Problem Gambling Education and Treatment in a Residential Setting ...
Problem Gambling Education and Treatment in a Residential Setting ...
Problem Gambling Education and Treatment in a Residential Setting ...
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PROBLEM<br />
<strong>Education</strong> <strong>and</strong> <strong>Treatment</strong><br />
<strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
GAMBLING<br />
Facilitator’s Guide
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
<strong>Education</strong> <strong>and</strong> <strong>Treatment</strong><br />
<strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Facilitator’s Guide
ii<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Facilitator’s Guide<br />
isbn: 978-1-77052-362-3 (PRINT)<br />
isbn: 978-1-77052-363-0 (PDF)<br />
isbn: 978-1-77052-364-7 (HTML)<br />
isbn: 978-1-77052-365-4 (ePUB)<br />
Pr<strong>in</strong>ted <strong>in</strong> Canada<br />
Copyright © 2009 Centre for Addiction <strong>and</strong> Mental Health, Toronto ON<br />
Facilitators offer<strong>in</strong>g this program have permission to download the manual <strong>and</strong><br />
copy <strong>and</strong> distribute the h<strong>and</strong>outs for use by participants. Otherwise, no part of this<br />
work may be reproduced or transmitted (for profit or otherwise) <strong>in</strong> any form or<br />
by any means electronic or mechanical, <strong>in</strong>clud<strong>in</strong>g photocopy<strong>in</strong>g <strong>and</strong> record<strong>in</strong>g, or by<br />
any <strong>in</strong>formation storage <strong>and</strong> retrieval system without written permission from<br />
the publisher—except for a brief quotation (not to exceed 200 words) <strong>in</strong> a review or<br />
professional work.<br />
4044/08-2009<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
iii<br />
Contents<br />
Introduction<br />
1 Why Is It Important to Talk about <strong>Gambl<strong>in</strong>g</strong> <strong>and</strong> <strong>Problem</strong><br />
<strong>Gambl<strong>in</strong>g</strong> with Clients Who Have Mental Health <strong>and</strong>/or<br />
Substance Use <strong>Problem</strong>s?<br />
2 How Is the Program Delivered?<br />
3 Screen<strong>in</strong>g for <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
3 Program Evaluation<br />
4 Acknowledgments<br />
Session-by-Session Guide<br />
7 Session 1: <strong>Gambl<strong>in</strong>g</strong> <strong>and</strong> <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
23 Session 2: Underst<strong>and</strong><strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong><br />
35 Session 3: Goal Sett<strong>in</strong>g <strong>and</strong> Identify<strong>in</strong>g High Risk-Situations<br />
41 Session 4: Develop<strong>in</strong>g Cop<strong>in</strong>g Strategies<br />
For High-Risk Situations<br />
49 References<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
iv<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Appendices<br />
53 Appendix A: <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Severity Index<br />
55 Appendix B: Sessions 1 <strong>and</strong> 2: Pretest/Post-test<br />
61 Appendix C: <strong>Problem</strong>atic vs. Non-<strong>Problem</strong>atic <strong>Gambl<strong>in</strong>g</strong><br />
63 Appendix D: Reduc<strong>in</strong>g the Risk<br />
65 Appendix E: How to Choose Your <strong>Gambl<strong>in</strong>g</strong> Goal<br />
67 Appendix F: My Goal Statement<br />
69 Appendix G: Self-Monitor<strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong> or Urges to Gamble<br />
71 Appendix H: <strong>Gambl<strong>in</strong>g</strong> Triggers<br />
73 Appendix I: Facilitator’s Evaluation<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 1<br />
Introduction<br />
The <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project at the Centre for Addiction <strong>and</strong> Mental Health<br />
(camh), <strong>in</strong> collaboration with the Georgianwood Concurrent Disorders Program at<br />
the Mental Health Centre Penetanguishene, is delighted to offer this problem<br />
gambl<strong>in</strong>g education <strong>and</strong> early treatment program for clients who are <strong>in</strong> a residential<br />
mental health <strong>and</strong>/or substance use sett<strong>in</strong>g.<br />
This program is <strong>in</strong>tended to help cl<strong>in</strong>icians <strong>in</strong>form clients with mental health <strong>and</strong>/or<br />
substance use problems about the potential risks associated with gambl<strong>in</strong>g <strong>and</strong> to<br />
provide some prelim<strong>in</strong>ary <strong>in</strong>terventions for those clients already engag<strong>in</strong>g <strong>in</strong> problematic<br />
gambl<strong>in</strong>g behaviour.<br />
Why Is It Important to Talk about <strong>Gambl<strong>in</strong>g</strong> <strong>and</strong> <strong>Problem</strong><br />
<strong>Gambl<strong>in</strong>g</strong> with Clients Who Have Mental Health <strong>and</strong>/or<br />
Substance Use <strong>Problem</strong>s?<br />
• Research shows a correlation between mental health problems, particularly depression<br />
<strong>and</strong> anxiety, <strong>and</strong> problem gambl<strong>in</strong>g.<br />
• Research also shows a correlation between substance use problems <strong>and</strong> problem<br />
gambl<strong>in</strong>g.<br />
• <strong>Gambl<strong>in</strong>g</strong> can be a potential trigger for substance use <strong>and</strong>/or mental health relapse.<br />
• People tend to be unaware of the risks associated with gambl<strong>in</strong>g.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
2 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
How Is the Program Delivered?<br />
The program comprises four sessions delivered by cl<strong>in</strong>icians <strong>in</strong> a group sett<strong>in</strong>g, <strong>and</strong><br />
<strong>in</strong>cludes this facilitator’s guide, PowerPo<strong>in</strong>t presentations <strong>and</strong> participant h<strong>and</strong>outs,<br />
all available free for download at www.<strong>Problem</strong><strong>Gambl<strong>in</strong>g</strong>.ca. You will also need a<br />
laptop computer, lcd projector, Internet access, flipchart <strong>and</strong> markers to deliver<br />
this program.<br />
Although a basic underst<strong>and</strong><strong>in</strong>g of problem gambl<strong>in</strong>g is beneficial, it is not required<br />
to deliver this program. The facilitator’s guide offers cl<strong>in</strong>icians all the <strong>in</strong>formation<br />
needed to deliver the program. The content from the PowerPo<strong>in</strong>t slides appears <strong>in</strong><br />
bold <strong>in</strong> this guide, <strong>and</strong> is accompanied by support<strong>in</strong>g notes for the facilitator. In<br />
certa<strong>in</strong> areas, the facilitator is also provided with additional <strong>in</strong>formation or is<br />
directed to further read<strong>in</strong>gs.<br />
Depend<strong>in</strong>g on the number of participants <strong>and</strong> the amount of group discussion, each<br />
session will take between 60 <strong>and</strong> 90 m<strong>in</strong>utes.<br />
Sessions 1 <strong>and</strong> 2 take a prevention <strong>and</strong> education approach toward gambl<strong>in</strong>g <strong>and</strong> are<br />
<strong>in</strong>tended for all clients. They provide <strong>in</strong>formation about gambl<strong>in</strong>g that is suitable for<br />
everyone, regardless of their <strong>in</strong>volvement <strong>in</strong> gambl<strong>in</strong>g.<br />
Session 1 focuses on <strong>in</strong>troductory <strong>in</strong>formation <strong>in</strong>clud<strong>in</strong>g:<br />
• how gambl<strong>in</strong>g <strong>and</strong> problem gambl<strong>in</strong>g are def<strong>in</strong>ed;<br />
• what activities are considered gambl<strong>in</strong>g;<br />
• prevalence rates of gambl<strong>in</strong>g <strong>and</strong> problem gambl<strong>in</strong>g;<br />
• risk factors for develop<strong>in</strong>g a gambl<strong>in</strong>g problem;<br />
• the impact of problem gambl<strong>in</strong>g;<br />
• how gambl<strong>in</strong>g <strong>and</strong> substance use are connected;<br />
• how gambl<strong>in</strong>g <strong>and</strong> mental health are connected; <strong>and</strong><br />
• a comparison of problematic <strong>and</strong> non-problematic gambl<strong>in</strong>g.<br />
Session 2 focuses on:<br />
• how games of chance work;<br />
• false beliefs <strong>and</strong> superstitions associated with gambl<strong>in</strong>g; <strong>and</strong><br />
• strategies for reduc<strong>in</strong>g the risk of develop<strong>in</strong>g a gambl<strong>in</strong>g problem.<br />
Sessions 3 <strong>and</strong> 4, on the other h<strong>and</strong>, are <strong>in</strong>tended for clients who are concerned about<br />
their gambl<strong>in</strong>g, or who have been identified as hav<strong>in</strong>g problems related to their gambl<strong>in</strong>g.<br />
These sessions provide clients with a little more <strong>in</strong>sight <strong>and</strong> awareness <strong>in</strong>to<br />
their gambl<strong>in</strong>g difficulties, <strong>and</strong> help them to identify their personal triggers <strong>and</strong> learn<br />
new skills for how to deal with these triggers.<br />
Session 3 focuses on:<br />
• how to set realistic gambl<strong>in</strong>g goals; <strong>and</strong><br />
• how to identify personal gambl<strong>in</strong>g triggers.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 3<br />
Session 4 focuses on:<br />
• how to develop cop<strong>in</strong>g strategies to deal with gambl<strong>in</strong>g triggers; <strong>and</strong><br />
• helpful resources.<br />
Sessions 3 <strong>and</strong> 4 offer clients support around gambl<strong>in</strong>g while they are <strong>in</strong> a residential<br />
treatment program for their substance use <strong>and</strong>/or mental health concerns. Once<br />
they leave residential treatment, however, clients should be encouraged to cont<strong>in</strong>ue<br />
to get support around their gambl<strong>in</strong>g.<br />
Over 55 specialized problem gambl<strong>in</strong>g treatment services are available, free of<br />
charge, throughout Ontario. Clients should be strongly encouraged to follow up with<br />
their local treatment provider once they return home. To f<strong>in</strong>d out where services<br />
are available <strong>in</strong> specific regions, contact the Ontario <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Helpl<strong>in</strong>e<br />
at 1 888 230-3505.<br />
Screen<strong>in</strong>g for <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Because of the correlation between mental health problems <strong>and</strong> problem gambl<strong>in</strong>g, as<br />
well as between substance use problems <strong>and</strong> problem gambl<strong>in</strong>g, screen<strong>in</strong>g for problem<br />
gambl<strong>in</strong>g among mental health <strong>and</strong>/or substance use clients is very important.<br />
The <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Severity Index (pgsi), which is <strong>in</strong>cluded <strong>in</strong> this guide<br />
(Appendix A), is a simple <strong>and</strong> easy-to-use gambl<strong>in</strong>g screen<strong>in</strong>g tool. Participants can<br />
complete it:<br />
• prior to the delivery of this program: you may choose to screen all clients when they<br />
are <strong>in</strong>itially admitted to your program; or<br />
• dur<strong>in</strong>g Session 1: you may choose to screen clients after you present the “Cont<strong>in</strong>uum<br />
of <strong>Gambl<strong>in</strong>g</strong> Behaviour” (slide 19).<br />
Anyone who scores 3 or higher should be encouraged to attend Sessions 3 <strong>and</strong> 4.<br />
Program Evaluation<br />
This program was pilot tested <strong>and</strong> was evaluated us<strong>in</strong>g a pretest <strong>and</strong> a post-test.<br />
Results from the evaluations were:<br />
• pretest mean of 60%<br />
• post-test mean of 76%.<br />
The pretest/post-test is available <strong>in</strong> this guide (Appendix B), so that you can measure<br />
clients’ learn<strong>in</strong>g as a result of participation <strong>in</strong> this program.<br />
Also <strong>in</strong>cluded is a Facilitator’s Evaluation form. Your feedback is important to us.<br />
Please take a few moments to complete the form (Appendix I).<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
4 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Acknowledgments<br />
Project leader: colleen tessier, senior project co-ord<strong>in</strong>ator, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Project, camh<br />
Written by: chantal dubois, problem gambl<strong>in</strong>g therapist <strong>and</strong> tra<strong>in</strong>er, <strong>Problem</strong><br />
<strong>Gambl<strong>in</strong>g</strong> Project, camh, <strong>and</strong> dr. shari mckee, psychologist, Georgianwood<br />
Concurrent Disorders Program, Mental Health Centre Penetanguishene<br />
We would like to thank the follow<strong>in</strong>g people for their contributions to the content:<br />
• gary hosk<strong>in</strong>s, problem gambl<strong>in</strong>g therapist <strong>and</strong> tra<strong>in</strong>er, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Project, camh<br />
• rena tennant, student, Georgianwood Concurrent Disorders Program, Mental<br />
Health Centre Penetanguishene<br />
We would also like to thank the follow<strong>in</strong>g people for their support with this project:<br />
• dr. daniela lobo, psychiatrist, camh<br />
• stephen meredith, senior project coord<strong>in</strong>ator, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project,<br />
camh<br />
• lisa pont, problem gambl<strong>in</strong>g therapist <strong>and</strong> tra<strong>in</strong>er, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project,<br />
camh<br />
• jan<strong>in</strong>e rob<strong>in</strong>son, problem gambl<strong>in</strong>g therapist <strong>and</strong> tra<strong>in</strong>er, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Project, camh<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 5<br />
Session-by-Session<br />
Guide<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 7<br />
Session 1<br />
Depend<strong>in</strong>g on the number of participants <strong>and</strong> the amount of group discussion, this<br />
session will take between 60 <strong>and</strong> 90 m<strong>in</strong>utes.<br />
For this session you will need:<br />
• laptop computer <strong>and</strong> lcd projector<br />
• Session 1 PowerPo<strong>in</strong>t presentation<br />
• participant h<strong>and</strong>outs:<br />
- <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Severity Index (Appendix A)<br />
- <strong>Problem</strong>atic vs. Non-<strong>Problem</strong>atic <strong>Gambl<strong>in</strong>g</strong> (Appendix C)<br />
- Session 1 PowerPo<strong>in</strong>t presentation<br />
Slide 2<br />
<strong>Gambl<strong>in</strong>g</strong> <strong>and</strong> <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
This first session focuses on <strong>in</strong>troductory <strong>in</strong>formation <strong>in</strong>clud<strong>in</strong>g:<br />
• how gambl<strong>in</strong>g <strong>and</strong> problem gambl<strong>in</strong>g are def<strong>in</strong>ed;<br />
• what activities are considered gambl<strong>in</strong>g;<br />
• prevalence rates of gambl<strong>in</strong>g <strong>and</strong> problem gambl<strong>in</strong>g;<br />
• the risk factors for develop<strong>in</strong>g a gambl<strong>in</strong>g problem;<br />
• the impact of problem gambl<strong>in</strong>g;<br />
• how gambl<strong>in</strong>g <strong>and</strong> substance use are connected;<br />
• how gambl<strong>in</strong>g <strong>and</strong> mental health are connected; <strong>and</strong><br />
• a comparison of problematic <strong>and</strong> non-problematic gambl<strong>in</strong>g.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
8 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 3<br />
Why Is It Important to Talk about <strong>Gambl<strong>in</strong>g</strong> <strong>and</strong> <strong>Problem</strong><br />
<strong>Gambl<strong>in</strong>g</strong>?<br />
People tend to be unaware of the risks associated with gambl<strong>in</strong>g.<br />
Unlike other high-risk activities, such as dr<strong>in</strong>k<strong>in</strong>g <strong>and</strong> other drug use, smok<strong>in</strong>g,<br />
impaired driv<strong>in</strong>g or unprotected sex, people are not always aware of the potential risks<br />
associated with gambl<strong>in</strong>g. As we will see throughout these sessions, gambl<strong>in</strong>g can<br />
lead to a variety of negative consequences such as f<strong>in</strong>ancial troubles, relationship<br />
problems <strong>and</strong> physical <strong>and</strong> mental health issues, just to name a few.<br />
<strong>Gambl<strong>in</strong>g</strong> can be a potential trigger for substance use <strong>and</strong>/or mental health relapse.<br />
Because gambl<strong>in</strong>g can lead to a variety of issues such as f<strong>in</strong>ancial loss, it may also<br />
trigger mental health problems like anxiety <strong>and</strong> depression. In addition, some <strong>in</strong>dividuals<br />
may turn to substances as a way of cop<strong>in</strong>g with negative feel<strong>in</strong>gs brought on<br />
by gambl<strong>in</strong>g.<br />
There is a l<strong>in</strong>k between mental health <strong>and</strong> substance use problems <strong>and</strong> problem<br />
gambl<strong>in</strong>g.<br />
Research shows that rates of mental health <strong>and</strong> substance use problems are higher<br />
among those experienc<strong>in</strong>g problems related to gambl<strong>in</strong>g. In addition, rates of problem<br />
gambl<strong>in</strong>g are higher among those experienc<strong>in</strong>g problems related to their substance<br />
use or mental health.<br />
There are some common biological factors shared by substance <strong>and</strong> gambl<strong>in</strong>g<br />
dependence.<br />
We all learn through reward <strong>and</strong> punishment, but for some people the reward system<br />
of the bra<strong>in</strong> works a bit differently. These <strong>in</strong>dividuals are able to take more risks <strong>and</strong><br />
are less sensitive to reward. As a result, it is believed that they are at <strong>in</strong>creased risk<br />
for addictions (Chambers et al., 2003).<br />
Slide 4<br />
<strong>Gambl<strong>in</strong>g</strong> Def<strong>in</strong>ition<br />
<strong>Gambl<strong>in</strong>g</strong> is def<strong>in</strong>ed as risk<strong>in</strong>g someth<strong>in</strong>g of value on an event that is determ<strong>in</strong>ed<br />
mostly by chance.<br />
A person is gambl<strong>in</strong>g if:<br />
• he or she puts up someth<strong>in</strong>g of value, such as money or property<br />
Although for the most part money is used for wager<strong>in</strong>g, th<strong>in</strong>gs such as jewelry,<br />
electronics <strong>and</strong> cloth<strong>in</strong>g can also be used.<br />
• the outcome has an element of chance beyond the person’s control<br />
We will focus on chance <strong>and</strong> how gambl<strong>in</strong>g games work <strong>in</strong> Session 2.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 9<br />
• once the bet is made, it is irreversible.<br />
Irreversibility is an important part of the def<strong>in</strong>ition of gambl<strong>in</strong>g because if a bet were<br />
reversible, there would be no negative consequences.<br />
Some people generalize the def<strong>in</strong>ition of gambl<strong>in</strong>g <strong>and</strong> say, for example, that gett<strong>in</strong>g<br />
married is a “gamble.” But would gett<strong>in</strong>g married meet our def<strong>in</strong>ition? It is true that<br />
people risk someth<strong>in</strong>g of value when they get married <strong>and</strong> the outcome is uncerta<strong>in</strong>.<br />
But is this decision irreversible? No. If after gett<strong>in</strong>g married a person decides that he<br />
or she is not satisfied with the outcome, the situation is reversible.<br />
Slide 5<br />
Types of <strong>Gambl<strong>in</strong>g</strong> Activities<br />
Note to facilitator:<br />
• If time allows, you could ask the group to bra<strong>in</strong>storm the various types of gambl<strong>in</strong>g activities.<br />
• For additional <strong>in</strong>formation on gambl<strong>in</strong>g games available <strong>in</strong> Ontario, visit the OLG website at www.olg.ca.<br />
• It’s important to stress that gambl<strong>in</strong>g is more than just cas<strong>in</strong>o games. In the same way that some people<br />
