Q and A, Gambling Addiction Webinar

Yes- so much good research out there now. Some of the main points from the research:

  1. A possible shared genetic vulnerability between problem gambling and other addictions
  2. Neuroimaging studies showing the similarities between process addictions (gambling) and substance addiction i.e. repetitive engagement in the behaviours despite adverse consequences, diminished control over the behaviour, increased tolerance over time
  3. The imbalance in neurotransmitter systems (serotonin, dopamine, endogenous opioids) and the impact on behaviours/substance use
  4. Some studies showing the effectiveness of the opioid antagonists (i.e. Naltrexone) in treatment of problem gambling
  5. Less activity shown in the parts of the brain controlling emotion regulation, decision making and impulse control when shown videos of gambling suggesting gamblers are more impulsive and sensation seeking in comparison with the control
  6. Studies showing problem gamblers demonstrate diminished brain activity and blunted responses to rewards as well as losses therefore increasing urge to seek further reward

Research suggests that using a cognitive behavioural therapy lens has been most successful for problem gambling. That being said, exposure therapy can be used to help decrease the activation experienced from the stimuli in the casinos. We focus on contaminating the fantasy of being in the casino with cognitive restructuring and inviting reality into the environment of the casino. This is where it is also helpful to review consequences of the gambling to allow the problem gambler to start to make different associations with being at the casino

They can serve as a temporary barrier, however, many of our clients have reported issues with this boundary. While most, if not all, casino’s carry a no access list, they are not often vigilant on following through with it. Many of our clients have reported being able to continue to gamble while being on the no access list. What is helpful about it is inviting it into the therapeutic process as a way of setting personal accountability measures. Sometimes the act of placing yourself on the list is enough of a mental barrier and can remind someone of the commitment they have made to not accessing the casino.

It has the potential to reinforce the money = reward as well as normalize playing games for money. That being said, some problem gamblers may only have an issue with one specific gambling behaviour, and cards may not be their gamble of choice. It’s important for each individual to set up their own bottom lines with gambling and if this includes all forms of gambling that means things like playing cards with family for money or buying lottery tickets because it has the potential to light up the same pathways in the brain.

Studies suggest a shared genetic vulnerability between presence of other addictions and problem gambling. Cultural beliefs, values and upbringing can certainly influence gambling behaviours as well as how one sees the value of money and  their responsibility in obtaining money i.e. the need to be a high earner and what it means to be without money. Cultural beliefs, values and upbringing can also influence whether a person reaches out for help.

Absolutely! It is so important for family members to get the support they need in coping with a loved one’s gambling addiction. Encouraging family to attend a family program where they can get support and education on the cycle of addiction, setting boundaries and relapse prevention. Bellwood has a three day virtual family program that focuses on supporting and educating family members. I also often recommend Gam-Anon if they are looking for more relatability with other family members of gamblers or for them to see their own therapist so that they have a venue to receive support focusing on their own recovery from a loved one’s addiction. We also believe the family should be involved in the process as much as possible if they are positive supports for their loved one. Having everyone on the same page for recovery is really important.

These have been helpful resources for family members:

 https://www.ncpgambling.org/wp-content/uploads/2014/08/loved_ones_guide_ncpg_booklet.pdf

Behind the 8-Ball: A Recovery Guide for the Families of Gamblers (Linda Berman)

Medication can be a helpful part of treatment, particularly when treating an underlying mental health condition like anxiety or depression that can drive the gambling. Studies have also shown effectiveness of opioid antagonists (Naltrexone) in the treatment of problem gamblers. While medication can be a helpful tool in recovery, it is also not the whole solution. The pharmacological intervention should be used in conjunction with a therapeutic intervention (i.e. CBT).

Cognitive restructuring is a big part of it- as well as many of the other skills from the CBT and DBT arena.

It definitely has an impact. It can be quite difficult to navigate all of the commercials, web ads, print ads and overall normalizing of gambling. And like many triggers, tend to be unavoidable. Part of the relapse prevention process with gamblers, as with many addictions, is focusing on how to manage the feelings (activation, urges and cravings) that may come up when faced with these triggers. Further to this, needing to remind oneself that promotions are often glorifying the behaviour and perpetuating the fantasy of the ‘big win’ and that in reality there is so much more loss, particularly when addiction is involved.

