GAMBLINGNOMORE.COM
bookdsd
PRESENTS
Tools for Counseling
Problem Gamblers
When Winning is Losing
Stuart Cline MA
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Information all counselors must know.
Important Disclaimer
The information in this Manual may be used for clinical practice and to pass
out the handouts to clients. Feel free to send people to gamblingnomore.com
for others to download their own copy. I reserve the right to make changes,
additions, and improvements to this book at any time without notice to any
person or organization.
By reading this manual you agree to not hold me liable for the outcome of
your clients’ progress or lack of it. Counseling by nature allows you to work
with people on a therapeutic level that builds trust and safety. I write this
manual trusting that you will use it in a manner that is in your scope of
practice. This book does not make the reader an expert in working with this
population, and I encourage readers who are interested in this field to follow
up with clinical training. Due to the nature of pathological gambling there are
often cross addictions and co-occurring disorders. As the reader using this
manual you are responsible to act on and focus on the mental illness that
needs the most attention first, such as active suicidal ideation, safety issues
with domestic violence, and abuse that falls within duty to warn of course.
This disclaimer is not intended to be a comprehensive summary of the risks
involved in working with problem and pathological gamblers.
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Content
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Important Disclaimer
Contents
Preface –Why I wrote this book
Section 1
Introduction
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Overview of book and quick reference
Section 2
More in-depth info on section 1's quick reference
 3 Phases of gambling
 2 Categories of gambling
 6 Types of gambling
 General risk factors contributing to problem gambling
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DSM V criteria changes for Pathological Gambling
Definition of gambling and problem gambling
Why people come into treatment
Treatment providers philosophy
3 Stages of pathological gambling
5 stages of addiction - Disease Model
4 stages of recovery
2 categories of pathological gamblers
6 types of gamblers
Types of issues caused by pathological gambling
Forms of gambling
Similarities between pathological gamblers and substance dependence
Financial Counseling
What counselors need to keep in mind when counseling problem gamblers
Therapeutic benefits of counseling treatment
What traps to avoid early in counseling
page 29
How does one become a problem gambler?
Relapse risk factors
Effects on the family
Warnings signs of teen gambling include
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Section 3
The brain and Pathological Gambling
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Section 4
Screenings, and Assessment
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page 41
Intro to the brain
Brain development
Brain health
Is gambling a brain disease?
Dopamine - The feel good neurotransmitter
What the prefrontal cortex does and why I need to know
Anterior Cingulate Gyrus (ACG)
Amygdala-
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Lie bet
SOGS –South Oaks Gambling Screen
GA 20 questions
DSM-IV Pathological Gambling assessment
Section 5
Tools to Help Problem and Pathological Gamblers
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Section 6
Documentation
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page 65
Harm reduction
Abstinence
Techniques to help you abstain from gambling
Self care list
Writing assignments
Mental Martial Arts
H.A.L.T.S
Sleep Hygiene tips
Dealing with Distorted Thoughts about Gambling
Values list and work sheet
Hobbies and leisure activities
Time Management
Stages of Change
Healing meditation
Gambling Coping Behavior Inventory (GCBI)
Limiting access to money
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Documentation Do's and Don'ts
Intake – form
Confidentiality- form
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Progress notes
Psycho-social – Client history /self assessment
Section 7
Treatment Goals and Plans
 List of Possible Treatment Goals
 Problem gambling treatment plans
Section 8
Substances to be aware of in recovery
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N-acetyl cysteine
Unsafe drug list for people in recovery
11 Keys to Sobriety
Section 9
Glossary of Terms
Page 118
Section 10
Problem Gambling Internet Resources
page 125
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State and country gambling hotline #’s and email addresses.
Section 11
Contact information for Inpatient Treatment
page 138
Section 12
References
page 144
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Preface
Why I wrote this book
In the Albuquerque Journal May 22, 2010, I read a front page article on the
death of a 51 year old mother. She took her own life two days before being
sentenced for embezzling 3.4 million dollars from the school district in
Jemez, New Mexico, to foster her gambling addiction. I completely
understand how compulsive gambling affects people’s lives to the point of
suicide. I know the addiction. I have been working with pathological gamblers
since 2005 in Albuquerque, New Mexico. Before that I have a history of
specializing in substance abuse and addiction. I have sat with a grandmother
who has been married for 50 years as she tells her husband that she spent
their entire life savings due to gambling. He is in his 60’s, has a high school
diploma, and together they had saved up $50,000 for their retirement. His
dreams of travel, security, helping out their children and grandchildren were
over. These are emotional sessions not only for the couple, but for me as a
counselor, too. Seeing the look in his eyes register the deception and
betrayal of trust by the closest person he knows was difficult. The look in his
eyes will be forever changed knowing that today is the end of a marriage as
he knew it.
I have also sat in the locked psychiatric ward of a hospital with a
private practice client of mine who called me after taking the prescription pills
she stockpiled to kill herself due to the stress caused by her compulsive
gambling. I helped get her into the hospital. I took the appropriate steps and
got an ambulance to her house to take her to the Emergency Room. After
being in the medical hospital for two days they transferred her to the adult
psychiatric unit. The night I went to speak with her in the hospital was hours
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after she attempted to kill herself in a seclusion room by wrapping the
hospital gown around her neck and lying across the doorway of the padded
room. A nurse looked up at the monitor to find, to her horror, her client’s head
was dark blue. The staff was able to save her. She was seconds from death
again. Even though my client apologized to the nurse and staff in this locked
ward psych unit, these people who ran to her aid will never forget that
moment. Nor will her three young adult children who came within seconds of
losing their only parent.
I have also spoken to a grandfather who had been disowned by his
children and his wife of 40 years because he lost all their money gambling.
He still lived with his wife until their divorce was final. She was elderly,
agoraphobic, and needed him. He often spoke of the rage he experienced
from his wife. She planned to move to Texas to live with the children and he
would move to Arizona to be alone, away from casinos. He felt as though his
family was treating him with “disgust and disdain” as if he was a “pedophile”.
He, too, was struggling for purpose to live.
Lives are forever changed when gambling moves from a fun leisure
activity to a compulsion that leads to suicide. Every one of these
aforementioned clients is an escape gambler. They played the slots to get
away from stressors in their life. Originally, they played for fun until they
became addicted and almost lost everything.
Another important reason I am writing this workbook is because this
field is a specialty. Not all counselors are the same. I want to give counselors
who need some more knowledge and tools in this field the help they need in
an easy straight forward manner. This came to me when, two weeks before I
read the May 22 article, a distraught counselor came to me and asked if I
could give her some ideas to help a woman who, for the past two months,
gambled away her mortgage and was at risk of losing her home. My first
suggestion was for her client to call the problem gambling hotline in the state
so she could talk with someone who specializes in Pathological gambling.
She said she did that, but only went to the counselor once. I asked “Why only
once?” The counselor said that this counselor thought this could be a past
life issue and then did hypnosis on her to see what past life is influencing her
to gamble. I was baffled and confused. I asked, to clarify “Your client is about
to lose her home and the therapist did a past life regression when she is in
crisis” Her answer “Yes”. I gave her some information and resources to pass
on, and her anxiety about what to do with this client went away. The next day
I saw one of my Pathological gambling clients in an individual session.
During the week she had attended a group session with a different counselor
with the focus of pathological gambling. I asked how it was going and found
out that she was not sure if she was going to go to the next meeting. I asked
why. She said that the psychologist was going to take them to a casino for
desensitization therapy. She spoke of how the group will go into the casino
and then afterwards leave and then process it. In my head alarms and
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whistles were going off. I know enough about the brain and why this would
sabotage what little recovery this person had. The reason she thought she
would not go to the next group was because she felt that this would trigger
her to want to gamble. I encouraged her to listen to her feelings. I agreed
with her that this was not a good idea for her.
For those who are reading this, I want you to know there is help.
There is treatment and I am here to give you some tools to help you better
handle problem and pathological gamblers. Knowledge is only a part of
power. Taking action to that knowledge is where the power really comes
from. Clients educated about problem gambling have a responsibility to
themselves and the people around them to not gamble, and to find more to
live for. The more clients know about how to handle triggers and cravings the
more responsibility they have in using these tools. If abstinence is not
enjoyable, why do it. Continue to read on and learn the tools to help your
clients build a new life. The life they want, but are unable to get to with the
same thinking that got them to the life they have now. This is why I wrote this
book.
Please feel free to email me at scline@gamblingnomore.com or if you
found this book helpful, Suggestions, or if you have any questions. I never
know the impact this may have on the people downloading this book. I also
do public speaking and am always interested to share about addictions in
general.
My best,
Stuart
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Section 1
INTRODUCTION
Overview of book and quick reference
History has demonstrated that the most notable winners usually encountered heartbreaking
obstacles before they triumphed. They won because they refused to become discouraged by
their defeats.
Bertie C. Forbes
Successful people succeed because they do what unsuccessful people do not want to do.Anonymous
This book will focus on cognitive behavioral approaches in helping
counselors whose clients are problem and/or pathological gamblers.
Currently, Pathological gambling is listed under “Impulse control disorders” in
the DSM-4-TR. In the future Diagnostic and Statistical Manual the DSM-5
which is not in print yet, but much talked about at this date and time, is
moving toward pathological gambling as being changed to a behavioral
addiction. Due to the nature of pathological gambling, I will refer to it as an
addiction in this book. The following is the proposed change for pathological
gambling for the DSM-5
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The DSM 5 work group has proposed that this diagnosis be reclassified
from Impulse-Control Disorders Not Elsewhere Classified to SubstanceRelated Disorders which will be renamed Addiction and Related
Disorders. The new proposed criteria and name for Pathological
Gambling is as follows:
Disordered Gambling
Persistent and recurrent maladaptive gambling behavior as indicated by five
(or more) of the following:
1. is preoccupied with gambling (e.g., preoccupied with reliving past gambling
experiences, handicapping or planning the next venture, or thinking of ways
to get money with which to gamble
2. needs to gamble with increasing amounts of money in order to achieve the
desired excitement
3. has repeated unsuccessful efforts to control, cut back, or stop gambling
4. is restless or irritable when attempting to cut down or stop gambling
5. gambles as a way of escaping from problems or of relieving a dysphoric
mood (e.g., feelings of helplessness, guilt, anxiety, depression)
6. after losing money gambling, often returns another day to get even (“chasing”
one’s losses)
7. lies to family members, therapist, or others to conceal the extent of
involvement with gambling
8. has jeopardized or lost a significant relationship, job, or educational or career
opportunity because of gambling
9. relies on others to provide money to relieve a desperate financial situation
caused by gamble
The gambling behavior is not better accounted for by a Manic Episode
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The reason behind the changes for the DSM-5
Include Pathological (Disordered) Gambling within Addiction and
Related Disorders
Pathological (disordered) gambling has commonalities in clinical expression,
etiology, co-morbidity, physiology and treatment with Substance Use
Disorders. These commonalities are addressed in selected papers from a
relatively large literature.
Lower Threshold for Pathological (Disordered) Gambling Diagnosis
Several empirical studies have supported lowering the threshold for a
diagnosis of pathological (disordered) gambling. Statistical analyses bearing
on this issue are also in progress.
Eliminate Illegal Act Criterion for Pathological (Disordered) Gambling
The illegal act criterion of pathological (disordered) gambling has been
shown to have a low prevalence with its elimination having little or no effect
on prevalence and little effect on the information associated with the
diagnosis in the aggregate.
Pathological gambling is a disorder that is treated by educating the client to
heal themselves. In order for the client to make changes in their life they
have to change their thoughts and behaviors in a way that will help them
overcome the strong desire to gamble. Their best thinking got them into the
state that they are in now and this is why their best thinking will not be able to
get them out of the addiction unless they have help changing their mind set.
The goal of this book is to help you, the counselor, help your clients manage
and gain control of their life again. In working with addictions, one of the key
components is to ask your client to change the people, places and things in
their life to reduce relapse triggers. This is asking a lot of anyone whether
they are dealing with an addiction or not. In some ways it is impossible to
have a pathological gambling client refrain from all people, places and things
in an active gambling culture. Not all forms of gambling put the gambler into
action as well. For example, someone addicted to betting on slot machines
may not be triggered to play the slot machines if they buy a state lottery
ticket. The brain does not respond to all gambling stimuli the same. This is
not the same with an alcoholic. If they are in recovery and their drink of
choice was rum, they may relapse on beer. It does not matter what the form
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alcohol comes in, it can still cause the person to go into the active addiction
