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Treatment Planning Treatment Planning with Problem and with Problem and

Pathological GamblersPathological Gamblers

Jennifer CleggJennifer CleggRecovery ResourcesRecovery Resources

jclegg@recres.org

Lynn BurkeyLynn BurkeyMeridian Community CareMeridian Community Care

lburkey@meridiancommunitycare.org

Slides by: Loreen Rugle, Ph.D.Slides by: Loreen Rugle, Ph.D.

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Problem Gambling & Problem Gambling & Treatment Planning: Treatment Planning:

ASAM CriteriaASAM Criteria Questions like:Questions like: “ “What is best care? Who provides best What is best care? Who provides best

care?”care?” What are acceptable outcomes?What are acceptable outcomes? Total lifelong abstinence, reduced Total lifelong abstinence, reduced

number of relapses, reduced negative number of relapses, reduced negative consequences, the use of harm reduction consequences, the use of harm reduction etc. are all part providing care to problem etc. are all part providing care to problem gamblers and their families.gamblers and their families.

We have moved away from one size fits We have moved away from one size fits all treatment.all treatment.

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Problem Gambling & Problem Gambling & Treatment Planning: Treatment Planning:

ASAM CriteriaASAM Criteria Six dimensions (+ 1):Six dimensions (+ 1):

1.1. Acute intoxication/withdrawal potentialAcute intoxication/withdrawal potential

2.2. Biomedical conditions and complicationsBiomedical conditions and complications

3.3. Emotional, behavioral or cognitive Emotional, behavioral or cognitive conditions and complicationsconditions and complications

4.4. Readiness to changeReadiness to change

5.5. Relapse, continued use or continued Relapse, continued use or continued problem potentialproblem potential

6.6. Recovery environmentRecovery environment

7.7. Financial (added for disordered gambling)Financial (added for disordered gambling)

Problem Issues to be Problem Issues to be ExploredExplored

Gambling BehaviorsGambling Behaviors Mental health Mental health AddictionsAddictions Health Health Developmental Disabilities Developmental Disabilities BehaviorsBehaviors FamilyFamily FinanceFinance Spiritual Spiritual Harm to self and others Harm to self and others

SuicidalitySuicidality ““Suicide attempts among pathological Suicide attempts among pathological

gamblers are higher than for any of gamblers are higher than for any of the addictions and second only to the addictions and second only to suicide attempt rates among suicide attempt rates among individuals with major affective individuals with major affective disorders, schizophrenia and a few disorders, schizophrenia and a few major hereditary disorders.”major hereditary disorders.”

-Dr. Rachel A. Volberg, President of Gemini -Dr. Rachel A. Volberg, President of Gemini Research, Ltd. (Gambling Research)12Research, Ltd. (Gambling Research)12

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Prioritizing Treatment: Where Prioritizing Treatment: Where to Beginto Begin

Immediate Life Threat/SafetyImmediate Life Threat/Safety

What will engage and motivate What will engage and motivate

Do we view the world through the client’s eyesDo we view the world through the client’s eyes

What does the client want mostWhat does the client want most

How can we help client to utilize strengthsHow can we help client to utilize strengths

Stabilization/Obstacles to Psychosocial TreatmentStabilization/Obstacles to Psychosocial Treatment

Abstinence/Most Significant Relapse Risk FactorsAbstinence/Most Significant Relapse Risk Factors

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Prioritizing Treatment: Where Prioritizing Treatment: Where to Beginto Begin

Acute Acute

IntoxIntox

Biomed.Biomed.

Emot/BehavEmot/Behav

CognitiveCognitive

ReadinessReadiness

To ChangeTo Change

Relapse/Relapse/

Cont. Gam Cont. Gam PotentialPotential

FinancialFinancial

RecoveryRecovery

EnvironmentEnvironment

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GamblingProblems

GamblingAssessment

GamblingScreen

GamblingScreen

Screen

Positive

Screen

Positive

Treatment Guidelines for Comorbid Treatment Guidelines for Comorbid Pathological GamblerPathological Gambler

ScreenNegative

ScreenNegative

Interpret andFollow Mental Health Protocol

Interpret andFollow

SA Protocol

MentalHealthCenter

SubstanceAbuseTreatmentCenter

Abstinence or Harm Reduction?

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Treatment Issues with Co-Treatment Issues with Co-Occuring DisordersOccuring Disorders

EducationEducation Pathological Gambling as Psychiatric, Pathological Gambling as Psychiatric,

Biopsychosocial/Spiritual DisorderBiopsychosocial/Spiritual Disorder On comorbid psychopathology and risk On comorbid psychopathology and risk

factors as well as pathological gamblingfactors as well as pathological gambling Interaction of gambling progression and Interaction of gambling progression and

psychopathologypsychopathology Coping with suicidalityCoping with suicidality

SuicidalitySuicidality ““Suicide attempts among pathological Suicide attempts among pathological

gamblers are higher than for any of gamblers are higher than for any of the addictions and second only to the addictions and second only to suicide attempt rates among suicide attempt rates among individuals with major affective individuals with major affective disorders, schizophrenia and a few disorders, schizophrenia and a few major hereditary disorders.”major hereditary disorders.”

-Dr. Rachel A. Volberg, President of Gemini -Dr. Rachel A. Volberg, President of Gemini Research, Ltd. (Gambling Research)12Research, Ltd. (Gambling Research)12

Pressure ReliefPressure Relief ( is not just a financial ( is not just a financial

issue)issue)Instability created by co-occurring issues create a large Instability created by co-occurring issues create a large

portion of emotional & physical complications for recovery. If portion of emotional & physical complications for recovery. If not addressed ,success in recovery is limited or at times not addressed ,success in recovery is limited or at times impossible. May lead to deeper hopelessness.impossible. May lead to deeper hopelessness.Emotional InstabilityEmotional InstabilityHealth issues.Health issues.Co- occurring Chemical dependencies.Co- occurring Chemical dependencies.Developmental & disability ConcernsDevelopmental & disability ConcernsBehavioral issues Behavioral issues Family turmoil.Family turmoil.Legal ConsequencesLegal ConsequencesFinancial pressures Financial pressures Grief/LossGrief/LossLonelinessLonelinessLoss of purposeLoss of purposeSpiritual voidsSpiritual voids

Financial pressureFinancial pressure“Stop The Bleeding” “Stop The Bleeding”

Restitution Restitution Planning:Planning:Manageable BudgetManageable BudgetEmploymentEmploymentFinancial responsibilityFinancial responsibilityMoney safetyMoney safetyMoney monitoring Money monitoring Debt reduction Debt reduction Restitution PaymentsRestitution PaymentsFamily restitutionFamily restitutionReward progress Reward progress

Family & Domestic Family & Domestic IssuesIssues

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”Domestic abuse “ the Family” Similar dynamics to gambler “But”Similar dynamics to gambler “But”HurtHurt Disappointment Disappointment WrongedWronged Cheated Cheated Lied toLied to Abandoned Abandoned

GOAL:GOAL:

INSTILL HOPE INSTILL HOPE RAISE ESTEEMRAISE ESTEEM

Slow and steady. Enjoy Slow and steady. Enjoy today!today!

Aftercare Planning Aftercare Planning

Financial StabilityFinancial Stability Family SupportFamily Support Health/Mental Health Follow-upHealth/Mental Health Follow-up Community Based SupportCommunity Based Support Spiritual GrowthSpiritual Growth Support ActivitiesSupport Activities Restitution PlanRestitution Plan

Questions?Questions?

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