view different substances as more or less dangerous or serious, people may say the same of gambl<strong>in</strong>g. They<br />
may say th<strong>in</strong>gs such as, “I don’t go to the cas<strong>in</strong>o, I just play b<strong>in</strong>go.” The reality is that, despite the fact<br />
that some gambl<strong>in</strong>g activities appear to cause more problems for people, all gambl<strong>in</strong>g has some<br />
degree of risk associated with it.<br />
Lottery, scratch, pull-tab <strong>and</strong> raffle tickets<br />
Lotteries are the most popular form of gambl<strong>in</strong>g among adults <strong>in</strong> Ontario. There are<br />
over 10,700 lottery retailers <strong>in</strong> Ontario.<br />
B<strong>in</strong>go<br />
B<strong>in</strong>go has changed a lot over the past few decades. New technology now allows b<strong>in</strong>go<br />
halls to “l<strong>in</strong>k” to each other. This means games are played at the same time, result<strong>in</strong>g<br />
<strong>in</strong> jackpots that are substantially larger. In addition, some locations now offer<br />
electronic term<strong>in</strong>als with touch screens that assist players <strong>in</strong> play<strong>in</strong>g several b<strong>in</strong>go<br />
cards at once.<br />
Sports bett<strong>in</strong>g<br />
The Ontario Lottery <strong>and</strong> Gam<strong>in</strong>g Corporation (olg) offers <strong>in</strong>dividuals the opportunity<br />
to bet on certa<strong>in</strong> sports (hockey, football, baseball, soccer, college football <strong>and</strong> basketball)<br />
through Pro-l<strong>in</strong>e. In addition, some people may place bets with bookies or simply<br />
participate <strong>in</strong> sports pools with friends or co-workers.<br />
Slot mach<strong>in</strong>es<br />
Slot mach<strong>in</strong>es are the most problematic gambl<strong>in</strong>g activity for Ontario adults. In fact,<br />
60% of people experienc<strong>in</strong>g gambl<strong>in</strong>g problems <strong>in</strong> Ontario have problems with the<br />
slots (Williams & Wood, 2004). In Ontario, slot mach<strong>in</strong>es are found <strong>in</strong> cas<strong>in</strong>os as well<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
10 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
as <strong>in</strong> racetrack venues. In other Canadian prov<strong>in</strong>ces, video lottery term<strong>in</strong>als (VLTs)<br />
are also available.<br />
Suggested read<strong>in</strong>g:<br />
For more <strong>in</strong>formation on slot mach<strong>in</strong>es <strong>and</strong> VLTs, read “How Do Slot Mach<strong>in</strong>es <strong>and</strong> Other Electronic<br />
<strong>Gambl<strong>in</strong>g</strong> Mach<strong>in</strong>es Actually Work?” by Nigel Turner <strong>and</strong> Roger Horbay, available at:<br />
www.camh.net/egambl<strong>in</strong>g/archive/pdf/JGI-issue11/JGI-Issue11-turner-horbay.pdf<br />
Card <strong>and</strong> table games<br />
Table games <strong>in</strong>clude th<strong>in</strong>gs such as craps <strong>and</strong> roulette, while card games <strong>in</strong>clude<br />
games such as poker <strong>and</strong> blackjack. In Ontario, card <strong>and</strong> table games can be played<br />
at cas<strong>in</strong>os. Some people also engage <strong>in</strong> private games at home or <strong>in</strong> social clubs.<br />
Horse bett<strong>in</strong>g<br />
Bett<strong>in</strong>g on horse races has a long history <strong>in</strong> Canada. Before cas<strong>in</strong>os <strong>and</strong> lotteries were<br />
<strong>in</strong>troduced, horse rac<strong>in</strong>g was the only legal gambl<strong>in</strong>g activity available <strong>in</strong> Canada.<br />
These days, horse rac<strong>in</strong>g has exp<strong>and</strong>ed far beyond plac<strong>in</strong>g bets at a local track.<br />
Technology now gives people the opportunity to place bets on horse races happen<strong>in</strong>g<br />
anywhere <strong>in</strong> the world.<br />
Internet gambl<strong>in</strong>g<br />
Onl<strong>in</strong>e bett<strong>in</strong>g opportunities are endless. For example, a Google search for “onl<strong>in</strong>e<br />
gambl<strong>in</strong>g sites” produces tens of thous<strong>and</strong>s of results. People can bet on cas<strong>in</strong>o<br />
games, sports activities or b<strong>in</strong>go. People can also gamble on activities such as who<br />
will be the next person voted off on Survivor, which movie will w<strong>in</strong> “best picture” at<br />
the Oscars <strong>and</strong> whether a pregnant actress will have a boy or a girl.<br />
Stock market speculation<br />
This activity <strong>in</strong>volves purchas<strong>in</strong>g stock with the sole purpose of sell<strong>in</strong>g it to someone<br />
else at a higher price. This is different from <strong>in</strong>vest<strong>in</strong>g <strong>in</strong> that the speculator takes<br />
higher risks <strong>in</strong> the hopes of mak<strong>in</strong>g a profit, while an <strong>in</strong>vestor looks at the value that<br />
logically may accrue over time.<br />
Bett<strong>in</strong>g on other games<br />
People can also engage <strong>in</strong> less formal gambl<strong>in</strong>g activities such as bett<strong>in</strong>g on a game<br />
of golf, a new baby’s date of birth or the w<strong>in</strong>ner of a reality television program.<br />
Slide 6<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Def<strong>in</strong>ition<br />
<strong>Gambl<strong>in</strong>g</strong> is a problem when it disrupts or damages your:<br />
• work, school or other activities;<br />
• mental or physical health;<br />
• f<strong>in</strong>ances;<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 11<br />
• reputation;<br />
• relationships with family or friends.<br />
Note to facilitator:<br />
It is important to note that problem gambl<strong>in</strong>g is not just about los<strong>in</strong>g money—it can affect a person’s<br />
entire life.<br />
Another important issue to consider is language. The term that we use here is problem gambl<strong>in</strong>g. It is<br />
important for you to be familiar with the different terms used <strong>in</strong> the field, <strong>and</strong> why we chose this one<br />
<strong>in</strong> particular.<br />
The three most common terms used to describe over-<strong>in</strong>volvement <strong>in</strong> gambl<strong>in</strong>g are compulsive gambl<strong>in</strong>g,<br />
pathological gambl<strong>in</strong>g <strong>and</strong> problem gambl<strong>in</strong>g.<br />
• Compulsive gambl<strong>in</strong>g is a term familiar to the general public <strong>and</strong> used by Gamblers Anonymous. The<br />
term is not entirely accurate because gambl<strong>in</strong>g is not a compulsive disorder. It is classified as an impulsecontrol<br />
disorder <strong>in</strong> the DSM-IV; however, there is disagreement <strong>in</strong> the field about whether gambl<strong>in</strong>g<br />
belongs <strong>in</strong> this category.<br />
• Pathological gambl<strong>in</strong>g is the diagnostic term used <strong>in</strong> the DSM-IV. Pathological gambl<strong>in</strong>g is def<strong>in</strong>ed as a<br />
maladaptive practice characterized by persistent <strong>and</strong> repetitive play<strong>in</strong>g that is present when clients meet<br />
five or more of the follow<strong>in</strong>g criteria:<br />
- they are preoccupied with gambl<strong>in</strong>g;<br />
- they need to gamble with <strong>in</strong>creas<strong>in</strong>g amounts of money to atta<strong>in</strong> the desired state of excitement;<br />
- they have repeatedly <strong>and</strong> unsuccessfully attempted to control, cut back or stop gambl<strong>in</strong>g;<br />
- they are restless or irritable when attempt<strong>in</strong>g to cut down or stop gambl<strong>in</strong>g;<br />
- they gamble as a way of escap<strong>in</strong>g from problems or reliev<strong>in</strong>g a dysphoric mood (e.g., feel<strong>in</strong>gs of helplessness,<br />
guilt, anxiety or depression);<br />
- after los<strong>in</strong>g money gambl<strong>in</strong>g, they often return another day to get even;<br />
- they lie to family, a therapist or others to conceal the extent of their gambl<strong>in</strong>g;<br />
- they have committed illegal acts such as forgery, fraud, theft or embezzlement to f<strong>in</strong>ance gambl<strong>in</strong>g;<br />
- they have jeopardized or lost a significant relationship, job or educational or career opportunity because<br />
of gambl<strong>in</strong>g; or<br />
- they rely on others to provide money to relieve a desperate f<strong>in</strong>ancial situation caused by gambl<strong>in</strong>g.<br />
Note: A person who meets five or more of the above criteria is not considered to be a pathological<br />
gambler if his or her actions can be expla<strong>in</strong>ed by a manic episode.<br />
• <strong>Problem</strong> gambl<strong>in</strong>g is the term that is most commonly used throughout Canada. It is descriptive <strong>and</strong> is<br />
compatible with the notion that this problem can be very significant or very m<strong>in</strong>or. People do not have to<br />
lose everyth<strong>in</strong>g <strong>in</strong> their lives before gett<strong>in</strong>g help for “problem” gambl<strong>in</strong>g. Therefore, the term is broader<br />
<strong>and</strong> more <strong>in</strong>clusive. It is often used to describe gambl<strong>in</strong>g behaviour that <strong>in</strong>volves some type of harmful<br />
consequence. <strong>Problem</strong> gambl<strong>in</strong>g <strong>in</strong>cludes, but is not limited to, compulsive <strong>and</strong> pathological gambl<strong>in</strong>g.<br />
It is the most effective term because it does not label or stigmatize the person with the problem <strong>in</strong> the way<br />
“pathological” or “compulsive” can.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
12 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Why does it matter what we call it? The behaviour—gambl<strong>in</strong>g problematically—is the issue on which to<br />
focus. People have the problem, but they are not the problem. For example, call<strong>in</strong>g someone a “problem<br />
gambler” can reduce him or her to one th<strong>in</strong>g: a problem. Describ<strong>in</strong>g the situation rather than labell<strong>in</strong>g the<br />
person—for example, “someone experienc<strong>in</strong>g a gambl<strong>in</strong>g problem” or “someone affected by problem<br />
gambl<strong>in</strong>g”—reduces blame <strong>and</strong> stigma.<br />
Slide 7<br />
<strong>Gambl<strong>in</strong>g</strong> Prevalence Rates<br />
63.3% of Ontario adults have gambled <strong>in</strong> the past year.<br />
(Wiebe et al., 2006)<br />
Lottery tickets, raffle tickets <strong>and</strong> scratch tickets are the most common gambl<strong>in</strong>g activities<br />
engaged <strong>in</strong> by Ontario adults.<br />
(Wiebe et al., 2006)<br />
Slide 8<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Prevalence Rates<br />
3.4% of Ontario adults have moderate to severe gambl<strong>in</strong>g problems.<br />
Although the research <strong>in</strong>dicates that 63% of adults <strong>in</strong> Ontario gamble, 3.4% experience<br />
moderate to severe problems with gambl<strong>in</strong>g. That is equal to approximately<br />
332,000 people (Wiebe et al., 2006).<br />
Another 5.8% are at risk of develop<strong>in</strong>g a gambl<strong>in</strong>g problem.<br />
(Wiebe et al., 2006)<br />
Slot mach<strong>in</strong>es are the most problematic gambl<strong>in</strong>g activity engaged <strong>in</strong> by Ontario adults.<br />
Slot mach<strong>in</strong>es are the most problematic gambl<strong>in</strong>g activity because they provide<br />
<strong>in</strong>termittent re<strong>in</strong>forcement—a type of re<strong>in</strong>forcement that is very powerful because<br />
it is not cont<strong>in</strong>uous.<br />
Not only are slot mach<strong>in</strong>es the gambl<strong>in</strong>g activity with which adults <strong>in</strong> Ontario have the<br />
most difficulty, they are also the gambl<strong>in</strong>g activity that derives the most revenue from<br />
those who experience problems. 60% of the revenue derived from those experienc<strong>in</strong>g<br />
gambl<strong>in</strong>g problems comes from slot mach<strong>in</strong>es (Williams & Wood, 2004).<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 13<br />
Slide 9<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Prevalence Rates (cont<strong>in</strong>ued)<br />
Men experience double the rates of gambl<strong>in</strong>g problems experienced by women.<br />
In Ontario, males are twice as likely as females to have a gambl<strong>in</strong>g problem (4.6% vs.<br />
1.4%) (Wiebe et al., 2006).<br />
Young adults aged 18 to 24 years have the highest rates of gambl<strong>in</strong>g problems.<br />
In Ontario, 6.7% of 18- to 24-year-olds experience moderate to severe gambl<strong>in</strong>g<br />
problems, compared to:<br />
• 4% for ages 25 to 34;<br />
• 3.2% for ages 35 to 49;<br />
• 2% for ages 50 to 59; <strong>and</strong><br />
• 2.2% for those aged 60 years <strong>and</strong> over.<br />
(Wiebe et al., 2006)<br />
Slide 10<br />
Some Risk Factors<br />
An early “big w<strong>in</strong>”<br />
A big w<strong>in</strong> early on can lead to false expectations about future w<strong>in</strong>s. It is important to<br />
keep <strong>in</strong> m<strong>in</strong>d that what is considered “big,” <strong>in</strong> terms of a w<strong>in</strong>, is subjective <strong>and</strong> may<br />
vary from person to person. For example, while some people may see $100 as a big<br />
w<strong>in</strong>, others might not consider this amount to be very significant.<br />
Not underst<strong>and</strong><strong>in</strong>g the odds of w<strong>in</strong>n<strong>in</strong>g<br />
As we will see <strong>in</strong> Session 2, people often have false beliefs about how gambl<strong>in</strong>g<br />
games work. These false beliefs (for example, believ<strong>in</strong>g that there is a system that will<br />
<strong>in</strong>crease one’s chance of w<strong>in</strong>n<strong>in</strong>g) put people at <strong>in</strong>creased risk of develop<strong>in</strong>g a gambl<strong>in</strong>g<br />
problem.<br />
A history of alcohol <strong>and</strong>/or other drug problems<br />
As we will see <strong>in</strong> more detail <strong>in</strong> just a few moments, there is a l<strong>in</strong>k between substance<br />
use problems <strong>and</strong> gambl<strong>in</strong>g problems.<br />
A history of mental health problems, particularly depression, anxiety or trauma<br />
As we will also see, there is a l<strong>in</strong>k between mental health issues <strong>and</strong> problem gambl<strong>in</strong>g.<br />
In addition, research shows that rates of adult <strong>and</strong> childhood trauma are high among<br />
those experienc<strong>in</strong>g gambl<strong>in</strong>g problems, <strong>and</strong> that problem gambl<strong>in</strong>g rates are higher<br />
among those who have experienced trauma (Boughton & Brewster, 2002;<br />
Ledgerwood & Petry, 2006; Biddle et al., 2005).<br />
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14 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
A family history of problem gambl<strong>in</strong>g<br />
Research shows higher rates of problem gambl<strong>in</strong>g when a first-degree relative also<br />
has or had a gambl<strong>in</strong>g problem (Lobo & Kennedy, 2006).<br />
Lonel<strong>in</strong>ess, boredom or lack of leisure activities<br />
<strong>Gambl<strong>in</strong>g</strong> can easily alleviate feel<strong>in</strong>gs of lonel<strong>in</strong>ess or boredom. Also, s<strong>in</strong>ce it is easily<br />
accessible <strong>and</strong> available <strong>and</strong> is promoted as “fun” <strong>and</strong> “excit<strong>in</strong>g,” it is easy to see<br />
why someone may turn to this activity.<br />
Slide 11<br />
Some Risk Factors (cont<strong>in</strong>ued)<br />
A habit of us<strong>in</strong>g gambl<strong>in</strong>g to cope with negative feel<strong>in</strong>gs or events<br />
The dissociative nature of gambl<strong>in</strong>g—the “escape” that it sometimes provides—may<br />
be very appeal<strong>in</strong>g to someone who is unable to cope with negative feel<strong>in</strong>gs.<br />
A tendency for impulsive behaviour<br />
As we will see <strong>in</strong> a few moments, those who struggle with impulse control have higher<br />
rates of problem gambl<strong>in</strong>g.<br />
F<strong>in</strong>ancial problems<br />
Some people who struggle f<strong>in</strong>ancially may falsely believe that gambl<strong>in</strong>g is a solution<br />
to their f<strong>in</strong>ancial problems.<br />
Note: The more factors that apply, the more likely a person is to develop a gambl<strong>in</strong>g<br />
problem.<br />
Note to facilitator:<br />
The reasons for develop<strong>in</strong>g a gambl<strong>in</strong>g problem are both wide-rang<strong>in</strong>g <strong>and</strong> complex. Accord<strong>in</strong>g to the<br />
pathways model, developed by Alex Blaszczynski (1998), people experienc<strong>in</strong>g gambl<strong>in</strong>g problems can be<br />
categorized <strong>in</strong>to one of the follow<strong>in</strong>g three groups or “pathways”:<br />
• Non-psychopathological or normal: For this group, problem gambl<strong>in</strong>g is l<strong>in</strong>ked to environment <strong>and</strong> learn<strong>in</strong>g.<br />
<strong>Problem</strong> gambl<strong>in</strong>g may stem from an early w<strong>in</strong> or false beliefs about be<strong>in</strong>g able to w<strong>in</strong>. These people<br />
do not necessarily have pre-exist<strong>in</strong>g psychological problems; they simply misunderst<strong>and</strong> the games, lose<br />
money <strong>and</strong>/or chase losses. (Chas<strong>in</strong>g losses refers to cont<strong>in</strong>u<strong>in</strong>g to gamble to try to w<strong>in</strong> back money already<br />
lost, which almost always results <strong>in</strong> more losses.) Accord<strong>in</strong>g to Blaszczynski, with early <strong>in</strong>tervention, these<br />
people may be able to control their gambl<strong>in</strong>g.<br />
• Emotionally vulnerable: For this group, gambl<strong>in</strong>g problems are due to difficulty <strong>in</strong> manag<strong>in</strong>g stress or crisis<br />
<strong>in</strong> their life. They use gambl<strong>in</strong>g as a way of avoid<strong>in</strong>g underly<strong>in</strong>g issues <strong>and</strong> current stresses. These people<br />
can even be vulnerable dur<strong>in</strong>g times of “good” stress, such as the birth of a child. Blaszczynski believes<br />
that abst<strong>in</strong>ence, as well as learn<strong>in</strong>g anxiety reduction techniques, is the best option for these people.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 15<br />
• Biologically <strong>in</strong>fluenced or impulsive: This group comprises <strong>in</strong>dividuals who tend to have an impulse<br />
disorder, such as attention-deficit/hyperactivity disorder (ADHD). For this small percentage of people,<br />
gambl<strong>in</strong>g can trigger other b<strong>in</strong>ge behaviours. Accord<strong>in</strong>g to Blaszczynski, these people should receive<br />
counsell<strong>in</strong>g to deal with impulse control. People <strong>in</strong> this pathway will require <strong>in</strong>tervention by a psychologist<br />
or psychiatrist.<br />
The pathways model demonstrates that people develop gambl<strong>in</strong>g problems for different reasons. The model<br />
might not, however, account for all the factors that lead people <strong>in</strong>to gambl<strong>in</strong>g problems.<br />
Slide 12<br />
Impact of <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Significant f<strong>in</strong>ancial loss<br />
The most common negative impact of problem gambl<strong>in</strong>g is f<strong>in</strong>ancial loss. Sav<strong>in</strong>gs,<br />
property or belong<strong>in</strong>gs may be lost <strong>and</strong> excessive spend<strong>in</strong>g on gambl<strong>in</strong>g may also<br />
mean that bills are not paid, utilities are cut off <strong>and</strong> money for necessities such as<br />
groceries is <strong>in</strong> short supply.<br />
Higher rates of relationship <strong>and</strong> family breakdown<br />
Because gambl<strong>in</strong>g can be hidden for a long time, many families are shocked when<br />
the full impact of the gambl<strong>in</strong>g is discovered. While some families are able to recover,<br />
not all are able to survive gambl<strong>in</strong>g problems.<br />
Higher rates of emotional <strong>and</strong> health problems<br />
