................................................... 17
Sports Betting..................................................................................................................... 20
Consumer Protections and Harm Minimization to Promote Safe Gambling Use......... 22
Self-Exclusion.................................................................................................................... 23
Game Features and Structural Characteristics................................................................... 24
Gambling Behavior Characteristics................................................................................... 26
Setting Limits..................................................................................................................... 27
Training Employees who Interact with Gamblers.............................................................. 28
CHAPTER 2: Understanding Gambling Disorder: Pathways towards Etiology, Prevalence, and Comorbid Determinants of Health 30
Etiological Predictors and Risk Factors for Developing Gambling Disorder................ 32
Biological/Neurological Implications................................................................................ 34
Psychological Implications................................................................................................ 37
Social-Cultural Implications.............................................................................................. 38
Spiritual Implications......................................................................................................... 41
Pathways Model of Problem Gambling............................................................................. 43
Considerations for Special Populations and Gambling.................................................... 48
Adolescents......................................................................................................................... 48
Older Adults....................................................................................................................... 49
Diverse Communities......................................................................................................... 50
Military............................................................................................................................... 51
Trauma and Survivors Issues............................................................................................. 52
Co-Occurring Disorders..................................................................................................... 53
CHAPTER 3: Models of Intervention................................................................................... 55
Transtheoretical Model....................................................................................................... 56
Treatment Approaches and Stance of Therapy................................................................ 58
Cognitive Therapy............................................................................................................. 58
Behavior Therapy.............................................................................................................. 59
Cognitive-Behavior Therapy............................................................................................. 59
Third-Wave Behavior Therapy.......................................................................................... 61
Motivational Interviewing................................................................................................. 63
Pharmacological Therapy.................................................................................................. 65
Treatment Considerations: Modality, Duration, and Targeting Relapse....................... 66
Online Modalities.............................................................................................................. 67
Brief Treatment.................................................................................................................. 68
Relapse Prevention............................................................................................................. 69
CHAPTER 4: Models of Intervention Applied..................................................................... 71
Closing the Doors................................................................................................................. 73
Addressing Gambling Symptoms....................................................................................... 77
Cognitive Distortions......................................................................................................... 77
Habituation......................................................................................................................... 78
Chasing Losses and Wins................................................................................................... 82
Session Considerations......................................................................................................... 83
Treatment Selection............................................................................................................ 83
Mindfulness in Session....................................................................................................... 84
Relapse Prevention............................................................................................................. 85
Terminating Therapeutic Relationship............................................................................... 88
CHAPTER 5: Where to Start and What to Ask in the Beginning...................................... 90
Gambling Screens, Assessments, and Diagnostic Tools.................................................... 90
Lie-Bet Questionnaire........................................................................................................ 91
Brief Biosocial Gambling Screen (BBGS)........................................................................ 91
GBIRT................................................................................................................................ 92
Gatekeeper Question.......................................................................................................... 92
Simply Asking Open-Ended Questions (Fun Assessment)............................................... 94
Diagnostic Statistical Manual-5 (DSM-5)......................................................................... 95
International Statistical Classification of Diseases and Related Health Problems (ICD-10)96
South Oaks Gambling Screen (SOGS).............................................................................. 97
Problem Gambling Severity Index (PGSI)........................................................................ 97
Gambling Pathways Questionnaire (GPQ)........................................................................ 97
Gambling Functional Assessment II (GFA-II).................................................................. 98
The Chicken or the Egg: Which Came First.................................................................... 98
Depression and Anxiety..................................................................................................... 98
Traumatic Brain Injuries (TBI).......................................................................................... 99
Drugs, Alcohol, Nicotine/Tobacco and Cannabis............................................................ 100
Suicide Risk Assessment................................................................................................. 101
Gambling Problem or Gambling Solution...................................................................... 101
Closing the Doors............................................................................................................ 102
It's a Control Thing.......................................................................................................... 103
Creating a Safe Place....................................................................................................... 103
The First Few Sessions...................................................................................................... 104
Where to Start and What to Ask...................................................................................... 104
Presence of Suicidal Ideation........................................................................................... 105
