Intervention

An intervention response is based on our understanding of problem gamblers:

• Problem gamblers are reluctant to seek help.
• US Studies found that around one third of gamblers recovered without formal treatment, one Canadian study found four out of six people recovered without treatment.
• Greater problem severity and co-existing problems increase the likelihood of using treatment.
• Natural or untreated recovery is the pathway chosen by gamblers with less severe problems.

How severe is the problem?

The Canadian Problem Gambling Index can be used to identify 'problem gambling' and also give indication of the major areas of concern. Patients are asked to answer Never, Sometimes, Most of the time, or Almost always to nine questions. (Ferris et al., 2001)

In the last 12 months how often have you [or have for item 7]?

1. Bet more than you could really afford to lose?
2. Needed to gamble with larger amounts of money to get the same feeling of excitement?
3. Gone back another day to try and win back the money you lost?
4. Borrowed money or sold anything to get money to gamble?
5. Felt that you might have a problem with gambling?
6. Felt that gambling has caused you health problems, including stress and anxiety?
7. People criticized your betting or told you that you have a gambling problem, whether or not you thought it was true?
8. Felt your gambling has caused financial problems for you or your household?
9. Felt guilty about the way you gamble or what happens when you gamble?

Scoring: 0 = Never, 1 = Sometimes, 2 = Most of the time, 3 = Almost always.

Scores for the nine items are summed, and the results are interpreted as follows:

0 = Non-problem gambling.

1-2 = Low level of problems with few or no identified negative consequences.

3-7 = Moderate level of problems leading to some negative consequences.

8 or more = Problem gambling with negative consequences and a possible loss of control.

Most, but certainly not all, clients seeking counselling at Gamblers Help services, fall into the 'problem gambler' category.

Broadly then, the severity of the problem guides the response - and there may be other important issues to consider, particularly reluctance to seek a counsellor's help. Reluctance to seek help suggests a brief intervention. Other factors may include irrationality around gambling, and perhaps a reluctance to face difficult issues in life.

• For low risk gamblers it may be enough to remind patients that gambling must be watched, as it can be very addictive and costly.
• For moderate risk gamblers self help information or a brief intervention may be appropriate.
• For full level problem gamblers referral to the Gambling Helpline to discuss issues, or a referral to a Gamblers Help counsellor is suggested.

Brief, solution-focused therapy is a short term intervention that attempts to help the client affect change by identifying immediate solutions to concrete problems.

The briefest of interventions may be to point out that many people have successfully controlled their gambling behaviour by employing strategies that are generally practical and problem focused, such as:

• avoiding gambling venues
• adopting gambling incompatible lifestyles
• reducing access to money
• recalling of gambling-related negative consequences (from PC Report 7.25).

The standard longer term treatment is cognitive behaviour therapy which attempts to identify the client's distorted thinking and replace it with more rational, adaptive thoughts and beliefs.

Health professionals can recommend this treatment to clients, even if they do not have time or expertise to explore it themselves. As The Problem Gambling Institute of Ontario points out:

"Many people with gambling problems have a host of other issues that will need to be addressed. Concurrent disorders such as depression, anxiety, ADHD and substance use are common. The financial implications of gambling frequently cause a client’s relationship to suffer. Problem gambling therapists also provide counselling to family members who have been hurt financially and emotionally by a significant other’s gambling."

Referral to the Gamblers Help service has practical aspects which do not include counselling:

• self-exclusion from gambling venues can be arranged
• financial support (brokerage fund payments) are available (conditions apply)
• and specialist financial counselling such as debt rescheduling can be explored.