The stress of problem gambl<strong>in</strong>g can cause health issues such as anxiety, depression<br />
or other stress-related issues such as poor sleep, ulcers, bowel problems, headaches<br />
<strong>and</strong> muscle pa<strong>in</strong>s.<br />
Work-related difficulties<br />
Once gambl<strong>in</strong>g problems beg<strong>in</strong>, preoccupation with gambl<strong>in</strong>g or gambl<strong>in</strong>g-related<br />
debt may lead to neglected work responsibilities or <strong>in</strong>creased absenteeism.<br />
Legal problems<br />
Some <strong>in</strong>dividuals may turn to theft, fraud or embezzlement to f<strong>in</strong>ance their gambl<strong>in</strong>g<br />
or to deal with gambl<strong>in</strong>g-related debt.<br />
Higher rates of suicide<br />
Suicide attempts are more frequent among those who are experienc<strong>in</strong>g problems<br />
related to gambl<strong>in</strong>g, compared with the general population. In addition, suicide<br />
attempts are more common among people experienc<strong>in</strong>g problems related to gambl<strong>in</strong>g<br />
than among those experienc<strong>in</strong>g problems with any other types of addictions<br />
(National Council of Welfare, 1996). As a result, it is important to screen those who<br />
are struggl<strong>in</strong>g with this issue for suicidality.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
16 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 13<br />
Concurrent Substance Use <strong>and</strong> <strong>Gambl<strong>in</strong>g</strong> <strong>Problem</strong>s<br />
There are higher rates of alcohol, other drug <strong>and</strong> nicot<strong>in</strong>e dependence among those<br />
who are experienc<strong>in</strong>g gambl<strong>in</strong>g problems.<br />
In both treatment <strong>and</strong> general population samples, research shows higher rates of<br />
alcohol, other drug <strong>and</strong> nicot<strong>in</strong>e dependence among those who are experienc<strong>in</strong>g<br />
gambl<strong>in</strong>g problems (Kennedy et al., 2008; Petry et al., 2005; Welte et al., 2001;<br />
Crockford & el-Guebaly, 1998; Smart & Ferris, 1994; Bl<strong>and</strong>, et al., 1993;<br />
Cunn<strong>in</strong>gham-Williams et al., 1998; Toneatto et al., 2002; Feigelman et al., 1998).<br />
There are also higher rates of problem gambl<strong>in</strong>g among <strong>in</strong>dividuals with substance<br />
use problems.<br />
In addition, research shows higher rates of problem gambl<strong>in</strong>g among <strong>in</strong>dividuals<br />
with substance use problems (Daghestani et al., 1996; Giacopassi et al., 1998;<br />
Lejoyeux et al., 1999; Crockford & el-Guebaly, 1998; Lesieur et al., 1986; St<strong>in</strong>chfield<br />
et al., 2005).<br />
Slide 14<br />
Possible L<strong>in</strong>ks between <strong>Gambl<strong>in</strong>g</strong> <strong>and</strong> Substance Use <strong>Problem</strong>s<br />
<strong>Gambl<strong>in</strong>g</strong> is falsely viewed as a safer alternative.<br />
Because gambl<strong>in</strong>g is promoted as a fun activity, <strong>and</strong> because people are not as aware<br />
of its potential risks, people who make changes to their substance use sometimes<br />
engage <strong>in</strong> gambl<strong>in</strong>g, believ<strong>in</strong>g it is safer than dr<strong>in</strong>k<strong>in</strong>g or us<strong>in</strong>g other drugs.<br />
<strong>Gambl<strong>in</strong>g</strong> is falsely viewed as a way to f<strong>in</strong>ance substance use.<br />
Someone need<strong>in</strong>g money for drugs, for example, may turn to gambl<strong>in</strong>g, believ<strong>in</strong>g<br />
that this is an easy way to make money.<br />
Us<strong>in</strong>g substances can lead to poor judgment <strong>in</strong> gambl<strong>in</strong>g activities.<br />
<strong>Gambl<strong>in</strong>g</strong> while under the <strong>in</strong>fluence is particularly risky, as it may lead to poor<br />
decision mak<strong>in</strong>g.<br />
Substances may be used to cope with negative consequences of gambl<strong>in</strong>g.<br />
Someone struggl<strong>in</strong>g with, for example, significant f<strong>in</strong>ancial losses because of gambl<strong>in</strong>g<br />
may turn to alcohol or other drugs to cope with negative feel<strong>in</strong>gs.<br />
There are some common biological factors shared by substance <strong>and</strong> gambl<strong>in</strong>g<br />
dependence.<br />
As already mentioned, we all learn through reward <strong>and</strong> punishment, <strong>and</strong> for some<br />
people the reward system of the bra<strong>in</strong> works a bit differently. These <strong>in</strong>dividuals are<br />
able to take more risks <strong>and</strong> are less sensitive to reward. As a result, it is believed that<br />
they are at <strong>in</strong>creased risk for addictions (Chambers et al., 2003).<br />
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<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 17<br />
Note to facilitator:<br />
These are some possible connections between gambl<strong>in</strong>g <strong>and</strong> substance use. You may want to ask participants<br />
if they can th<strong>in</strong>k of additional connections.<br />
Slide 15<br />
Mood Disorders <strong>and</strong> <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Mood disorders are very common among those who are experienc<strong>in</strong>g gambl<strong>in</strong>g<br />
problems.<br />
Mood disorders such as major depressive disorder <strong>and</strong> dysthymic disorder, as well as<br />
manic <strong>and</strong> hypomanic episodes, are common among those who experience gambl<strong>in</strong>g<br />
problems (Petry et al., 2005).<br />
Also, accord<strong>in</strong>g to a study conducted by Kennedy et al. (2008), there is more than<br />
twice the Canadian average rate of problem gambl<strong>in</strong>g <strong>in</strong> people seek<strong>in</strong>g help for<br />
major depressive disorder. Further, this study found that more than 70% of people<br />
experienc<strong>in</strong>g gambl<strong>in</strong>g problems reported that their mood disorder came before<br />
their gambl<strong>in</strong>g problem.<br />
In addition, accord<strong>in</strong>g to a Canadian study by McIntyre et al. (2007), <strong>in</strong>dividuals who<br />
have been diagnosed with bipolar disorder have double the rates of problem gambl<strong>in</strong>g<br />
experienced by the general population.<br />
In some cases mood disorders can lead to the development of a gambl<strong>in</strong>g problem;<br />
<strong>in</strong> other cases, gambl<strong>in</strong>g problems can lead to a mood disorder.<br />
In some cases, the mood disorder is a contribut<strong>in</strong>g factor to the development of the<br />
gambl<strong>in</strong>g problem, while <strong>in</strong> other cases, it is the result of the gambl<strong>in</strong>g problem. For<br />
example, someone who struggles with depression may turn to gambl<strong>in</strong>g because it<br />
helps to alleviate depressive symptoms. Or, because of f<strong>in</strong>ancial losses due to gambl<strong>in</strong>g,<br />
a person may start experienc<strong>in</strong>g mood-related problems.<br />
In some cases, the mood <strong>and</strong> gambl<strong>in</strong>g problems may be cyclical—the mood disorder<br />
leads to a gambl<strong>in</strong>g problem which <strong>in</strong> turn leads to more mood issues, <strong>and</strong> so on.<br />
Be<strong>in</strong>g aware of the connection between gambl<strong>in</strong>g <strong>and</strong> mood problems is important<br />
as it will have an impact on treatment for both of these issues.<br />
Slide 16<br />
Anxiety Disorders <strong>and</strong> <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Anxiety disorders are very common among those who are experienc<strong>in</strong>g gambl<strong>in</strong>g<br />
problems.<br />
Anxiety disorders such as panic disorder (with or without agoraphobia), social phobia,<br />
specific phobias, generalized anxiety <strong>and</strong> obsessive-compulsive disorder are common<br />
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among those who are experienc<strong>in</strong>g gambl<strong>in</strong>g problems (Petry et al., 2005; Crockford<br />
& el-Guebaly, 1998). In fact, accord<strong>in</strong>g to a study conducted by Kennedy et al. (2008),<br />
people with gambl<strong>in</strong>g problems reported higher rates of anxiety disorders than the<br />
Canadian average.<br />
In some cases anxiety disorders can lead to the development of a gambl<strong>in</strong>g problem;<br />
<strong>in</strong> other cases, the gambl<strong>in</strong>g problem can lead to an anxiety disorder.<br />
Similar to mood disorders, <strong>in</strong> some cases the anxiety disorder is a contribut<strong>in</strong>g factor<br />
to the development of the gambl<strong>in</strong>g problem, while <strong>in</strong> other cases, it is the result<br />
of the gambl<strong>in</strong>g problem. For example, people who are hav<strong>in</strong>g difficulty deal<strong>in</strong>g with<br />
anxiety may turn to gambl<strong>in</strong>g because the sometimes dissociative nature of gambl<strong>in</strong>g<br />
helps to alleviate their anxiety symptoms. Or, some people may struggle with anxiety<br />
result<strong>in</strong>g from the many lies they have told to conceal their gambl<strong>in</strong>g problem.<br />
In some cases, the anxiety <strong>and</strong> gambl<strong>in</strong>g problems may be cyclical—the anxiety disorder<br />
leads to a gambl<strong>in</strong>g problem which <strong>in</strong> turn leads to more anxiety, <strong>and</strong> so on.<br />
Be<strong>in</strong>g aware of the connection between gambl<strong>in</strong>g <strong>and</strong> anxiety problems is important<br />
as it will have an impact on treatment for both of these issues.<br />
Slide 17<br />
Impulsivity <strong>and</strong> <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Impulsivity <strong>in</strong> general is common among those experienc<strong>in</strong>g gambl<strong>in</strong>g problems.<br />
Research shows that impulsivity as a trait—as well as disorders that <strong>in</strong>clude aspects<br />
of impulsivity, such as attention-deficit/hyperactivity disorder, antisocial personality<br />
disorder <strong>and</strong> substance-related disorders—are common among those experienc<strong>in</strong>g<br />
gambl<strong>in</strong>g problems (Rodriguez-Jimenez et al., 2006; Petry et al., 2005; Crockford &<br />
el-Guebaly, 1998). Pathological gambl<strong>in</strong>g is classified as an impulse-control disorder<br />
<strong>in</strong> the DSM-IV.<br />
The person’s lack of impulse control can make self-restra<strong>in</strong>t difficult.<br />
Slide 18<br />
Psychosis <strong>and</strong> <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong><br />
Rates of pathological gambl<strong>in</strong>g are higher among <strong>in</strong>dividuals who have been diagnosed<br />
with schizophrenia than <strong>in</strong> the general population.<br />
There is not a lot of research on gambl<strong>in</strong>g <strong>and</strong> psychotic disorders. The research that<br />
exists, however, suggests that rates of pathological gambl<strong>in</strong>g (this term is discussed<br />
<strong>in</strong>a moment) are higher among <strong>in</strong>dividuals who have been diagnosed with schizophrenia<br />
than <strong>in</strong> those who have not been diagnosed (Borras & Huguelet, 2007).<br />
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Psychosis is not as common among those experienc<strong>in</strong>g gambl<strong>in</strong>g problems as are<br />
mood <strong>and</strong> anxiety disorders or impulsivity.<br />
Although psychosis is not as common as other mental health disorders among those<br />
experienc<strong>in</strong>g gambl<strong>in</strong>g problems, it rema<strong>in</strong>s an issue for some. For some, psychotic<br />
symptoms such as auditory halluc<strong>in</strong>ations may be a contribut<strong>in</strong>g factor to gambl<strong>in</strong>g.<br />
For example, a person may hear voices tell<strong>in</strong>g him or her to gamble. In addition, for<br />
those who already struggle with psychosis, the stress of problem gambl<strong>in</strong>g may be a<br />
trigger for psychotic symptoms.<br />
Slide 19<br />
Cont<strong>in</strong>uum of <strong>Gambl<strong>in</strong>g</strong> Behaviour<br />
Note to facilitator:<br />
Expla<strong>in</strong> the cont<strong>in</strong>uum to the group. Be sure to clarify that a person can be at more than one place on the<br />
cont<strong>in</strong>uum. For example, you may place yourself at “occasional gambl<strong>in</strong>g” for your b<strong>in</strong>go play <strong>and</strong> “regular<br />
gambl<strong>in</strong>g” for your lottery use.<br />
Once you’ve described the cont<strong>in</strong>uum, ask participants where they “fit” on the cont<strong>in</strong>uum <strong>in</strong> terms of their<br />
own gambl<strong>in</strong>g behaviours. Depend<strong>in</strong>g on people’s comfort level, this activity can either be done as a group<br />
or <strong>in</strong>dividually.<br />
For those who fall <strong>in</strong>to the “No <strong>Gambl<strong>in</strong>g</strong>,” “Occasional <strong>Gambl<strong>in</strong>g</strong>” <strong>and</strong> “Regular <strong>Gambl<strong>in</strong>g</strong>” categories of<br />
the cont<strong>in</strong>uum, prevention <strong>and</strong> education is recommended. This is the purpose of Sessions 1 <strong>and</strong> 2.<br />
For those who fall <strong>in</strong>to the “<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>” <strong>and</strong> “Pathological <strong>Gambl<strong>in</strong>g</strong>” categories of the cont<strong>in</strong>uum,<br />
changes related to their gambl<strong>in</strong>g behaviour are recommended. This can mean either reduc<strong>in</strong>g or quitt<strong>in</strong>g<br />
some or all gambl<strong>in</strong>g activities. These clients should also participate <strong>in</strong> Sessions 3 <strong>and</strong> 4, where gambl<strong>in</strong>g<br />
problems are addressed <strong>in</strong> more detail.<br />
At this time, if you have not already done so, have participants complete the “<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Severity<br />
Index” screen<strong>in</strong>g tool (Appendix A). Anyone who scores a 3 or higher should be encouraged to attend<br />
Sessions 3 <strong>and</strong> 4.<br />
No gambl<strong>in</strong>g<br />
With no gambl<strong>in</strong>g, there is no risk of develop<strong>in</strong>g a problem.<br />
Occasional gambl<strong>in</strong>g<br />
A person who gambles occasionally is someone who may, for example, go to the cas<strong>in</strong>o<br />
for an even<strong>in</strong>g of enterta<strong>in</strong>ment once <strong>in</strong> a while. <strong>Gambl<strong>in</strong>g</strong> is not this person’s<br />
ma<strong>in</strong> leisure activity.<br />
Regular gambl<strong>in</strong>g<br />
A person who gambles regularly may dedicate considerable time to gambl<strong>in</strong>g but not<br />
to the po<strong>in</strong>t where it is damag<strong>in</strong>g to other areas of his or her life. This person may,<br />
for example, buy weekly lottery tickets or go to weekly b<strong>in</strong>go.<br />
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<strong>Problem</strong> gambl<strong>in</strong>g<br />
As already def<strong>in</strong>ed, problem gambl<strong>in</strong>g is a pattern of gambl<strong>in</strong>g that disrupts or damages<br />
one’s health, f<strong>in</strong>ances, reputation, relationships or vocational/academic pursuits.<br />
The problems can range from mild to severe.<br />
Pathological gambl<strong>in</strong>g<br />
For a small but significant number of people, gambl<strong>in</strong>g seriously harms all aspects<br />
of their lives. People with gambl<strong>in</strong>g problems this severe are unable to control the<br />
urge to gamble, despite the harm it causes.<br />
Slide 20<br />
<strong>Problem</strong>atic vs. Non-<strong>Problem</strong>atic <strong>Gambl<strong>in</strong>g</strong><br />
Note to facilitator:<br />
Give participants a copy of the “<strong>Problem</strong>atic vs. Non-<strong>Problem</strong>atic <strong>Gambl<strong>in</strong>g</strong>” h<strong>and</strong>out (Appendix C) <strong>and</strong><br />
review it with them. If time allows, prior to distribut<strong>in</strong>g the h<strong>and</strong>out, you can also do a bra<strong>in</strong>storm with the<br />
group to come up with examples of problematic <strong>and</strong> non-problematic gambl<strong>in</strong>g.<br />
F<strong>in</strong>ancial limits<br />
Non-problematic: Individuals who gamble non-problematically only lose money<br />
that they can afford to lose. Money is budgeted for this activity <strong>in</strong> the same way that<br />
money is budgeted for other social activities. When the funds are spent, the gambl<strong>in</strong>g<br />
stops.<br />
<strong>Problem</strong>atic: Individuals who gamble problematically lose more money than they<br />
can afford to lose <strong>and</strong> often make the situation worse by try<strong>in</strong>g to w<strong>in</strong> back what they<br />
have lost.<br />
Time limits<br />
Non-problematic: Individuals who gamble non-problematically control the amount<br />
of time they spend gambl<strong>in</strong>g.<br />
<strong>Problem</strong>atic: Individuals who gamble problematically often lose track of time <strong>and</strong><br />
spend more time gambl<strong>in</strong>g than they <strong>in</strong>tend.<br />
Enterta<strong>in</strong>ment<br />
Non-problematic: Individuals who gamble non-problematically enjoy gambl<strong>in</strong>g as a<br />
form of social or recreational activity <strong>in</strong> which they engage periodically. <strong>Gambl<strong>in</strong>g</strong><br />
meets personal social needs such as gett<strong>in</strong>g out of the house <strong>and</strong> see<strong>in</strong>g other people.<br />
<strong>Problem</strong>atic: Individuals who gamble problematically are more likely to see gambl<strong>in</strong>g<br />
as a form of <strong>in</strong>come or a game of skill that they can conquer.<br />
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Other activities<br />
Non-problematic: Individuals who gamble non-problematically enjoy gambl<strong>in</strong>g as<br />
one of many social activities <strong>in</strong> a balanced lifestyle.<br />
<strong>Problem</strong>atic: Individuals who gamble problematically often spend a great deal of<br />
time gambl<strong>in</strong>g while miss<strong>in</strong>g family functions <strong>and</strong> skipp<strong>in</strong>g other activities that they<br />
used to enjoy. They often th<strong>in</strong>k about gambl<strong>in</strong>g even when they are not gambl<strong>in</strong>g.<br />
Relationships<br />
Non-problematic: Individuals who gamble non-problematically do not allow their<br />
gambl<strong>in</strong>g to disrupt their personal, social <strong>and</strong> professional relationships.<br />
<strong>Problem</strong>atic: Individuals who gamble problematically f<strong>in</strong>d that gambl<strong>in</strong>g disrupts<br />
personal, social <strong>and</strong> professional relationships.<br />
Personal control<br />
Non-problematic: Individuals who gamble non-problematically have control over the<br />
amount of money they spend gambl<strong>in</strong>g.<br />
<strong>Problem</strong>atic: Individuals who gamble problematically lose control over the amount of<br />
time <strong>and</strong> money they spend gambl<strong>in</strong>g.<br />
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©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 23<br />
Session 2<br />
Depend<strong>in</strong>g on the number of participants <strong>and</strong> the amount of group discussion, this<br />
session will take between 60 <strong>and</strong> 90 m<strong>in</strong>utes.<br />
For this session you will need:<br />
• laptop computer <strong>and</strong> lcd projector<br />
• Session 2 PowerPo<strong>in</strong>t presentation<br />
• Internet access<br />
• flipchart <strong>and</strong> markers<br />
• participant h<strong>and</strong>outs:<br />
- Reduc<strong>in</strong>g the Risk (Appendix D)<br />
- Session 2 PowerPo<strong>in</strong>t presentation<br />
Slide 21<br />
Underst<strong>and</strong><strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong><br />
This second session focuses on:<br />
• how games of chance work;<br />
• false beliefs <strong>and</strong> superstitions associated with gambl<strong>in</strong>g; <strong>and</strong><br />
• strategies for reduc<strong>in</strong>g the risk of develop<strong>in</strong>g a gambl<strong>in</strong>g problem.<br />
