Identification and treatment strategies for youth with gambling problems
Download
1 / 52

Identification and treatment strategies for youth with gambling problems - PowerPoint PPT Presentation


  • 269 Views
  • Uploaded on

Identification and treatment strategies for youth with gambling problems . Jeffrey L. Derevensky, Ph.D. McGill University. International Centre for Youth Gambling Problems and High-Risk Behaviors www.youthgambling.com Delaware, 2007. Our current state of knowledge .

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Identification and treatment strategies for youth with gambling problems ' - Sharon_Dale


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Identification and treatment strategies for youth with gambling problems l.jpg

Identification and treatment strategies for youth with gambling problems

Jeffrey L. Derevensky, Ph.D.

McGill University

International Centre for Youth Gambling Problems and High-Risk Behaviors

www.youthgambling.com

Delaware, 2007


Our current state of knowledge l.jpg
Our current state of knowledge gambling problems

  • Gambling is more popular amongst males than females

  • Adolescent pathological gamblers are greater risk-takers

  • Gambling has become a family activity

  • Adolescents with gambling problems have poor general coping skills

  • Adolescent problem gamblers report beginning gambling at earlier ages, approximately 10 years of age

  • Rapid movement from social gambler to problem gambler


Slide3 l.jpg

  • Adolescent problem gamblers have lower self- esteem compared with other adolescents

  • Adolescent problem gamblers have higher rates of depression

  • Adolescent problem gamblers dissociate more frequently when gambling

  • Adolescents with gambling problems, ages 14-17, are at heightened risk for suicide ideation and suicide attempts

  • Old friends are often replaced by gambling associates

  • Remain at increased risk for the development of an addiction or multiple addictions

  • Score higher on excitability, extroversion, impulsive and anxiety & lower on conformity and self-discipline measures


Slide4 l.jpg

  • More major life events and early childhood traumas with other adolescents

  • Gambling venues are relatively easily accessible Old friends are often replaced by gambling associates

  • Increased delinquency and crime, disruption of familial relationships and decreased academic performance

  • More self-reported learning and behavioral problems


Similarities between youth and adult problem gamblers l.jpg
Similarities between youth and adult problem gamblers with other adolescents

  • Pervasiveness of the problem

  • Similar reasons for reporting gambling

  • Lying, stealing, cheating

  • Illusion of control (Irrational cognitions and thinking)

  • Preoccupation with thoughts of gambling

  • High suicide ideation and attempts

  • Chasing behavior

  • Gambling as a means of escape/dissociation

  • Depression/Anxiety

  • Missing of work and/or school

  • Loss of friends and changes in social support


Videotape l.jpg

Videotape with other adolescents


Slide7 l.jpg

Profile of the adolescent problem gambler with other adolescents

  • Predominantly male

  • Significant anxiety

  • Familial problems and poor peer relationships

  • Preoccupation with gambling- reported inability to stop despite repeated efforts

  • VLT, sports betting, cards

  • Serious financial difficulties

  • Failure in school and/or at work

  • Lying to family and friends


Slide8 l.jpg

Profile - continued with other adolescents

  • Friends usually have similar gambling problems

  • Stealing from family, friends, stores, bank fraud, etc.

  • Depression or “feeling dead inside”

  • Gambling to escape and to feel better

  • General lack of effective coping abilities and problem solving skills

  • Confused and conflicted about whether they really want to stop gambling

  • Need for arousal or strong sensations


Why do i gamble l.jpg
Why do I gamble? with other adolescents

  • Gambling was there for me when no one else was. Gambling made me know I was special and even powerful. The days flew by…I was in a different world. Nothing else was important to me (male, age 14).

  • Of course I stole money from my family. It’s nothing personal, I needed the money (male, age 18).

  • If you really think of it, it was easy to come up with reasons why I should keep playing. If I was winning..well that was reason enough. If I was losing, well that is OK because I’d be winning soon. But its more about the chase than the actual dollars. The chase allows you to forget about everything else (male, age 14).


Slide10 l.jpg

  • Everything that was good about gambling is now bad. It is my whole life and I’m tired. I’m tired of lying and stealing…for something I can’t seem to control, but don’t want to do. What has happened to me? I need help (male, age 14).

  • My problems are like a tree. The root is my gambling with one branch being a thief, another a liar, another being out of school and work. If you cut a branch off you haven’t gotten to the root of my problem…gambling (male, age 19).


