Emberwood Center offers counseling for gambling that has caused financial, relationship, legal, and other problems in one’s life. Thanks to a grant from the Division of Mental Health and Addictions of Indiana, a number of services can be offered free of charge.
Gambling is defined as risking something of value, usually money, on the outcome of an event decided at least partially by chance. Lottery tickets, bingo games, blackjack at a casino, the Friday night poker game, the office sports pool, gambling Web sites, horse and dog racing, animal fights, and slot machines—there are now more opportunities to gamble than ever before.
More than 75 percent of Americans ages 18 and older have gambled at least once, and many people view gambling as a harmless form of entertainment. Only about 10 percent of people with a gambling problem seek treatment for the problem. When people do seek help, financial pressures that result from their gambling problem are often the main reason they seek treatment, not a desire to abstain from gambling. In addition, people with a gambling problem are more likely to have sought help for other behavioral health conditions than for their gambling problem. If the client assessment reveals a problem with gambling, then that disorder (and its consequences) is a major issue in the client’s treatment for any behavioral health condition.
Furthermore, a variety of other problems can be related to gambling, including victimization and criminalization; social problems; and health issues, including higher risk for contracting sexually transmitted diseases and HIV/AIDS. Pathological gambling is associated with suicide, suicidal ideation, and suicide attempts. Among the many risk factors are financial difficulties and depression. People who have pathological gambling and also have an SUD may be at greater risk of attempting suicide; some research has found substance abuse to be the only factor that distinguishes people who gamble pathologically and attempt suicide from people who gamble pathologically but only think about suicide.
How Common Are Gambling Problems?
Estimates from large national surveys show that about 0.5 percent of Americans have had pathological gambling at some time in their lives. Extrapolating from the survey estimates suggests that roughly 1.5 million Americans have experienced pathological gambling. The milder condition, problem gambling, is more common than pathological gambling and may affect two to four times as many Americans as pathological gambling.
Who Typically Has a Gambling Problem?
Anyone can develop a gambling problem; such problems occur in all parts of society. However, men are more likely than women to have gambling problems. Gambling problems show some association with adolescence and young adulthood, ethnic minority status, low income and low socioeconomic status, high school education or less, and unmarried status. Some people gamble because the activity is stimulating. These people tend to be “action gamblers” who favor forms of gambling that involve some skill or knowledge, such as playing poker or betting on sports. Most of these types of gamblers are men. Gambling can also serve as a relief (an “escape”) from stress or negative emotions. In this type of gambling (e.g., bingo, lottery, slot machines), the outcome is determined by pure chance. Most of these “escape” gamblers are women.
Are there Tools for Screening and Treating Gambling Problems?
More than 20 different tools are available for screening for gambling problems. The Lie/Bet Screening Instrument consists of two questions:
- Have you ever felt the need to bet more and more money?
- Have you ever had to lie to people important to you about how much you gambled?
A “yes” response to one of these questions warrants further investigation using a longer tool, such as the South Oaks Gambling Screen (SOGS). The SOGS consists of 16 items and differentiates between no gambling problems, some problems, and probable pathological gambling. This is the tool that Emberwood Center uses, and it is also available online.
Although a variety of approaches have been researched and found to be useful in treating gambling problems, none has been clearly shown to be more effective than another. Emberwood Center utilizes mainly Cognitive Behavioral Therapy and Motivational Interviewing:
- CBT to treat gambling disorder usually involves identifying and changing cognitive distortions about gambling, reinforcing nongambling behaviors, and recognizing positive and negative consequences. CBT helps people recognize that the short-term experiences and sensations are not worth the long-term negative consequences of debt, legal problems, and harm to one’s family. CBT usually incorporates some relapse prevention techniques. Relapse prevention consists of learning to identify and avoid risky situations that can trigger or cue feelings or thoughts that can lead to relapse to gambling. The gambling risk situations clients learn to identify include places (e.g., casinos, lottery outlets), feelings (e.g., anger, depression, boredom, stress), and other difficulties (e.g., finances, problems with work or family). In addition to techniques learned in CBT, developing a support system, attending Gamblers Anonymous meetings, and participating in continuing care may help prevent relapse.
- Motivational interviewing MI, also known as motivational enhancement, seeks to help clients address their ambivalence toward behavior change. MI is frequently combined with CBT. Researchers have reported that even very brief motivational interventions can help people with gambling problems. Treatment that combined MI and CBT has been delivered effectively over the Internet and with brief phone calls from trained therapists.
Gamblers Anonymous, the structure of which is modeled on Alcoholics Anonymous, is a mutual-help group for people with gambling problems. Although mutual-help groups are not treatment or counseling, they can be an important support to people in recovery.
Resources for Clients and Families
- Debtors Anonymous: http://www.debtorsanonymous.org
- Gam-Anon: http://www.gam-anon.org
- Gamblers Anonymous: http://www.gamblersanonymous.org