Treating Gambling Problems

Acknowledgments     xviiSeries Preface     xixPreface     xxiAbout the Authors     xxivConceptual Foundations of Gambling DisordersIntroduction to Gambling     1Definitions of Problem and Pathological Gambling     5Definitional Distinctions     5An Introduction to the Three Cs of Problem and Pathological Gambling     7Myths versus Facts about Problem and Pathological Gambling     9Transient versus Chronic Problems     11Spontaneous Remission and Maturing Out     13Clinical versus Nonclinical Populations: Why Some Gamblers Do Not Mature Out     14Risk Factors for Gambling Disorders     16Exposure, History, Attitudes, and Expectancies     16Personality Variables     17Blaszczynski's Types     17Specific Contradictory Personality Variables     18Comorbid Psychiatric Disorders     20Biology and Genetic Factors     20Coexisting Addictive Disorders     22Epidemiology of At-Risk Populations     22Gender Differences     24Gambling, the Family, and Multicultural Considerations     25What the Future Holds for the Treatment of ThisDisorder     26Where the Field Is Going     26Summing Up     28Key Terms     29Recommended Reading     30Recognizing Gambling Disorders: Signs and SymptomsDevelopmental Stages in the Progression of Problem and Pathological Gambling Behavior's     33The Gambling Continuum     34Recognizing Gambling Disorders     36The Signs and Symptoms of Pathological Gambling     38Client Information     39Coexisting Addictive Disorder Screening     42Other Client Signs     47What Spouses or Others May Report     49Employers and Supervisors     50Traditional Psychological Assessment     51Complicating Diagnostic Issues     56Healthy versus Problematic Attitudes and Behaviors     59Social Settings     60Professional Collaboration, Accountability, and Responsibility in the Screening-Intake Process     60Summing Up     62Key Terms     63Recommended Reading     64Utilizing Optimal Professional ResourcesReferral Benefits and Disadvantages     68Screening Reports, Documentation, and Responsibility     71How to Develop a Professional Referral Network     72State and National Councils on Compulsive and Pathological Gambling     73Gambling Hotlines     74Liaison with Gamblers Anonymous     75GamAnon     78Psychiatrists and Emergency Facilities     78Matching Clients with the Best Professional Options     79Referrals to Counselors under Contract in the Private Sector     80Referral Do's and Don'ts     81Motivation Strategies and Techniques for Getting a Person to Professionals     83Ambivalence     84Using Motivational Interviewing     85Avoiding Anger and Shame: The Rapid Demotivators     87Procrastination     88Overcoming Client Obstacles     88Common Practical Obstacles     89The "Controlled Gambling Experiment"     90Preventing and Dealing with Crisis Situations     91Family and Concerned Others Involvement     93Risk Management Strategies and Techniques to Protect Clients and Families     94Suicide and Suicidal Ideation     94Six Step Model     96Define the Problem     96Ensure the Person's Safety     96Provide Support      96Explore Options and Alternatives     97Make a Plan     97Get a Commitment     97Risk Management Strategies and Techniques to Protect Counselors     101Duty to Warn for Property Damage     101Referral Follow-Up and Cautionary Notes     103Summing Up     103Key Terms     104Recommended Reading     104Developing an Effective Treatment PlanTherapeutic Benefits of Treatment     108Initial Attrition     110Telephone Contact and Crisis Intervention     112Client Intake     113The Counselor's Tasks During the Intake     115Questions That You Might Need to Ask Yourself     117Helpful Information Before the Intake     117Informed Consent and Limits of Confidentiality     118HIPAA, Intake, and Client Records     123Intake Do's and Don'ts     124Formal Assessment Processes     125Assessment Measures and Instruments Commonly Used and Why They Are Useful     127Diagnostic Processes and Determinations     128Treatment Planning     129Fees and Insurance Coverage     130Managed Care      131Filing for Insurance: The Practice of Responsible Client Billing     131Ethics of Insurance: Modeling Financial Responsibility for the Pathological Gambler     132Family and Concerned Others Involvement     132Recovery Contracts     134Action Plans     135Summing Up     138Key Terms     138Recommended Reading     139Resource for General Paperwork     139HIPAA     139Dual-Diagnoses Clients     140Recovery Theories, Programs, and ToolsAn Overview: What We Know from Other Addictions     143Levels of Traditional Gambling Treatment     