quickly.
The difference with addictions, including pathological gambling, is that it is a
progressive brain disease and if it is not treated, it can kill people.
Pathological gambling has a higher rate of suicide then other addictions. It
also has a high of domestic violence, and smoking. Suicide is often related to
a combination of the isolation they feel from all of the secrets and lies they
have been using to cover up over the years involving financial debt, legal
issues, marital and family issues, depression, shame, and guilt, to name a
few. In casinos there is a lot of smoking. The second hand smoke is not what
kills people, but pathological gamblers are more prone to smoking than to
other addictions. If a smoker has stopped this compulsion, going to the
casino can trigger taking up the cigarette addiction again. Smoking kills more
people than all substance abuse combined. There is a higher rate of
domestic violence with pathological gamblers as well. The domestic violence
is more from the family members and loved ones than the gamblers
themselves. When family members find out that there is no longer food for
the week, gas in the car and no money to get more, life savings and or
vacation money spent, the family gets angry and it can be expressed in
explosive ways. The loss of trust is a huge issue with family members and
loved ones.
One of the challenges with problem gamblers is that often they do not realize
how the gambling is affecting other aspects of their life even after they leave
the casino. Gambling seems to be compartmentalized by the gambler so
they do not think their behaviors are affecting anybody else. There is no
smell to gambling, like alcohol or other drugs, so it is easy to keep secret.
However, even though a substance is not ingested with gambling, the brain
scan of a pathological gambler is very similar to that of a cocaine addict. The
brain chemistry of pathological gamblers is different than non-pathological
gamblers.
Let’s go over some basics.
What is Gambling?
Any time you bet money or something of value on an event of uncertain
outcome, you are gambling.
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Pathological Gambling definition
Pathological gambling is a progressive disorder in which an individual
has a psychological uncontrollable preoccupation with an urge to
gamble, resulting in damage to vocational, family and social interests.
…It is characterized by a chronic and progressive inability to resist the
impulse to gamble.
…It was first diagnosed and recognized by the American Psychiatric
Association in 1980 and published in the Diagnostic Statistical
Manual (DSM). Pathological gambling can also be called gambling addiction
and compulsive gambling.
The assessment and criteria for pathological gambling is located in the
section of this book under assessments and screenings.
How I use the term Problem Gambling and Pathological Gambling.
In short - You have to have a problem with gambling to be termed Problem or
Pathological. In this book the tools and worksheets can be used with both
Problem and pathological gamblers. I regularly use the term Problem
Gambling to also include Pathological Gambling. However, when I am
educating and use the diagnosis Pathological Gambling I do not mean
Problem Gambling, but rather, the clinical diagnosis.
Below I use Substance Abuse and addiction in relation to the
difference between problem and pathological gambling to help clarify.
Just like with substance abuse and substance addiction there is a distinction.
This distinction is similar to the distinction between Problem gambling and
pathological gambling. In this simplified example I am associating Substance
Abuse with similar behaviors as Problem Gambling and Substance Addiction
can be related to Pathological Gambling in this description. A person with
substance abuse may have direct consequences to the problems the drug of
choice is causing them in their personal and/or professional world.
Substance abuse people do not have the same brain chemistry make up as
someone who is addicted to the substance. The substance abuse person
may stop after the 1st DUI or black-out and not have withdrawals or cravings.
They may never use again. These people can stop using and do not
understand why others can’t stop just like they have done. The addict's brain
chemistry is forever changed, and they are not able to stop on their own.
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They will try to control their use or stop use to no avail, over time, and go
back to using with a higher tolerance and with greater and greater negative
consequences in all aspects of their life. Problem Gambling and Pathological
Gambling are similar in this way.
Other terms used interchangeably for the term Pathological Gambling in this
book.
 Compulsive Gambling
 Gambling Addiction
Why do people come into treatment for gambling?
People typically come into treatment for gambling for the following reasons.
The most common reason seems to be family members confronting the
problem gambler.
1. Family- Spouse may find money missing and confront the gambler
with bank statements.
2. Legal problems – Fraud or stealing to continue with the gambling
problem.
3. Employment – finds out about money being embezzled, losing days
at work.
Some other reasons people come into counseling stemming from
Pathological Gambling, although they do not associate it with gambling are:
1. Health reasons – bladder problems, sleep problems
2. Co-occurring Disorders Axis I – Increased mental health issues due to
the stress of problem gambling i.e. anxiety, depression, relationship
problems, trust issues with partner, increased substance abuse or behavioral
addictions, Change in addictions = cross addictions.
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Brief overview of treatment information on Pathological
Gambling
Early in treatment:
First, make sure your client feels safe, develop trust and rapport. Let them
know there is help and if they gamble between sessions, encourage them to
be honest and to still come back. Understand that there is often a lot of
shame, fear, guilt, and hopelessness. Give them hope. Their life can get
better with new tools and skills. If they could have stopped on their own with
their best thinking then they would have already. “Focus on progress not
perfection”.
Help client deal with the past, but do it with the focus of
staying in the present. In the present they are making
changes. If you focus only on the past early in recovery,
it will bring the client pain and be a potential for relapse
and for not coming back to counseling. If you focus on
their future, you will bring up fear. Stay in the here and
now. Focus on little successes at first. Build up ego
strength, and safety. Giving the client homework will give
them something positive to focus on during the week. It
is proactive material to help them move away from their
destructive behaviors and into the life they want.
Treatment
Provider’s
Philosophy on
Problem Gambling
As treatment
providers we are not
for or against
gambling. We are
neutral. We help
people in need.
Stages of Pathological gambling
1. Winning phase
2. Losing phase
3. Desperation phase
Pathological gambling is a brain disease.
What is a Disease?
Disease Definition
An abnormal state of physiology reflected in signs and symptoms that
progress in a predictable way in a predictable response to treatment. Dr.
Pinskey
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In addiction treatment using the disease model the outcome depends mainly
on the patient’s active role in their own recovery. One of the phrases used in
treatment is “I help you to help yourself”.
5 stages of addiction- Disease model
Pathological gambling fits with the disease model of being:
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Primary- Main focus in life, chemically predisposed in brain
Progressive- Gets worse over time
Chronic- Life long - (brain) disease with genetic, psychosocial and
environmental factors influencing its development
Fatal- It can kill you
Treatable – Quality of life comes back
4 Stages of Recovery
1. Identification – Stepping out of isolation and identifying there is a
problem.
2. Acknowledge - how it has effected them
3. Survival- taking care of self, financial, family, health, etc.
4. Rebuilding – going to meetings, counseling, financial changes, the
family needs to make changes as well
Types of Gamblers
Gamblers fall into two categories:
1. Action gamblers – wear flashy jewelry; show off money, like attention
2. Escape gamblers – isolate, numb out, do not want attention
There are six types of gamblers (see page 33):
1. Pathological gambler –Life is out of control on most levels
2. Problem gambler- aspects of life have been negatively disrupted
by gambling
3. Professional gambler – are not emotionally involved in their bets.
4. Social/Recreational gambler- enjoy gambling but have other
activities they enjoy doing equally.
5. Anti social gambler – Will get money in illegal ways.
6. Binge gambler – do not gamble for long periods of time, but when
they do it has serious negative consequences to their life.
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Gambling Issues can Include:
1. Relationships - Trust issues, neglect - (children, elderly)
2. Legal - embezzlement, writing bad checks, stealing, theft
3. Job - missing work, embezzlement, stealing
4. Spiritual- Lack of connection, not participating in church, hopeless
5. Financial - debt, creditors, loss of house, car, savings
6. Break in values - lying, keeping secrets, lack of integrity, inconsistent..
7. Dual diagnosis - any of the Axis II, Bi-polar, anxiety, depression…
8. Cross addiction - Alcohol, cocaine, porn, internet…
9. Domestic Violence -Emotional and physical safety
10. Depression - suicidal ideation, lack of motivation, hopeless
11. Anxiety - fear, difficult to take action
12. Bladder problems - due to sitting at the slot machine or poker table for
hours and not wanting to leave.
13. Sleep issues - Anxiety, depression, thinking of ways to chase losses.
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Forms of Gambling
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Slot Machines, poker Machines,
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Other gambling machines
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Dice Games, Not at a Casino
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Games of Skill for Money
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Sports
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Office Pools, Raffles or Charitable
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Small-Stakes Gambling
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Internet
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Trading or “Chasing” Cards
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Flipping Coins
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Dares
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Lottery
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Horse/Dog Racing
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Dog/cock fighting
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Land Based Casinos*
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Native American Casinos
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Floating Casinos
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Jai Alai
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Bingo
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Stock or Commodities Market
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Numbers
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Cards for Money, Not at a Casino
It is important for the counselors to be aware of the comparisons between
substance dependence and pathological gambling. Listed below are the
similarities and differences (based on material from Lesieur and Anderson,
1999)
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Similarities between Pathological Gambling and Substance
Dependence
1. Progressive diseases with similar phases and stages
2. Preoccupation
3. Low self‐esteem and high ego
4. Denial
5. First drink/first win remembered
6. High of gambling similar to rush of cocaine
7. Lack of control
8. Tolerance developed
9. Inability to stop
10. Severe depression and mood swings
11. Co morbidity
12. Chasing the first win/high
13. Addiction used to escape from pain and emotional discomfort
14. Dysfunctional families
15. Use of rituals
16. Poor self esteem
17. Need for immediate gratification
18. Superstitious behavior
19. Use/abuse of substances
20. Poor communication
21. Low tolerance for frustration
22. Poor coping skills
23. Lack of integrity, honesty
24. Inconsistent with actions
25. Withdrawals i.e. depression, anxiety, sleep disturbance
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Differences between Pathological Gambling and Substance
Dependence
1.
2.
3.
4.
5.
6.
7.
8.
Invisible addiction
No substance ingestion
Individuals cannot overdose: there is no saturation point
Financial crisis demands intervention
Very functional until bottom is hit
Perception/acceptance of disorder different
Compulsive gamblers can function at employment site
Fewer resources available for compulsive gamblers and their
families
9. 1 in 5 attempt suicide
10. High is internal not external
11. Often solitary activity
12. Lengthy time before hope becomes reality
13. Prevention programs nonexistent
14. Families impact felt longer
15. 100% abstinence very difficult
16. Public awareness of disorder-minimal
17. Education programs for youth-very rare
18. Higher rates of smoking cigarettes
19. Divorce rate is twice as high as non gamblers.
You cannot beat a roulette table unless you steal money from it. ~ Albert Einstein
Despite Einstein’s admonition, some research demonstrates that people diagnosed
with a gambling disorder have higher than usual belief in their ability to control
chance (de Stadelhofen, Aufrère, Besson, & Rossier, 2009).
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Financial Counseling
To deal with the financial aspect of pathological
gambling find a financial counselor who specializes
in pathological gambling. As counselors this
generally is not a form of expertise that is taught in
graduate school. For example If you have difficulty
balancing your check book it would not make sense
to counsel someone on their finances.
If you do not know of one go to the resources in the
back of this book and call or email your state
problem/ pathological gambling council for referrals
to find a financial counselor in your area.
This book does not focus on financial counseling;
however, it is important to have access to referrals.
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Counselors Keep in mind with problem gamblers
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Give them hope. Counselor needs to show problem gamblers the light
at the end of the tunnel.
Gambling is a quick fix disease. They want, what they want, when
they want it, when it comes to gambling. Low prefrontal cortex activity.
Adults with Pathological gambling are more likely to have multiple cooccurring disorders, including Major Depressive Disorder and
Dysthymic Disorder, particularly for women.
PG also has high rates of Anxiety.
Gamblers have poor impulse control and low frustration tolerance.
Problem gambling can get worse over time. Often the problem
gambler does not view it as a problem until the gambling problems are
moderate to severe. Denial is part of the problem.
Treat dependency as a brain disease. It is a brain chemical issue.
Remember change is a process and it will take time
The first three months are usually the most difficult.
Pathological gamblers have a higher rate of suicide and divorce.
Money to a pathological gambler is the drug. Money in the pocket is
no different than an alcoholic having alcohol in their pocket. It is only a
matter of time before they use.
Ask each session if they gambled and if so "How much did you win
and lose on gambling? Stay away from "how much did you spend" on
gambling.
Early in recovery, many people set unrealistic expectations for
themselves. Keep goals manageable.
Have client sign release of information in beginning session for parole