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24 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 22<br />
The Slot Mach<strong>in</strong>e: What Every Player Needs to Know<br />
Note to facilitator:<br />
Most people are unaware of how games of chance actually work, <strong>and</strong> false beliefs are particularly common<br />
with slot mach<strong>in</strong>es. “The Slot Mach<strong>in</strong>e: What Every Player Needs to Know” is a 10-m<strong>in</strong>ute video that was<br />
co-developed by the Ontario <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Research Centre <strong>and</strong> OLG. This video challenges many of<br />
the myths associated with slot mach<strong>in</strong>es <strong>and</strong> clearly shows how they really work.<br />
To view the “The Slot Mach<strong>in</strong>e: What Every Player Needs to Know” video, go to the www.KnowYourLimit.ca<br />
website. The l<strong>in</strong>k to the video is available at the bottom of the home page.<br />
This video is <strong>in</strong>tended as a prevention tool. It is not meant to encourage anyone who has quit gambl<strong>in</strong>g to<br />
resume. Be sure to <strong>in</strong>form participants of this prior to show<strong>in</strong>g the video. In addition, although the focus<br />
of this video is slot mach<strong>in</strong>es, it describes a number of important concepts that are relevant to all games<br />
of chance.<br />
After the group watches the video, ask participants what they thought:<br />
• Was this new <strong>in</strong>formation?<br />
• Did they know the odds would always be the same for each play of the slot mach<strong>in</strong>e?<br />
Or did they believe the odds changed based on when the mach<strong>in</strong>e last paid out?<br />
• Were they surprised that past w<strong>in</strong>s/losses have no impact on current or future w<strong>in</strong>s?<br />
• If they do occasionally gamble on slot mach<strong>in</strong>es, will this <strong>in</strong>formation change how<br />
they play? If so, how?<br />
Slide 23<br />
The Co<strong>in</strong> Toss: Activity 1<br />
Note to facilitator:<br />
Expla<strong>in</strong><strong>in</strong>g important concepts about how games of chance work (for example, r<strong>and</strong>omness, <strong>in</strong>dependent<br />
outcomes, odds) can be particularly challeng<strong>in</strong>g. The follow<strong>in</strong>g co<strong>in</strong> toss activities are <strong>in</strong>tended to help you<br />
demonstrate these concepts <strong>in</strong> a simple way. Some participants may question whether this activity is considered<br />
gambl<strong>in</strong>g. Because no one is risk<strong>in</strong>g anyth<strong>in</strong>g of value, it is not.<br />
Activity 1:<br />
• Flip a co<strong>in</strong> five times <strong>and</strong> write the five outcomes (“heads” or “tails”) on the board.<br />
• Now flip the co<strong>in</strong> another five times, but before each flip ask participants what they<br />
th<strong>in</strong>k the outcome will be. Record each outcome.<br />
• Once you’ve completed all 10 co<strong>in</strong> tosses, ask participants what made them pick<br />
heads or tails. What was their reason<strong>in</strong>g?<br />
Debrief:<br />
• Guess<strong>in</strong>g heads or tails is just that—a guess. There is no sure way to know what will<br />
come up. It is r<strong>and</strong>om.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
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• People often mistakenly look for patterns, lucky streaks or what is “due to come up”<br />
when they gamble. All games of chance have an element of r<strong>and</strong>omness that affects<br />
the outcome. There is no way to predict what the outcome will be. (We will go <strong>in</strong>to<br />
more detail about r<strong>and</strong>omness <strong>in</strong> a moment.)<br />
Slide 24<br />
The Co<strong>in</strong> Toss: Activity 2<br />
Activity 2:<br />
• For this second activity, ask participants which of these three patterns is the most<br />
likely to occur <strong>and</strong> why they picked the pattern they did.<br />
Heads or tails?<br />
H H H T H H H T T T<br />
T T T T T H H H H H<br />
T T T T T T T T T T<br />
Debrief:<br />
• People are likely to choose the first pattern.<br />
• As mentioned for the previous activity, however, there is no pattern that is more likely<br />
to come up. People choose the first pattern because it appears to be more r<strong>and</strong>om; that<br />
is, it looks more like what we would expect. The second <strong>and</strong> third patterns seem too<br />
ordered to occur naturally. However, s<strong>in</strong>ce each <strong>in</strong>dependent flip of the co<strong>in</strong> has a 50%<br />
chance of l<strong>and</strong><strong>in</strong>g on heads or tails, all three series of 10 flips are equally likely to occur.<br />
Slide 25<br />
R<strong>and</strong>omness<br />
Most gambl<strong>in</strong>g games are based on r<strong>and</strong>omness, mean<strong>in</strong>g they occur without reason,<br />
aim or pattern. This means:<br />
• no one can predict the outcome;<br />
• there is no connection between results;<br />
• all outcomes are equally likely.<br />
Note to facilitator:<br />
When gambl<strong>in</strong>g, people often mistakenly try to assign patterns. For example, someone may believe that a<br />
slot mach<strong>in</strong>e is “due for a w<strong>in</strong>” because it has lost several times <strong>in</strong> a row. But, s<strong>in</strong>ce each sp<strong>in</strong> activates a<br />
r<strong>and</strong>om number generator, there is no way of know<strong>in</strong>g when a mach<strong>in</strong>e is due to w<strong>in</strong>—each sp<strong>in</strong> is r<strong>and</strong>om.<br />
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26 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Another example to consider is the lottery. Whether you buy a quick pick ticket or you select the numbers<br />
yourself has no impact on the outcome. All outcomes are equally likely.<br />
(Turner & Powel, 2007)<br />
Slide 26<br />
Independent Outcomes<br />
Most gambl<strong>in</strong>g games <strong>in</strong>volve <strong>in</strong>dependent outcomes.<br />
R<strong>and</strong>om events are <strong>in</strong>dependent from each other; <strong>in</strong> other words, gambl<strong>in</strong>g games<br />
have no memories.<br />
For example, a sp<strong>in</strong> of the roulette wheel is <strong>in</strong> no way affected by the previous sp<strong>in</strong>.<br />
Note to facilitator:<br />
What happened on previous plays has no impact on current or future play. If we consider our co<strong>in</strong> toss<br />
example aga<strong>in</strong>, a co<strong>in</strong> toss has no effect on the next co<strong>in</strong> toss. The co<strong>in</strong> doesn’t “remember” what the<br />
last outcome was <strong>and</strong> is not capable of “balanc<strong>in</strong>g” the overall outcome so that it is 50/50 (Turner &<br />
Powel, 2007).<br />
Slide 27<br />
The House Edge<br />
The “house” is the organization that sponsors the games.<br />
Examples <strong>in</strong>clude the cas<strong>in</strong>o, b<strong>in</strong>go hall, racetrack <strong>and</strong> lottery commission.<br />
The house edge is what the house “charges” the player to play the game.<br />
When people gamble on cas<strong>in</strong>o or lottery games, for example, they are always play<strong>in</strong>g<br />
at a mathematical disadvantage, because the odds are set up <strong>in</strong> favour of the<br />
house. Even <strong>in</strong> games that <strong>in</strong>volve some skill (for example, poker, sports bett<strong>in</strong>g) the<br />
game is set up to guarantee a profit for the house.<br />
Over time, no amount of skill can beat this house edge.<br />
Although people may w<strong>in</strong> <strong>in</strong> the short term, because of this built-<strong>in</strong> advantage, over<br />
time they will likely lose more than they will w<strong>in</strong>. This is what makes cas<strong>in</strong>os <strong>and</strong> lotteries<br />
so profitable.<br />
(Turner & Fritz, 2007)<br />
Examples of the house edge:<br />
• Blackjack: When both the player <strong>and</strong> the dealer go over 21 (technically a tie), the<br />
player loses.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 27<br />
• Roulette: The wheel has 38 slots but only 36 have numbers <strong>and</strong> are either red or<br />
black. The two rema<strong>in</strong><strong>in</strong>g slots are 0 <strong>and</strong> 00 <strong>and</strong> both green. Therefore, when the<br />
marble l<strong>and</strong>s on either 0 or 00, all the players who bet on red or black lose their bets.<br />
Slide 28<br />
Odds<br />
The odds are your chances of w<strong>in</strong>n<strong>in</strong>g.<br />
For example, <strong>in</strong> a co<strong>in</strong> toss your chance of accurately predict<strong>in</strong>g the outcome is two<br />
to one (50%).<br />
In gambl<strong>in</strong>g, the odds are always aga<strong>in</strong>st the person plac<strong>in</strong>g the bet.<br />
The house (the cas<strong>in</strong>o, b<strong>in</strong>go hall, racetrack, lottery commission, etc.) is absolutely<br />
guaranteed mathematically to w<strong>in</strong> over time. This is how they make their money.<br />
The longer you gamble, the more likely it is you will lose.<br />
Because the house has a mathematical advantage, the longer you gamble, the more<br />
likely it is you will lose.<br />
The house always has the edge.<br />
This is because the odds are set up <strong>in</strong> favour of the house.<br />
(Turner & Powel, 2007)<br />
Slide 29<br />
What Are Your Chances?<br />
Say that my brother lived somewhere <strong>in</strong> Ontario but I did not know his phone number.<br />
If I were to r<strong>and</strong>omly dial any Ontario residential phone number, what do you th<strong>in</strong>k<br />
the odds are that I would reach him?<br />
Most people would say that this is impossible! And yet so many people play Lotto<br />
6/49 <strong>and</strong> believe they have a good chance of w<strong>in</strong>n<strong>in</strong>g.<br />
Note to facilitator:<br />
Accord<strong>in</strong>g to Statistics Canada, <strong>in</strong> 2008, the Ontario population was approximately 12,900,000. If you consider<br />
that not every s<strong>in</strong>gle Ontarian has a residential telephone number, you can see that the chances of<br />
reach<strong>in</strong>g my brother by telephone are better than my chances of w<strong>in</strong>n<strong>in</strong>g the Lotto 6/49 (which are approximately<br />
one <strong>in</strong> 14 million)(Statistics Canada, 2009).<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
28 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 30<br />
Games of Chance—No Skill<br />
These games are based only on chance, r<strong>and</strong>omness <strong>and</strong> <strong>in</strong>dependent outcomes.<br />
Examples:<br />
• lottery/scratch tickets<br />
• roulette<br />
• b<strong>in</strong>go<br />
• dice games<br />
• slot mach<strong>in</strong>es<br />
(Turner & Fritz, 2007)<br />
Slide 31<br />
Games of Chance—Some Skill<br />
These games <strong>in</strong>volve some skill, but so much r<strong>and</strong>omness is <strong>in</strong>volved that the<br />
chances of w<strong>in</strong>n<strong>in</strong>g are still very low.<br />
The house advantage is lower than games that require no skill, but although players<br />
may w<strong>in</strong> <strong>in</strong> the short term, it is mathematically likely that over time, they will lose<br />
more than they w<strong>in</strong>.<br />
Examples:<br />
• card games<br />
By follow<strong>in</strong>g a basic strategy, skilled players may have more opportunity to m<strong>in</strong>imize<br />
their losses, or play for longer with the same amount of money. It is important to<br />
remember, however, that card games still have a r<strong>and</strong>om element (there are only so<br />
many cards <strong>and</strong> you don’t know which cards will be dealt) <strong>and</strong> that players can lose<br />
many times consecutively regardless of how well they play.<br />
• sports bett<strong>in</strong>g<br />
There is still a great deal of uncerta<strong>in</strong>ty <strong>in</strong> sports bett<strong>in</strong>g (for example, weather conditions,<br />
health of the players, etc.). For Pro-l<strong>in</strong>e, for example, you have to make the<br />
po<strong>in</strong>t spread <strong>and</strong>/or choose the three w<strong>in</strong>n<strong>in</strong>g teams <strong>in</strong> order to w<strong>in</strong>.<br />
• horse bett<strong>in</strong>g<br />
There is also a great deal of uncerta<strong>in</strong>ty <strong>in</strong> horse bett<strong>in</strong>g (for example, health of the<br />
horse or the jockey, track conditions, etc.). In addition, the odds are based on how<br />
many bets have been placed on a certa<strong>in</strong> horse.<br />
(Turner & Fritz, 2007)<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 29<br />
Slide 32<br />
Cognitive Distortions<br />
False <strong>and</strong> superstitious thoughts, ideas or beliefs<br />
As we will see, cognitive distortions are of particular importance when it comes to<br />
gambl<strong>in</strong>g.<br />
Common <strong>in</strong> all societies<br />
For example, <strong>in</strong> North American culture, the follow<strong>in</strong>g superstitions <strong>and</strong> beliefs are<br />
common:<br />
• walk<strong>in</strong>g under a ladder = bad luck<br />
• cross<strong>in</strong>g the path of a black cat = bad luck<br />
• groom see<strong>in</strong>g the bride before the wedd<strong>in</strong>g = bad luck<br />
• break<strong>in</strong>g a mirror = seven years of bad luck<br />
• open<strong>in</strong>g an umbrella <strong>in</strong> the house = bad luck<br />
• a rabbit’s foot = good luck<br />
• blow<strong>in</strong>g out c<strong>and</strong>les on a birthday cake = good luck (your wish will come true, but<br />
only if you do not tell anyone what you wished for!)<br />
• an itchy palm = money will come your way<br />
• number 13 = unlucky (most large build<strong>in</strong>gs <strong>in</strong> North America do not have a 13th<br />
floor—the elevator numbers go from 12 to 14!)<br />
Risk factor for problem gambl<strong>in</strong>g<br />
Although cognitive distortions are common to us all, when it comes to gambl<strong>in</strong>g,<br />
they are of particular concern.<br />
Slide 33<br />
Common <strong>Gambl<strong>in</strong>g</strong>-Related Cognitive Distortions<br />
Note to facilitator:<br />
This slide looks at a number of gambl<strong>in</strong>g-specific cognitive distortions. You can go <strong>in</strong>to as much or as<br />
little detail as needed, depend<strong>in</strong>g on the time available <strong>and</strong> the <strong>in</strong>terest of the group.<br />
Control over luck<br />
Luck as a variable: Actively try<strong>in</strong>g to manipulate luck through superstitious behaviours,<br />
such as wear<strong>in</strong>g a lucky bracelet.<br />
Luck as a trait: Believ<strong>in</strong>g that you are naturally lucky with certa<strong>in</strong> games <strong>and</strong> unlucky<br />
with others.<br />
Align<strong>in</strong>g with luck: Believ<strong>in</strong>g that, s<strong>in</strong>ce luck cannot be manipulated directly, it is<br />
important to wager strategically, wait<strong>in</strong>g for periods of good luck (streaks) <strong>and</strong> avoid<strong>in</strong>g<br />
periods of bad luck.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
30 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Luck as a contagion: Believ<strong>in</strong>g that success <strong>in</strong> other areas of one’s life will br<strong>in</strong>g success<br />
at gambl<strong>in</strong>g, or that other people br<strong>in</strong>g either good or bad luck (for example,<br />
leav<strong>in</strong>g a blackjack table because the dealer is unlucky).<br />
Superstitious behaviours<br />
Talismanic superstitions: Believ<strong>in</strong>g that possess<strong>in</strong>g a certa<strong>in</strong> object, such as a shirt,<br />
hat or doll, <strong>in</strong>creases one’s chances of w<strong>in</strong>n<strong>in</strong>g.<br />
Behavioural superstitions: Believ<strong>in</strong>g that certa<strong>in</strong> actions or rituals <strong>in</strong>crease the<br />
chance of w<strong>in</strong>n<strong>in</strong>g. These are usually non-verbal behaviours, such as sitt<strong>in</strong>g <strong>in</strong> a preferred<br />
seat at b<strong>in</strong>go, hold<strong>in</strong>g the cards a specific way or pull<strong>in</strong>g the arm on a slot<br />
mach<strong>in</strong>e <strong>in</strong>stead of press<strong>in</strong>g the button.<br />
Cognitive superstitions: Believ<strong>in</strong>g that one’s mental state can <strong>in</strong>fluence the chance of<br />
w<strong>in</strong>n<strong>in</strong>g. Examples <strong>in</strong>clude pray<strong>in</strong>g, hop<strong>in</strong>g, th<strong>in</strong>k<strong>in</strong>g optimistically <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g<br />
a positive state of m<strong>in</strong>d.<br />
Magnification of skills<br />
Overrat<strong>in</strong>g one’s ability to w<strong>in</strong> <strong>and</strong> exaggerat<strong>in</strong>g self-confidence, despite persistent<br />
losses.<br />
Selective memory<br />
Recall<strong>in</strong>g w<strong>in</strong>s, especially large ones, but not losses.<br />
Attribution biases<br />
Attribution errors: Expla<strong>in</strong><strong>in</strong>g w<strong>in</strong>s by overestimat<strong>in</strong>g the importance of dispositional<br />
factors (e.g., skills <strong>and</strong> abilities) <strong>and</strong> underestimat<strong>in</strong>g situational factors (e.g., luck<br />
<strong>and</strong> probability); losses are <strong>in</strong>terpreted as near w<strong>in</strong>s, <strong>and</strong> w<strong>in</strong>s are <strong>in</strong>terpreted as a<br />
sign of skill.<br />
Anthropomorphism: Attribut<strong>in</strong>g human characteristics to gambl<strong>in</strong>g objects, by<br />
giv<strong>in</strong>g names to slot mach<strong>in</strong>es, for example. Also credit<strong>in</strong>g these objects with w<strong>in</strong>s<br />
or blam<strong>in</strong>g them for losses, assum<strong>in</strong>g a relationship can exist with the game or<br />
its objects.<br />
Gambler’s fallacy: Interpret<strong>in</strong>g losses as an <strong>in</strong>dication that a w<strong>in</strong> is imm<strong>in</strong>ent. This<br />
often leads to chas<strong>in</strong>g—when someone tries to make up previous losses through<br />
more gambl<strong>in</strong>g. Chas<strong>in</strong>g usually <strong>in</strong>volves tak<strong>in</strong>g greater risks <strong>and</strong>/or mak<strong>in</strong>g larger<br />
bets. The goal may be not only to rega<strong>in</strong> the money that was lost, but also to reexperience<br />
the feel<strong>in</strong>g of how great it was to w<strong>in</strong>.<br />
Over-<strong>in</strong>terpretation of cues<br />
Over-<strong>in</strong>terpret<strong>in</strong>g ambiguous stimuli, such as bodily sensations, <strong>in</strong>tuitions or unusual<br />
events, to guide gambl<strong>in</strong>g decisions, such as whether to cont<strong>in</strong>ue play<strong>in</strong>g. In this<br />
case, feel<strong>in</strong>gs equal knowledge.<br />
(Toneatto, 2000)<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 31<br />
Slide 34<br />
Reduc<strong>in</strong>g the Risk<br />
Note to facilitator:<br />
Give participants a copy of the “Reduc<strong>in</strong>g the Risk” h<strong>and</strong>out (Appendix D). If time allows, prior to giv<strong>in</strong>g<br />
out the h<strong>and</strong>out you can do a bra<strong>in</strong>storm with the group to come up with strategies to reduce the risk of<br />
develop<strong>in</strong>g a gambl<strong>in</strong>g problem.<br />
Set a limit on time <strong>and</strong> money.<br />
Spend only what you can afford to lose. Leave your bank <strong>and</strong> credit cards at home.<br />
When your budget is gone <strong>and</strong> your time is up, walk away! Do not try to w<strong>in</strong> back<br />
your losses or use rent or grocery money to cont<strong>in</strong>ue to gamble. Keep a diary of how<br />
much time you play <strong>and</strong> record your w<strong>in</strong>s <strong>and</strong> losses—memory is selective <strong>in</strong><br />
remember<strong>in</strong>g only the w<strong>in</strong>s.<br />
Th<strong>in</strong>k of gambl<strong>in</strong>g as enterta<strong>in</strong>ment <strong>and</strong> not as a way to make money.<br />
Play know<strong>in</strong>g that you will almost certa<strong>in</strong>ly lose. Go with friends who do not have<br />