145Applying ASA Levels of Care To Gambling Treatment     146Recovery Theories and Models     147The Disease Model     148The Alternative Model     149Motivational Therapies     155Social Interventions     156Medical Treatments     157Responsible Gambling     158Teaching How Video Gambling Works     159Family Therapy     160Psychosocial Therapies     162Insight and Psychodynamic Therapies     163Grief Counseling      164Behavioral Therapies     164Cognitive and Cognitive-Behavioral Models     164Existential and Spiritual Interventions     166Holistic and Alternative Treatments     167Financial Counseling     167Support Groups     167Internet Treatment     171Formal Treatments     172Very Minimal Treatment     172Develop a Gambling Intervention Tool Box     172Workbook and Journaling Programs     173Cultural Pathways of Recovery     175Summing Up     176Key Terms     176Recommended Reading     177Continuing Care: When and How Should Clients Be DischargedRecovery-What Are the Goals?     181Criteria for Exiting Clients from Supervised Treatment     183Discharge Criteria For Different Problem Intensities     184Gambling Problems and Mastery-Based Discharge: Using Cognitive Corrections     185Gambler Discharge or Step-Down Criteria     185Discharge Criteria and Concerns during Various Stages of Recovery     186Discharge and the Developmental Recovery Processes     188Continuing Care Plan Procedures and Guidelines     189Legal, Moral and Ethical Issues     192Proper and Improper Methods of Termination     193Abandonment     194Assessing Community Resources     195Organizing Recovery Supports Where Lacking     196Styles of Recovery: Methods of Disease Management     197Spheres of Recovery     199Family and Concerned Others Involvement and Spheres of Recovery     200Rates of Recovery and Failure     201Summing Up     203Key Terms     204Recommended Reading     204Posttreatment Recovery Management: Models and Protocols of Relapse PreventionRelapse Prevention     208Models of Relapse Prevention     208Behavioral Models of Relapse Prevention     209Cognitive Models of Relapse Prevention     210Cognitive-Behavioral Models     210Belief that relapses are inevitable     211Belief that relapses are impossible     211Belief that God intervenes to allow chance to favor people in need     211Belief that all problems (finance, stress, etc.) need immediate solutions     212Belief that "What did not work in the past will suddenly start to work."     212An Integrated Model of Relapse Prevention      212Baumeister's Model of Self-Regulation     212Proactive Strategies for Preventing and Dealing with "Triggers" for Relapse     213Cognitive Triggers     213Triggers in Cognitive Behavioral Therapy     215Developing Relapse Prevention Plans     216Common Themes in Relapse Prevention     219Emergence of Sadness and Subclinical Depression     219Sleep     220Modification of Social Networks     220Reduction in Other Addictive Substances     221Exercise     221Monitoring and Negotiating Follow Up in Recovery     223Emergency Plans     224Obstacles in Relapse Prevention: Emerging Difficulties     225Emergence of Psychiatric Disorders     225Emergence of Physical Problems     226Emergence of Couples and Family Problems     227Community Linkage as Relapse Reversion Prevention     228Community-Based Vocational Counseling     228Academic Counseling     228Financial Counseling     229Pastoral Counseling     230Leisure Counseling     230Health Counseling     230Telephone and Internet Follow Up      231Family and Concerned Others Involvement during Posttreatment Recovery     232Preventing Chronic Relapses     233Mindfulness     233Summing Up     235Key Terms     236Recommended Reading     236New Beginnings: Moving Beyond the AddictionMoving Beyond     240Recovery in Psychological and Mental Health Domains     241Personality Changes     242Psychotherapies     244Psychodynamic Therapy     244Narrative Psychotherapy     245Humanistic Psychotherapies     246Increasing Positive Emotions and Happiness     248Moral Development     250Beyond Selfhood     251Family Recovery     253Vocational Recovery     255Physical Health and Spirituality     257Summing Up     258Key Terms     259Recommended Reading     259References     261Index     271

\ From the Publisher"Above all, this is a brutally honest, candid book about the treatment of problem gamblers that may have application to the other impulse, addictive, and compulsive disorders. This is a refreshing book, and I recommend it highly to all comers. It should be on everyone's reference shelf and read and reread." (PsycCRITIQUES, February 20, 2008)\ \ \