Please reach out to me directly for the template ([email protected])

I haven’t experienced that in my work at Bellwood, but it is definitely a co-occurrence that can happen. It does become problematic because essentially what is happening is cross addiction (using a different behaviour or substance to meet the same addictive/unhealthy need). This is certainly something to be addressed in treatment.

It is certainly possible. Some problem gamblers may identify one specific gambling activity as past of their addiction while feeling like they are able to maintain control with other forms of gambling. I would ask them to stay curious about their thoughts, feelings and behaviours when they socially gamble and whether anything feels similar to what it is like when they play the VLT’s. I would also say in early recovery it would be helpful to abstain from all forms of gambling for at least a period of time, to allow for healthier brain pathways to be built.

Cognitive reframing/restructuring, thought records, exposure (mostly related to handling/managing money), letting the story play out (identifying worst case scenario and identifying how to manage) and mindfulness/grounding strategies. Distress tolerance and emotion regulation techniques from DBT are also helpful.

There’s not a lot out there- most statistics are around the percentage of people who gamble/ identify as problem gamblers as well as the amount of money that goes into gambling country wide.

Rates of relapse can sometimes depend on how much effort the person puts into their recovery- amount of treatment as well as ongoing support in the first few years of recovery. There is a correlation between rates of success with recovery and people’s participation in things like 12 step groups, aftercare groups or Smart Recovery. It can also depend on the severity of the addiction and/or the person’s ability to create immediate changes that supports their recovery ongoing.

Time frames very depending on the severity of the addiction. Our inpatient program for problem gambling is 7 weeks, however, I would consider someone in early recovery for about a year. To me that means ensuring that the supports are in place and they are doing active/ongoing work (to be reduced over time) on a consistent basis. If all of that active work has been done I would then consider someone in a maintenance phase of their recovery. Again- timeframe typically depends on how much active work was done in the initial stages of recovery.
We would use it to diagnose the client with a gambling disorder/problem gambling as well as the severity of their addiction. Our psychiatrist would also utilize it to diagnose any other underlying mental health conditions.

The risk of online gambling becoming problematic is high- particularly for those who already identify with compulsive gambling. It’s easy, it’s accessible and the risk of quick and significant loss is there (many sites expect you to have a card uploaded to your account and it’s easy to just keep making bets). It’s also very isolating. At the beginning of the pandemic, as the casinos closed, there was almost certainly a rise in online gambling. Research tends to show that males are more likely to online gamble, as they are more likely to use other forms of gambling as well. The risk is higher for people who tend to isolate anyway, are looking for an accessible form of stimulation and for those looking for a quick fix to financial problems (i.e. behind on bill payments). 

Yes, we would definitely consider that. Feel free to reach out to me directly ([email protected])

We use the South Oaks Gambling Screen and the G20

Simultaneously. Any of our problem gamblers with concurrent addictions would also be in our Core program or other speciality programs (i.e. sex and love addiction program). The expectation would be that both addictions would be addressed at the same time to understand how they may or may not be connected as well as to provide a more holistic approach to relapse prevention.

Yes. We have a Concussion and Brain Injury Support program here at Bellwood that assists with something like this. You would need to consider pacing of treatment to avoid mental fatigue, some of the cognitive restructuring tasks would need to be adapted and it would be helpful to consider working with an occupational therapist to map out clear directives on managing the compulsive behaviours.
Absolutely. It is essentially also considered a win. We would call this ‘something for nothing’ and it relates to things like theft and shoplifting. It can also be a way of increasing tolerance.

I think it is often equally as important as those identifying with problem gambling often have an unhealthy relationship with money which needs to be addressed both practically and therapeutically. It also allows for them to create a more extensive relapse prevention plan that extends to finances as often debt restitution is needed due to significant financial losses in the addiction.

You can visit our website edgewoodhealthnetwork.com for more information! Or give our admissions team a call on 1-866-349-3869 and they would be more than happy to discuss our programs with you and answer any questions you may have.