gambl<strong>in</strong>g problems <strong>and</strong> ask them to support you <strong>in</strong> stay<strong>in</strong>g with<strong>in</strong> your pre-set limits.<br />
See the money lost as part of your enterta<strong>in</strong>ment budget.<br />
Underst<strong>and</strong> the odds. The house always has the edge.<br />
Make your gambl<strong>in</strong>g decisions based on an accurate underst<strong>and</strong><strong>in</strong>g of your odds of<br />
w<strong>in</strong>n<strong>in</strong>g. Expect to lose. Accept that you have no control over the outcome of gambl<strong>in</strong>g.<br />
It is truly r<strong>and</strong>om. You cannot change the outcome, there are no w<strong>in</strong>n<strong>in</strong>g<br />
strategies <strong>and</strong> you cannot <strong>in</strong>fluence luck. The odds are stacked aga<strong>in</strong>st you <strong>and</strong><br />
always <strong>in</strong> favour of the house.<br />
Recognize risk factors.<br />
Do not gamble when you are feel<strong>in</strong>g vulnerable, bored, lonely, anxious or angry. Be<br />
careful not to use gambl<strong>in</strong>g as a way to escape problems or to avoid difficult feel<strong>in</strong>gs<br />
or situations. Mix<strong>in</strong>g alcohol or other drugs with gambl<strong>in</strong>g is risky <strong>and</strong> should also<br />
be avoided.<br />
If you choose to gamble, keep it as part of a balanced lifestyle.<br />
If you choose to participate <strong>in</strong> gambl<strong>in</strong>g, see it as an enjoyable part of a balanced<br />
lifestyle. Have other mean<strong>in</strong>gful activities <strong>in</strong> your life—not just gambl<strong>in</strong>g.<br />
Listen to the concerns of others.<br />
If others express concern about your gambl<strong>in</strong>g, listen to them! They may see someth<strong>in</strong>g<br />
you don’t. People who do not have gambl<strong>in</strong>g problems do not let their gambl<strong>in</strong>g<br />
behaviours negatively affect relationships <strong>in</strong> their personal, social or professional lives.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
32 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 35<br />
Helpful Resources<br />
Ontario <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Helpl<strong>in</strong>e<br />
1 888 230-3505<br />
www.opgh.on.ca<br />
If you are concerned about your own gambl<strong>in</strong>g or the gambl<strong>in</strong>g behaviour of someone<br />
close to you, free <strong>and</strong> confidential help is available <strong>in</strong> Ontario. To f<strong>in</strong>d treatment<br />
services near you, contact the Ontario <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Helpl<strong>in</strong>e (ConnexOntario).<br />
www.<strong>Problem</strong><strong>Gambl<strong>in</strong>g</strong>.ca<br />
This website about gambl<strong>in</strong>g <strong>and</strong> problem gambl<strong>in</strong>g is geared toward the general<br />
public, people concerned about their own gambl<strong>in</strong>g or someone else’s gambl<strong>in</strong>g, <strong>and</strong><br />
professionals.<br />
www.KnowYourLimit.ca<br />
This website provides <strong>in</strong>formation about how gambl<strong>in</strong>g works, myths <strong>and</strong> facts, <strong>and</strong><br />
helpful tips to reduce the risk of develop<strong>in</strong>g a gambl<strong>in</strong>g problem.<br />
Slide 36<br />
Prevent<strong>in</strong>g <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: Take-Home Messages<br />
People with a history of substance use problems are at higher risk of develop<strong>in</strong>g<br />
a gambl<strong>in</strong>g problem.<br />
People with a mental health problem are at higher risk of develop<strong>in</strong>g a gambl<strong>in</strong>g<br />
problem.<br />
People who have problems with gambl<strong>in</strong>g are at higher risk of suicide.<br />
Slide 37<br />
Take-Home Messages (cont<strong>in</strong>ued)<br />
The house edge ensures that over time, you will likely lose more money than you w<strong>in</strong>.<br />
<strong>Gambl<strong>in</strong>g</strong> games are mostly based on r<strong>and</strong>omness <strong>and</strong> <strong>in</strong>dependent outcomes, <strong>and</strong><br />
your chances of w<strong>in</strong>n<strong>in</strong>g are smaller than your chances of los<strong>in</strong>g.<br />
Luck is really just a cognitive distortion <strong>and</strong> many people get <strong>in</strong>to trouble because of<br />
a lack of underst<strong>and</strong><strong>in</strong>g about how games of chance work.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 33<br />
Slide 38<br />
Take-Home Messages (cont<strong>in</strong>ued)<br />
The cas<strong>in</strong>os <strong>and</strong> lottery corporations are billion-dollar <strong>in</strong>dustries.<br />
<strong>Gambl<strong>in</strong>g</strong> is a problem when it damages your f<strong>in</strong>ances, work, health, relationships<br />
or reputation.<br />
You can reduce your risk of develop<strong>in</strong>g a problem by sett<strong>in</strong>g limits on time <strong>and</strong><br />
money, <strong>and</strong> view<strong>in</strong>g gambl<strong>in</strong>g as enterta<strong>in</strong>ment <strong>and</strong> not as a way of mak<strong>in</strong>g money.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
34 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 35<br />
Session 3<br />
Depend<strong>in</strong>g on the number of participants <strong>and</strong> the amount of group discussion, this<br />
session will take between 60 <strong>and</strong> 90 m<strong>in</strong>utes.<br />
For this session you will need:<br />
• laptop computer <strong>and</strong> lcd projector<br />
• Session 3 PowerPo<strong>in</strong>t presentation<br />
• flipchart <strong>and</strong> markers<br />
• participant h<strong>and</strong>outs:<br />
- How to Choose Your <strong>Gambl<strong>in</strong>g</strong> Goal (Appendix E)<br />
- My Goal Statement (Appendix F)<br />
- Self-Monitor<strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong> or Urges to Gamble (Appendix G)<br />
- <strong>Gambl<strong>in</strong>g</strong> Triggers (Appendix H)<br />
- Inventory of <strong>Gambl<strong>in</strong>g</strong> Situations (igs) tool<br />
- Session 3 PowerPo<strong>in</strong>t presentation<br />
Note: The Inventory of <strong>Gambl<strong>in</strong>g</strong> Situations tool is not <strong>in</strong>cluded <strong>in</strong> this guide. A copy<br />
of this tool is available <strong>in</strong> the Inventory of <strong>Gambl<strong>in</strong>g</strong> Situations User’s Guide<br />
(pages 18-21). You can access this guide from the follow<strong>in</strong>g l<strong>in</strong>k:<br />
http://www.problemgambl<strong>in</strong>g.ca/EN/Documents/InventoryGambUserGuide2009<br />
F<strong>in</strong>alProtected.pdf<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
36 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 39<br />
Goal Sett<strong>in</strong>g <strong>and</strong> Identify<strong>in</strong>g High-Risk Situations<br />
This third session focuses on:<br />
• how to set realistic gambl<strong>in</strong>g goals; <strong>and</strong><br />
• how to identify personal gambl<strong>in</strong>g triggers.<br />
Slide 40<br />
Goal Sett<strong>in</strong>g<br />
Different goals are appropriate for different people:<br />
• abst<strong>in</strong>ence; or<br />
• reduced gambl<strong>in</strong>g<br />
Some people might choose to absta<strong>in</strong> from gambl<strong>in</strong>g, while others may set themselves<br />
a goal of reduced gambl<strong>in</strong>g.<br />
Reduced gambl<strong>in</strong>g can <strong>in</strong>clude reduc<strong>in</strong>g <strong>in</strong>volvement <strong>in</strong> gambl<strong>in</strong>g, or quitt<strong>in</strong>g some<br />
forms of gambl<strong>in</strong>g but cont<strong>in</strong>u<strong>in</strong>g to engage <strong>in</strong> others. As we will see <strong>in</strong> the next slide,<br />
you should take many factors <strong>in</strong>to consideration when choos<strong>in</strong>g a gambl<strong>in</strong>g goal.<br />
However, an <strong>in</strong>itial period of abst<strong>in</strong>ence is recommended for everyone.<br />
For many reasons, even if you choose a goal of reduced gambl<strong>in</strong>g, a period of abst<strong>in</strong>ence<br />
is recommended because:<br />
• It may br<strong>in</strong>g some relief from the pressures you are experienc<strong>in</strong>g as a result of gambl<strong>in</strong>g.<br />
• It may help you recognize hidden motivations for, or attractions to, gambl<strong>in</strong>g not<br />
obvious to you now.<br />
• It gives you time to come up with a concrete <strong>and</strong> realistic plan for reduced gambl<strong>in</strong>g.<br />
• It proves to yourself that you are able to absta<strong>in</strong> from gambl<strong>in</strong>g.<br />
• It helps put gambl<strong>in</strong>g <strong>in</strong>to perspective with other life responsibilities <strong>and</strong> activities.<br />
This <strong>in</strong>itial period of abst<strong>in</strong>ence may vary from person to person depend<strong>in</strong>g on<br />
circumstances. For example, some people may feel they simply need a few days or<br />
weeks to come up with a realistic plan, while others may feel they need a longer period<br />
to allow them to address their f<strong>in</strong>ancial problems.<br />
Note to facilitator:<br />
Historically, most addiction treatment programs were abst<strong>in</strong>ence-based. Over the past few decades, however,<br />
there has been a shift toward a harm reduction approach.<br />
When applied to problem gambl<strong>in</strong>g, harm reduction means reduc<strong>in</strong>g the harm associated with gambl<strong>in</strong>g.<br />
This can <strong>in</strong>clude reduc<strong>in</strong>g <strong>in</strong>volvement <strong>in</strong> gambl<strong>in</strong>g, quitt<strong>in</strong>g some forms of gambl<strong>in</strong>g or absta<strong>in</strong><strong>in</strong>g from<br />
all forms of gambl<strong>in</strong>g. Talk<strong>in</strong>g a harm reduction approach allows cl<strong>in</strong>icians to support clients at all stages<br />
of change. As well, it respects the rights of clients to set their own goal.<br />
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<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 37<br />
Slide 41<br />
Choos<strong>in</strong>g Your <strong>Gambl<strong>in</strong>g</strong> Goal<br />
Abst<strong>in</strong>ence is recommended when:<br />
• you are experienc<strong>in</strong>g significant f<strong>in</strong>ancial problems;<br />
• you cont<strong>in</strong>ue to see gambl<strong>in</strong>g as a solution to f<strong>in</strong>ancial problems;<br />
• you gamble to escape <strong>and</strong>/or cope with negative situations <strong>and</strong> moods;<br />
• your gambl<strong>in</strong>g is related to an impulse disorder;<br />
• you have been m<strong>and</strong>ated to by the legal system;<br />
• you have already made unsuccessful attempts to reduce your gambl<strong>in</strong>g; or<br />
• your relationships or employment may be at risk if you cont<strong>in</strong>ue to gamble.<br />
(Toneatto et al., 2003)<br />
Note to facilitator:<br />
Give participants a copy of the “How to Choose Your <strong>Gambl<strong>in</strong>g</strong> Goal” questionnaire (Appendix E) <strong>and</strong><br />
have them fill it out.<br />
This tool is helpful when decid<strong>in</strong>g between abst<strong>in</strong>ence <strong>and</strong> reduced gambl<strong>in</strong>g. It has eight questions that<br />
focus on the person’s previous gambl<strong>in</strong>g behaviour <strong>and</strong> it recommends a gambl<strong>in</strong>g goal based on his or<br />
her responses. A “yes” answer to any of the questions <strong>in</strong>dicates that cutt<strong>in</strong>g down may not be the best<br />
choice <strong>and</strong> a goal of abst<strong>in</strong>ence is recommended. Despite this, the ultimate decision is the client’s.<br />
A “no” answer to all eight questions <strong>in</strong>dicates that the client may succeed at reduced gambl<strong>in</strong>g. If the person’s<br />
choice is reduction, it is important to establish clear guidel<strong>in</strong>es <strong>and</strong> discuss the follow<strong>in</strong>g issues:<br />
• which gambl<strong>in</strong>g activities the client will <strong>and</strong> will not engage <strong>in</strong>;<br />
• how frequently the client will gamble;<br />
• how much money <strong>and</strong> time the client will spend on gambl<strong>in</strong>g; <strong>and</strong><br />
• the times when the client will not gamble (for example, when he/she is feel<strong>in</strong>g sad or has consumed alcohol<br />
or taken other drugs).<br />
Another po<strong>in</strong>t to consider is that of w<strong>in</strong>s. If clients choose a goal of reduced gambl<strong>in</strong>g, it is important for<br />
them to th<strong>in</strong>k about how they will address possible w<strong>in</strong>s. A w<strong>in</strong> might, for example, be seen as a change<br />
<strong>in</strong> luck. And, <strong>in</strong> try<strong>in</strong>g to duplicate the w<strong>in</strong>, the client may f<strong>in</strong>d himself or herself experienc<strong>in</strong>g further problems.<br />
In addition, without careful plann<strong>in</strong>g, a w<strong>in</strong> can easily lead clients <strong>in</strong>to believ<strong>in</strong>g they no longer have<br />
a gambl<strong>in</strong>g problem. As such, it is important for clients to plan for this situation, <strong>in</strong> case it should arise.<br />
Otherwise, a w<strong>in</strong> may trigger clients to return to gambl<strong>in</strong>g activities they have been absta<strong>in</strong><strong>in</strong>g from; or, for<br />
activities they are still engaged <strong>in</strong>, it may trigger them to exceed the limits they have set for themselves.<br />
F<strong>in</strong>ally, although we do not impose specific goals on clients, you may choose to recommend a goal based on<br />
your knowledge <strong>and</strong> expertise. If you recommend a goal of abst<strong>in</strong>ence, however, it is important to reassure<br />
clients that your support is not conditional on their agree<strong>in</strong>g to this goal, or on their success at absta<strong>in</strong><strong>in</strong>g.<br />
Use language like the follow<strong>in</strong>g: “You have the right to choose your own goal, <strong>and</strong> I will support you no<br />
matter what you choose. However, based on what you are tell<strong>in</strong>g me, I feel I have to recommend that you<br />
absta<strong>in</strong> from gambl<strong>in</strong>g.” At this po<strong>in</strong>t provide details about why you are recommend<strong>in</strong>g abst<strong>in</strong>ence; for<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
38 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
example, the client’s serious f<strong>in</strong>ancial situation, the risk to his or her employment or unsuccessful past<br />
attempts to reduce gambl<strong>in</strong>g. Conclude by reassur<strong>in</strong>g the client, “If you choose to work on a goal of<br />
reduced gambl<strong>in</strong>g, I will cont<strong>in</strong>ue to support you.”<br />
Slide 42<br />
My Goal Statement<br />
Note to facilitator:<br />
Give participants a copy of the “My Goal Statement” h<strong>and</strong>out (Appendix F) <strong>and</strong> have them complete it.<br />
• In the <strong>Gambl<strong>in</strong>g</strong> Activity column, they should <strong>in</strong>dicate every gambl<strong>in</strong>g activity they have been <strong>in</strong>volved <strong>in</strong>.<br />
If participants are engag<strong>in</strong>g <strong>in</strong> numerous activities, a second copy of this h<strong>and</strong>out may be necessary.<br />
• In the <strong>Gambl<strong>in</strong>g</strong> Goal column, participants should <strong>in</strong>dicate what their goal will be for each gambl<strong>in</strong>g<br />
activity. If they choose a goal of reduced gambl<strong>in</strong>g, they should <strong>in</strong>clude as much detail as possible (see<br />
example on h<strong>and</strong>out).<br />
Tell participants that you will be review<strong>in</strong>g this h<strong>and</strong>out <strong>in</strong> Session 4 <strong>and</strong> ask them to br<strong>in</strong>g it to the<br />
next session.<br />
Slide 43<br />
Triggers<br />
Personal triggers<br />
What triggers one person to want to gamble is not necessarily what will trigger another.<br />
For example, watch<strong>in</strong>g a sport<strong>in</strong>g event on television may be a trigger for some people<br />
who’ve had problems with sports bett<strong>in</strong>g, but it may not be a trigger for others who’ve<br />
had similar problems.<br />
Identify<strong>in</strong>g one’s personal triggers is very important <strong>and</strong> can be done <strong>in</strong> a number of<br />
ways. For example, through self-monitor<strong>in</strong>g, a person may beg<strong>in</strong> to recognize what<br />
triggers gambl<strong>in</strong>g urges, <strong>in</strong> addition to identify<strong>in</strong>g patterns over time.<br />
Multiple triggers<br />
People who experience problems related to gambl<strong>in</strong>g usually have more than one<br />
trigger. To simply focus on one trigger <strong>and</strong> neglect others sets a person up for relapse.<br />
Occasional triggers<br />
Occasional triggers (less frequent triggers) also need special attention, because they<br />
may take the person by surprise. For example, someone who is do<strong>in</strong>g well with his<br />
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or her gambl<strong>in</strong>g goal while at home may f<strong>in</strong>d that an unexpected work trip triggers<br />
strong urges to gamble. Identify<strong>in</strong>g periodic triggers, such as a sports season or holidays,<br />
is also strongly encouraged.<br />
Note to facilitator:<br />
At this time, give participants a copy of the “Self-Monitor<strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong> or Urges to Gamble” h<strong>and</strong>out<br />
(Appendix G) <strong>and</strong> review it with participants. Encourage them to start us<strong>in</strong>g this tool to keep track of gambl<strong>in</strong>g<br />
urges <strong>and</strong>/or actual gambl<strong>in</strong>g occurrences.<br />
Tell participants that you will be review<strong>in</strong>g this h<strong>and</strong>out <strong>in</strong> Session 4 <strong>and</strong> ask them to br<strong>in</strong>g it to the next<br />
session.<br />
Slide 44<br />
Identify<strong>in</strong>g Triggers<br />
Triggers:<br />
• situations (people, places <strong>and</strong> th<strong>in</strong>gs)<br />
Situational triggers could be people you used to gamble with, places such as corner<br />
stores or sport<strong>in</strong>g events or th<strong>in</strong>gs such as receiv<strong>in</strong>g bills <strong>in</strong> the mail or pay day.<br />
• thoughts<br />
Thoughts such as “Just one more time,” “I am due to w<strong>in</strong>” or “Today is my birthday<br />
so it has to be lucky” can be triggers.<br />
• moods (positive <strong>and</strong> negative)<br />
Negative moods such as anger, desperation, lonel<strong>in</strong>ess or grief <strong>and</strong> positive moods<br />
such as joy, confidence or excitement can be triggers.<br />
How are these triggers connected to each other?<br />
For example, gett<strong>in</strong>g a bill <strong>in</strong> the mail may lead to feel<strong>in</strong>gs of desperation, which may<br />
lead to thoughts of “Just one more time.”<br />
Note to facilitator:<br />
Give participants a copy of the “<strong>Gambl<strong>in</strong>g</strong> Triggers” h<strong>and</strong>out (Appendix H). Depend<strong>in</strong>g on the time or the<br />
number of people <strong>in</strong> the session, either:<br />
• have them complete the worksheet on their own <strong>and</strong> then have a group discussion about it; or<br />
• do this exercise as a group by writ<strong>in</strong>g the head<strong>in</strong>gs “Situations”, “Thoughts” <strong>and</strong> “Moods” on the board<br />
or on a flipchart <strong>and</strong> then do<strong>in</strong>g a bra<strong>in</strong>storm for triggers <strong>and</strong> plac<strong>in</strong>g them <strong>in</strong> the appropriate columns.<br />
Note that at this time, participants are only fill<strong>in</strong>g <strong>in</strong> the triggers for Situations, Thoughts <strong>and</strong> Moods. They<br />
are not complet<strong>in</strong>g the Action Plan section yet (this will be done <strong>in</strong> the f<strong>in</strong>al session).<br />
Tell participants that you will be review<strong>in</strong>g this h<strong>and</strong>out <strong>in</strong> Session 4 <strong>and</strong> ask them to br<strong>in</strong>g it to the<br />
