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
