A Stitch in Time Saves Nine: screening problem gamblers and their families with the EIGHT and COGS s

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A Stitch in Time Saves Nine screening problem
gamblers and their families with the EIGHT and
COGS screens to raise awareness of harm

• Sean Sullivan PhD
• Abacus Counselling Training Supervision Ltd
• www.acts.co.nz

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Why do people seek help?

• People appear to seek help for addictions when
• They hit rock bottom and do not wish to
  continue to sustain the negative consequences of
  their behaviour
• Circumstances provide insight before rock bottom
  reached e.g. birth of a child, a relevant shock
• Are pressured into help by family or
  circumstances e.g. Get help or else
• See a possible benefit e.g. sentencing mitigation
  

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How does problem gambling fit?

• Help-seeking may be less likely than other
  addictions because
• Rock bottom may never be reached because of a win
  being always just within reach
• Gambling becoming socially accepted, money a
  powerful reward, conditioning process resilient,
  so early insights of growing harm are few
• Less obvious symptoms so less early pressure from
  others to seek help
• Little mitigation hope due to little
  understanding of problem gambling as an addiction

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Few access specialist help for problem gambling

• Approximately 1.2 of NZs adult population may
  have severe (Level 3) gambling problems
  (n40,000)
• A similar number may have moderate (Level 2)
  gambling problems (Level 3 Level 2 1.9)
• Approximately 4000 problem gamblers in NZ
  accessed help in 2005 (5?) with few Level 2

Level 2
Level 3
5
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Late (or not) help-seeking the norm

• In NZ
• Over 90 of problem gambling clients attending
  treatment in 2005 scored as probable
  pathological gamblers (5) on the SOGS and
  average just under 10
• Over 1 in 3 clients attend 3 or less hours in
  treatment
• Estimate only between 3 and 10 (5?) of problem
  gamblers seek help, and these at late stage in
  their addiction

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Harm from gambling enduring

• Treatment of problem gambling cannot undo the
  damage caused by lost wealth....and lost wealth
  can have an impact on health for decades, and
  even generations
• Poulin CMAJ 2006

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An case for brief and early intervention

• Secondary prevention interventions aim to prevent
  the progression of early to serious harm from
  gambling
• May also raise awareness of those experiencing
  serious harm
• May access the 90 to 97 of problem gamblers who
  dont seek help
• A central tool for brief and early intervention
  is a brief, simple and valid screen

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Barriers to problem gambling screening

• Provided in non-problem gambling treatment
  settings are skills sufficient to safely raise
  it?
• Opportunistic people dont attend these settings
  for problem gambling harm - do clients think it
  relevant or intrusive?
• Workers in these settings
• may not see it as their role to screen
• may feel uncomfortable raising the issue
• may not see problem gambling harm as important as
  other issues they deal with

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Barriers can change to opportunities

• Information, awareness and training can address
  the barriers because
• Otherwise left with late help-seeking by relative
  few
• Experience is other settings can be positively
  motivated by prevalence of problem gambling harm
  amongst their clients
• Relevance of addressing problem gambling for
  their setting important

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Screen simplicity important

• Many screens available, however many are either
  too long or too complex to score quickly and
  allow immediate feedback
• Should identify early as well as late stage
  problem gambling
• Complicated by the absence of a true gold
  standard for serious problem gambling, and even
  moreso for earlier stage problems
• Ease of screen use will assist to motivate
  interventions in non-specialist settings

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EIGHT Screen (any 4 yes is a positive)

• 1.Sometimes Ive felt depressed or anxious after
  a session of gambling A.Yes, thats true
  B.No, I havent
• 2.Sometimes Ive felt guilty about the way I
  gamble A.Yes, thats so B. No, that isnt
  so
• 3. When I think about it, gambling has sometimes
  caused me problems
• A.Yes thats so B.No, that isnt so
• 4.Sometimes Ive found it better not to tell
  others, especially my family, about the amount of
  time or money I spend gambling A.Yes, thats
  true B.No, I havent
• 5.I often find that when I stop gambling Ive run
  out of money
• A.Yes, thats so B.No, that isnt so
• 6.Often I get the urge to return to gambling to
  win back losses from a past session A.Yes,
  thats so B.No, I havent
• 7.Yes, I have received criticism about my
  gambling in the past
• A.Yes, thats true B.No I havent
• 8.Yes, I have tried to win money to pay debts
  A.Yes, thats true B.No, I havent

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EIGHT Screen

• Designed to
• be completed by clients within 1 minute or less
• can be scored instantly
• can be used by non-health professionals with
  limited training
• starting to be used more widely overseas
• validated - www.acts.co.nz

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The COGS a family screen

• Few screens focus upon the family although may be
  7 times as many affected
• The COGS developed to
• focus awareness on themselves of harm to the
  family of the problem gambling
• motivate their help-seeking by raising awareness
  and allowing them to retain control (client
  centred)

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Concerned Others Gambling Screen (COGS)

• 1. Do you think you have been affected by someone
  elses gambling?
• a. No, never
• b. Dont know for sure if their gambling
  affected me c. Yes, in the past
• d. Yes, thats happening to me now
• 2. How would you describe the effect of that
  persons gambling on you now?
• a. I worry about it sometimes b. It is
  affecting my health
• c. It is hard to talk with anyone about it d.
  I am concerned about my, or my familys, safety
  e. Im still paying for it financially
• g.It doesnt affect me any more
• 3. What would you like to happen?
• a. I would like some information b. I
  would like to talk about it in confidence with
  someone
• c.I would like some support or help d.Nothing
  at this stage

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Examples of non-specialist settings

• Doctors practices
• range 3 NZ European to 24 Pacific people
• Chinese doctors practice (n150) identified 13
  positives with EIGHT Screen and 11 COGS
  positives
• compared with NZ national survey finding no
  problems with Chinese safety perceived
  in GP setting?

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Examples of non-specialist settings

• Clients (1200) attending NZ foodbanks competed
  EIGHT and COGS
• 13 positive for problem gambling and one in
  three affected by anothers gambling
• 9 accepted brief on-site counselling when
  offered
• Used effectively in a prison study (Sullivan,
  Brown and Skinner, 2007) and in alcohol treatment
  services where approximately one in five were
  found to be also problem gambling

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Expanding brief interventions in NZ

• A recent study (n883) trained a wide range of
  workers in non-specialist services to screen for
  gambling harm
• NZ approach is to widen the opportunities to
  assist problem gamblers and their families to
  raise their awareness about harm, and to provide
  referral opportunities
• Non-specialist organisations appear open to
  screening when relevance to their work is
  provided

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Conclusion

• Problem gambling help will fail to be accessible
  to most if it only focuses upon providing help to
  those who have reached the decision to seek help
  by themselves
• Training in brief interventions, including
  screening, with a range of non-specialist
  settings can assist to access the over 90 of
  those affected by harm who, unassisted, may not
  seek help
• These services have been found open to such
  training
• end