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NRGP

National Gambling Board

South African Responsible Gambling Foundation

Problem Gambling - Treatment Options

  • Introduction
  • The South African situation
  • Pathological gamblers
  • Problem gamblers

4.1 Introduction

By now we are clear that problem and pathological gamblers need help – although they may well wish to quit, we have seen that this is very hard for them to do on their own. It is this factor, the difficulty in quitting the behaviour that leads to problem and pathological gambling being described as an addiction.

As with all treatments for addictive behaviours, the aim is to get the individual to stop the activity totally. This is sometimes known as a Zero-Tolerance approach. This means that there can be no chance of a problem or pathological gambler simply being able to come round to being a recreational gambler. If we accept the Medical model then we have to accept that gambling, as with other forms of compulsive or addictive disorders, is progressive in nature and has to be stopped in its entirety. By progressive we mean that the condition worsens over time. This is in line with the Medical model mentioned earlier, as many physical disorders are also progressive in nature. This is the approach taken to dealing with substance abuse, such as drug, tobacco and alcohol abuse and addiction.
 

4.1.1 Mind of the Gambler

Before we look at various treatment options we need to look briefly at the psychology of gambling. Research has shown that thrill seekers or risk takers experience greater hits of the brain chemical dopamine, when engaging in high risk behaviour. This means that such individuals experience such pleasure from risk taking that they continually repeat risk taking behaviour. This has implications for all types of addictive behaviours, including gambling

This is possibly a reason why certain people gamble – they are thrill addicts much as sky divers or bungee jumpers may be. They gamble for the high they experience during risk taking.

 

For a brief introduction to this relatively new area of research see:
http://www.time.com/time/health/article/0,8599,1869106,00.html?iid=tsmodule

An overall idea of the type of question this poses about risk taking (applied here to smoking) is available at:
http://www.thetech.org/genetics/ask.php?id=134

 Other people may gamble out of ignorance or lack of education about what is involved in gambling. Such people may simply not know that “the machine always wins” or they may genuinely believe that gambling is an intelligent way to attempt to make money.

For this category of gambling, a form of therapy known as cognitive-behavioural therapy may be the best approach. As the name suggests, CBT is based on a combination of thought correction and changing behaviour. In the case of gambling, a problem gambler may have to examine his or her ideas (thoughts or cognition) about gambling. If the therapist can show the person that the thoughts or beliefs they have about gambling (such as misconceptions about odds, superstitions and so on) are faulty, the behaviour of the individual may change.

This type of therapy could therefore prove extremely helpful when dealing with problem gamblers.

A useful look at CBT compared to other therapies can be found at:
http://www.rcpsych.ac.uk/mentalhealthinfo/problems/problemgambling.aspx

4.2. The South African approach 

Dr Vincent Maphai who in 2002 was elected to head up the NRGP in South Africa made the following statement: He said that South Africa had needed to develop a response to problem gambling which was unique to its developing nation status.

"South Africa now has a tightly controlled and regulated gambling industry, in which the state imposes high standards of compliance on operators with regard to social issues.

"However, unlike in first world countries where problem gambling programmes are funded by the state, it was clear to us from the start that other pressing socio-economic demands on the public purse would make it unlikely, if not impossible, for provinces or central government to allocate the resources which needed to be applied in this case. Therefore, South Africa needed an innovative approach to fund our national campaign to deal with problem gambling, the consequence of which is that I'm hopeful that we will have over R7-million this year with which to do it.

"Our approach, a public/private sector partnership, involving government, with state oversight and extensive industry funding, has drawn favourable international comment, and a number of jurisdictions in the world are likely to replicate the South African model, not least of which the United Kingdom.

"Through the NRGP, we offer services including a toll-free problem gambling counselling line, free counselling and treatment for problem gamblers, which is an international first, as well as a public education campaign and a research programme which monitors gambling behaviour and trends in South Africa.

"Qualified psychologists are available in 21 cities and town in South Africa, in eight of the country's official languages, to conduct out-patient treatment, the necessity for which is assessed by professional counsellors who staff the national problem gambling counselling line. In extreme cases, in-patient treatment is also provided. “

From: http://www.responsiblegambling.co.za/content.asp?id=24&pr=74

Before the NRGP started their work in South Africa, much research had been done in other countries to find effective ways to treat problem and pathological gambling. Let us look at some of these, Let us start by looking at treatment for the most severe form of gambling disorder, namely:
Pathological Gambling

 

4.3 Treatment of Pathological Gamblers

A variety of treatments exist for pathological gambling including counseling, self-help groups, and psychiatric medications. However, no one treatment is considered to be most effective on its own and no medications have been approved for the treatment of pathological gambling by medical groups who control and  regulate drugs, such as the Medical Councils in various countries.

We have already mentioned Gambling Anonymous when we looked at their questionnaire earlier. Gamblers Anonymous (GA) is a commonly used treatment for gambling problems. Modeled after Alcoholics Anonymous, GA uses a 12-step model that emphasizes a mutual-support approach. Meetings are free and are held most nights of the week.  In South Africa, pathological gamblers who receive in-patient treatment at addiction centres, usually also get introduced at this stage to GA and this becomes an important part of their recovery.

There is some international evidence, mostly from the USA that certain drugs may help with pathological gambling.

For a good overview of Pathological Gambling, including a study of treatment with drugs, look at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1857322/

Generally in-patient treatment in a clinic with help from qualified professionals coupled with individual and group counselling and attendance at GA meetings is seen as the preferred treatment for pathological gambling in South Africa. Individuals who meet the DSM IV criteria for pathological gambling and who cannot afford to pay for  their own treatment are assisted in this regard by the NRGP in South Africa.