Motivation and Consequences of Gambling.................................................................... 105
Games/Gambling............................................................................................................. 106
Development of Gambling Habits................................................................................... 106
Current Gambling Problem.............................................................................................. 106
DSM-5 Diagnostic Criteria and Other Assessments........................................................ 106
Finances........................................................................................................................... 107
Current Living Conditions............................................................................................... 107
Other Compulsive or Addictive Behaviors...................................................................... 107
Prior Mental Health and Health Problems....................................................................... 108
Personal Strengths and Resources.................................................................................... 109
Steps Taken Prior to Seeking Treatment.......................................................................... 109
Summary of Initial Recommendations............................................................................. 109
Clinical Impressions......................................................................................................... 110
Gambling Bio-Psycho-Social-Spiritual Evaluation......................................................... 112
Chapter 6: Harm Reduction Approaches Across the Continuum.................................... 123
Harm Reduction to Self-Exclusion: A Shared Continuum............................................ 124
Using Harm Reduction with Clients................................................................................ 125
10 Rules of Responsible Gambling................................................................................... 127
Using Harm Reduction with Specific Populations......................................................... 131
Self-Exclusion as Harm Reduction................................................................................... 134
Case Examples of Harm Reduction on a Continuum..................................................... 137
Case 1: Susan...................................................................................................................... 137
Case 2: Joe.......................................................................................................................... 138
Chapter 7: On Finances........................................................................................................ 140
Real Money and Gambling Money................................................................................... 141
Why Bankruptcy Is Not an Option.................................................................................. 141
Money Protection............................................................................................................... 143
Financial Inventory for Restitution Plan......................................................................... 144
Clarifying Debt and Expenses.......................................................................................... 144
Debt Repayment / Financial Restitution Plan................................................................... 146
Involving Family Member................................................................................................. 147
Asset Protection Plan for Partner/Spouse and Children................................................ 148
Case Examples for Implementing Finance Strategies.................................................... 151
Case 1: Eva......................................................................................................................... 151
Case 2: Noah....................................................................................................................... 153
CHAPTER 8: Family Involvement...................................................................................... 155
Family Systems Theory Review........................................................................................ 155
First and Second Order Change....................................................................................... 156
Provide Education About Suicide.................................................................................... 159
Provide Education About Gambling Disorder................................................................. 159
Working with the Family : Spouse/Partner and Gambler............................................. 163
Working With the Family : Family Only........................................................................ 165
Protect Family Member's Financial Assets..................................................................... 165
Core areas of conflict....................................................................................................... 166
Enabling as a form of bailout........................................................................................... 167
Setting limits and boundaries........................................................................................... 167
Trust, anger/love, confidence........................................................................................... 167
Expectations of new lifestyle........................................................................................... 168
Working with the Family: Parents and the (Adult) Gambler........................................ 168
Working with the Family : Parents and (Adolescent) Gambler.................................... 169
Working with the Family : Final Stage of therapy.......................................................... 171
CHAPTER 9: Self-Help and Peer Supports........................................................................ 173
Self-Help Programs............................................................................................................ 173
12-Step Programs............................................................................................................... 174
Gamblers Anonymous...................................................................................................... 174
Celebrate Recovery............................................................................................................ 176
SMART Recovery............................................................................................................... 177
Peer Supports...................................................................................................................... 177
Having the Conversation................................................................................................... 179
Understanding the Younger Generations......................................................................... 180
Other Online Supports..................................................................................................... 180
CHAPTER 10: Gambling and the Law............................................................................... 182
Gambler or Criminal Profile............................................................................................. 183
Legal Involvement: Before & During............................................................................... 185
The 5 Rs' of Treatment and Documentation.................................................................... 186
Act As If You Are Already in Front of the Judge............................................................ 188
Clinical Report Sections..................................................................................................... 189
Legal Involvement: After................................................................................................... 193
Providing Expert Testimony.............................................................................................. 194
Example Report Evaluation to inform and educate sentencing.................................... 195
Full Report to an attorney on behalf of your client - example....................................... 203
REFERENCES 206