next session.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
40 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 45<br />
Inventory of <strong>Gambl<strong>in</strong>g</strong> Situations (igs) Tool<br />
Note to facilitator:<br />
The IGS tool, developed by Littman-Sharp & Turner (1999), is a 61-item questionnaire that identifies an<br />
<strong>in</strong>dividual’s risk situations for gambl<strong>in</strong>g. It is based on the Inventory of Dr<strong>in</strong>k<strong>in</strong>g Situations (IDS) tool, which<br />
has been used for many years for the same purpose with people experienc<strong>in</strong>g problems with alcohol.<br />
Have each participant complete the IGS tool. To score the tool manually, read the directions <strong>in</strong> the Inventory<br />
of <strong>Gambl<strong>in</strong>g</strong> Situations User’s Guide (http://www.problemgambl<strong>in</strong>g.ca/EN/Documents/<br />
InventoryGambUserGuide2009F<strong>in</strong>alProtected.pdf), pages 10-12.<br />
You can also score this tool electronically by <strong>in</strong>putt<strong>in</strong>g the data <strong>in</strong> the electronic IGS tool at:<br />
http://www.problemgambl<strong>in</strong>g.ca/EN/ResourcesForProfessionals/Pages/Inventoryof<strong>Gambl<strong>in</strong>g</strong>Situations<br />
Questionnaire.aspx<br />
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Session 4<br />
Depend<strong>in</strong>g on the number of participants <strong>and</strong> the amount of group discussion, this<br />
session will take between 60 <strong>and</strong> 90 m<strong>in</strong>utes.<br />
For this session you will need:<br />
• laptop computer <strong>and</strong> lcd projector<br />
• Session 4 PowerPo<strong>in</strong>t presentation<br />
• flipchart <strong>and</strong> markers<br />
• participant h<strong>and</strong>outs:<br />
- participants’ scored Inventory of <strong>Gambl<strong>in</strong>g</strong> Situations (igs) tool<br />
- Session 4 PowerPo<strong>in</strong>t presentation<br />
Slide 46<br />
Develop<strong>in</strong>g Cop<strong>in</strong>g Strategies for High-Risk Situations<br />
This fourth session focuses on:<br />
• develop<strong>in</strong>g cop<strong>in</strong>g strategies to deal with gambl<strong>in</strong>g triggers; <strong>and</strong><br />
• helpful resources.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
42 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Slide 47<br />
Review<strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong> Goals, Triggers <strong>and</strong> Self-Monitor<strong>in</strong>g<br />
In the previous sessions, we focused on sett<strong>in</strong>g goals <strong>and</strong> identify<strong>in</strong>g triggers. Have<br />
participants pull out the follow<strong>in</strong>g h<strong>and</strong>outs:<br />
• My Goal Statement (Appendix F)<br />
• Self-Monitor<strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong> or Urges to Gamble (Appendix G)<br />
• <strong>Gambl<strong>in</strong>g</strong> Triggers (Appendix H)<br />
Review the worksheets with participants.<br />
• How did they do with their goal(s)?<br />
• Do they want to add anyth<strong>in</strong>g to their list of triggers?<br />
• Do they want to make any changes around any of their gambl<strong>in</strong>g goals?<br />
Debrief as necessary.<br />
Slide 48<br />
Review<strong>in</strong>g Your IGS Results<br />
Note to facilitator:<br />
H<strong>and</strong> out each participant’s scored IGS results. Let them know that each subscale has a number between<br />
0 <strong>and</strong> 100 <strong>and</strong> that the higher numbers are an <strong>in</strong>dication that this subscale is a high-risk situation for them.<br />
Give them a few moments to review the results <strong>and</strong> ask if there are any surprises <strong>and</strong>/or questions about<br />
the results.<br />
You should also briefly expla<strong>in</strong> each subscale to the group. Po<strong>in</strong>t out that while the IGS focuses on their<br />
past gambl<strong>in</strong>g behaviour <strong>and</strong> under what circumstances they gambled the most, it makes sense that those<br />
same circumstances or situations are their highest-risk times to relapse <strong>in</strong> the future. So, the IGS provides a<br />
k<strong>in</strong>d of priority list of high-risk situations that clients can anticipate <strong>and</strong> plan for <strong>in</strong> the future.<br />
Negative emotions<br />
<strong>Gambl<strong>in</strong>g</strong> to escape from, or cope with, negative emotions such as sadness, anger,<br />
guilt or stress.<br />
Conflict with others<br />
<strong>Gambl<strong>in</strong>g</strong> to cope with conflict with others.<br />
Need for excitement<br />
<strong>Gambl<strong>in</strong>g</strong> for the thrill or excitement of it.<br />
Test<strong>in</strong>g personal control<br />
<strong>Gambl<strong>in</strong>g</strong> to test imposed limits on self or one’s ability to gamble without negative<br />
consequences.<br />
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<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 43<br />
Pleasant emotions<br />
<strong>Gambl<strong>in</strong>g</strong> to celebrate or when feel<strong>in</strong>g happy <strong>and</strong> content.<br />
Social pressure<br />
<strong>Gambl<strong>in</strong>g</strong> when pressured to or when <strong>in</strong> a social situation where gambl<strong>in</strong>g is expected.<br />
Worried about debts<br />
<strong>Gambl<strong>in</strong>g</strong> to relieve f<strong>in</strong>ancial pressures.<br />
W<strong>in</strong>n<strong>in</strong>g <strong>and</strong> chas<strong>in</strong>g<br />
<strong>Gambl<strong>in</strong>g</strong> to recoup gambl<strong>in</strong>g loses, or believ<strong>in</strong>g that one more try is needed or that<br />
this time the outcome will be profitable.<br />
Confidence <strong>in</strong> a skill<br />
<strong>Gambl<strong>in</strong>g</strong> when confident, or believ<strong>in</strong>g that this time it will be a sure th<strong>in</strong>g.<br />
Urges <strong>and</strong> temptations<br />
<strong>Gambl<strong>in</strong>g</strong> when the urge comes, out of habit, when rem<strong>in</strong>ded of gambl<strong>in</strong>g or when<br />
gambl<strong>in</strong>g is available.<br />
Note to facilitator:<br />
The participants could also compare their IGS results to their “Identify<strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong> Triggers” h<strong>and</strong>outs.<br />
Are they similar or different? Some clients are already aware of their worst triggers <strong>and</strong> may already be<br />
address<strong>in</strong>g them. They may be unaware, however, of less <strong>in</strong>tense or less frequent triggers, which can just<br />
as easily lead to a relapse. For <strong>in</strong>stance, clients who have dealt with some temptations, such as availability<br />
or friends gambl<strong>in</strong>g, may be less aware of their vulnerability to cognitive distortions, such as confidence<br />
<strong>in</strong> skill.<br />
Based on these results, participants may also want to make some changes to their gambl<strong>in</strong>g goals. For<br />
example, if they scored highly on Negative Emotions <strong>and</strong> they chose a goal of reduced gambl<strong>in</strong>g, they may<br />
want to make it a goal to not gamble when they feel sad, mad or frustrated.<br />
Slide 49<br />
Develop<strong>in</strong>g Cop<strong>in</strong>g Strategies<br />
Match strategies to your triggers.<br />
Once you identify specific triggers, you must develop specific strategies to cope with<br />
them. Not all strategies work for everyone, so be specific about your own needs.<br />
Use:<br />
• action strategies;<br />
• th<strong>in</strong>k<strong>in</strong>g strategies; <strong>and</strong><br />
• feel<strong>in</strong>g strategies.<br />
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44 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
As with triggers, it is helpful to divide the strategies <strong>in</strong>to action, th<strong>in</strong>k<strong>in</strong>g <strong>and</strong> feel<strong>in</strong>g<br />
strategies; for example, avoid<strong>in</strong>g go<strong>in</strong>g to sports bars (action), us<strong>in</strong>g positive self-talk<br />
(th<strong>in</strong>k<strong>in</strong>g), or deal<strong>in</strong>g with negative emotions (feel<strong>in</strong>g).<br />
If one plan doesn’t work, try another.<br />
You should never have just one plan to deal with triggers. Come up with a plan A, B,<br />
C <strong>and</strong> even D so that you are prepared to address whatever challenges may come up.<br />
Don’t simply focus on avoidance.<br />
Although it’s good to focus on avoid<strong>in</strong>g triggers at the beg<strong>in</strong>n<strong>in</strong>g, over time, you<br />
should focus on engag<strong>in</strong>g <strong>in</strong> healthy replacement behaviours, rather than simply<br />
avoid<strong>in</strong>g old harmful ones. For example, some people may need to develop better<br />
connections with family <strong>and</strong> friends to feel a greater sense of belong<strong>in</strong>g <strong>and</strong> have a<br />
wider variety of activities to take part <strong>in</strong>.<br />
Slide 50<br />
Examples of Strategies<br />
Avoid th<strong>in</strong>gs/places that trigger the urge to gamble, for example:<br />
• the corner store where you can buy lottery tickets;<br />
• the sports pages of the newspaper;<br />
• sports or poker tournaments on TV.<br />
Avoid people who will trigger the urge to gamble, for example:<br />
• friends or family you used to gamble with.<br />
Slide 51<br />
Examples of Strategies (cont<strong>in</strong>ued)<br />
Avoid dr<strong>in</strong>k<strong>in</strong>g or other drug use dur<strong>in</strong>g high-risk times.<br />
Reduce the withdrawal limit on your debit card.<br />
Reduce the limit on your credit card.<br />
Carry limited amounts of cash.<br />
If you go somewhere that gambl<strong>in</strong>g will be available, leave your credit <strong>and</strong> debit cards<br />
at home.<br />
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Slide 52<br />
Examples of Strategies (cont<strong>in</strong>ued)<br />
Tell friends <strong>and</strong> family that you no longer gamble.<br />
If you f<strong>in</strong>d yourself <strong>in</strong> a place/situation where you are feel<strong>in</strong>g triggered to gamble,<br />
leave.<br />
Associate yourself with supportive people.<br />
Attend a support group for people who also struggle with gambl<strong>in</strong>g.<br />
Slide 53<br />
Some Recommended Strategies<br />
Self-exclusion<br />
Some people with gambl<strong>in</strong>g problems f<strong>in</strong>d it helpful to create an extra barrier to prevent<br />
them from go<strong>in</strong>g to cas<strong>in</strong>os or slot mach<strong>in</strong>e venues at raceways. Self-exclusion,<br />
or “bann<strong>in</strong>g” oneself from cas<strong>in</strong>os <strong>and</strong> slot mach<strong>in</strong>e venues, is a voluntary program<br />
offered by olg to people who would like to stay away from gambl<strong>in</strong>g facilities.<br />
To self-exclude, clients should go to their local olg gambl<strong>in</strong>g facility or to a designated<br />
off-site location for a voluntary <strong>in</strong>terview with security staff. Their photograph will be<br />
taken <strong>and</strong> they will be asked to sign a self-exclusion form. This <strong>in</strong>formation is then<br />
forwarded to all other olg gambl<strong>in</strong>g sites <strong>in</strong> Ontario. For example, if clients selfexclude<br />
at Woodb<strong>in</strong>e Racetrack <strong>in</strong> Toronto, they are not only bann<strong>in</strong>g themselves<br />
from this venue, but from all olg cas<strong>in</strong>os <strong>and</strong> olg slot mach<strong>in</strong>e venues with<strong>in</strong><br />
the prov<strong>in</strong>ce.<br />
Self-exclusion contracts are irrevocable for the time period covered <strong>and</strong> are enforced<br />
by cas<strong>in</strong>o security personnel. If someone who is on the self-exclusion list is found <strong>in</strong><br />
a cas<strong>in</strong>o or slot mach<strong>in</strong>e venue, he or she may be asked to leave, or may be subject to<br />
a trespass<strong>in</strong>g charge <strong>and</strong>/or f<strong>in</strong>e.<br />
After a m<strong>in</strong>imum of six months, clients can ask to have their self-exclusion overturned.<br />
A written request must be submitted to an olg cas<strong>in</strong>o or olg slot mach<strong>in</strong>e<br />
venue. Requests are not considered until six months after the <strong>in</strong>itial date <strong>and</strong> there<br />
is a 30-day wait<strong>in</strong>g period before re<strong>in</strong>statement is granted.<br />
For more <strong>in</strong>formation about self-exclusion, visit www.KnowYourLimit.ca.<br />
GamBlock: Blocks access to all onl<strong>in</strong>e gambl<strong>in</strong>g.<br />
For those who gamble onl<strong>in</strong>e, GamBlock is an excellent tool. It is easily downloadable<br />
from the follow<strong>in</strong>g website: www.GamBlock.com. Once this program is <strong>in</strong>stalled<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
46 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
on the person’s computer, it will block access to all gambl<strong>in</strong>g sites.<br />
Because the cost for a one-year subscription is approximately US $75, however, it may<br />
not be a realistic option for everyone.<br />
Address f<strong>in</strong>ancial issues by:<br />
• deal<strong>in</strong>g with debt<br />
Debt is often a big trigger for gambl<strong>in</strong>g, s<strong>in</strong>ce some people falsely believe that the<br />
only way to pay off their debt is by w<strong>in</strong>n<strong>in</strong>g at gambl<strong>in</strong>g. Putt<strong>in</strong>g an end to this cycle<br />
is crucial, <strong>and</strong> there are f<strong>in</strong>ancial experts who can help. For example, the Ontario<br />
Association of Credit Counsell<strong>in</strong>g Services can assess a person’s f<strong>in</strong>ances <strong>and</strong> make<br />
recommendations specific to his or her situation <strong>and</strong> needs. Contact <strong>in</strong>formation for<br />
the Ontario Association of Credit Counsell<strong>in</strong>g Services is available on the f<strong>in</strong>al slide of<br />
this session.<br />
• consider<strong>in</strong>g temporarily h<strong>and</strong><strong>in</strong>g over control of your f<strong>in</strong>ances.<br />
Dur<strong>in</strong>g the early stage of treatment, limit<strong>in</strong>g access to money is often essential to<br />
reduc<strong>in</strong>g or stopp<strong>in</strong>g gambl<strong>in</strong>g <strong>in</strong> the short term. Family members <strong>and</strong> friends can be<br />
enlisted for support if they are will<strong>in</strong>g; most families are relieved to take this on. If a<br />
client chooses this option, it can be helpful for the cl<strong>in</strong>ician to assist <strong>in</strong> negotiat<strong>in</strong>g<br />
these limits. Generally speak<strong>in</strong>g, it is better <strong>in</strong> the long run if the arrangements are<br />
decided collaboratively, as part of a help<strong>in</strong>g plan, rather than imposed on the client.<br />
Slide 54<br />
<strong>Gambl<strong>in</strong>g</strong> Triggers: My Action Plans<br />
Note to facilitator:<br />
At this time, have participants go back to the “<strong>Gambl<strong>in</strong>g</strong> Triggers” h<strong>and</strong>out (Appendix H) that they completed<br />
<strong>in</strong> the previous session, <strong>and</strong> have them fill <strong>in</strong> the Action Plan section for Situations, Thoughts <strong>and</strong><br />
Moods. Depend<strong>in</strong>g on time <strong>and</strong> the number of participants, you may ask them to do it <strong>in</strong>dividually, <strong>in</strong> pairs<br />
or <strong>in</strong> the larger group.<br />
Optional role-play<strong>in</strong>g activity:<br />
It may be particularly beneficial for clients with both gambl<strong>in</strong>g problems <strong>and</strong> a major mental illness to have a<br />
chance to role-play how to effectively h<strong>and</strong>le some of the suggestions <strong>in</strong> this session.<br />
Some suggestions for client role-play<strong>in</strong>g <strong>in</strong>clude:<br />
• Practise ask<strong>in</strong>g a family member to temporarily take over control of your f<strong>in</strong>ances.<br />
• Practise tell<strong>in</strong>g a family member that, at family gather<strong>in</strong>gs, you would rather not play cards for money<br />
any more.<br />
• Practise go<strong>in</strong>g <strong>in</strong>to a cas<strong>in</strong>o <strong>and</strong> tell<strong>in</strong>g security staff that you would like to self-exclude.<br />
• Practise tell<strong>in</strong>g your family <strong>and</strong> friends that you no longer gamble.<br />
• Practise the steps you would take to get out of a high-risk situation (e.g., you are at a friend’s house, <strong>and</strong><br />
an impromptu game of poker starts up—how would you get out of there without gambl<strong>in</strong>g?)<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 47<br />
You have just had an argument with a family member. You are frustrated <strong>and</strong> angry—which is usually<br />
when you feel the urge to gamble. Practise different ways of h<strong>and</strong>l<strong>in</strong>g your negative emotions more effectively<br />
(such as tak<strong>in</strong>g a long, warm shower; go<strong>in</strong>g for a walk; focus<strong>in</strong>g on your breath; listen<strong>in</strong>g to music; or do<strong>in</strong>g<br />
a thought record).<br />
Slide 55<br />
Some F<strong>in</strong>al Thoughts<br />
Th<strong>in</strong>k ahead.<br />
Prevent or avoid triggers by identify<strong>in</strong>g the processes that lead to gambl<strong>in</strong>g.<br />
Plan healthy alternatives to gambl<strong>in</strong>g <strong>and</strong> rewards for not gambl<strong>in</strong>g.<br />
Healthy, positive alternatives <strong>and</strong> rewards are essential. You need to acknowledge<br />
your hard work <strong>and</strong> progress.<br />
Identify barriers <strong>and</strong> plan to overcome them.<br />
There will be barriers <strong>and</strong> rough spots—you should anticipate these <strong>and</strong> plan for<br />
them. For example, if family gather<strong>in</strong>gs <strong>in</strong>volve play<strong>in</strong>g cards for money, you have to<br />
come up with a plan that will work for you. You may decide to:<br />
• avoid family gather<strong>in</strong>gs for a certa<strong>in</strong> period of time;<br />
• tell family about your difficulties <strong>and</strong> ask them to plan alternative activities dur<strong>in</strong>g<br />
family get-togethers; or<br />
• ask if the wager<strong>in</strong>g aspect of card games can be omitted.<br />
Slide 56<br />
Some Helpful Resources<br />
Ontario <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Helpl<strong>in</strong>e<br />
www.opgh.on.ca<br />
1 888 230-3505<br />
<strong>Problem</strong> gambl<strong>in</strong>g can be overcome, <strong>and</strong> although these sessions are important first<br />
steps <strong>in</strong> address<strong>in</strong>g this issue, clients should be encouraged to cont<strong>in</strong>ue to get support.<br />
Over 55 specialized problem gambl<strong>in</strong>g treatment services are available, free of<br />
charge, throughout Ontario. Clients should be strongly encouraged to follow up with<br />
their local treatment provider once they return home. To f<strong>in</strong>d out where services are<br />
available <strong>in</strong> specific regions, contact the Ontario <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Helpl<strong>in</strong>e. This<br />
service is free, confidential, anonymous <strong>and</strong> available 24 hours a day.<br />
www.<strong>Problem</strong><strong>Gambl<strong>in</strong>g</strong>.ca<br />
This bil<strong>in</strong>gual website, developed by the camh <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project, is <strong>in</strong>tended<br />
for the general public, for those concerned about their own gambl<strong>in</strong>g or someone<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
48 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
else’s gambl<strong>in</strong>g, <strong>and</strong> for professionals. It conta<strong>in</strong>s <strong>in</strong>formation about gambl<strong>in</strong>g <strong>and</strong><br />
problem gambl<strong>in</strong>g, screen<strong>in</strong>g tools, pr<strong>in</strong>table h<strong>and</strong>outs <strong>and</strong> self-help resources.<br />
Some client resources are available <strong>in</strong> an additional 20 languages.<br />