officer, legal issues if involved.
Need financial counselor – if you are not a financial counselor call a
problem gambling hotline in your state to see if they have resources
and referrals.
Discuss with client the possibility of having no ATM, Credit, or Money,
later, yes, but not now. Find out who can monitor money.
Ban self from casinos – go to security office of gambling establishment
and fill out self ban. Have someone go with them to do it.
Be aware of aspects of law – fraud etc.
Difficult connecting with appropriate emotions.
Gamblers anonymous- explain what meetings are like if they have not
gone. Encourage client to go to weekly meetings. I encourage all
counselors to go to a meeting so you know what they are like.
Gam-anon – Support for family members. Google Gamanon and get a
local listing of meetings for family members.
Give client problem gambling resources, internet sites, worksheets, list
of GA meetings.
Clients need specific attainable goals. Help them create them.
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Work toward enjoying life. If recovery is not fun then why do it.
Help client realize they have value and help them find what they value.
Typically there are more male compulsive gamblers than female. Let
females know this when going to GA meetings for the first time. Have
them bring a friend if not comfortable going alone.
Encourage client to abstain from all addictions, no drinking or mood
altering drugs- no cross addictions.
Easier to have this on inpatient but
more difficult on outpatient
HIGH RISK ETHICAL
counseling. Discuss with client.
ISSUES
Review cross addiction and help
them understand what the symptoms
 Suicide
are so they can be aware.
 Termination/aban
Have Clients stay away from “what
donment of
ifs” do not indulge in this - stay
treatment
present
Group treatment is the best way to
 Multiple
help individuals with addiction. They
relationships
learn from each other and do not feel
alone.
 Difficult clients
Children of gamblers and or addicts
 Supervision/cons
guess at what normal is. Family
ultation
systems similar to behaviors of Adult
Children of Alcoholics.
 Records
Encourage family members to attend
sessions and educate about this
 Homicide
addiction. This is a family disease.
 Informed Consent
No bail outs – If family and or friends
keep bailing problem gamblers out
 Scope of Practice
then they do not get into desperation
phase and have the motivation to
change.
FYI - For inpatient treatment a Doctor
could sign off for compulsive gambling to take family leave so client
can go to inpatient treatment. Check your state to see if there are free
resources.
Problem gamblers and addicts in general often have a hypersensitivity
to criticism. They often beat themselves up worse than anyone else in
their life as a defense mechanism. So when others do criticize them
they have already done worse. It is a type of emotional self protection.
This has to be addressed in recovery because they cannot move on
until they forgive themselves. The shame and guilt they feel will keep
them a prisoner and from full recovery and moving forward.
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Give clients Gamblers Anonymous introduction book before they go to
group for the first time so they know what they are getting into or at
least tell them what the meetings are like. These introductory books
can be found at GA meetings.
Pressure-relief groups- A feature of GA, composed of people who
have a longer history of recovery and who volunteer to assist new
comers with legal and financial problems. They help the person form
a plan, help support them, and help build self esteem back by paying
off debt.
Co-Occurring disorders
General Population Research
43,093 household adult residents interviewed.
 73.2% of pathological gamblers had an alcohol
use disorder
 38.1% had a drug use disorder
 60.4% had a nicotine dependence
 49.6% had a mood disorder
 41.3% had an anxiety disorder
 60.8% had a personality disorder
Source: Petry, Nancy M. et al. (2005) Comorbidity of DSM-IV
Pathological Gambling and other psychiatric disorders: results from the
national epidemiologic survey on alcohol and related conditions. Journal of
Clinical Psychiatry, 66(5). 564-74.
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Therapeutic benefits of counseling treatment
Pathological or problem gambling can cause a lot of distress in one’s life on
every level. Here are some benefits of seeking help from a counselor
specializing in this field.
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Less stress
Life becomes manageable
You like your self
The ability to reach your potential
More positive attitude
Acceptance of responsibility
Sleep is improved
Not looking over your shoulder or dreading when the phone would ring
for creditors
Increased hobbies and leisure activities
Thinking more rationally
Less domestic violence
Prioritize and live your new found values
Reconnect with spiritual or religious beliefs.
Less depressed
More serenity
Reduce unhealthy activities such as smoking, eating junk food etc…
Reduced anxiety
Reduced depression
New achievements in life
Improved self esteem and self worth
Reduction or elimination of homicidal thoughts (if present)
Attaining and meeting new goals
Reduced procrastination
Reduced boredom
Improved scheduling of activities in the week.
New friends
Improved relationships with family and friends.
Financial stability
Resolved, or a plan to resolve, legal problems (if present before)
Improved health
Experiences of more pleasurable activities.
Laughing again
Wanting to live.
Enjoying life
Living instead of surviving.
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What Traps to Avoid Early in Counseling
Early in counseling the client decides if they can connect with you. They size
you up to see if you are safe, trust worthy, competent, and knowledgeable
about helping them with their issue. William Miller, the creator of motivational
interviewing, spoke at the 2010 NIDA national conference in Albuquerque,
New Mexico. In his talk he said that in most professions people get better
results at what they do. He did a study on this with counselors and found that
with counseling this is not the case. He did find that if they incorporated
motivational interviewing counselors improved their client’s results with
minimizing or stopping substance abuse. The following 6 techniques to
avoid are based on William Miller PhD’s work. These traps are duplicated
here with permission by Ann Fields MA, CADCIII,CGACII Portland Oregon
2004 who wrote the following 7 traps which can be found in her
book "Motivational Enhancement Therapy for Problem and Pathological
Gamblers - A five Session Curriculum-Based Group intervention"
The other suggestions 7+ are not based on statistics like Dr. Millers but from
my experience in talking with other therapists and clients who have had a
bad experience with counselors. The suggestions I write about are the
reasons I am writing this book. I want to help counselors better help their
clients who suffer from pathological gambling. Pathological gambling has a
higher rate of suicide than other addictions. It is important to be aware and
implement what does work and let the rest…rest in peace.
1. Question-Answer trap: This sets up the expectations that the counselor
will ask enough questions and then have the answers, fostering client
passivity. It can happen inadvertently by asking many specific questions
to “fill out forms” early in treatment. Consider having clients fill out
questionnaires in advance, or wait until the end of the session to obtain
the details you need. This is a specific form of a more general “Expert”
trap. This is best remedied by asking questions, letting the client talk, and
using reflective listening.
2. Confrontation-Denial Trap: This is the classic mistake of the counselor
taking responsibility for the “healthy” side of ambivalence and the client
arguing for the opposite. Another form is for the counselor to make
suggestions and the client to explain why it won’t work (Yes, but…). If you
find yourself falling into this role, change strategies.
3. Labeling-Trap: Diagnostic and other labels represent a common
obstacle to change. There is no persuasive reason to focus on labels, and
positive change is not dependent upon acceptance of a diagnostic label.
If it seems a sensitive issue, avoid “problem” labels, or refocus attention
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(e.g., “Labels are not important. You are important, and I’d like to hear
more about…”).
4. Premature-Focus Trap: Some clients are not ready at the outset to talk
about what the counselor sees as the target problem, and premature
pressure to focus on “the problem” may elicit resistance. Explore the
client’s own concerns, and look for ways to tie these in.
5. Blaming-Trap: Clients may also expect that an early task of counseling
is to determine who is at fault, who is sick, etc. If this seems an issue, it is
useful to defuse it early by explaining that placing of blame is not a
purpose of counseling.
6. Expert-Trap: Clients may come into the session viewing you as the
expert, expecting you to tell them what they need to change, when they
may not be ready to change. This can bring up passivity or resistance.
What is helpful is to give the client the opportunity to explore and resolve
their uncertainty about change, for themselves. Let them come up with
their own arguments for change.
My suggestions below are created out of talks with distressed clients and
therapists who have not been helped by counselors who have done the
following:
7. Diversion strategies that involve clients going to the casinos.
Pathological gambling is a compulsion not a phobia. There are different brain
responses in a gambler than, let’s say, someone who has a phobia of
elevators. Taking a pathological gambler to a casino or place of betting for
therapy may be potentially worse than taking an alcoholic early in their
recovery to a bar for counseling. Casinos engage the gambler on all five
senses sight, smell, touch, taste, and hearing. Going to a casino will only
trigger the brains reward system and amygdala on an emotional level before
they have a thought. This is why in treatment we recommend clients to
change people, places, and things that remind the person of past use
with gambling. This helps clients avoid triggers which lead to cravings and
in turn leads to use. Why are triggers an issue? Think of Pavlov and his dog,
food, and bell experiment. Let me explain. Here is a quick recap of his
scientific experiment. Pavlov would ring a bell every time he fed his dogs.
After many days he chose not to feed the dogs when he rang the bell to see
what the response would be. The dogs came running and were salivating
before they even saw food. Their bodies developed a conditioned response
to the bell. They connected the sound of the bell with food and their digestive
tract became activated without even seeing food. Ok, not to call humans
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dogs, but yes, pathological gambling brains have been altered similarly to
those dogs. It is a conditioned response. Returning to the casino activates
those conditioned receptors and bingo (no pun intended and, no, you do not
have b12, sorry) your amygdala is lit up like the 4th of July, but instead of
celebrating Independence Day your brain is reminding you that you are
dependent on gambling.
8. Past Life Regression: When a single, 60 year old female comes into
counseling for the first time saying that she has a gambling problem and it is
so bad that she is late on her car payment, three months behind on her
house payment and is very scared about going into foreclosure, not to
mention being anxious and depressed, I adamantly suggest you do not do a
past life regression during this session. A similar case did happen. The
counselor wanted the client to find out what unresolved issues happened in
their previous life to better help the client understand why they want to
gamble in this life. This client is in severe crisis. This person needs to deal
with the here and now right now. She needs to stop gambling, look into
different approaches of paying for or letting go of these possessions. This
person may be homeless in the near future, and even if you were Al Capone
or Nefertiti in your previous life, it does not help give you hope in the
moment. Nor does it help this person take back control of her life to get
through another day. So, in short, when a client is in crisis, it does not matter
if she was Al Capone or Nefertiti. What matters is the here and now and what
she is going to do about it. Her best thinking got her to where she is in her
life. This same thinking will not get her out of her crisis. If this person came to
you, then they are asking for something they could not give themselves,
which is help. They need a new perspective and by coming to you they are
asking for help. The next step is for her to accept the help and then take
action. This disease often leads to isolation, shame, escape, grief and loss.
When pathological gamblers come to counselors, it is typically because they
are in crisis. This book is a start, not past life regression.
9. Do not use your client as a learning tool. Ethics 101- If you do not have
training or an understanding of pathological gambling, then refer this person
to someone else until you get the training and have regular supervision.
People’s lives are at stake. People are losing their houses, cars, marriages,
families, lives etc. This book will help you better understand problem
gamblers and what to be aware of.
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Section 2
More information about quick reference
3 phases of gambling
1. Winning
2. Losing
3. Desperation / hopeless
Stage 1 - The Winning Phase
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Often problem gamblers experience a big win or winning streak early
in their gambling history.
This phase may last for days, weeks or years.
The person starts to gamble more often.
The person focuses more on gambling and less on other activities and
hobbies.
Gambling is still viewed as a fun activity.
The person enjoys the escape gambling provides and/or the euphoria
and excitement.
The person will often tell gambling stories of them winning.
During this stage the gambler feels they are a gifted gambler and
winning comes easily.
During this time gambling is not seen as a problem.
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Stage 2 - The Losing Stage
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During this stage the amount of time gambling increases.
Less free time with family, friends or other activities.
Gambling often becomes ritualized.
A tolerance develops. They need to play more to get the same
euphoria.
Gamblers begin to chase losses, feeling a need to win back gambling
losses as soon as possible.
More free time is spent gambling. Family life and work may begin to
suffer from neglect.
The gambler begins to pawn belongings and/or need to ask for loans
from friends or family, or they may take out bank or credit card loans,
or pay day loans.
The gambler typically begins to lie more about the amount and time
they have gambled. They may not lie about going to gamble but they
will lie about losing.
Anxiety and/or depression begin due to their financial situation.
The gambler may try to quit, or control their gambling, but ultimately
fail.
The gambler will often deny, even to themselves.
Family becomes affected by up and down moods related to wins and
losses.
Step 3 – The Desperation Phase - hopeless phase
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Financial pressures increase and intensify. The gambler may start
selling belongings, or may even break the law to get money for
gambling.
Depression and anxiety increase.
Sleep may be affected, health may suffer.
The gambler becomes much more isolated from friends and family.
If married - Increased chance of divorce.
Suicidal thoughts are common.
The potential for suicide attempts increases.
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2 Categories of Gambling.
Problem and Pathological Gambling often falls under one of the following
forms of gambling:
1. Action gamblers
2. Escape gamblers
Action Gambler:
The action gambler typically is male and plays games that achieve a high
level of excitement such as cards, craps, roulette, sports betting. This
excitement becomes a major focus or the gamblers life. This gambler
typically has the following traits: high intelligence, Type-A, ambitious, "driven
to succeed". These gamblers are more likely to gamble when feeling good,
happy or lucky. These gamblers often have money set aside for gambling
and it is not to be used for anything else like bills. They can wear showy
jewelry, expensive watches, bracelets, have a big wads of cash and are out
going. They often want to be seen.
Escape Gambler:
These gamblers typically go to escape emotional and/or physical pain. There
is a higher rate of females than males. They do not want to socialize. The
game of choice is slot machines and video poker. They go to numb out in a
trance like state to avoid problems. It is more common for people who are
retired, women whose children have left the house, "empty nesters", and the
elderly.
Grief and Loss
Grief and loss is often an issue in working with escape gamblers. Some of
the issues could be: the loss of a loved one or pet, loss of a relationship,
loss of home or other possessions, loss of family’s trust, loss of hopes and
dreams, loss of reputation etc…
keep this in the back of your mind early in treatment.
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6 Types of Gambling
1.
2.
3.
4.
5.
6.
Social or recreational gamblers.
Problem gamblers
Pathological or compulsive gamblers
Professional gamblers
Anti-social gamblers
Binge Gambler
1. Social Gambler.
This person gambles for social interaction and gambling is one of many
leisure activities they engage in. They typically do not gamble with any
regularity, but may have a monthly poker game with friends. They can take or
leave gambling and do not have any negative life consequences. These
people do not feel guilt or shame after gambling and do not keep it a secret.
These people usually have an idea of how much they are going to spend and
stick to it. There are no financial negative consequences to their behavior.
2. Problem Gamblers.
The person begins to make gambling more of a priority over other
recreational activities. They may see their gambling as a second job and
want to be a professional gambler. They are seen as regulars at the
gambling venue. They start to have financial problems and chase their losses
and/or use money to gamble before paying some bills first. Family is aware
of the increased amount of time and money the gambler is spending and it is
becoming a family issue. This person may stop or cut down their gambling
for periods of time to prove they do not have a problem. Mood swings start
increasing which are connected to wins and losses. They become more
secretive about their gambling and minimize it or deny that it is a problem.
They may begin to borrow money from friends and family or use credit cards
to help finance their gambling. They meet 1-3 of the DSM-IV criteria for
Pathological gambling.
3. Pathological Gambling
This form of gambling is out of control and compulsive. The person is unable
to stop their gambling without intervention. This intervention can come in the
way of Legal, Employment, Family, and /or Health. They may miss important
family or work functions.
They are often anxious and or depressed and lose sleep because of it. This
gambler often puts their winnings back into the machine and leave with
nothing except an empty feeling of guilt and shame. They typically play
longer than they intended and spend more than planned. They often feel
urges and cravings to go gamble. Frequent fights with spouse/partner and
blames them for the problems. They isolate themselves and gamble alone
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more. This gambler usually thinks that they are only hurting themselves,
unaware of the impact of their gambling on others. They typically promise
self or other to quit gambling after a large loss or win, but can't or does not
quit for long. Very often they have had at least one financial bailout from a
friend or family member, maxed out credit cards or taken out loans from
financial institution, unless they are affluent, although some pathological
gamblers never have had a bailout. They deny or minimize their behavior to
others. Usually talk about and remember the wins and discount the losses.
These people blame others for stress they are creating. They feel excited
when gambling or about to gamble, might have a rush just walking into
gambling establishment. Winning means more time to gambling, wins are
usually "re-invested" into more gambling. Pathological gamblers may try to
win money needed for basic living expenses. They may be behind in house
and or car payments. They may not have money for food. They may neglect
their children and other aspects of their lives. If they have children they may
leave children in the car at casino parking lot for hours so they can gamble.
These people may have burned out relationships due to gambling and
borrowing. They are unable to easily quit gambling for long periods of time.
They may forge checks, steal, and embezzle money from employment to
maintain gambling. This form of gambling meets 5 out of the 10 criteria in the
DSM IV.
4. Professional Gambler:
Gambling is their primary source of income. Gambling is methodical and
planned (e.g., a professional horse gambler may not bet on every race).
Maintain discipline and refrain from impulsive betting. Rarely loses control
when placing bets. Accept financial losses without chasing to win them back.
Most problem and pathological gamblers fantasize about being a
professional gambler or mistakenly believe that they are. There are very few
true professional gamblers. Many professional gamblers will eventually
evolve in to problem or pathological gambling. Professional gamblers do not
meet the DSM-IV criteria for pathological gambling, but may have a couple of
symptoms.
5. Antisocial gambler
These people engage in criminal activities, scams and rip-offs. Gambling is a
method to steal money, may use loaded dice, marked cards, and fixed sports
events or horse races.
6. Binge Gambler.
These gamblers have long periods of time without gambling, but when they
do it is excessive and can be very costly financially, emotionally and
damaging to relationships. The relapse cycle is often triggered by having a
"surplus" of money. These binge cycles typically end after a huge loss. There
is an illusion of being in control that is a function of the ability to have
extended periods of not gambling.
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General risk factors contributing to problem gambling
There is a statistic that shows during any year, 2.9 percent of U.S. adults are
considered to be either pathological or problem gamblers. Problem Gambling
can start the first time someone wins at a slot machine or poker table, but
this is not the norm. Often it takes years for people to move from being a
social gambler to a problem gambler and then to a pathological gambler.
Gambling affects people in different ways. Some people never have a
problem, just like someone who deals with alcoholism. Two people could
grow up drinking the same amount and one person becomes dependent and
the other does not. There are a variety of factors that contribute to problem
gambling and it does not have to do with how old you are, how smart you
are, your race, culture, religion, marital status, sexual orientation, job
etc…There are many reasons and ultimately many stressors that provide the
right environment to develop problem gambling. Here are some of the risk
factors that contribute to the development of problem gambling.
To clarify how I define and use the term problem and pathological
gambling refer to page 11.
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How does one become a problem gambler?
Someone is at a higher risk of becoming a problem gambler if they:
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have a big win early in their use of gambling. This leads to false hope
and expectations of future wins. “If it was that easy I can do it again”
type of thinking.
have easy access to their preferred form of gambling
have no financial accountability and do not take steps to monitor
gambling wins and losses. Often people will remember the wins but do
not remember the losses as clearly.
have had recent life stressors such as divorce, job loss, children
recently moved out of house, death of a loved one, or retirement.
get bored or lonely regularly.
have a history of risk-taking or impulsive behavior. Ex. I want what I
want when I want it.
have financial problems
hold false beliefs about the odds of winning. I have never heard of a
casino going out of business. The odds are stacked against the
players.
have few or no other interests, leisure activities or hobbies
have no goals and are too comfortable in their life.
have a history of mental health problems, particularly depression
and/or
anxiety.
have been abused or traumatized
have a parent who also has (or has had) problems with gambling
have (or have had) problems with alcohol or other drugs, gambling
or overspending
tie their self-esteem to gambling wins or losses. Wanting to feel like a
winner.
The chance of becoming a problem gambler is more likely to increase with
the more risk factors one has.
One of the worst things that can happen to you in life is to win a bet on a
horse at an early age. ~ Danny Mcgoorty
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The following are relapse risk factors for clients abstaining
from gambling.
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Getting angry easily.
Living mostly in the past or in the future- Past brings up pain, future
brings up anxiety of the unknown.
Using more alcohol or drugs
Boredom
Too much free time
Not scheduling days
Feeling overwhelmed by stress, loneliness, frustration, anger,
sadness, grief, loss.
Over extend themselves
Client begins to talk more about the glory days of gambling.
Over confidence
Isolation
Lying
Feeling depressed all the time
Blaming other people for my problems
Client start to tell themselves that they are cured and can control their
gambling
They pay off too much of their debt.
Resisting talking to others about problems.
Not doing homework in counseling
Sleeping
No plan for goals in the future, lack of motivation.
Not applying what they learn in therapy
No involvement with family in treatment
Missing appointments
Beginning to or increasing time spent with gamblers.
No Budget or money management
Non-compliance with medication
Not attending GA
Biggest trigger is money. Money is the drug, but cannot be avoided;
If you must play, decide upon three things at the start: the rules of the
game, the stakes, and the quitting time. Chinese Proverb
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FAMILY
What Families learn when living with a pathological gambler
The following is an important aspect that has been learned often non-verbally
in the home of pathological gambling and addiction in general. These are
survival tools family members pick up to protect themselves emotionally,
physically, to overcome unspoken and unhealthy truths learned in the home.
Don’t talk
Don’t feel
Don’t trust
Don’t talk - Family members learn not to talk because it may not be safe.
They may get yelled at if told the truth or lied to so they question their own
insights, and later guess at what normal is when they grow up and out of the
home. The truth may be shameful behavior that the gambler has done.
Don’t feel –This is learned as the mood in the house may be labile and
unpredictable. The family members learn not to get their hopes up due to
frequent disappointment. Money may be all or nothing. For the gambler when
payday comes from their job they will be in a good mood and all will be well.
The family relaxes for a moment, but know it will not last. Soon after the
gambler gambles all or a lot of the money away making it difficult or
impossible to pay off all the bills. The good mood is lost and the family will
feel the consequences. The lack of money and not knowing when more will
be available puts the family on survival mode. The family is aware that this is
a topic not to talk about due to the potential for a heated conflict. The family
members feel as if they have to walk on egg shells due to the unpredictable
nature of living with someone with an addiction. Family members can be
promised something one minute and the money could be gambled away the
next. Children can be neglected on many levels without the gambler being
fully aware of it.
Don’t Trust – Many promises have been broken and many lies have been
told. Enough so that it is for self-preservation not to trust.
Family members need to let go of the guilt, shame, self-blame and
understand that as a family member:
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I didn’t cause it
I can’t cure it
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I can’t control it
I can take better care of myself by communicating my feelings to safe
people.
My family is not alone and can attend Gam anon support groups.
I can learn and make healthy choices.
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These are helpful for family members to be aware of.
The Family System: Closed and OPEN
The communication style with the family of Pathological Gamblers is identical
to a family growing up with an alcoholic. As Virgina Sitir states in her book
The New People Making the dysfunctional family with addiction learns to
survive in a “closed system”. These styles of communication create what
feels like crazy making due to blurred or no boundaries, families lack of
insight, lack of honesty, and the families’ denial of what is happening by
enabling the addict.
This style of CLOSED communication creates the following in families.
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
-
-
Low self esteem
Communication is indirect, unclear, unspecific, incongruent, growthimpeding.
Restrictions on commenting
The styles of communication the family members use as defense
mechanisms to survive in this household.
Blaming- Not taking responsibility for words or behaviors. It is
everybody else’s fault.
Placating – being overly agreeable and saying “everything will be
alright” even though abuse may be happening. This person does not
like conflict. The Pacator can be what’s called a non-offending
parent (NOP). This person may see or know about the abuse going
on with family members but feels helpless and will not stop it. If
children are involve. The children will have no consistant protection
from the parents allowing other siblings to take the role of protector.
Computing- This person is disconnected from their feelings so
much so that they become or think they are super intellectual. They
justify, rationalize, and over think situations and or just know they
have all the answers and they are right and you are wrong.
These people are very disconnected from how they feel, and may
not relate to a conversation if it deals with feelings. They will
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distance themselves from deep seated painful feelings by
intellectualizing the situation.
- Distracting – This style is used by certain family members when
there is anxiety in the house. This could including arguing, or conflict
of any kind. This style of communication can come in the form of
Humor often physical humor with children to get the attention off of
the topic and make people laugh. This can also be accident prone
people, or focusing on an illness if it helps diffuse the conflict in the
moment.
 Rules of this family are – Covert, out of date, in human rules remain
fixed; people change their needs to conform to established rules.
Outcome: The family is chaotic, destructive, inappropriate. Self worth
becomes doubtful and depends more and more heavily on other people. This
creates an unhealthy co-dependency and limits a person’s individuality and
identity.
When people are in recovery. The families can begin to more into the other
type of system. The open system
This style of open communication creates the following in families. An open
system of Communication is what to strive for. The goal is progress not
perfection. In a Family with an open system of communication the family’s





