Preventing relapse has amounted to a very difficult task for many compulsive gambling counseling programs. Relapse has been studied extensively for other addictive behaviors, however. Identifying high-risk situations or triggers that in the past have signaled an addictive behavior constitutes a central factor. Effective interventions prepare individuals to avoid relapse by recognizing and then evading or coping with these situations.
Relapse prevention authority Terence Gorski has stated that “since most recovering people have never been taught how to identify and manage relapse warning signs, they don't notice them until the pain becomes too severe to ignore.” Some research has examined relapse triggers in gamblers and how they described their mood states both leading up to relapse and after relapse. Understanding predictors of relapse can assist in developing meaningful relapse prevention strategies.
Relapse rates among pathological gamblers are very high. Every treatment program concerned about effectively treating relapse-prone patients needs to develop a policy for dealing with relapse. An enlightened relapse policy recognizes the goal of dealing with relapse therapeutically rather than punitively, whenever possible.
Importance of fellowship
Jerome D. Kriss, MS, LMHC, has been running a highly successful outpatient treatment program for pathological gamblers in Albany, N.Y. The Center for Problem Gambling's program was designed using aspects of 12-Step type meetings with cross talk, recovery coaching concepts, and professional guidance. The program is designed to last 18 months, with up to four group meetings and an individual session weekly. Although there is a concluding session, clients who complete the program are encouraged to continue the fellowship beyond that with a formal mentor (recovery coach).
The success of the program is attributed in part to the “fellowship” of the meetings; the formal mentorship is supported by interaction among the participants. Many meet for dinner before the meeting and interact in other ways on their own time.
We conducted brief interviews with four of the program's clients and noted a clear positive response to the “peer recovery” process inherent in the Center for Problem Gambling's program. Several interviewees noted that as they became more involved in the outpatient program, they also began to attend more Gamblers Anonymous (GA) meetings. One woman enjoyed the program's “respectful cross talk” and honest instant feedback based on feeling safe. Some interviewees stated that they were members of other 12-Step groups, and credited the process they had experienced in the agency's meetings for helping them feel safe and respected.
The agency's team of mentors has demonstrated long-term success with a program that previously had a significant record of relapse. Within two years of Kriss's coming on board at the agency, he saw the need to bring on a female counselor who could follow this model. Elena Matcovich, RN, now oversees a women-only group every week.
Prior to being hired to run the Center for Problem Gambling program, Kriss worked as senior assistant director for the Committee for Physicians Health, a division of the New York State Medical Society. The counseling/intervention model for programs for addicted physicians includes aspects of the recovery coach approach, which has shown positive outcomes in treatment. Kriss brought this approach to his new agency and just naturally started to use it.
Counseling staff in the program act more as recovery coaches than as clinicians only. In turn, this role helps to influence participants in the groups to act as peer advocates for one another.
Addiction field historian William L. White states, “A recovery coach is a person who helps remove personal and environmental obstacles to recovery, links the newly recovering person to the recovering community, and serves as a personal guide and mentor in the management of personal and family recovery. Such supports are generated by mobilizing volunteer resources within the recovery community, or provided by the recovery coach where such natural support networks are lacking”.1
In its recovery coach trainings, the Connecticut Community for Addiction Recovery (CCAR) cites the differences among a clinician, a recovery coach and a sponsor. It presents these in many contexts. In terms of the service/support framework, CCAR states that a counselor works within a particular organizational treatment philosophy; a recovery coach works across multiple frameworks of recovery based on the choices of those with whom they work; and a sponsor works within the beliefs and practices of a particular recovery fellowship.
From information gathered in conducting individual interviews and observing the group process at the Center for Problem Gambling, it became quite apparent that the incorporation of recovery coach principles, the clinical training of staff, and the use of 12-Step approaches emphasizing fellowship have contributed to a successful recovery program for the treatment of compulsive gamblers. The Albany-based program is a model program that has been honored by New York state's Office of Alcoholism and Substance Abuse Services (OASAS).
Richard D. Froilan-Dávila, PhD, MSW, a certified compulsive gambling counselor, is a Professor at the Springfield College School of Human Services and coordinator of the school's Addiction Studies track. His e-mail address is firstname.lastname@example.org. Michael Mendel Galer, DBA, MEd, a recovery coach and trainer, is an adjunct professor at Springfield College. He is also a former show host at the Talk American Radio network and a pioneer in the Recovery Television Network.