Ontario Association of Credit Counsell<strong>in</strong>g Services<br />
www.oaccs.com<br />
1 888 204-2221<br />
Anyone who has f<strong>in</strong>ancial problems related to gambl<strong>in</strong>g should be encouraged to<br />
contact this service. This not-for-profit prov<strong>in</strong>cial organization provides <strong>in</strong>formation<br />
<strong>and</strong> referral to 26 member credit counsell<strong>in</strong>g services throughout Ontario. Their<br />
services <strong>in</strong>clude budget<strong>in</strong>g, deal<strong>in</strong>g with creditors, pay<strong>in</strong>g off debt at a rate that is<br />
manageable, <strong>and</strong> restor<strong>in</strong>g credit.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 49<br />
References<br />
Biddle, D., Hawthorne, G., Forbes, D. & Coman, G. (2005). <strong>Problem</strong> gambl<strong>in</strong>g <strong>in</strong> Australian PTSD treatment-seek<strong>in</strong>g<br />
veterans. Journal of Traumatic Stress, 18 (6), 759–767.<br />
Bl<strong>and</strong>, R., Newman, S., Orn, H. & Stebelsky, G. (1993). Epidemiology of pathological gambl<strong>in</strong>g <strong>in</strong><br />
Edmonton. Canadian Journal of Psychiatry, 38 (2), 108–112.<br />
Blaszczynski, A. (1998). Overcom<strong>in</strong>g Compulsive <strong>Gambl<strong>in</strong>g</strong>: A Self-Help Guide To Us<strong>in</strong>g Cognitive Behavioural<br />
Techniques. London: Rob<strong>in</strong>son Publish<strong>in</strong>g.<br />
Borras, L. & Huguelet, P. (2007). Schizophrenia <strong>and</strong> pathological gambl<strong>in</strong>g. The American Journal on<br />
Addiction, 16, 269–271.<br />
Boughton, R. & Brewster, J. (2002). Voices of Women Who Gamble <strong>in</strong> Ontario, A Survey of Women’s<br />
<strong>Gambl<strong>in</strong>g</strong>, Barriers to <strong>Treatment</strong> <strong>and</strong> <strong>Treatment</strong> Service Needs. Report for the M<strong>in</strong>istry of Health <strong>and</strong> Long-<br />
Term Care, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Unit Addictions Program.<br />
Chambers, R., Taylor, J. & Potenza, M. (2003). Developmental neurocircuitry of motivation <strong>in</strong> adolescence:<br />
A critical period of addiction vulnerability. American Journal of Psychiatry, 160, 1041–1052.<br />
Crockford, D. & el-Guebaly, N. (1998). Psychiatric comorbidity <strong>in</strong> pathological gambl<strong>in</strong>g: A critical review.<br />
Canadian Journal of Psychiatry, 43 (1), 43–50.<br />
Cunn<strong>in</strong>gham-Williams, R., Cottler, L. & Compton, W. (1998) Tak<strong>in</strong>g chances: <strong>Problem</strong> gamblers <strong>and</strong> mental<br />
health disorders—Results from the St. Louis epidemiological catchment area study. American Journal of<br />
Public Health, 88 (7), 1093–1096.<br />
Daghestani, A., Elenz, E. & Crayton, J. (1996). Pathological gambl<strong>in</strong>g <strong>in</strong> hospitalized substance abus<strong>in</strong>g veterans.<br />
Journal of Cl<strong>in</strong>ical Psychiatry, 57 (8), 360–363.<br />
Feigelman, W., Willisch, L. & Lesieur, H. (1998). <strong>Problem</strong> gamblers, problem substance users <strong>and</strong> dualproblem<br />
<strong>in</strong>dividuals: An epidemiological study. American Journal of Public Health, 88 (3), 467–470.<br />
Giacopassi, D., Stitt, B. & V<strong>and</strong>iver, M. (1998). An analysis of the relationship of alcohol to cas<strong>in</strong>o gambl<strong>in</strong>g<br />
among college students. Journal of <strong>Gambl<strong>in</strong>g</strong> Studies, 14 (2), 135–149.<br />
Kennedy, S., McIntyre, R., O’Donovan, C., Milev, R., le Melledo, J., Bisserbe, J. et al. (2008). Frequency <strong>and</strong><br />
Correlates of <strong>Gambl<strong>in</strong>g</strong> <strong>Problem</strong>s <strong>in</strong> Depressed <strong>and</strong> Bipolar Outpatients. Guelph, ON: Ontario <strong>Problem</strong><br />
<strong>Gambl<strong>in</strong>g</strong> Research Centre.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
50 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Ledgerwood, D. & Petry, N. (2006). Posttraumatic stress disorder symptoms <strong>in</strong> treatment-seek<strong>in</strong>g pathological<br />
gamblers. Journal of Traumatic Stress, 19 (3), 411–416.<br />
Lejoyeux, M., Feuche, N., Loi, S., Solomon, J. & Ades, J. (1999). Study of impulse-control disorders<br />
among alcohol-dependent patients. Journal of Cl<strong>in</strong>ical Psychology, 60 (5), 302–305.<br />
Lesieur, H., Blume, B. & Zappa, R. (1986). Alcoholism, drug abuse, <strong>and</strong> gambl<strong>in</strong>g. Alcoholism: Cl<strong>in</strong>ical <strong>and</strong><br />
Experimental Research, 10, 33–38.<br />
Littman-Sharp, N. & Turner, N. (1999). The Inventory of <strong>Gambl<strong>in</strong>g</strong> Situations: A Newly Revised Instrument<br />
for the Identification of <strong>Problem</strong> Gamblers’ High Risk Situations. Presentation at the Canadian Foundation<br />
on Compulsive <strong>Gambl<strong>in</strong>g</strong> Annual Conference 1999.<br />
Lobo, D. & Kennedy, J. (2006). The genetics of gambl<strong>in</strong>g <strong>and</strong> behavioural addictions. CNS Spectrums, 11<br />
(12), 931–939.<br />
McIntyre, R., McElroy, S., Konarski, J., Soczynska, J., Wilk<strong>in</strong>s, K. & Kennedy, S. (2007). <strong>Problem</strong> gambl<strong>in</strong>g<br />
<strong>in</strong> bipolar disorder: Results from the Canadian community health survey. Journal of Affective Disorders, 102,<br />
27–34.<br />
National Council of Welfare (1996). <strong>Gambl<strong>in</strong>g</strong> <strong>in</strong> Canada. Available:<br />
http://www.ncwcnbes.net/en/publications/pub-094.html. Accessed February 2, 2009.<br />
Petry, N., St<strong>in</strong>son, F. & Grant, B. (2005). Comorbidity of DSM-IV pathological gambl<strong>in</strong>g <strong>and</strong> other psychiatric<br />
disorders: Results from the national epidemiological survey on alcohol <strong>and</strong> related conditions. Journal<br />
of Cl<strong>in</strong>ical Psychiatry, 66 (5), 564–574.<br />
Rodriguez-Jimenez, R., Avila, C., Jimenez-Arriero, M., Ponce, G., Monasor, R., Jimenez, M. et al. (2006).<br />
Impulsivity <strong>and</strong> susta<strong>in</strong>ed attention <strong>in</strong> pathological gamblers: Influence of childhood ADHD history. Journal<br />
of <strong>Gambl<strong>in</strong>g</strong> Studies, 22, 451–461.<br />
Smart, R. & Ferris, J. (1994). Alcohol, drugs <strong>and</strong> gambl<strong>in</strong>g <strong>in</strong> the Ontario adult population. Canadian<br />
Journal of Psychiatry, 41 (1), 36–45.<br />
Statistics Canada. (2009). Population by Year, by Prov<strong>in</strong>ce <strong>and</strong> Territory. Available:<br />
http://www40.statcan.gc.ca/l01/cst01/demo02a-eng.htm. Accessed February 2, 2009.<br />
St<strong>in</strong>chfield, R., Kushner, M. & W<strong>in</strong>ters, K. (2005). Alcohol use <strong>and</strong> prior substance abuse treatment <strong>in</strong> relation<br />
to gambl<strong>in</strong>g problem severity <strong>and</strong> gambl<strong>in</strong>g treatment outcome. Journal of <strong>Gambl<strong>in</strong>g</strong> Studies, 21 (3),<br />
273–297.<br />
Toneatto, T. (2001). Cognitive therapy for problem gambl<strong>in</strong>g. In R.D. Murray (Ed.), Help<strong>in</strong>g the <strong>Problem</strong><br />
Gambler (pp. 47–62). Toronto: Centre for Addiction <strong>and</strong> Mental Health.<br />
Toneatto, T., Kosky, B. & Leo, G. (2003). How to Quit or Reduce Your <strong>Gambl<strong>in</strong>g</strong>: A Self-Help Workbook.<br />
Available: http://www.problemgambl<strong>in</strong>g.ca/EN/Gett<strong>in</strong>gHelp/Pages/SelfHelpWorkbook.aspx. Accessed<br />
February 2, 2009.<br />
Toneatto, T., Sk<strong>in</strong>ner, W. & Dragonetti, R. (2002). Patterns of substance use <strong>in</strong> treatment-seek<strong>in</strong>g problem<br />
gamblers: Impact on treatment outcomes. Journal of Cl<strong>in</strong>ical Psychology, 58 (7), 853–859.<br />
Turner, N. & Fritz, B. (2007). Games <strong>and</strong> Systems. Available:<br />
http://www.problemgambl<strong>in</strong>g.ca/EN/ResourcesForProfessionals/Pages/Games<strong>and</strong>Systems.aspx. Accessed<br />
February 2, 2009.<br />
Turner, N. & Powel, J. (2007). Probability, R<strong>and</strong>om Events <strong>and</strong> the Mathematics of <strong>Gambl<strong>in</strong>g</strong>. Available:<br />
http://www.problemgambl<strong>in</strong>g.ca/EN/ResourcesForProfessionals/Pages/ProbabilityR<strong>and</strong>omEvents<strong>and</strong>theMat<br />
hematicsof<strong>Gambl<strong>in</strong>g</strong>.aspx. Accessed February 2, 2009.<br />
Wiebe, J., Mun, P. & Kauffman, N. (2006). <strong>Gambl<strong>in</strong>g</strong> <strong>and</strong> <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> <strong>in</strong> Ontario 2005. Toronto:<br />
Responsible <strong>Gambl<strong>in</strong>g</strong> Council (Ontario).<br />
Welte, J., Barnes, G., Wieczorek, W., Tidwell, M. & Parker, J. (2001). Alcohol <strong>and</strong> gambl<strong>in</strong>g pathology among<br />
US adults: Prevalence, demographic patterns <strong>and</strong> comorbidity. Journal of Studies on Alcohol, 62 (5), 706–712.<br />
Williams, R. & Wood, R. (2004). The Demographic Sources of Ontario Gam<strong>in</strong>g Revenue. Guelph, ON:<br />
Ontario <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Research Centre.<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 51<br />
Appendices<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g Screen<strong>in</strong>g Tool · 53<br />
Appendix A<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Severity Index<br />
Th<strong>in</strong>k<strong>in</strong>g about the last 12 months . . .<br />
Have you bet more than you could really afford to lose?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
Still th<strong>in</strong>k<strong>in</strong>g about the last 12 months, have you needed to gamble with larger<br />
amounts of money to get the same feel<strong>in</strong>g of excitement?<br />
o Never 1 Sometimes 2 Most of the time 3 Almost always<br />
When you gambled, did you go back another day to try to w<strong>in</strong> back the money you lost?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
Have you borrowed money or sold anyth<strong>in</strong>g to get money to gamble?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
Have you felt that you might have a problem with gambl<strong>in</strong>g?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
Has gambl<strong>in</strong>g caused you any health problems, <strong>in</strong>clud<strong>in</strong>g stress or anxiety?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
Have people criticized your bett<strong>in</strong>g or told you that you had a gambl<strong>in</strong>g problem,<br />
regardless of whether or not you thought it was true?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
Has your gambl<strong>in</strong>g caused any f<strong>in</strong>ancial problems for you or your household?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
Have you felt guilty about the way you gamble or what happens when you gamble?<br />
0 Never 1 Sometimes 2 Most of the time 3 Almost always<br />
scor<strong>in</strong>g<br />
0: Non-problem gambl<strong>in</strong>g.<br />
1 or 2: Low level of p0roblems with few or no identified negative consequences.<br />
3 to 7: Moderate level of problems lead<strong>in</strong>g to some negative consequences.<br />
8 or more: <strong>Problem</strong> gambl<strong>in</strong>g with negative consequences <strong>and</strong> a possible loss of control.<br />
Reference: Ferris, J., & Wynne, H. (2001). The Canadian problem gambl<strong>in</strong>g <strong>in</strong>dex:<br />
F<strong>in</strong>al report. Submitted for the Canadian Centre on Substance Abuse.<br />
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54 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 55<br />
Appendix B<br />
Sessions 1 <strong>and</strong> 2: Pretest/Post-Test<br />
1. Why is it important to talk about gambl<strong>in</strong>g, even if you’ve never gambled before?<br />
a. Because everyone gambles<br />
b. Because people who have substance use <strong>and</strong>/or mental health problems are at risk<br />
for develop<strong>in</strong>g gambl<strong>in</strong>g problems<br />
c. Because gambl<strong>in</strong>g can be a trigger for substance use or mental health relapse<br />
d. All of the above<br />
e. b <strong>and</strong> c<br />
2. Which of the follow<strong>in</strong>g elements is not part of the def<strong>in</strong>ition of gambl<strong>in</strong>g?<br />
a. Someth<strong>in</strong>g of value is risked<br />
b. It is a social activity<br />
c. The outcome has an element of chance<br />
d. Once the bet is made, it is irreversible<br />
3. Which of the follow<strong>in</strong>g would be considered gambl<strong>in</strong>g activities?<br />
a. Slot mach<strong>in</strong>es<br />
b. Horse bett<strong>in</strong>g<br />
c. B<strong>in</strong>go<br />
d. Lotteries<br />
e. Gett<strong>in</strong>g married<br />
f. All of the above<br />
g. All except e<br />
4. Lots of people gamble without it becom<strong>in</strong>g a problem. You know it has become a<br />
problem when it damages your:<br />
a. F<strong>in</strong>ances<br />
b. Work<br />
c. Relationships<br />
d. Reputation<br />
e. All of the above<br />
5. What percentage of adults <strong>in</strong> Ontario have gambled <strong>in</strong> the past year?<br />
a. 90%<br />
b. 74%<br />
c. 63%<br />
d. 29%<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
56 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
6. What is the most common gambl<strong>in</strong>g activity among adults <strong>in</strong> Ontario?<br />
a. Slot mach<strong>in</strong>es<br />
b. Lottery tickets<br />
c. B<strong>in</strong>go<br />
d. Horse bett<strong>in</strong>g<br />
7. What percentage of adults <strong>in</strong> Ontario have a moderate to severe gambl<strong>in</strong>g problem?<br />
a. 31.2%<br />
b. 19.8%<br />
c. 9.5%<br />
d. 3.4%<br />
8. Which of the follow<strong>in</strong>g statements best describes those who are experienc<strong>in</strong>g problems<br />
with gambl<strong>in</strong>g?<br />
a. Many struggle with mood disorders<br />
b. Many struggle with anxiety disorders<br />
c. Many struggle with psychosis<br />
d. All of the above<br />
e. a <strong>and</strong> b<br />
9. Which of the follow<strong>in</strong>g is not a risk factor for problem gambl<strong>in</strong>g?<br />
a. An early big w<strong>in</strong><br />
b. Mistaken beliefs about the odds of w<strong>in</strong>n<strong>in</strong>g<br />
c. Hav<strong>in</strong>g a family member who has had a big lottery w<strong>in</strong><br />
d. A history of substance use <strong>and</strong>/or mental health problems<br />
10. Why is gambl<strong>in</strong>g especially problematic for people who have a substance use problem?<br />
a. They may believe, <strong>in</strong> error, that it is a safer activity<br />
b. If they gamble when <strong>in</strong>toxicated, they can get <strong>in</strong>to f<strong>in</strong>ancial trouble<br />
c. They may believe, <strong>in</strong> error, that gambl<strong>in</strong>g would be a good way to f<strong>in</strong>ance their substance<br />
use<br />
d. If they lose money while gambl<strong>in</strong>g, they are more likely to use substances to cope<br />
e. All of the above<br />
11. People who are considered to gamble non-problematically would be people who:<br />
a. See gambl<strong>in</strong>g as one of many types of recreational activities <strong>and</strong> realize that gambl<strong>in</strong>g<br />
can be a way of <strong>in</strong>creas<strong>in</strong>g their <strong>in</strong>come<br />
b. Only gamble what they can afford to lose <strong>and</strong> enjoy the fun of gambl<strong>in</strong>g so much<br />
that they lose track of time<br />
c. Do not allow gambl<strong>in</strong>g to <strong>in</strong>terfere with their personal relationships <strong>and</strong> make sure<br />
that they stay long enough to w<strong>in</strong> back what they have lost<br />
d. Control the amount of money they spend on gambl<strong>in</strong>g <strong>and</strong> see gambl<strong>in</strong>g as one of<br />
many types of recreational activities<br />
12. Which of the follow<strong>in</strong>g are characteristics of someth<strong>in</strong>g that is r<strong>and</strong>om?<br />
a. All outcomes are equally likely<br />
b. No one can predict the outcome<br />
c. There is no connection between results<br />
d. All of the above<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 57<br />
13. Which phrase best illustrates the idea of <strong>in</strong>dependent outcome?<br />
a. “The house always w<strong>in</strong>s.”<br />
b. “<strong>Gambl<strong>in</strong>g</strong> games have no memories.”<br />
c. “This slot mach<strong>in</strong>e is due for a payout.”<br />
d. “I never gamble on a Sunday.”<br />
14. Which of the follow<strong>in</strong>g statements is true?<br />
a. You should keep play<strong>in</strong>g the same lottery numbers—it <strong>in</strong>creases your chances<br />
of w<strong>in</strong>n<strong>in</strong>g.<br />
b. When look<strong>in</strong>g for a slot mach<strong>in</strong>e to play, you should try to f<strong>in</strong>d one that hasn’t paid<br />
out <strong>in</strong> a while.<br />
c. The lottery numbers drawn this week have no effect on the numbers that will be<br />
drawn next week.<br />
d. If a fair co<strong>in</strong> is tossed five times <strong>and</strong> you get “tails” each time, the sixth time the<br />
co<strong>in</strong> is more likely to turn up “heads.”<br />
15. Which are examples of the house advantage?<br />
a. If I flip a co<strong>in</strong> four times <strong>and</strong> it l<strong>and</strong>s on heads each time, the chance that I flip<br />
heads on the fifth flip rema<strong>in</strong>s 50%.<br />
b. In cas<strong>in</strong>o blackjack, when both the dealer <strong>and</strong> the player go over 21, the player loses<br />
his or her money.<br />
c. In roulette, the wheel has 38 slots but only 36 have numbers <strong>and</strong> are either red or<br />
black. The two rema<strong>in</strong><strong>in</strong>g slots are 0 <strong>and</strong> 00 <strong>and</strong> both green. Therefore, when the<br />
marble l<strong>and</strong>s on either 0 or 00, all the players who bet on red or black lose their bets.<br />
d. All of the above<br />
e. b <strong>and</strong> c<br />
16. Which of the follow<strong>in</strong>g is a game of pure chance?<br />
a. Slot mach<strong>in</strong>es<br />
b. Card games<br />
c. Sports bett<strong>in</strong>g<br />
d. Horse bett<strong>in</strong>g<br />
17. Cognitive distortions are:<br />
a. False <strong>and</strong> superstitious thoughts, ideas or beliefs<br />
b. Common <strong>in</strong> all societies<br />
c. A risk factor for problem gambl<strong>in</strong>g<br />
d. All of the above<br />
e. a <strong>and</strong> c<br />
18. To reduce the risk associated with gambl<strong>in</strong>g, you should:<br />
a. Set a limit on time <strong>and</strong> money<br />
b. Th<strong>in</strong>k of gambl<strong>in</strong>g as enterta<strong>in</strong>ment, not a way to make money<br />
c. Remember that the house always has the advantage<br />
d. All of the above<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
58 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 59<br />
Sessions 1 <strong>and</strong> 2: Pretest/Post-Test Answers<br />
1. Why is it important to talk about gambl<strong>in</strong>g, even if you’ve never gambled before?<br />
e. b <strong>and</strong> c<br />
2. Which of the follow<strong>in</strong>g elements is not part of the def<strong>in</strong>ition of gambl<strong>in</strong>g?<br />
b. It is a social activity<br />
3. Which of the follow<strong>in</strong>g would be considered gambl<strong>in</strong>g activities?<br />
g. All except e<br />
4. Lots of people gamble without it becom<strong>in</strong>g a problem. You know it has become a<br />
problem when it damages your:<br />
e. All of the above<br />
5. What percentage of adults <strong>in</strong> Ontario have gambled <strong>in</strong> the past year?<br />
c. 63%<br />
6. What is the most common gambl<strong>in</strong>g activity among adults <strong>in</strong> Ontario?<br />
b. Lottery tickets<br />
7. What percentage of Ontario adults have a moderate to severe gambl<strong>in</strong>g problem?<br />
d. 3.4%<br />
8. Which of the follow<strong>in</strong>g statements best describes those who are experienc<strong>in</strong>g problems<br />
with gambl<strong>in</strong>g?<br />
e. a <strong>and</strong> b<br />
9. Which of the follow<strong>in</strong>g is not a risk factor for problem gambl<strong>in</strong>g?<br />
c. Hav<strong>in</strong>g a family member who has had a big lottery w<strong>in</strong><br />