Self-esteem is High
Communication is direct, clear, congruent, growth-producing
The style of communication is one of respect and allows for honesty
and individuality. Communication is appropriate for the age group
being spoken to.
Rules of this family are: overt, up-to-date, human rules; rules
change when need arises. Family members have full freedom to
comment on anything
Outcome: self-worth grows ever more reliable, confident, and draws
increasingly more from the self.
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Warnings signs of teen gambling include:
-
Obsession with betting.
Everything else takes a back seat.
Gambling is out of control.
Depression.
Grades worsen.
Relationships deteriorate.
Debts increase.
Broken promises.
Gambler gets angry when confronted.
General fear.
Loss of sleep.
Source: Connecticut Council on Problem Gambling
The goal of recovery is to live an enjoyable, manageable life with quality.
Owning what is ours, making amends of our past while living in the
present and focusing on what you do want in life .
Recovery is moving from surviving to living. Moving from an out of control
fear based existence with secrets and isolation and into healthy thoughts,
actions, and activities, while reaching out and maintaining healthy
relationships in your life.
Stuart Cline
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Section 3
The Brain and Pathological Gambling
The obvious now scientifically proven;
Brain scans are finding near-wins a trigger.
In the May 5th, 2010, issue of The Journal of Neuroscience it suggests that
near-wins at the slot machines may trigger problem gamblers. A British study
using Functional Magnetic Resonance Imaging (FMRI) finds that a near-win
triggers an intense response in the brain’s reward system, which may push
problem gamblers to gamble more. Functional MRI scans detect changes in
blood flow to particular areas of the brain. The researchers used this FMRI to
scan the brains of the participants while they played a slot machine.
When the two images on the slot machine matched and the player
won 75 cents, their brain reward pathways became active. This did not
happen when they lost, but when the slot machine wheels stopped within one
image of a winning play, the brain reward pathways were activated.
"These findings are exciting because they suggest that [near-win]
outcomes may elicit a dopamine response in the more severe gamblers,
despite the fact that no actual reward is delivered," study author Luke Clark,
of the University of Cambridge, said in a news release. "If these bursts of
dopamine are driving addictive behavior, this may help to explain why
problem gamblers find it so difficult to quit."
Dopamine is a neurotransmitter that is a feel good chemical in the
brain that is associated with addiction. Strong responses to near-wins were
detected in the midbrain, which is filled with dopamine- releasing brain cells.
In addition, other brain areas that are associated with reward and learning the ventral stritum and anterior insula - showed increased activity as well.
Everything you do has everything to do with the brain. When you gain control
over your brain then you have mastered your life. As psychiatrist Dr. Amen
of Amen Clinics states, "If your brain works right then you work right."
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A little about the brain: (and I am not implying that your brain is little.)
Introduction to the Brain
It has:
- 100 billion neurons
- As many as 40,000 connections between cells
- More connections than stars in the universe
-2% of body's weight- typically 3 pounds
-Brain uses 20 -30% of the calories consumed. The more new information
you learn the more neural pathways you create and the more calories you
burn.
-Thoughts move between 200-400 mph. Psychiatrist and SPECT scan expert
Dr. Amen states that thoughts move at "268 miles an hour”. Now you may
ask how do they know that? Do they have a scientist ask you a question like
“what is 2+2” and then have a police radar gun clock your answer? That’s a
good guess but, no. Dr. Amen has a more sophisticated and accurate
method of tracking the speed of thought. However, when you are in your
addiction your brain does not work as effectively as that. Using alcohol and
drugs also limits the speed and accuracy of your thoughts that go to your
short term part of the brain to the long term part of the brain, and yes you
need your short term part of the brain to work correctly for the information to
be entered into long term part of the brain.
Brain Development
The brain develops from the fetus until the age of 25. 25% of
development is in the fetus. The brain continues to develop until age 25
however there are growth spurts in the brain between age 2-3 and 14-16
years old. Usually girls start early in that range from 14-15 and 15-16 for
boys. Girls develop faster. Boys brains are typically larger than girls, but that
has nothing to do with intelligence. During the two growth spurts (age 2-3
and 14-16 yrs old) the behaviors are similar i.e. the terrible twos...Well the
teens have this as well with the difference that they begin to experiment with
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drugs and alcohol, interest in sex, and then they get their drivers license,
which brings more independence...possibly most parents’ nightmare.
Yippee . The good news is when people reach 25 their prefrontal cortex
genetically should be fully developed allowing us to make better choices and
our car insurance rates go down due to this. Well I feel better. Anyway…
Brain Health
The Brain is the consistency of soft butter or raw egg. If you drop soft butter
on the ground what happens??? sqwoosh. If you hit your head with enough
force in your lifetime you may have had a brain injury such as being in a car
accident without your seat belt....it matters. More brain scans are revealing
that professional football players may have brain damage from all the
collisions with their head.
The Skull is really hard with sharp ridges. So when you have an impact on
your head, the brain with the consistency of soft butter only has a hard
surface to push against.
We have learned more about the brain in the past 6 years than we have in
the past 50 years.
We do grow new brain cells and, yes, contrary to what I was taught as a
child, we do use 100% of our brain...unless you are abusing alcohol or drugs,
gambling or have a brain injury. Then our brain function is reduced and we
do kill a lot of brain cells. A movie in 2010 with Nickolas Cage, called the
Sorcerers’ Apprentice claimed that the reason Nickolas’ character and the
apprentice were sorcerers, and others were not, is because they use 100%
of their brain and the average human only uses 10%. Sorry, the movie was
false. Humans do use 100% of their brains if treated right. Also, if using
100% of our brain made us into sorcerers then most likely the Harry Potter
franchise would not have been the block buster it is. We would have been
more like Ho Hum another wizard story…boring.
We do lose much more brain function if we are using drugs and/or alcohol.
Remember, pathological gambling brain scans look very similar to those of
cocaine addicts. Different parts of the brain have a good chance to be
functioning at less than 55% of its optimum capacity like the prefrontal cortex.
Other areas of the brain become over active like the anterior cingulated
gyrus. This is explained later in this section under prefrontal cortex and
anterior cingulated gyrus.
So when you are gambling and/or using drugs and/or alcohol you literally are
not in you right mind...
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Is Gambling a Brain Disease?
•
Do addicts including pathological gamblers:
- Have difficulty learning from mistakes?
- Have difficulty saying no to the addiction?
- Feel depressed
- Feel anxious
The above answers are all YES.
Do addicts including pathological gamblers:
- Loss control over their impulse to gamble?...compulsions?
- Live by all of their values and morals when in the addiction?
- Plan for the future and have clear goals that they are working
towards?
- Consistently do what they say they are going to do?
- Think and behave rationally about the effects of their addiction?
The above answers are NO
Why? Because of imbalances in brain chemistry as well as reduced
activity in the Prefrontal Cortex combined with an over active Anterior
Cingulate Gyrus as well as a trigger happy Amygdala which is
associated with strong emotions and the fight or flight response and I
cannot forget about the flood of the feel good brain chemical into the
brain called Dopamine. Dopamine is a neurotransmitter (feel good
chemical in the brain) associated with addiction. This feel good
chemical makes us want to do the behavior again, and again, and
again and… I am focusing on Dopamine however, Serotonin and
Norepinephrine Genes contribute about equally to genetic risk for
Pathological Gambling.
Question... was dopamine given its name because people feel dopey
when it is flooded into the brain? not likely, but I do wonder.
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Tell me more about this feel good chemical- Dopamine
Dopamine is a neurotransmitter in the brain associated with addiction.
It is a natural feel good neurotransmitter = big name for brain chemical.
Dopamine is used as a natural reward system for our brains for a variety of
things. One main one is procreation. This helps keep humans and
animals from extinction. It is a primal ability to help with the survival of our
species. When we eat food dopamine is naturally released making use feel
good and to support us in doing more of that. More Dopamine is
released when we have sex. Dopamine is released even when we are
thinking of sex. Ok reader stop thinking about sex and refocus on
dopamine. When we gamble and are excited even more dopamine is
released and thus we want to feel this again.
How does addiction happen?
The more dopamine that is released in the brain and the greater the
speed that it is released increases the ability to be addicted. Addiction
usually does not happen like a switch that has just been turned on. It takes
some training and rewiring of the brain to put you into pathological gambling.
That is why abstinence is key for Pathological gamblers. After the brain
releases a flood of Dopamine into the pleasure areas of the brain then it
needs time to recoup. Why?
Imagine, I told you (yes, you the reader) that you and I had to run a
mile around a track and the last one who finished would die, and we have to
do it right now! Assuming you want to live you would give it all you have. We
amazingly run around the track and finish in a tie. Well done! Speaking for
myself I know I would be on the ground gasping for air, not being able to do
anything except just sit on the ground and feeling like I am going to have a
heart attack or die. Well dopamine is like that, too. It needs to recharge
before flooding again. While people wait for dopamine to feel rested and to
produce its "normal amount" of the chemical, the person is often more
depressed. One reason is due to a lack of dopamine.
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Dopamine - The feel good neurotransmitter
Remember even though dopamine is the neurotransmitter (feel good brain
chemical) that is associated with addiction and reward, it is just one of others
involved in the whole process. The other neurotransmitters associated with
problem gambling include Serotonin, norepinephrine, and beta endorphins.
(Mccown G. William, 2007) There is also the Enkephalins (opioid system)
and the GABA (inhibitory system). With that said I will focus on dopamine
and simplify a complex process to explain happiness with an addict.
When a two year does something and is rewarded by an external stimulus
like a hug and praise from a care giver then they will do it again and again
because they like the positive attention and feeling. When a gambler
gambles and is rewarded by winning “big”. They will do it again and again in
hopes of being rewarded again by an internal stimulus – dopamine.
Dopamine rewards us for our actions that support our survival as a
species including, procreation, eating, sex, happiness, and other life
supporting actions on a primal level. It is one neurotransmitter with a few
others that is responsible for being rewarded for doing these things and
making us feel good and thus happy - dopamine. One definition of happiness
is. "The feeling between a sense of wellbeing to extreme Joy".(about.com)
When people are in the action of gambling and or on brain altering drugs
dopamine will be tricked into unnaturally flooding the brain with dopamine.
When this feel good supply of dopamine floods the brain very quickly then
after the high there will be a letdown. This chemical will need time to make
more. When your brain is low on supply of dopamine you stop feeling good
and are no longer rewarded for things that gave you pleasure before. At this
point you are not within the range of “a sense of wellbeing to extreme joy”,
but people want to be in this range and feel happy so they go and use or
gamble again to chase the high and the roller coaster continues.
•Dopamine –Neurotransmitter – reward
• Reinforce survival enhancing choices
• Learning and memory
• Millions of years old
• Hijacked by other drugs of abuse
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Effects of Drugs on Dopamine System
 Alcohol and Opiates: Increases dopamine release by decreasing
activity of dopamine inhibitory neurons
 Cocaine and Amphetamines: Block dopamine receptors
 Nicotine: Stimulates dopamine release
 Caffeine: Stimulates dopamine release (but in different brain areas)
(Joanna Franklin, MS NCGC II, Lori Rugle, Ph.D. NCGC II
Institute for Problem Gambling Inc. Presented at The Responsible
Gaming Association of New Mexico conference 8-22-08.)
Roles of Neurotransmitters
Neurotransmitter
Norepinephrine (NE)
Serotonin (5HT)
Dopamine (DA)
Opioids
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_______
Role in Impulse Control
Arousal, Excitement
Behavior-Initiation/Cessation
Reward, Reinforcement
Pleasure, Urges
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What the prefrontal cortex does and why I need to know
The Pre Frontal Cortex (PFC) is the front 33% part of your
brain. When you were a child and your parent or care giver would check your
forehead for a fever that is the area of your pre-frontal cortex. In short,
it helps with judgment, learning from mistakes, empathy, impulse control, will
power, attention, ethics, morality, inhibition, and follow through. The PFC is
the first part of the brain that is hijacked when we gamble and/or use
alcohol/drugs. What I mean by Hijacked is it's ability to function and function
appropriately is dramatically impaired. Its ability to function normally is
disabled and greatly reduced to less than 55% of its natural ability. So those
who have a strong will power have just sabotaged themselves. This is why it
is important to change people, places and things: to stop a majority of the
brain triggers. If your PFC is not working, then neither is your good judgment,
ability to control impulses, the ability to learn from mistakes or have much will
power. People procrastinate, make poor decisions, lose inhibitions, and
throw morality and ethics by the way side. By disabling the PFC we resort to
being the equivalent of a 2 year old with minimal PFC. At this point it is about
the pleasure principle: I want what I want, when I want it, without the thought
of consequences. ADD and ADHD people fall into this category as well. The
key to recovery is to create a surrogate prefrontal cortex in your external life
meaning surround yourself in an environment that your prefrontal cortex
(morals and ethics) would have if it was working correctly. So change 1.
People - i.e. gamblers, people who bail you out, enablers and change them
with people in recovery. 2. Places - avoid casinos, race tracks etc… and find
new hobbies and leisure activities to occupy your time and thoughts. 3.
Things - Cancel mailings from casinos, let go of lotto tickets and replace
them with goals that you want to move toward in your life. As time goes on,
about 3 months, it seems that people have a stronger control over the
compulsion. This tells me that the brain is being retrained and allowing the
PFC to function closer to its full potential. The brain is resilient.
Jack Canfield, the author of Chicken Soup for the Soul books, talked about a
NASA experiment in an interview for his book The Success Principles. The
story is as follows. NASA had astronauts wear goggles over their eyes that
would make everything they see upside down. This went on for weeks and
weeks to see if people got nauseous, vertigo, etc… and what they found
astounded everyone. After 25-30 days the astronauts’ eyes adjusted to the
goggles and reverted the images to right side up again. This is an example of
the resiliency of the brain and the time it takes for the brain to assess
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changes and make changes. If your client’s life is upside down due to
gambling, there is hope that they can turn their life right side up.
When the prefrontal cortex is working right it does the following.
Who riled up the Anterior Cingulate?
Anterior Cingulate Gyrus
The white area shows over active Cingulate.
Anterior Cingulate Gyrus (ACG): When working normally this part of the
brain helps you switch from one thought to another with ease and flexibility. It
is often thought of as the brain’s gear shifter, and is known for helping us with
cognitive flexibility, cooperation, going from idea to idea, and going with the
flow. It is also responsible for error detection. Its location: it runs length wise
through the PFC. Think between your eyes to the back of your head. Think
Mohawk in your brain. When we are in the addiction, this part of the brain
over acts and then… Darth Vader music please…then our view of the world
and problem solving gets ridged. This part of the brain, when over stimulated,
has great difficulty shifting from one thought to another and gets focused on
the negative aspects of life like gambling, or the glass is half empty not full.
These are the people that Dr. Amen refers to as the people who "like to play
the game “let’s have a problem". This area is active with people who deal
with addictions, compulsions, OCD, and people we may consider anal
retentive.
Scenario 1.
This is how I view the anterior cingulate gyrus. Using the metaphor of eye
sight and problem solving imagine you are looking for something you have
lost… let’s say your marbles. Yes, let's say you have lost your actual glass
marbles and you want them back. When your anterior cingulate gyrus is
working normally you are flexible and able to look many places as well as
rethink when you last had your marbles with different problem solving
techniques. You are able to actually view your surroundings with 360
degrees of sight looking up and down, left and right. You get to look at the
problem with 360 degrees of problem solving thinking ability, and low and
behold you find your marbles in your coat pocket in record time. Well done!
Scenario 2.
Now using the same scenario and same metaphor: You have lost your
marbles, but this time your anterior cingulate gyrus is over active (Darth
Vader music please). Imagine your neck is locked and you cannot turn
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without moving your whole body. You also can not look up or down. Your
eyes now have blinders on them like a horse in the Kentucky Derby and you
know for sure that your marbles went under the couch in the living room.
When you lift up the couch and they're not there you start to think someone
took them. Because you knew they were there. In fact you are convinced that
someone took your marbles. You ask your spouse and children “did you see
my marbles”. When they say “no” you do not believe them. You tell them that
they are going to be in big trouble unless they find your marbles. No one
finds them. You give up looking and think there is a conspiracy against you
and your marbles. You either begin to argue or shut down because you knew
they were under the coach and someone must have taken them. Throughout
the day you continue to look under the couch knowing that they should be
there, but to no avail. The marbles do not materialize under the couch. The
family is now avoiding you because you will not listen to reason. Later that
day it is time to go out and feed the homeless. To your surprise when you put
your jacket on you find the marbles in your jacket pocket. Even though you
did put them there you may not remember because you have it in your head
that they are under the couch. However, you still may think that someone
took them from under the couch and put them in your pocket because you
just cannot let this go. You know that you were right. Now people who have
an over active anterior cingulate gyrus do sometimes act like they have lost
their marbles and I do not mean the glass ones. They are so rigid in their
thinking it is difficult for them to see a different side to a situation.
How does this relate to gambling? When a gambler has a craving to gamble
they get tunnel vision from the ACG and will find a way to use just like with
any other addiction. Rationality and possibly their marbles are out the
window. When the PFC is under active and the ACG is over active people
are literally not in their right mind. Their brain chemistry has changed. This
does not excuse the behavior or minimize the potential for negative
consequences. People are responsible for their actions. In treatment they get
to gain more control over what triggers them to gamble and it is their
responsibility to apply these tools. Our brain is resilient and this is the best
time in history to be in recovery.
Over active ACG:
Gets stuck, Trouble shifting
Inflexible , worries
Holds grudges and hurts from past, oppositional
Obsesses, Argumentative
Compulsions, Excessive error detection
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Prefrontal
Cortex
Nucleus
Acumbens
Amygdala
Reward Deficiency Syndrome