Coping as a mediating factor l.jpg
Coping as a mediating factor whole life and I’m tired. I’m tired of lying and stealing…for something I can’t seem to control, but don’t want to do. What has happened to me? I need help (male, age 14).

Off-kilt physiological resting state Maladaptive coping

Psychological nature

characterized by unhealthy feelings, either due to trauma, loss, or poor upbringing.

Addictive behavior


Identification and classification l.jpg
Identification and Classification whole life and I’m tired. I’m tired of lying and stealing…for something I can’t seem to control, but don’t want to do. What has happened to me? I need help (male, age 14).


Nomenclature hodge podge winters 2001 l.jpg
Nomenclature Hodge-Podge whole life and I’m tired. I’m tired of lying and stealing…for something I can’t seem to control, but don’t want to do. What has happened to me? I need help (male, age 14).(Winters, 2001)

Problem Severity Continuum

Compulsive gambling

At-Risk gambling

Problem gambling

Social gambling

No gambling

Pathological gambling

Habitual gambling


Slide14 l.jpg

Is Youth Problem Gambling whole life and I’m tired. I’m tired of lying and stealing…for something I can’t seem to control, but don’t want to do. What has happened to me? I need help (male, age 14).

A Primary Disorder?

Alcohol

Dependence

ADHD

Conduct

Disorder

Problem

Gambling

Other

Disorder

Depression

Drug

Dependence


Clinical description of pathological gambling l.jpg
Clinical Description of Pathological Gambling whole life and I’m tired. I’m tired of lying and stealing…for something I can’t seem to control, but don’t want to do. What has happened to me? I need help (male, age 14).

Continuous involvement in and preoccupation with gambling (and an inability to stop) despite resulting adverse consequences


Diagnostic statistical manual iv adapted for juveniles dsm iv j l.jpg
Diagnostic Statistical Manual-IV Adapted for Juveniles (DSM-IV-J)

  • DSM-IV-J (Fisher, 1992); DSM-IV-MR-J (Fisher, 2000) developed for children and adolescents.

  • Consists of 12 items, 9 categories and responses are given in "yes" or "no" format- new scale has multiple responses.

  • Modeled very closely on the adult version (DSM-IV criteria for pathological gambling), with several significant adaptations.

  • Other scales include the SOGRS-RA, GA-20.



Slide18 l.jpg

DSM-IV-J gambling screen (Fisher, 1992)* (DSM-IV-J)

Do you often find yourself thinking about gambling activities at odd times of the day and/or planning the next time you will play? (81.6%)

Do you lie to your family or friends or hide how much you gamble? (78.9%)

After spending money on gambling activities do you play again another day to try and win your money back? (More than half the time?) (73.7%)

In the past year have you spent your school dinner money, or money for bus fares, on gambling activities? (68.4%)


Slide19 l.jpg

In the past year have you taken money from someone you live with, without their knowing, to gamble? (57.9%)

Do you ever gamble as a way of escaping problems? (50.0%)

Do you find you need to spend more and more money on gambling activities? (36.8%)

In the past year, have you stolen money from outside the family, or shoplifted, to gamble? (28.9%)

Do you become restless, tense, fed up, or bad tempered when trying to cut down or stop gambling? (26.3%)


Slide20 l.jpg

  • In the past year, have you gone to someone for help with a serious money worry caused by participation in gambling? (21.1%)

  • Have you fallen out with members of your family, or close friends, because of your gambling behavior? (10.5%)

  • In the past year, have you missed school to participate in gambling experiences? (5 times or more) (7.9%)

    • 4 or more to meet the criteria for PPG

    • * Percentages of endorsements from study of adolescents by Derevensky & Gupta (2000).


Do all gamblers present with the same profile l.jpg
Do all gamblers serious money worry caused by participation in gambling? (21.1%)present with the same profile?


The pathways model l.jpg

The Pathways Model serious money worry caused by participation in gambling? (21.1%)


Pathways model proposes that l.jpg
Pathways Model proposes that... serious money worry caused by participation in gambling? (21.1%)

  • All problem gamblers are not alike.

  • There are three (or more) distinct pathways to problem gambling.

  • Gamblers in each pathway differ by the presence or absence of psycho-social and biological factors and behavioral manifestations.

  • Gamblers in different pathways require different treatment strategies.