10. Why is gambl<strong>in</strong>g especially problematic for people who have a substance use problem?<br />
e. All of the above<br />
11. People who are considered to gamble non-problematically would be people who:<br />
d. Control the amount of money they spend on gambl<strong>in</strong>g <strong>and</strong> see gambl<strong>in</strong>g as one of<br />
many types of recreational activities<br />
12. Which of the follow<strong>in</strong>g are characteristics of someth<strong>in</strong>g that is r<strong>and</strong>om?<br />
d. All of the above<br />
13. Which phrase best illustrates the idea of <strong>in</strong>dependent outcome?<br />
b. “<strong>Gambl<strong>in</strong>g</strong> games have no memories.”<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
60 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
14. Which of the follow<strong>in</strong>g statements is true?<br />
c. The lottery numbers drawn this week have no effect on the numbers that will be<br />
drawn next week.<br />
15. Which are examples of the house advantage?<br />
e. b <strong>and</strong> c<br />
16. Which of the follow<strong>in</strong>g is a game of pure chance?<br />
a. Slot mach<strong>in</strong>es<br />
17. Cognitive distortions are:<br />
d. All of the above<br />
18. To reduce the risk associated with gambl<strong>in</strong>g, you should:<br />
d. All of the above<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g Session 1 H<strong>and</strong>out · 61<br />
Appendix C<br />
<strong>Problem</strong>atic vs. Non-<strong>Problem</strong>atic <strong>Gambl<strong>in</strong>g</strong><br />
life non-problematic problematic<br />
areas gambl<strong>in</strong>g gambl<strong>in</strong>g<br />
Individuals who gamble non-problem- Individuals who gamble problem-<br />
atically only lose money that they can atically lose more money than<br />
afford to lose. Money is budgeted they can afford to lose <strong>and</strong> often<br />
for this activity <strong>in</strong> the same way that make the situation worse by<br />
money is budgeted for other social try<strong>in</strong>g to w<strong>in</strong> back what they<br />
activities. When the funds are spent, have lost.<br />
the gambl<strong>in</strong>g stops.<br />
F<strong>in</strong>ancial<br />
limits<br />
Time Individuals who gamble non- Individuals who gamble<br />
limits problematically control the amount problematically often lose track<br />
of time they spend gambl<strong>in</strong>g. of time <strong>and</strong> spend more time<br />
gambl<strong>in</strong>g than they <strong>in</strong>tend.<br />
Enterta<strong>in</strong>- Individuals who gamble non- Individuals who gamble<br />
ment problematically enjoy gambl<strong>in</strong>g problematically are more likely<br />
as a form of social or recreational to see gambl<strong>in</strong>g as a form of<br />
activity <strong>in</strong> which they engage peri- <strong>in</strong>come or a game of skill that<br />
odically. <strong>Gambl<strong>in</strong>g</strong> meets personal they can conquer.<br />
social needs such as gett<strong>in</strong>g out of<br />
the house <strong>and</strong> see<strong>in</strong>g other people.<br />
Other Individuals who gamble non- Individuals who gamble<br />
activities problematically enjoy gambl<strong>in</strong>g problematically often spend a great<br />
as one of many social activities deal of time gambl<strong>in</strong>g, while<br />
<strong>in</strong> a balanced lifestyle.<br />
miss<strong>in</strong>g family functions <strong>and</strong><br />
skipp<strong>in</strong>g other activities that they<br />
used to enjoy. They often th<strong>in</strong>k<br />
about gambl<strong>in</strong>g even when they<br />
are not gambl<strong>in</strong>g.<br />
Relation- Individuals who gamble non- Individuals who gamble<br />
ships problematically do not allow their problematically f<strong>in</strong>d that gambl<strong>in</strong>g<br />
gambl<strong>in</strong>g to disrupt their personal, disrupts personal, social <strong>and</strong><br />
social <strong>and</strong> professional relationships. professional relationships.<br />
Personal Individuals who gamble non- Individuals who gamble<br />
control problematically have control over problematically lose control over<br />
the amount of money they spend the amount of time <strong>and</strong> money<br />
gambl<strong>in</strong>g.<br />
they spend gambl<strong>in</strong>g.<br />
Reference: <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project, camh<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
62 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g Session 2 H<strong>and</strong>out · 63<br />
Appendix D<br />
Reduc<strong>in</strong>g the Risk<br />
All gambl<strong>in</strong>g has potential risks. If you are experienc<strong>in</strong>g f<strong>in</strong>ancial, emotional or physical<br />
health problems because of your gambl<strong>in</strong>g, you should consider tak<strong>in</strong>g a break<br />
to fully underst<strong>and</strong> its impact on your life <strong>and</strong> to help you ga<strong>in</strong> control. If you do<br />
choose to gamble, consider the follow<strong>in</strong>g strategies to limit your risk:<br />
Set a limit on your time <strong>and</strong> money.<br />
Spend only what you can afford to lose. Leave your bank <strong>and</strong> credit cards at home.<br />
When your budget is gone <strong>and</strong> your time is up, walk away! Do not try to w<strong>in</strong> back<br />
your losses or use rent or grocery money to cont<strong>in</strong>ue to gamble. Keep a diary of how<br />
much time you play <strong>and</strong> record your w<strong>in</strong>s <strong>and</strong> losses—memory is selective <strong>in</strong><br />
remember<strong>in</strong>g only the w<strong>in</strong>s.<br />
Th<strong>in</strong>k of gambl<strong>in</strong>g as enterta<strong>in</strong>ment <strong>and</strong> not as a way to make money.<br />
Play know<strong>in</strong>g that you will almost certa<strong>in</strong>ly lose. Go with friends who do not have<br />
gambl<strong>in</strong>g problems <strong>and</strong> ask them to support you <strong>in</strong> stay<strong>in</strong>g with<strong>in</strong> your pre-set limits.<br />
See the money lost as part of your enterta<strong>in</strong>ment budget.<br />
Underst<strong>and</strong> the odds. The “house” always has the edge.<br />
Make your gambl<strong>in</strong>g decisions based on an accurate underst<strong>and</strong><strong>in</strong>g of your odds of<br />
w<strong>in</strong>n<strong>in</strong>g. Expect to lose. Accept that you have no control over the outcome of gambl<strong>in</strong>g.<br />
It is truly r<strong>and</strong>om. You cannot change the outcome, there are no w<strong>in</strong>n<strong>in</strong>g<br />
strategies <strong>and</strong> you cannot <strong>in</strong>fluence luck. The odds are stacked aga<strong>in</strong>st you <strong>and</strong><br />
always <strong>in</strong> favour of the house.<br />
Recognize risk factors.<br />
Do not gamble when you are feel<strong>in</strong>g vulnerable, bored, lonely, anxious or angry. Be careful<br />
not to use gambl<strong>in</strong>g as a way to escape problems or to avoid difficult feel<strong>in</strong>gs or situations.<br />
Mix<strong>in</strong>g alcohol or other drugs with gambl<strong>in</strong>g is risky <strong>and</strong> should also be avoided.<br />
If you choose to gamble, keep it as part of a balanced lifestyle.<br />
If you choose to gamble, see gambl<strong>in</strong>g as an enjoyable part of a balanced lifestyle.<br />
Have other mean<strong>in</strong>gful activities <strong>in</strong> your life—not just gambl<strong>in</strong>g.<br />
Listen to the concerns of others.<br />
If others express concern about your gambl<strong>in</strong>g, listen to them! They may see someth<strong>in</strong>g<br />
that you don’t. People who do not have gambl<strong>in</strong>g problems do not let their gambl<strong>in</strong>g<br />
behaviours negatively affect relationships <strong>in</strong> their personal, social or professional lives.<br />
Reference: <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project, camh<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
64 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g Session 3 H<strong>and</strong>out · 65<br />
Appendix E<br />
How to Choose Your <strong>Gambl<strong>in</strong>g</strong> Goal<br />
To help you choose the best goal for you, you might f<strong>in</strong>d it helpful to ask yourself the<br />
follow<strong>in</strong>g questions. A “yes” answer to any of the questions <strong>in</strong>dicates that cutt<strong>in</strong>g<br />
down may not be the best choice <strong>and</strong> a goal of abst<strong>in</strong>ence is recommended.<br />
YES<br />
NO<br />
1. Is my gambl<strong>in</strong>g considered to be a severe problem?<br />
2. Have I already made an attempt(s) to moderate my gambl<strong>in</strong>g<br />
but did not succeed?<br />
3. Will any gambl<strong>in</strong>g hurt me f<strong>in</strong>ancially?<br />
4. Have I been m<strong>and</strong>ated to seek treatment by my employer<br />
or by the crim<strong>in</strong>al justice system?<br />
5. Are my personal relationships at risk (that is, friends or family)<br />
if I cont<strong>in</strong>ue to gamble?<br />
6. Do I want to cont<strong>in</strong>ue gambl<strong>in</strong>g so that I can w<strong>in</strong> back lost money?<br />
7. Am I always th<strong>in</strong>k<strong>in</strong>g about gambl<strong>in</strong>g <strong>and</strong> ways to w<strong>in</strong>?<br />
8. Am I us<strong>in</strong>g gambl<strong>in</strong>g to escape other problems or feel<strong>in</strong>gs?<br />
(Toneatto et al., 2003)<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
66 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g Session 3 H<strong>and</strong>out · 67<br />
Appendix F<br />
My Goal Statement<br />
Decide what goals you will follow over the next several weeks/months <strong>and</strong> <strong>in</strong>dicate<br />
your choice by complet<strong>in</strong>g the follow<strong>in</strong>g goal statements. Be specific <strong>and</strong> set a goal for<br />
every gambl<strong>in</strong>g activity that you have been <strong>in</strong>volved <strong>in</strong> (for example, lottery tickets,<br />
scratch tickets, cards, horse bett<strong>in</strong>g, b<strong>in</strong>go, slot mach<strong>in</strong>es, Internet bett<strong>in</strong>g, etc.). An<br />
example is <strong>in</strong>cluded below.<br />
Date: _____________________________<br />
Signature: _________________________<br />
gambl<strong>in</strong>g<br />
activity<br />
gambl<strong>in</strong>g goal<br />
Example: Poker ■ Abst<strong>in</strong>ence<br />
■✓<br />
Reduced gambl<strong>in</strong>g<br />
This means I will gamble: 1 time(s) per ■ day, ■ week, or ■✓<br />
month.<br />
I will wager a maximum of $50 per gambl<strong>in</strong>g occasion.<br />
additional <strong>in</strong>formation: I will not play poker <strong>in</strong> cas<strong>in</strong>os or<br />
onl<strong>in</strong>e—only at home with friends. I will not play if I have<br />
been dr<strong>in</strong>k<strong>in</strong>g or us<strong>in</strong>g drugs <strong>and</strong> I will not play if I am feel<strong>in</strong>g<br />
lonely, angry or sad.<br />
gambl<strong>in</strong>g<br />
activity<br />
___________<br />
gambl<strong>in</strong>g goal<br />
(check one)<br />
■ Abst<strong>in</strong>ence<br />
■ Reduced gambl<strong>in</strong>g<br />
This means I will gamble: ___ time(s) per ■ day, ■ week, or ■ month.<br />
I will wager a maximum of $_____ per gambl<strong>in</strong>g occasion.<br />
additional <strong>in</strong>formation: _______________________________<br />
______________________________________________________<br />
______________________________________________________<br />
Reference: <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project, camh<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
68 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
___________<br />
■ Abst<strong>in</strong>ence<br />
■ Reduced gambl<strong>in</strong>g<br />
This means I will gamble: ___ time(s) per ■ day, ■ week, or ■ month.<br />
I will wager a maximum of $_____ per gambl<strong>in</strong>g occasion.<br />
additional <strong>in</strong>formation: _______________________________<br />
______________________________________________________<br />
______________________________________________________<br />
___________<br />
■ Abst<strong>in</strong>ence<br />
■ Reduced gambl<strong>in</strong>g<br />
This means I will gamble: ___ time(s) per ■ day, ■ week, or ■ month.<br />
I will wager a maximum of $_____ per gambl<strong>in</strong>g occasion.<br />
additional <strong>in</strong>formation: _______________________________<br />
______________________________________________________<br />
______________________________________________________<br />
___________<br />
■ Abst<strong>in</strong>ence<br />
■ Reduced gambl<strong>in</strong>g<br />
This means I will gamble: ___ time(s) per ■ day, ■ week, or ■ month.<br />
I will wager a maximum of $_____ per gambl<strong>in</strong>g occasion.<br />
additional <strong>in</strong>formation: _______________________________<br />
______________________________________________________<br />
______________________________________________________<br />
___________<br />
■ Abst<strong>in</strong>ence<br />
■ Reduced gambl<strong>in</strong>g<br />
This means I will gamble: ___ time(s) per ■ day, ■ week, or ■ month.<br />
I will wager a maximum of $_____ per gambl<strong>in</strong>g occasion.<br />
additional <strong>in</strong>formation: _______________________________<br />
______________________________________________________<br />
______________________________________________________<br />
Reference: <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project, camh<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g Session 3 H<strong>and</strong>out · 69<br />
Appendix G<br />
Self-Monitor<strong>in</strong>g <strong>Gambl<strong>in</strong>g</strong> or Urges to Gamble<br />
Learn<strong>in</strong>g to underst<strong>and</strong> <strong>and</strong> control gambl<strong>in</strong>g urges is an important step <strong>in</strong> rega<strong>in</strong><strong>in</strong>g<br />
control over gambl<strong>in</strong>g behaviour. Record<strong>in</strong>g urges to gamble, as well as actual<br />
gambl<strong>in</strong>g situations, can help you to discover gambl<strong>in</strong>g patterns, triggers <strong>and</strong> cop<strong>in</strong>g<br />
strategies that are work<strong>in</strong>g for you.<br />
Date Time Type Where With Mood Gambled? Time Net<br />
whom spent w<strong>in</strong>/loss<br />
Comments: ____________________________________________________________<br />
Consequences if you gambled: ____________________________________________<br />
Cop<strong>in</strong>g strategies if you did not: ___________________________________________<br />
Date Time Type Where With Mood Gambled? Time Net<br />
whom spent w<strong>in</strong>/loss<br />
Comments: ____________________________________________________________<br />
Consequences if you gambled: ____________________________________________<br />
Cop<strong>in</strong>g strategies if you did not: ___________________________________________<br />
Reference: N<strong>in</strong>a Littman-Sharp, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Service, camh<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
70 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
Date Time Type Where With Mood Gambled? Time Net<br />
whom spent w<strong>in</strong>/loss<br />
Comments: ____________________________________________________________<br />
Consequences if you gambled: ____________________________________________<br />
Cop<strong>in</strong>g strategies if you did not: ___________________________________________<br />
Date Time Type Where With Mood Gambled? Time Net<br />
whom spent w<strong>in</strong>/loss<br />
Comments: ____________________________________________________________<br />
Consequences if you gambled: ____________________________________________<br />
Cop<strong>in</strong>g strategies if you did not: ___________________________________________<br />
Date Time Type Where With Mood Gambled? Time Net<br />
whom spent w<strong>in</strong>/loss<br />
Comments: ____________________________________________________________<br />
Consequences if you gambled: ____________________________________________<br />
Cop<strong>in</strong>g strategies if you did not: ___________________________________________<br />
Reference: N<strong>in</strong>a Littman-Sharp, <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Service, camh<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g Session 3 H<strong>and</strong>out · 71<br />
Appendix H<br />
<strong>Gambl<strong>in</strong>g</strong> Triggers<br />
situations<br />
action plan<br />
thoughts<br />
moods<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
72 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g 73<br />
Appendix I<br />
Facilitator’s Evaluation<br />
Your feedback is important to us. Please take a few moments to complete this evaluation.<br />
Thank you for tak<strong>in</strong>g the time to complete this evaluation form. Please fax it to:<br />
<strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong> Project, camh<br />
416 260-4185<br />
facilitator’s guide<br />
strongly strongly<br />
disagree<br />
agree<br />
The facilitator’s guide was easy to use. 1 2 3 4 5<br />
The facilitator’s guide was clear <strong>and</strong> concise. 1 2 3 4 5<br />
The facilitator’s guide provided enough<br />
<strong>in</strong>formation for me to deliver this program. 1 2 3 4 5<br />
powerpo<strong>in</strong>t slides<br />
strongly<br />
disagree<br />
strongly<br />
agree<br />
The <strong>in</strong>formation is presented <strong>in</strong> a way that is easy<br />
for participants to underst<strong>and</strong>. 1 2 3 4 5<br />
The language level used <strong>in</strong> the slides is at an<br />
appropriate level. 1 2 3 4 5<br />
The concepts presented are easy for participants<br />
to underst<strong>and</strong>. 1 2 3 4 5<br />
participant h<strong>and</strong>outs<br />
strongly strongly<br />
disagree<br />
agree<br />
The h<strong>and</strong>outs are helpful to the participants. 1 2 3 4 5<br />
The h<strong>and</strong>outs are clear <strong>and</strong> concise. 1 2 3 4 5<br />
The language used <strong>in</strong> the h<strong>and</strong>outs is at<br />
an appropriate level. 1 2 3 4 5<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health
74 <strong>Problem</strong> <strong>Gambl<strong>in</strong>g</strong>: <strong>Education</strong> <strong>and</strong> <strong>Treatment</strong> <strong>in</strong> a <strong>Residential</strong> Sett<strong>in</strong>g<br />
additional <strong>in</strong>formation<br />
strongly<br />
disagree<br />
strongly<br />
agree<br />
The 60- to 90-m<strong>in</strong>ute suggested timeframe is<br />
suitable to deliver each session. 1 2 3 4 5<br />
The preparation time needed to deliver each<br />
session is reasonable. 1 2 3 4 5<br />
“The Slot Mach<strong>in</strong>e: What Every Player Needs<br />
to Know” video via the Internet is accessible<br />
<strong>and</strong> easy to use. 1 2 3 4 5<br />
The Inventory of <strong>Gambl<strong>in</strong>g</strong> Situations (igs)<br />
tool is easy to adm<strong>in</strong>ister to clients. 1 2 3 4 5<br />
“The Slot Mach<strong>in</strong>e: What Every Player Needs<br />
to Know” video <strong>and</strong> Inventory of <strong>Gambl<strong>in</strong>g</strong><br />
Situations (igs) tool are useful components<br />
of this program. 1 2 3 4 5<br />
Was anyth<strong>in</strong>g miss<strong>in</strong>g? ___________________________________________________<br />
______________________________________________________________________<br />
______________________________________________________________________<br />
Additional comments: ___________________________________________________<br />
______________________________________________________________________<br />
______________________________________________________________________<br />
I have used the follow<strong>in</strong>g sessions with clients:<br />
■ Sessions 1 <strong>and</strong> 2<br />
■ Sessions 3 <strong>and</strong> 4<br />
Number of times delivered: _________________________<br />
Average number of participants per session: ___________<br />
Number of times delivered: _________________________<br />
Average number of participants per session: ___________<br />
I work <strong>in</strong> the follow<strong>in</strong>g field:<br />
■ Addiction<br />
■ Mental health<br />
■ Concurrent disorders<br />
■ Other (Specify):<br />
Date evaluation form was completed: ______________________________________<br />
©2009 Centre for Addiction <strong>and</strong> Mental Health