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  1. Liar, Liar, Money’s on FireTreating Families of Problem Gamblers Gary Lange PhD MFT, NCGC, CAS, BACC 760-773-1014 www.GaryLangePhD.com

  2. Codependency • Co-dependent: “A person who has let someone else’s behavior affect him or her and is obsessed with controlling other people’s behavior” M. Beattie • Co-dependency is “when you depend on another person for your happiness, security, life satisfaction, even self worth.” Sugg and Siegel 2009 • Enabler: person who intervenes in such a way as to prevent the problem gambler from facing the consequences of their actions.

  3. Focus on the family means.... The family needs time and resources Their recovery is different and they need their own program beyond getting the gambler to stop They need knowledge for protection They deserve hope for a better life 3

  4. Treatment overview: Emotional Issues Betrayal, deceit and resentment May have enjoyed the winning times and are reluctant to give up the spoils May have truly not known about the problem May have believed they were crazy Little known about impact on children

  5. Significant Other* Involvement • Ingle et.al. 2008 • Gamblers who have a Significant Other, are older, employed and have had some undergraduate education, stay in treatment longer and are more successful

  6. Characteristics of Families Loyal; Defer gratification; overly responsible Personal/Family History of Addictions High resilience and tolerance for pain Low self-esteem Over emphasis on $$$$$$

  7. Putting out the Fire Involve Family Assess who is supportive $$$ Protection Diffuse emotions Push Gam-Anon, support

  8. Gary Lange Ph.D. Dissertation 23 Symptoms/Patterns of Codependents studied before and after Betty Ford Center’s Family Week of Treatment 17 statistically significant reduction over 4 months 10 statistically significant reduction over 12 months

  9. 10/23 Symptoms/Patterns statistically significant reduction over 12 months (Lange, ’86) Frequency of drinking/using Frequency of over drinking/using* Functional sexual problems Nervous/apprehensive Difficulty concentrating Stiff neck and shoulders Depressed Withdrawing from supportive relationships Sleeping problems Weight loss* (not stats sig at 4 mos.)

  10. Family Phases of Progression: 1. Denial: makes excuses for gambling; becomes great financial manager/manipulator 2. Stress Phase: arguments; attempts to control gambler; enjoys gifts from gambler; provides bailouts; secrets, isolation 3. Exhaustion Phase: confusion; physical symptoms; rage; anxiety and panic; separation/divorce 4. Hopeless Phase: reactive, suicidal (Wexler)

  11. Stages of Recovery 1. Critical Phase: desires and accepts help; recognizes true problem; self-focus and self-care; guilt diminishes; deals with resentments; stops bailouts 2. Rebuilding Phase: increased self-confidence; communication; problem solving; making decisions; realistic planning 3. Growing Phase: sharing; relaxed; closer with family; more affectionate and trusting (Wexler)

  12. The 8 Techniques for Treating Families(Lange, 2012) • Crisis Intervention • Educatation • Forgiveness • Making Decisions • Assertiveness • Managing Stress • Negotiating • Trust and Hope

  13. 1. Crisis Intervention(Lange, 2012) Monitor for Safety, physical, emotional or sexual abuse, neglect Assess Co-occurring Disorders: Depression, anxiety, Axis II… Monitor needs of all family members/kids/others Assess severity of $$$ and legal problems “Yes we love you, No to gambling”

  14. 2. Educate about the Recovery Process(Lange, 2012) Path is seldom smooth, quick or easy The Gamblers’ impaired midbrain and affects of Neurotransmitters Each chose their path and speed Decrease stress  Decrease Craving  Treatment will improve the families’ physical and emotional health

  15. 3. Forgiveness vs. Forgetting(Lange, 2012) Survival based on learning and remembering Write a list of things that are difficult to forgive him/her for doing Apologize Forgetting is a spiritual release

  16. 4. Making Decisions(Lange, 2012) Stop Procrastinating NOW What do you have power over? Establishing priorities Communicating; “When you gamble/_____I feel…” 3 things important to me…

  17. 5. Assertiveness(Lange, 2012) • Tender (Passive) Tough (Bulldozer) • Refusing others' requests if they are too demanding • Being firm so that your rights are respected • Expressing positive AND negative emotions

