COMMON COMPONENTS IN THE

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

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Common Components

• What is common in these programmes?

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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
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1st Component Evaluation

• The first component is the pre-treatment
  evaluation of the different factors leading to
  the gamblers pathological gambling.

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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.

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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.

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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 patients co-morbidity is stabilised,
  the treatment of the pathological gambling can
  begin.

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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)

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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.

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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)?

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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.

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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)

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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
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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.

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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

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Danger of false beliefs

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

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The Gambling Traps
Thinking is focus on Winning
Emotionally aroused
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Recognising Gambling Traps

• Gambling traps occur when the gamblers 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.

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Importance of correcting the gamblers idea of
chance

• Correcting the gamblers 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.

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Challenging erroneous beliefs
Erroneous Thinking
Emotional arousal
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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

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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