As the casino boats were coming into its immediate area in 1993, the Illinois Institute for Addiction Recovery was beginning to treat compulsive gambling. Coleen Moore, Marketing and Admissions Manager at the treatment organization, remembers when it began.
She explains, “What we were finding was that many of our clients who were in treatment for alcoholism, were coming back to us were saying, ‘Okay, I’m not drinking, but I’m going to the boat and I’m gambling. And I feel like I’m not in recovery.’” After these comments, Moore says the staff really began to grasp the mechanics of gambling as an addiction. They found that although there are some differences, the behaviors of a person with gambling issues look very similar to the experiences of someone suffering from alcoholism.
‘A hidden addiction’
Soon after, the organization got connected with the South Oaks Gambling Screen (SOGS), and have been implementing the screening tool for all of its clients – whether or not they say they’re presenting with compulsive gambling – ever since.
Moore believes it’s important to screen all clients that walk through the door because “it’s a hidden addiction.” Unlike a drug or alcohol addiction, “people don’t really see it. We can’t smell it or detect it with a urine screen or anything like that,” she says.
“Sometimes gambling problems can be presented in other fashions such as depression, anxiety or some kind of panic attack or panic disorder, and the clinician may be taking a completely different path with the client,” Moore explains. She says screening is also crucial because of the statistics on gambling prevalence and the accessibility for people to be able to gamble.
It’s also difficult because this addiction is one that is seen as “socially acceptable,” according to Moore. Although there is an age restriction on gambling, she says that parents and grandparents providing scratch-off lottery tickets to their young ones for Christmas or other celebrations doesn’t help to show that gambling could turn into an problem.
“It’s hard for not only the society to see this as an issue, but it’s also sometimes hard for clinicians to see this as an issue as well. And most people don’t talk about it when they’re coming into therapy, unless they see that it is one of the presenting problems,” says Moore. Hence, questions must be asked.
Quantity does not matter
She explains that although she utilizes SOGS, it isn’t necessary to use a lengthy screening tool. Some screening tools, such as the Lie/Bet Questionnaire, ask only two questions. Based on the client’s responses, the clinician can then perform a further evaluation to determine whether or not there’s a diagnosis there.
The two questions were selected from the DSM-IV criteria for pathological gambling after they were identified as the best predictors of pathological gambling.
1. Have you ever had to lie to people important to you about how much you gambled?
2. Have you ever felt the need to bet more and more money?
If a person answers yes to either of these questions, it would be in the best interest of clinician at some point in time to gather more information about that person’s gambling behaviors.
Moore says that she tends to encourage clinicians to use the Lie/Bet Questionnaire, especially if they don’t already have protocols implemented in their initial assessment of a client.
“The person might be very ashamed, guilty about their gambling behavior and they don’t want to talk about it. But if the clinician asks about it, it may open that door for the person to truly talk about what’s going on in their life,” she explains.
“Statistics show that 10% of the population suffers from some type of compulsive gambling behavior. If you have a private practice of 20 people, there’s a high likelihood that you’ve got at least one or two people in your practice that can be suffering from compulsive gambling. And if you’re not asking the questions, then they aren’t being forthright with information for whatever reason, and that clinician may not be treating the client appropriately and wondering why they aren’t making any progress. It could be that the person is still gambling while they’re seeing you as a therapist,” says Moore.
Questions, then help
For those who may wonder, “Now that I’ve asked the questions, how do I help this person?” Moore says there is training available to clinicians to work with clients who have compulsive gambling concerns.
“If they already are familiar with working with someone suffering from an addiction, a lot of times I tell people, ‘Well, don’t take that addiction hat off. You’re still going to be utilizing the same methods that you’d utilize in working with someone with addiction.’”
Being aware that the suicide rate is much higher among those with gambling problems due to their massive debt loads is important for clinicians, says Moore. She stresses that it’s also imperative for clinicians to be able to point out those in the practice or community who can work with someone suffering from a gambling issue. At the Illinois Institute for Addiction Recovery, Moore says that they find that integrating Motivational Interviewing Techniques, Cognitive Behavioral Therapy, and a 12-Step program of Gambler's Anonymous to be the most effective approach.