Pathways model blaszczynski nower 2002 l.jpg
Pathways Model serious money worry caused by participation in gambling? (21.1%)(Blaszczynski & Nower, 2002)

  • Behaviourally conditioned

    • Reinforcement & cognitive distortions  bad decisions

  • Emotionally vulnerable

    • Relieve/modulate pre-morbid aversive affective states + become behaviourally conditioned

  • Biologically-based impulsive

    • Impulsivity, multiple maladaptive behaviours + behaviourally conditioned


Slide25 l.jpg

Treatment approaches……. serious money worry caused by participation in gambling? (21.1%)


Psychosocial treatments l.jpg
Psychosocial Treatments serious money worry caused by participation in gambling? (21.1%)

  • Behavior Therapy

    • Individual stimulus control (e.g., Echeburua et al., 1996): PGs are taught ways to avoid high risk situations for gambling.

    • Cue exposure and response prevention (e.g., Brent & Nicki, 1997): PGs are exposed to gambling-related cues, then prevented from acting on gambling urges.

    • Systematic desensitization (e.g., McConaghy et al., 1991): After induction of relaxation, PGs imagine scenes in which they are exposed to increasing approximations to their preferred gambling venue.


Psychosocial treatments27 l.jpg
Psychosocial Treatments serious money worry caused by participation in gambling? (21.1%)

  • Cognitive Behavior Therapy

    • Restructuring of gambling-specific cognitive distortions (e.g., Ladouceur & Walker, 1996)

      • The concept of randomness

      • Understanding erroneous beliefs (“the illusion of control”, “the gambler’s fallacy”)

      • Awareness of inaccurate perceptions

      • Cognitive correction of erroneous perceptions


Psychosocial treatments28 l.jpg
Psychosocial Treatments serious money worry caused by participation in gambling? (21.1%)

  • Cognitive Behavior Therapy (2)

    • Restructuring of gambling-specific cognitive distortions, problem-solving training, social skills training, & relapse prevention training (e.g., Sylvain, Ladouceur, & Boisvert, 1997)

    • Relapse prevention training (e.g., Hodgins & el-Guebaly, 2000)


Psychosocial treatments29 l.jpg
Psychosocial Treatments serious money worry caused by participation in gambling? (21.1%)

  • Cognitive-Behavioral Treatments to induce Controlled Gambling: Ladouceur and his colleagues have also undertaken a series of cognitive-behavioral treatment studies in recent years that have led them to conclude that “using abstinence as the unique proposed treatment goal may not be a panacea for all pathological gamblers.”


Psychosocial treatments30 l.jpg
Psychosocial Treatments serious money worry caused by participation in gambling? (21.1%)

  • Motivational Enhancement (e.g., Hodgins, Currie, el-Guebaly, 2001): Designed to provide PGs feedback on likely consequences of their pathological gambling, in an effort to increase their motivation to reduce or eliminate their pathological gambling behavior.


Pharmacological treatments l.jpg
Pharmacological Treatments serious money worry caused by participation in gambling? (21.1%)

  • SSRIs (to reduce comorbid depression and OCD and decrease urges to gamble): Especially fluvoxamine, but also including clomipramine, paroxetine, citalopram, and fluoxetine

  • Lithium carbonate: A mood stabilizer that can help PGs with a bipolar spectrum diagnosis

  • Opioid antagonist: Naltrexone (to reduce urge-related symptoms and decrease problematic behaviors).


Therapeutic approaches for problem gamblers l.jpg

Therapeutic Approaches for Problem Gamblers serious money worry caused by participation in gambling? (21.1%)

The McGill Model


Intake assessment l.jpg
Intake assessment serious money worry caused by participation in gambling? (21.1%)

  • Semi-structured interview (general information), including DSM-IV criteria

  • Allow them to ask questions about procedures and expectations

  • Completion of forms- personal information, questionnaire pertaining to their gambling behavior, frequency and severity of problem, family history, academic/work history, medical history, and identification of co-existing addictions.


Slide34 l.jpg

  • Risk-taking measures (SSS and AISS) serious money worry caused by participation in gambling? (21.1%)

  • Personality assessment (HSPQ- selected subscales)

  • Depression, suicide ideation, suicide attempts, and hopelessness assessment (RADS, BHS)


The stages of change l.jpg
The Stages of Change serious money worry caused by participation in gambling? (21.1%)

Stage 1: Precontemplation

gambling is not viewed as a problem

Stage 2: Contemplation

beginning to think about gambling as an activity to change

Stage 3: Preparation

decision to change gambling behavior


Slide36 l.jpg

Stage 4: Action serious money worry caused by participation in gambling? (21.1%)

the gambler takes steps to stop gambling

Stage 5: Maintenance

long-term success requires continued work to sustain initial changes

Stage 6: Termination

gambling no longer represents a temptation or problem


Slide37 l.jpg

When you treat an individual with a gambling problem, you must take into account their entire person…. Not just the fact that they gamble uncontrollably.