  18. 6. Managing Stress(Lange, 2012) • Is the crisis over with? • Continue to set priorities, structure • Breathe, walk, sit, play, sleep, eat, relax… • Explore options for assistance. • Therapy • Gam-Anon • Sponsor • Family/group support

  19. The Gam-Anon Myths of Trust • Trust is something you can give to another. • Trust should be given unconditionally to a loved one. • Trust is the foundation of a relationship. • A person is completely trustworthy or completely untrustworthy. • Love and trust always co-exist. • Adapted from "The Gam-Anon Way of Life"

  20. 7. Negotiation around $$$ (Lange, 12) • Pull a credit report; what is in your name or held jointly? • Take in the mail or use a P. O. Box • Work together to pay bills, although a responsible family member should probably handle the money. • Change passwords on all accounts. • Meet with someone about pressure and budget relief

  21. 8. Trust and Hope (Lange, 12) • Stop name calling and negative projections • Practice small behavioral trust exercises • Utilize your support system • Acceptance • Spiritual release • Change Today and have Hope in a Better Tomorrow

  22. Stages of Family Recovery Jo Ann Towle, MA www.familyinterv.com • Respect that family members are at different phases of grief and understanding of their pain • Accept the reality of the loss (shock, denial, bargaining) • Working through the pain (anger and depression) • Adjusting to the environment (starting to accept) • Emotional relocation of the loss (acceptance and recovery)

  23. Families Recovering Against All Odds Helping Family Members of Problem Gamblers Rebuild A 15-Session Workbook Judith Sugg, Ph.D., and Renee Siegel, M.A. 24

  24. Family Cases • What are the crisis/clinical issues? • What legal/ethical issues are present? • What is your diagnosis on all axes? • What would your treatment plan be?

  25. Case I: Sarah • Sarah is a passive, codependent female client who complains that her husband is gambling and spending all of the family’s money. She claims that her extended family is tired of bailing them out. If she fears the “embarrassment” of going to Gam-Anon and doesn’t believe in a God, how can you help her? What resources, books, etc would help her?

  26. Case II: Fan and her husband Fan is a 34 yo Asian immigrant who comes with her husband who has a black jack addiction. They have two children and he began gambling when she was first pregnant. He works 12 hours per day earning $9/hr. and is worried that if he doesn’t stop gambling, he’ll lose his job, the only income for his family. Fan’s English is understandable, but her husband has a strong accent and refuses help in his native language. Fan often translates for him during the session. It is difficult to strategize about treatment options, support systems or developing behavioral strategies because of the language barriers. A psychic told her husband that he would have a curse for 2 more years. Fan is busy with the children and the household but knows you can tell him what to do to stop gambling.

  27. Case IV: Rodriguez Family • The Rodriguez Family of 4 come because the divorced mother is scared and wants to leave town. She reports answering the door one night to two large guys who say if she does not give them $2000 by Friday, they are going to harm, her 17-year-old son, Manuel. Even though Manuel reports 5 symptoms of DSM IV 312.31, he minimizes his gambling and seems aloof. The daughter, Maria who knew about her brother’s gambling is willing to give her mother the money out of her savings. Their live-in grandfather says, “to hell with the threat”.

  28. Resources Berman, Linda and Siegel, Mary-Ellen, 2008, Behind the Eight-Ball, "A Guide for Families of Gamblers", University. Ingle, Prajkta et.al., 2008 Significant Others and Gambling Treatment Outcomes, J Gambling Studies 24:381-394 Gam-Anon:www.gam-anon.org Lange, Gary, 2010, You Bet Your Life: Pathological Gambling, DVD, GaryLangePhD.com Petry, Nancy, 2005, Pathological Gambling: Etiology, Comorbidity, and Treatment, Wash, DC., www.apa.org Personal Financial Strategies for the Loved Ones of Problem Gamblers. National Endowment for Financial Education and the National Council on Problem Gambling Sugg, Judith and Siegel, Renee 2009, Families Recovering Against All Odds: “Helping Family Members of Problem Gamblers Rebuild”, ABC Wellness Centre, Scottsdale, AZ

  29. GaryLangePhD.com DVDs: “Pathological Gambling”, “T-ender L-oving C-ommunication”, “It’s About Time Management”, “Feelings ‘R’ Us” and “Getting Past Tense” $25.00 each (760-773-1014) Gary@GaryLangePhD.com