This review of a book on the treatment of Pathological Gambling gives us a good picture of various issues and options:
http://psychservices.psychiatryonline.org/cgi/content/full/56/8/1031

The article highlighted gives a clear description of the extent and definition of Problem Gambling aswell as looking at the range of treatments available, including in-patient therapy and medication:
http://www.psychiatrictimes.com/display/article/10168/1443158?pageNumber=2

4.4 Treatments for Problem Gambling

4.4.1 Defining the Issue

In South Africa, the NRGP has set up telephonic help lines for problem gamblers. In addition to the help line number 0800 006 008, they also offer a link to a useful self help test. This is reproduced below, (with permission). You may notice that some of the items in this instrument are similar to those you have seen in other Screening instruments.  Before we look at how counselling can help we want you to look at this test. If you know anyone who is struggling to break the hold of any “habit” such as drinking or drugs, or if you yourself have some issue, you may want to see how the individual concerned might fare in this self test.

 

Self Check Quiz

 

4.4.2 Counselling

Counselling is different to psychotherapy in that in counselling the focus is generally on a specific issue and not a general examination of feelings or anxieties. Counsellors may have professional qualifications or may be “lay” people with a great deal of experience in dealing with a particular issue. This last statement is particularly true when looking at counselling for any form of addiction or habit an individual is struggling with. A person, who has for example taken the Self Test above and decided that he or she has a problem with gambling may feel more comfortable getting support from someone who herself has struggled and overcome a problem with gambling, has spoken to many others about her problem and has studied the subject informally.

In counselling an experienced and skilful counsellor realises that only the individual can make a decision to change. Many people have suffered terribly by insisting that a friend or relative gets help when the person concerned is not ready for this step. A counsellor has no magic tricks – she can only listen with empathy and offer support and make suggestions. This is a hard fact to accept – only the person with the problem can decide to make the change and recognise that he or she has a problem. This applies to gambling, as well as drinking, over-eating; compulsive dieting; to shooting-up heroin.

Counselling however is a powerful tool in recovery once an individual has recognised that he or she has a problem. It is a shred journey between counsellor and client on the road to recovery and health. As a concerned relative or friend you can encourage someone to at least try counselling – sometimes the breakthrough may be made at that point and the realisation made. An interesting Australian website that looks at Problem Gambling and offers links to other sites is available at:

http://www.relationships.com.au/advice/problem-gambling

 

4.4.3 Step Programme

The Step Approach to helping Problem Gamblers is based on the twelve steps to recovery originally developed by Alcoholics Anonymous. Basically it is a set of principles which describe a way forward in terms of action to be taken towards recovery from addictive or compulsive behaviours. The twelve steps were first outlined in the book Alcoholics Anonymous: the Story of How More Than One Hundred Men Have Recovered from Alcoholism which was published in 1939. Since then the twelve step programme has been adapted for a range of compulsive or addictive behaviours so that nowadays one finds Gamblers Anonymous; Narcotics Anonymous (for substance abusers) ‘ Overeaters Anonymous; Sex Addicts Anonymous to name a few. This proliferation serves to underline how successful the programme is seen to be.

Essentially the twelve step programme is seen by the American Psychological Association as involving the following principles:-

  • admitting that one cannot control one's addiction or compulsion;
  • recognizing a greater power that can give strength;
  • examining past errors with the help of a sponsor (experienced member);
  • making amends for these errors;
  • learning to live a new life with a new code of behavior;
  • helping others that suffer from the same addictions or compulsions

VandenBos, Gary R. (2007). APA dictionary of psychology (1st ed.). Washington, DC: American Psychological Association

Although some people dislike the heavy emphasis on group participation in which one attends meetings at which experiences are shared; there is no doubt that the Twelve Step Programme has worked for a great many people throughout the world. Confidentiality is strictly emphasised and support is always available should one feel one is “slipping”.  Some people are also uncomfortable with the notion of acknowledging the existence of a Higher Power; this issue is at  times addressed by assuring individuals that the power can be anything or entity  they wish – even themselves in a “sober” state. 

It is impossible to measure the true success of this approach as meetings are voluntary; members are anonymous; and no statistics are kept -  it is an extremely democratic flat structure – no-one is in charge of meetings and people can attend wherever and whenever they wish to. Obviously there is a small amount of organisation necessary in order to book rooms for meetings, provide tea and so on. Some heavily disillusioned individuals who feel that the Step programme failed them will refer to it as “brainwashing” or a “cult” but the fact is that millions appear to have benefited from this approach.

For a more detailed look at the history and structure of the Twelve Step Programme go to:

http://en.wikipedia.org/wiki/Twelve-step_program

 

4.4.4 Peer support and self help

A growing method of treatment is peer support. With the advancement of online gambling, many gamblers experiencing issues use various online peer-support groups to aid their recovery. This protects their anonymity whilst allowing individuals the chance to attempt to self-recover often without having to disclose their issues to loved ones.

Research into self-help for problem gamblers is showing promising results. Some research into the use of workbooks explaining the complexities and issues around gambling, as well as offering advice on how to stop gambling are showing some positive results in certain countries. Often this form of self-help can be supported by telephone counselling.

Adapted in part from: http://en.wikipedia.org/wiki/Compulsive_gambling

For a look at how peer support for issues such as gambling can function in the workplace go to:
http://www.aadac.com/documents/its_our_business_workplace_peer_support.pdf

To learn more about a self-help programme go to:
http://www.freeyourself.com.au/freeyourselfprogram.html

 

>>  Point to Ponder 6

In the light of what you now know, do you think it is possible for an alcoholic or a compulsive gambler to stop for a certain period of time, using some of the treatment options mentioned above and then become a social or recreational drinker or gambler? Think about reasons for your response.