Slide38 l.jpg

Gambling Problems must take into account their entire person…. Not just the fact that they gamble uncontrollably.

Gamble to

Escape

Truancy/

Delinquency

Chase

Losses

Preference

for

Gambling

Stealing

Money

Problem

Gambling

Lying

about

Gambling

Family/

Peer

Problems


Clinical practice l.jpg

Clinical practice must take into account their entire person…. Not just the fact that they gamble uncontrollably.


Clinical implications l.jpg
Clinical implications must take into account their entire person…. Not just the fact that they gamble uncontrollably.

  • Gambling is a form of maladaptive coping

  • Identification of underlying stressors

  • Assessment for depression and anxiety

  • Assessment for substance abuse


Treatment l.jpg
Treatment must take into account their entire person…. Not just the fact that they gamble uncontrollably.

  • Emphasis on the importance of honesty and mutual respect.

  • Provide a non-judgmental environment.

  • Allowing them to feel understood…that their beliefs, perceptions and behaviors are common among young problem gamblers.

  • Discussion of reasons underlying the need to gamble.


Treatment42 l.jpg
Treatment must take into account their entire person…. Not just the fact that they gamble uncontrollably.

  • Emphasize the importance of honesty and mutual respect.

  • Provide a non-judgmental environment.

  • Allowing them to feel understood…that their beliefs, perceptions and behaviors are common among young problem gamblers.


Slide43 l.jpg

  • Discussion of reasons underlying the need to gamble. must take into account their entire person…. Not just the fact that they gamble uncontrollably.

  • Discussion of gambling as a consequence of the need to escape and feel better.

  • Emphasize that it must be their decision to stop gambling.

  • Discussion of abstinence vs. reduction.

  • Encourage a decrease in gambling participation (time and money).

  • Have individual’s record their gambling activities (including wins and losses, time spent, and type of activity) on a daily basis.


Essential therapeutic goals l.jpg
Essential therapeutic goals must take into account their entire person…. Not just the fact that they gamble uncontrollably.

  • Acceptance of gambling as a problem.

  • Identifying and clarifying the irrationality of their though processes when gambling (beginning of cognitive restructuring).

  • Building social support systems for the adolescent. This can include involving parents, siblings, and close friends in the treatment process. As well, we make ourselves available for social support, by providing a pager number.


Slide45 l.jpg

  • Reconstruct a healthy peer environment. This includes having them stop socializing with friends who gamble. In order to accomplish this, they may have to contact childhood friends, and friends that were present before the gambling onset. Techniques to develop to make and maintain new friends are discussed.

  • Restructure their free time so that they remain busy engaging in activities other than gambling. These include participating in sports, exercise programs, hobbies, returning to school, and/or obtaining and maintaining a job.


Therapeutic tools l.jpg
Therapeutic tools them stop socializing with friends who gamble. In order to accomplish this, they may have to contact childhood friends, and friends that were present before the gambling onset. Techniques to develop to make and maintain new friends are discussed.

  • Incorporate an eclectic and flexible approach.

  • Use significant individuals (i.e., parents, siblings, friends) in the adolescent’s environment as a support network.

  • Work in conjunction with a psychiatrist or general physician.


Slide47 l.jpg

  • Encourage them to experience other age appropriate activities. This is particularly difficult as they are often depressed and anxious, and have difficulty deriving pleasure from non gambling-related activities (e.g., movies, restaurants, dating, etc.).

  • In general, most adolescents receiving treatment report that in comparison to their gambling, nothing approximates the pleasure and enjoyment received when gambling (independent of the financial outcome).

  • Provide a “reality check”. Adolescents have a distorted perception of the amount of money and

    time they spend gambling.


Final outcome l.jpg
Final outcome activities. This is particularly difficult as they are often depressed and anxious, and have difficulty deriving pleasure from non gambling-related activities (e.g., movies, restaurants, dating, etc.).

  • Once therapy is completed the adolescent should be abstinent for several months.

  • Success is not complete until the adolescent had adopted a healthy lifestyle. This includes maintaining friendships with individuals who would not be considered to be a ‘negative’ influence. Newly acquired coping skills should result in enhanced emotional stability.


Slide49 l.jpg


Slide50 l.jpg

Alternative approaches????? risk for relapse. In the ideal setting the individual will choose abstinence over controlled gambling.


ad