Nucleus accumbens – Pleasure center
Complex interaction of neurotransmitters leading to feelings of well
being, satisfaction
Disruption of system results in negative emotions: anxiety, anger,
cravings
Interacts with learning and memory
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Amygdala- (size of an almond)
Problem gambling increases the release of Norepinephrine to the Amygdala.
Norepinephrine is both a hormone and a neurotransmitter. As a
hormone, secreted by the adrenal gland, it works alongside epinephrine /
adrenaline to give the body sudden energy in times of stress, known as
the "fight or flight" response.
The amygdala is the size of an almond in the limbic or emotional part of the
brain. It deals with strong emotions as well as the flight or fight response.
Fight or flight response is a primitive response to deal with life threatening
situations. When the Amygdala is activated due to a threat, it reacts without
even having a thought. The body goes into auto pilot. The heart beats faster,
breathing increases, body begins to perspire, adrenaline gets activated, all
due to the body’s natural defense mechanism to preserve life. Well, when we
are craving gambling or the drug, the body is in a hyper vigilant mode of self
protection and only thinking about what you need now, in the moment, with
no fore thought. When someone has a biological craving to gamble, the
amygdala is sensing that you are at high risk and may die on a primitive
level. Gambling Increases the release of Norepinephrine to the amygdala
Imagine if this amygdala lights up like a red hot iron that has been left in the
fire. When this happens the anterior cingulate gyrus kicks into action and
begins to overwork making your thoughts ridged and in the moment, focusing
only on the problem and the one thing that can solve it.
The amygdala and anterior cingulated gyrus, in my imagination, behave like
this:
Scene: Suzy driving on the road that leads to a casino, the same road she
has taken hundreds of times. Tonight she had no plans of going to the casino
until she sees a billboard and then begins to think about stopping for just a
little while and playing the slots. The more she thinks the more active her
brain becomes to reward her with dopamine because gambling is "fun" and
she feels that tonight could be the night to win the big one. In her mind she
says "no" she has to get dinner for the kids, but she is still willing to fantasize
what it would be like "this time". Her brain has been down this road before
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and just like Pavlov’s dogs salivating at the sound of a bell thinking that food
would be ready for them, Suzy's indulging in her fantasies has activated that
primal amygdala. She woke it up with her thoughts as if each thought was
pounding on the door to the amygdala room and it wakes her up and it lights
up like the fourth of July. The amygdala is now in hyper alert mode. Thinking
there is a crisis. It believes that this is a life and death situation. When the
Amygdala lights up, the brain goes into primal mode and begins to shut down
some systems and over-activate others. The attention is on the here and
now. The focus is how do I solve this problem. If it is a craving for gambling,
then the answer is to gamble and the ACG locks onto it, and bam! the cycle
begins again.
Mental Martial Acts section and The Thought Stopping Technique and action
card (shown in the worksheet section of this book), help people so they
minimize getting to this point.
.
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Section 4
Suicide information, Depression, Screenings, and
Assessments
Keep in mind when you do the assessment.
First assess for Pathological Gambling
Next assess for:





Substance abuse issues
Depression
Other impulse control disorders and behavioral addictions
Suicidality/threat to others over rides everything else and guides initial
treatment intervention.
If initial assessment indicates depression and presence of potential
lethality, then make immediate referral for psychiatric assessment or send
to the emergency room for a psych evaluation.
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I see dead people. OK I don’t but,
I will occasionally know if they are going to kill themselves.
Let me explain.
Stuart
I recommend administering the Becks Depression Inventory which is a
helpful tool in finding out your client’s level of depression. I know of a
psychologist who has their client fill it out every session. I encourage you to
ask if your client is suicidal. If so you can refer them to the Emergency room
and have them assessed by a psychiatrist. I have had a variety of
experiences with this issue of suicide. I encourage everyone to listen to their
intuition on this as well. One client came to my office in the hospital for an
assessment for the Intensive Outpatient Program for substance abuse I was
counseling in. The client was very emotional and something was just different
about this person. I gently asked them if they were suicidal and He cautiously
said yes. I followed the procedure of the hospital and had security walk him
to the emergency room for an evaluation for mental health inpatient
treatment. Before doing this I explained the whole procedure to him and after
he made some calls and I gave him some reassuring encouragement he
welcomed the idea of being assessed in the ER.
Another time years ago before my hair was turning grey I was working in a
behavioral health locked ward unit doing art therapy. People were in this
short term care for a variety of crises. The people were admitted to this ward
if they had severe suicidal ideation or attempts, homicidal ideation, as well as
psychotic people off their medication. The people were generally there
because they wanted or needed help. One day while I was helping facilitate
the art therapy group during my internship after graduate school I spoke to a
woman who was being released that afternoon. This woman had a very
difficult life and struggled with many things including depression. She had
many admissions in the past to our facility. On this particular day she drew a
picture of a rainbow and sun. When asked about her picture and plans for
after being discharged she became very gamey. I could not get a straight
answer out of her. The hairs on the back of my neck began to raise and I got
goose pimples. I just had a feeling she was going to go home and kill herself.
when I asked if she was going to kill herself She denied this adamantly. I told
my strong feeling to my supervisor and suggested that she not go home that
night. My supervisor told the psychiatrist on the unit. The psychiatrist met
with her again and did not see any reason to be alarmed. He signed her
release papers to be discharged that afternoon. She left and returned the
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next day to the unit due to overdosing. She did attempt suicide that night.
Since then I have had other experiences that had the hairs on the back of my
neck stand up due to my suspicion of a client going to attempt suicide. They
were right. Please trust your instincts and follow up with them. I had another
hair raising experience with a client I saw in private practice for Compulsive
Gambling and followed her to the ER. I went in with her and made sure she
was assessed and admitted. She was admitted for over a week and tells
people that I saved her life. I have more stories but you get the idea.
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The following are the screenings and assessment that are described next.
1.
2.
3.
4.
Lie bet
SOGS –South Oaks Gambling Screen
20 questions
DSM-IV Pathological Gambling
Lie/Bet Screen
(Johnson et al., 1997)
2- question version of the DSM IV criteria:
1. Have you ever had to lie to people important to you about how
much you gambled?
2. Have you ever felt the need to bet more and more money
If either of these questions were answered with a yes, assess using the DSM
IV criteria for Pathological gambling. (conveniently located in this section of
the book.)
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The South Oaks Problem Gambling Screen
The South Oaks Gambling Screen is a 20-item questionnaire based on DSMIV –TR criteria for pathological gambling. It may be self-administered or used
by non professional or professional interviewer. The time frame
recommended while answering the questions is the past 6-12 months.
Remember a screen is used when you think they may have a problem with
gambling. It is to screen people to see if they need an assessment. If the
screen suggests that problem or pathological gambling is probable then the
assessment allows you to see if they meet the criteria for a DSM Diagnosis.
SOUTH OAKS GAMBLING SCREEN
[SOGS]
Name:________________________________________________
Date:________________
1. Please indicate which of the following types of gambling you have done in your lifetime. For
each type, mark one answer: “Not at All,” “Less than Once a Week,” or “Once a Week or More.”
PLEASE “✓” ONE ANSWER FOR EACH STATEMENT:
Less
Once a
NOT
than
week or
AT ALL once a
more
week
a. Played cards for money.
b. Bet on horses, dogs, or other animals (at OTB, the track, or with a
bookie).
c. Bet on sports (parlay cards, with bookie, at Jai Alai.
d. Played dice games, including craps, over and under, or other dice
games.
e. Went to casinos (legal or otherwise).
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f. Played the numbers or bet on lotteries.
g. Played bingo.
h. Played the stock and/or commodities market.
i. Played slot machines, poker machines, or other gambling machines.
j. Bowled, shot pool, played golf, or some other game of skill for money.
k. Played pull tabs or "paper" games other than lotteries.
l. Some form of gambling not listed above (please specify):
2. What is the largest amount of money you have ever gambled with on any
one-day?
_____ Never gambled ______More than $100.00 up to $1,000.00
_____ $1.00 or less ______ More than $1,000.00 up to $10,000.00
_____ More than $1.00 up to $10.00 ______ More than $10,000.00
_____ More than $10.00 up to $100.00
3. Check which of the following people in your life has (or had) a gambling
problem.
_______ Father _______ Mother
_______ Brother/Sister _______ My Spouse/Partner
_______ My Child(ren) _______ Another Relative
_______ A Friend or Someone Important in My Life
4. When you gamble, how often do you go back another day to win back
money you have lost?
________ Never _______ Most of the Times I Lose
________ Some of the Time _______ Every Time I Lose
(less than half the time I lose)
5. Have you ever claimed to be winning money gambling, but weren’t really?
In fact, you lost?
________ Never
________ Yes, less than half the time I lost
________ Yes, most of the time
6. Do you feel you have ever had a problem with betting or money gambling?
________ No ________ Yes _________ Yes, in the past, but not now
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7. Did you ever gamble more than you intended to? _____ Yes _____ No
8. Have people criticized your betting or told you that you had a
problem, regardless of whether or not you thought it was true? _____ Yes
_____ No
9. Have you ever felt guilty about the way you gamble, or what
happens when you gamble? _____ Yes _____ No
10. Have you ever felt like you would like to stop betting money
on gambling, but didn’t think you could? _____ Yes _____ No
11. Have you ever hidden betting slips, lottery tickets, gambling
money, IOUs, or other signs of betting or gambling from your
spouse, children or other important people in your life? _____ Yes _____No
12. Have you ever argued with people you live with over how you
handle money? _____ Yes _____ No
13. (If you answered “Yes” to question 12) Have money arguments
ever centered on your gambling? _____ Yes _____ No
14. Have you ever borrowed from someone and not paid them back
as a result of your gambling? _____ Yes _____ No
15. Have you ever lost time from work (or school) due to betting
money or gambling? _____ Yes _____ No
16. If you borrowed money to gamble or to pay gambling debts, who or
where did you borrow from (check “Yes” or “No” for each):
a. From household money _____ Yes _____ No
b. From your spouse _____ Yes _____ No
c. From other relatives or in-laws _____ Yes _____ No
d. From banks, loan companies, or credit unions _____ Yes _____ No
e. From credit cards _____ Yes _____ No
f. From loan sharks _____ Yes _____ No
g. You cashed in stocks, bonds or other securities _____ Yes _____ No
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h. You sold personal or family property _____ Yes _____ No
i. You borrowed on your checking accounts (passed bad checks) _____ Yes
_____ No
j. You have (had) a credit line with a bookie _____ Yes _____ No
k. You have (had) a credit line with a casino _____ Yes _____ No
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SOUTH OAKS GAMBLING SCREEN [SOGS]– SCORE SHEET
Scores on the SOGS are determined by scoring one point for each question
that shows the “at risk” response indicated and adding the total points.
Question 1 ___X__ Not counted
Question 2 ___X _ Not counted
Question 3 ___X Not counted
Question 4 ______ Most of the time I lose or Yes, most of the time
Question 5 ______ Yes, less than half the time I lose or Yes, most of the
time
Question 6 ______ Yes, in the past but not now or Yes
Question 7 ______ Yes
Question 8 ______ Yes
Question 9 ______ Yes
Question 10 ______ Yes
Question 11 ______ Yes
Question 12 ___X Not counted
Question 13 ______ Yes
Question 14 ______ Yes
Question 15 ______ Yes
Question 16 a ______ Yes
Question 16 b ______ Yes
Question 16 c ______ Yes
Question 16 d ______ Yes
Question 16 e ______ Yes
Question 16 f ______ Yes
Question 16 g ______ Yes
Question 16 h ______ Yes
Question 16 i ______ Yes
Question 16 j X Not counted
Question 16 k X Not counted
TOTAL
POINTS:_______________
(Maximum score = 20)
INTERPRETING THE SCORE:
0 No problem with gambling
1-4 Some problems with gambling
5 or more Probable pathological gambler TI: South Oaks Gambling Screen
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GA 20 Questions
Gambler’s Anonymous (GA) Twenty Questions
1. Did you ever lose time from work or school due to gambling?
2. Has gambling ever made your home life unhappy?
3. Did gambling affect your reputation?
4. Have you ever felt remorse after gambling?
5. Did you ever gamble to get money with which to pay debts or otherwise
solve financial difficulties?
6. Did gambling cause a decrease in your ambition or efficiency?
7. After losing did you feel you must return as soon as possible and win back
your losses?
8. After a win did you have a strong urge to return and win more?
9. Did you often gamble until your lost dollar was gone?
10. Did you ever borrow to finance your gambling?
11. Have you ever sold anything to finance gambling?
12. Were you reluctant to use “gambling money” for normal expenditures?
13. Did gambling make you careless of the welfare of yourself and your
family?
14. Did you ever gamble longer than you planned?
15. Have you ever gambled to escape worry or trouble?
16. Have you ever committed, or considered committing, an illegal act to
finance gambling?
17. Did gambling cause you to have difficulty in sleeping?
18. Do arguments, disappointment or frustrations create within you an urge
to gamble?
19. Did you ever have an urge to celebrate any good fortune by a few hours
of gambling?
20. Have you ever considered self-destruction or suicide as a result of your
gambling?
Most compulsive gamblers will answer yes to at least seven of these
questions. If yes to seven or more then do DSM assessment.
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Criteria for Pathological Gambling
DSM IV CHECKLIST (312.31)
1. Are you preoccupied with gambling (e.g., preoccupied with reliving past
gambling experiences, handicapping or planning the next venture, or thinking
of ways to get money with which to gamble)?
Yes____ No____
2. Do you need to gamble with increasing amounts of money in order to
achieve the desired excitement?
Yes____ No____
3. Have you made repeated unsuccessful efforts to control, cut back, or stop
gambling?
Yes____ No____
4. Are you restless or irritable when attempting to cut down or stop
gambling?
Yes____ No____
5. Do you gamble as a way of escaping from problems or of relieving feelings
of helplessness, guilt, anxiety, or depression?
Yes____ No____
6. After losing money gambling, do you often return another day to get even?
Yes____ No____
7. Do you lie to family members, therapists, or to others to conceal the extent
of involvement with gambling?
Yes____ No____
8. Have you committed illegal acts such as forgery, fraud, theft, or
embezzlement to finance gambling?
Yes____ No____
9. Have you jeopardized or lost a significant relationship, job or educational
or career opportunity because of gambling?
Yes____ No____
10. Do you rely on others to provide money to relieve a desperate financial
situation caused by gambling?
Yes____ No____
Diagnostic Classifications for the DSM-IV. If a person meets the following
criteria they will be classified as:
1 - 2 criteria = At-Risk
3 - 4 criteria = Problem Gambling
5+ criteria = Pathological Gambling
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Section 5
Tools to help Problem and Pathological Gamblers
HARM REDUCTION
What is harm reduction?
 Enters into a supportive relationship
 Non-blaming
 Gives options
 Accepts their choices
 Gains awareness
 Educates around potential harm or risk
Based on “Changing for Good” Prochaska and DiClemente and Milligan & Walker of Ontario
YMCA Youth Gambling Project.
To abstain or not to abstain that is the question.
The goal in harm reduction for pathological gamblers is an exercise of self
awareness about their self control. In general my experience has taught me
that pathological gamblers have to abstain from gambling. Now that is a
blanket statement that does not cover the whole issue. As a counselor, I
recommend they stay away from casinos all together. If they play the state
or national lottery every so often and they can control it then this is up to
them. It is only a problem as long as it is maladaptive. If your client is a
pathological gambler and during the week they buy a candy bar out of a
vending machine and two come out rather than one. Will that trigger them to
gamble? Should they take just the one and not the other? It really depends
on what triggers your client. I have also experienced that some pathological
gamblers come into counseling thinking that they just need to get their
gambling under control but still want to gamble “a little”. In this case we set
some guidelines for when they gamble again.
Below are some other helpful ideas for you to talk to your client about before
they gamble. The key to this is to have your client decide on an amount of
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time and money they are going to allow for gambling. If your client cannot
stay within these boundaries then this becomes a therapeutic issue to
discuss. This would be the time to:
 Help the client see the consequences of own behavior
 Have the client understand alternative options
 constantly re-clarify clients goals
 judge clients adherence to plan as measure of motivation
 continue feedback loop to client
 see if client can consider abstinence as an option now
If abstinence is not something for you right now then try:
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Decide ahead of time how much money you plan to gamble with.
Set a time limit on how long you will gamble.
Play only if all your bills are paid.
Understand that you will lose more then you win. Casinos do not go
bankrupt. They are in the business of winning.
Understand the odds. For example slot machines have computer chips in
them that play the game in between you pushing the button. Each play is
independent of the last play. It knows win and how much it will pay out
Think of gambling as a form of entertainment – not a way to make money.
Are you going to spend all you brought or until you win a certain amount?
Don’t gamble when you are tired, bored, anxious or angry.
Keep track of how much time and money you spend on gambling.
Take your family and friends seriously. If they are worried about your
gambling, they might be seeing something you don’t see.
Only use your own money to gamble. Don’t borrow.
When gambling, take regular breaks - walk around, eat, or go outside to
clear your head. Avoid being in “the zone”= numbed out.
Keep your head clear when you gamble – Do not use alcohol or drugs.
Have other leisure activities in your life other then gambling and do them.
Go gambling with someone who doesn’t have a problem with gambling.
Do not be attached to your wins or losses. Go for entertainment. That’s it.
Don’t take your credit and bank cards with you when you gamble.
Spend less time with friends who gamble.
Don’t use gambling as a way of avoiding negative feelings or situations.
Instead talk to a trusted friend, counselor, clergy or sponsor who
understands problem gambling.
I searched through rebellion, drugs, diets, mysticism, religions,
intellectualism and much more, only to begin to find that truth is basically
simple - and feels good, clean and right.
- Chick Corea
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For those who are committed to stop gambling.
Techniques to Help you abstain from gambling
1.
2.
3.
4.
Get problem gambling counseling and do homework.
Get financial counseling
Cut off transportation
Get rid of internet access – if this is a
trigger for internet gamblers.
Five Components
5. Remove your name from casino
Which Make A Gaming
marketing lists
Activity Addictive
6. Ban self from casinos take a friend – go
1. Immediacy
to the security office to do it.
2. Ability to increase
7. Cut up credit cards if not willing to do
3. Perception of skill
4. Ability to lose yourself
that make it very difficult for you to
5. Intermittent rewards
obtain them
8. Carry only cash you need for the day, no
debit or credit cards
9. Have someone else manage your
money
10. Go to GA meetings
11. Attend GA pressure relief group meetings to aid with financial
problems
12. Get a sponsor
13. Have direct deposit so you do not handle checks
14. Create a budget and stick to it.
15. Have a to do list at all times
16. Create a plan of action before triggered
17. Write life story read aloud to group or counselor
18. Journaling – people forget the bad things in addiction but remember
the wins. Writing helps clients remember the life of gambling. When
triggered they can refer back to it. They cannot dispute it because it is
in their own words.
19. Boredom is a trigger - stay active, schedule days activities the night
before.
20. Plan activities, setting goals, Be accountable with your time,
21. Find new hobbies
22. Call someone who you trust when triggered i.e. a friend, GA Sponsor,
family member or therapist
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23. Talk to bank to put daily limit on amount you can withdraw.
24. Do something that is fun and playful
25. Work the twelve steps
26. Limit sugar and caffeine.
27. Eat regularly to regulate blood sugar
28. Get enough sleep
29. Have a plan to repay debt
30. Be honest with people
31. Take up a class…a fun one, art, music…
32. Schedule your time - plan a head – fail to plan plan to fail.
33. Do not focus on desire to gamble. If you think about it three times in a
row get up and do something different.
34. Avoid isolating, be with people
35. Stay in the moment
 Do not dwell on the past usually brings up painful emotions
 Do not dwell on the future usually brings up fears
36. Stress management - learning to relax, learning anger management
37. Be aware of self care
38. Forgive yourself. The feeling of shame and guilt that can persist long
after the client stops gambling. Counseling and Support groups like
GA and can be very helpful in the healing process. If the shame and
guilt are unresolved they can easily sabotage recovery.
39. Admitting they have a problem and that it affects more than just them.
40. Reaching out and talking
41. Avoiding gambling establishments
42. Exercising – 3-4 times a week. Helps the brain and reduces boredom
43. Volunteering - Participating in community, Social support
44. Financial accountability
45. Meditation
46. Acknowledging superstitious beliefs and their illusion
47. Taking medication if needed for co-occurring disorders i.e. bi-polar,
major depression etc..
48. Find new Interests in activities i.e. hobbies, leisure activities.
49. Reconnect with Spirituality
50. Learn new problem solving skills – this increases coping skills.
51. Self efficacy- the belief that one is capable of performing in a certain
52. Think of ways you can attain certain goals
53. Identify triggers and risk factors
54. Monitor gambling thoughts, desires, urges, cravings and create a plan
of action when they arise.
55. - Thought Stopping Technique
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56. Increase self awareness through talking and self exploration.
57. Anger Management
58. Stress Management
59. Financial Planning
60. Assertiveness
61. Think it through using ABC = Action- Behavior- Consequence
62. Work the 12 GA steps. - acknowledge can't control gambling and
need help, Accept help, get honest with self and others, Make amends
to decrease guilt, shame and anger as risk factors, Develop spiritual
63. Connect with others who are healthy.
64. Focus on being healthy not on being “normal”. “Normal” today is not
healthy.
65. Goodbye letter to gambling
66. Practice H.A.L.T.S. never get too Hungry, Angry, Lonely, Tired, or
Stressed
67. Help client write out an action card with 5 action steps to do when
triggered
68. Find out your top 10 values and live them.
69. Gratitude list
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If abstaining from gambling is not enjoyable over the long run why do it.
Here are some suggestions for self care. Helping you get your needs met
so you may enjoy life more.
Create a self-care list:

