COMMON COMPONENTS IN THE TREATMENT OF PATHOLOGICAL GAMBLERS

1. COMMON COMPONENTS IN THE TREATMENT OF PATHOLOGICAL GAMBLERS DR ANG YONG GUAN CONSULTANT PSYCHIATRIST

2. Introduction • Various treatment programmes have been developed to help pathological gamblers • overcome their addiction and • deal with the consequences • financial, • social, • psychological and • family of their excessive gambling.

3. Common Components • What is common in these programmes?

4. Core Components in the Management of the Pathological Gambler 5. Challenge and Correct Erroneous Beliefs 4. Identify and Cope With High Risk Situations 3. Set Goals and Focus on Motivation 2. Treat Co-morbidity 1.Do pre-treatment Evaluation

5. 1st Component: Evaluation • The first component is the pre-treatment evaluation of the different factors leading to the gambler’s pathological gambling.

6. Pre-treatment Evaluation Topics • Motives of Consultation • Factors that lead to a partial or complete lost of control. • History of gambling habits • Information on the current gambling problem • Consequences of the gambling problem • Presence of suicidal ideation • Current living conditions / degree of support • Other present or past addictions • Presence of prior mental health problems • Personal strategies and resources available.

7. 2nd Component: Co-morbidity • To detect and treat co-morbid psychological conditions such as • depression, • anxiety, • personality disorders • suicidal ideation, and • other addictions such as alcohol.

8. More difficult to treat if co-morbidity is present • Sometimes, the more severe co-morbidity should be treated first by another doctor if necessary. • Once the patient’s co-morbidity is stabilised, the treatment of the pathological gambling can begin.

9. Four Strategies for treating co-morbidities • 1. Integrated Treatment: • The same therapist treats all of the identified problems at the same time. • 2. Parallel Treatment: • Two therapists treat the addictions at the same time. • 3. Sequential Treatment: • Problems are treated one after another • 4. Individual treatment: • Only one of the problem is treated. • (Najavitis, 2003)

10. 3rd Component: Motivation • Clarify the goals of the gambler and • Focus on his motivation to stop gambling. - When the motivation level is high, the gambler is ready to invest time and effort to solve his gambling problem and the prognosis will be good.

11. Understanding Motivation to Change • What cause the gambler to modify his gambling? • Is he ready to make efforts to gamble less or cease gambling? • What is his objective for change? • Are the reasons personal (internally motivated) or from others (externally motivated)?

12. 4th: Identifying high-risk situations To help the gambler identify high-risk situations that lead to increased gambling. Behavioural interventions will then be devised to help the gambler handle such high-risk situations and to regain control over his life.

13. Examples of Risky Situations • Exposure to Gambling • Easy access to gambling place • Finding oneself near a gambling place • Financial Situation • Easy access to money • Tight financial situation • Relationship Difficulties • Lack of trust from family and relatives • Lack of Occupation and Activities • Consuming Alcohol and Drugs • Daily Problems (Frustration, Failure, Rejection)

14. Thoughts and Feelings activated (Urge to gamble) Thinking Feeling First bet (start small) High-Risk Situation More and bigger bets Behaviour LOSSES Chasing Loses Problem Gambling Behavioural Chain

15. 5th: Identifying Erroneous Beliefs • To identify erroneous ideas and beliefs the gambler holds concerning his chances of winning or “beating the system”. • The more intensely such erroneous thoughts are held, the more the gambler will remain hooked to gambling.

16. Analysing thoughts during gambling • Ask the gambler to express the thoughts that crossed his mind before, during and after a recent gambling session. • For example, thoughts about • his ability to outsmart chance • his sure-win attitude • using strategies to win or break the bank • superstitious beliefs

17. Danger of false beliefs • Such false beliefs make the gambler more vulnerable to continue gambling. • Treatment consists of attacking these erroneous thoughts

18. The Gambling Traps Thinking is focus on Winning Emotionally aroused

19. Recognising Gambling Traps • Gambling traps occur when the gambler’s thoughts take over and tell him that it is possible to improve his chances. • Such thoughts will lead to betting more and more money. • Impairment of control sets in and the pathological gambling begins.

20. Importance of correcting the gambler’s idea of chance • Correcting the gambler’s mistaken understanding of the concept of chance. • Helping them to distinguish between games of skill and games of chance will hopefully dispel the various myths and illusions associated with gambling.

21. Challenging erroneous beliefs Erroneous Thinking Emotional arousal

22. Cognitive Behavioural Programmes • Various successful cognitive behavioural programmes have been devised so far for the treatment of pathological gambling • (Ladouceur et al. 2005) • Most programmes contain some if not all of these five components

23. 5 Key Components Conclusion 1: Do Pre-treatment Evaluation 2: Rule out co-morbid conditions 5: Challenge and correct Erroneous Beliefs 4: Identify and cope with High-risk Situtions 3: Set Goals and Focus on Motivations