1. 1 Treatment Planning with Problem and Pathological Gamblers Jennifer Clegg Recovery Resources jclegg@recres.org Lynn Burkey Meridian Community Care lburkey@meridiancommunitycare.org Slides by: Loreen Rugle, Ph.D.

2. 2 Problem Gambling & Treatment Planning: ASAM Criteria Questions like: Questions like: “What is best care? Who provides best care?” “What is best care? Who provides best care?” What are acceptable outcomes? What are acceptable outcomes? Total lifelong abstinence, reduced number of relapses, reduced negative consequences, the use of harm reduction etc. are all part providing care to problem gamblers and their families. Total lifelong abstinence, reduced number of relapses, reduced negative consequences, the use of harm reduction etc. are all part providing care to problem gamblers and their families. We have moved away from one size fits all treatment. We have moved away from one size fits all treatment.

3. 3 Problem Gambling & Treatment Planning: ASAM Criteria Six dimensions (+ 1): Six dimensions (+ 1): 1. Acute intoxication/withdrawal potential 2. Biomedical conditions and complications 3. Emotional, behavioral or cognitive conditions and complications 4. Readiness to change 5. Relapse, continued use or continued problem potential 6. Recovery environment 7. Financial (added for disordered gambling)

4. Problem Issues to be Explored Gambling Behaviors Gambling Behaviors Mental health Mental health Addictions Addictions Health Health Developmental Disabilities Developmental Disabilities Behaviors Behaviors Family Family Finance Finance Spiritual Spiritual Harm to self and others Harm to self and others

5. Suicidality “Suicide attempts among pathological gamblers are higher than for any of the addictions and second only to suicide attempt rates among individuals with major affective disorders, schizophrenia and a few major hereditary disorders.” “Suicide attempts among pathological gamblers are higher than for any of the addictions and second only to suicide attempt rates among individuals with major affective disorders, schizophrenia and a few major hereditary disorders.” -Dr. Rachel A. Volberg, President of Gemini Research, Ltd. (Gambling Research)12

6. 6 Prioritizing Treatment: Where to Begin Immediate Life Threat/Safety Immediate Life Threat/Safety What will engage and motivate What will engage and motivate Do we view the world through the client’s eyes Do we view the world through the client’s eyes What does the client want most What does the client want most How can we help client to utilize strengths How can we help client to utilize strengths Stabilization/Obstacles to Psychosocial Treatment Stabilization/Obstacles to Psychosocial Treatment Abstinence/Most Significant Relapse Risk Factors Abstinence/Most Significant Relapse Risk Factors

7. 7 Prioritizing Treatment: Where to Begin AcuteIntoxBiomed. Emot/BehavCognitive Readiness To Change Relapse/ Cont. Gam Potential Financial RecoveryEnvironment

8. 8 Gambling Problems Gambling Assessment Gambling Screen Gambling Screen Positive Screen Positive Treatment Guidelines for Comorbid Pathological Gambler Screen Negative Screen Negative Interpret and Follow Mental Health Protocol Interpret and Follow SA Protocol Mental Health Center Substance Abuse Treatment Center Abstinence or Harm Reduction?

9. 9 Treatment Issues with Co-Occuring Disorders Education Education Pathological Gambling as Psychiatric, Biopsychosocial/Spiritual Disorder Pathological Gambling as Psychiatric, Biopsychosocial/Spiritual Disorder On comorbid psychopathology and risk factors as well as pathological gambling On comorbid psychopathology and risk factors as well as pathological gambling Interaction of gambling progression and psychopathology Interaction of gambling progression and psychopathology Coping with suicidality Coping with suicidality

10. Suicidality “Suicide attempts among pathological gamblers are higher than for any of the addictions and second only to suicide attempt rates among individuals with major affective disorders, schizophrenia and a few major hereditary disorders.” “Suicide attempts among pathological gamblers are higher than for any of the addictions and second only to suicide attempt rates among individuals with major affective disorders, schizophrenia and a few major hereditary disorders.” -Dr. Rachel A. Volberg, President of Gemini Research, Ltd. (Gambling Research)12

11. Pressure Relief ( is not just a financial issue) Instability created by co-occurring issues create a large portion of emotional & physical complications for recovery. If not addressed,success in recovery is limited or at times impossible. May lead to deeper hopelessness. Emotional Instability Emotional Instability Health issues. Health issues. Co- occurring Chemical dependencies. Co- occurring Chemical dependencies. Developmental & disability Concerns Developmental & disability Concerns Behavioral issues Behavioral issues Family turmoil. Family turmoil. Legal Consequences Legal Consequences Financial pressures Financial pressures Grief/Loss Grief/Loss Loneliness Loneliness Loss of purpose Loss of purpose Spiritual voids Spiritual voids

12. Financial pressure “Stop The Bleeding” Restitution Planning: Manageable Budget Employment Financial responsibility Money safety Money monitoring Debt reduction Restitution Payments Family restitution Reward progress

13. Family & Domestic Issues Domestic abuse “the Gambler” Domestic abuse “the Gambler” Anger, Resentment, Guilt, & Frustration Anger, Resentment, Guilt, & Frustration Potential to harm self & others. Potential to harm self & others. Short fuse as the losses build up. Short fuse as the losses build up. Domestic abuse “ the Family” Similar dynamics to gambler “But” Similar dynamics to gambler “But” Hurt Disappointment Wronged Cheated Lied to Abandoned

14. GOAL: GOAL: INSTILL HOPE RAISE ESTEEM INSTILL HOPE RAISE ESTEEM

15. Slow and steady. Enjoy today! “Recovery is a Marathon and “Recovery is a Marathon and Not a Sprint.”

16. Aftercare Planning Financial Stability Financial Stability Family Support Family Support Health/Mental Health Follow-up Health/Mental Health Follow-up Community Based Support Community Based Support Spiritual Growth Spiritual Growth Support Activities Support Activities Restitution Plan Restitution Plan

17. Questions? 17