Create a community of friends and/or family who support and love
you. i.e. volunteer, soup kitchen, hospital, church, animal shelter.
Get involved.

Live within your means, including savings. Create a budget so you
know what that is

Time to journal, meditate or regroup.

Healthy eating and exercise, limit caffeine and sugar, take a
multivitamin, and omega 3 if ok with your doctor. Studies have
found people who are depressed and suicidal have lower omega 3
levels then people who are not depressed or suicidal. Check with
doctor to make sure it is appropriate for you.

Laughter. – find Cd’s, mp3’s, movies, comedians that make you
laugh. It changes your mood, attitude, and gives another
perspective to life

Living a life that honors your values and standards. Make a list of
your values and review them often to see if you are living those
each week. If not, what can you do to improve?

Getting proper sleep and rest. This is difficult with many people in
recovery. Sleep can affect every aspect of our lives. It is hugely
under-rated in today’s world. If sleep is a problem learn to meditate
daily which can help your sleep deprivation and rejuvenate you.

Create a to-do list and allow yourself enough time to get projects
done. Avoid getting overwhelmed. Take one project at a time.

Saying NO more often (Yes, you can!). Say yes to life more.

Regular medical and dental check-ups.

Time to play. Have fun, go to the park, swing, swim, skate, ski, hike,
go star watching, go fishing, catch butterflys… let them catch you.

Personal pampering that makes you feel great (this is where the
messages, bubble baths, pedicures, etc., are included).
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Writing assignment
Planning ahead
Name:_________________________
Date _____________
When you get triggered imagine what will happen if you gamble. In your
initial fantasy, you are winning, of course. But what happens in reality? You
put the winnings back in and are unable to leave with it. Even winning is
losing. You keep playing until you have lost everything. Then what? Imagine
yourself out in the parking lot after gambling feeling disgusted, angry and
ashamed and then you have to drive home. How long did you realistically
gamble? How do you feel? What happens when you get home and see your
spouse’s face, and he or she knows you have been gambling? How do you
feel? What does your week look like? Can you pay your bills? Do you have
money for the basics? Continue and consider the ramifications of Legal
issues, work issues, family, health, spiritual issues, Bills, etc…Write this out,
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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Writing assignment
Pros and Cons of Gambling
Name: ____________________________
Date: ________________
Write the short and long term pros and cons of gambling.
1. What are the short term positive reasons to gambling?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
2. What are the short term negative reasons to gambling?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
3. What are the long term positive reasons for gambling?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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4. What are the long term negative reasons for gambling?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Notes:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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Writing assignment:
Goodbye Letter to Gambling
Write down a goodbye letter to your addiction. Treat it like a relationship
you’ve had as if written to someone you once knew.
- When did you first meet? What was it like? What did it feel like? How did it
help you?
- What was the middle of the relationship like? Does the gambling want
more from you? is it not as much fun? Were you giving up some hobbies?
Less time with friends?
- Then the last phase of the relationship. Why do you want to stop. Is the
relationship with gambling taking more and not giving back. How does it
make you feel? How is it affecting your other relationships in your life.
Isolating?
Some say that having an addiction is like having an affair. We spend money
and time with this relationship, and we keep part or all of it a secret.
Then sign the letter Good bye,... read it out loud to your counselor. How
does it make you feel? Then process with counselor.
Think about the following aspects in each phase of the relationship and how
it affected them.
-Legal issues- fraud? , Divorce?, Bankruptcy?, etc.
-Career – are you still working, are you losing more time from work?
-Mental health – depression?, anxiety?, Stress, other addictions etc..
-Physical health- blood pressure, diabetes, exercise, How is your sleep
ulcers, etc.…
-Spiritual health- Meditation?, church?, volunteering?, etc….
-Family relationships- with children?, spouse?, cousins?, parents?,
grandparents?, grand children? etc…
-Finances – savings, furniture, bankruptcy, saving for college fund?, saving
for new car? House?etc…
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Writing assignment: 1-5 years
1. Write done what your life will look like in 1 year and
5 years if you continue to gamble.
2. Write down what your life will look like in 1year and
if you stop gambling.
5 years
Keep in mind the following topics:
-Legal issues- fraud? , Divorce?, Bankruptcy?, etc.
-Career – are you still working, are you losing more time from work?
-Mental health – depression?, anxiety?, Stress, other addictions etc..
-Physical health- blood pressure, diabetes, exercise, How is your sleep?,
ulcers, etc.…
-Spiritual health- Meditation?, church?, volunteering?, etc….
-Family relationships- with children?, spouse?, cousins?, parents?,
grandparents?, grand children? etc…
-Finances – savings, furniture, bankruptcy, saving for college fund?, saving
for new car? House? etc…
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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_____________________________________________________________
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Thought Stopping Technique
Materials needed - 1 loose fitting rubber band
What is thought stopping and how is it going to help me?
The following thought stop technique is to train you in the art of Mental
Martial Arts. It is to help you take back control of your thoughts and thus
emotions since what you think is directly related to the emotions you feel. So
if you think peaceful thoughts you will feel peaceful. If you think MORE
peaceful thoughts you will feel MORE peaceful. If you think angry thoughts
you are going to feel angry. If you think MORE angry thoughts you will get
even MORE angry. If you think about gambling you may have an urge to
gamble. If you think more about gambling you will have a strong desire, a
craving to gamble. The only way to ensure that a thought won't lead to
gambling is to stop the thought before it leads to craving.
This technique will help you focus and feel more of what you want to think
and feel. We all have an internal critical self-telling us negative things at
times. Dr. Amen calls them ANT's= Automatic Negative Thoughts. Do not
believe everything you think. Your compulsion to gamble may say things like
"no one will know if I gamble", "I will go for one hour and spend just $20,", "I
deserve this", "I can control this now". If you allow gambling thoughts to
continue then they will develop into cravings and then you will sabotage
yourself and gamble. Then you become your worst enemy. This technique is
to help you live the life you want despite your addiction.
It is not a matter of if triggers or cravings will happen it’s when. It can come at
predictable and unpredictable times. This technique will prepare you if and
when they happen. Knowledge is power. It is better to be prepared and have
no triggers/ cravings than to not be prepared and have triggers/cravings.
The way to beat a craving is to put time and space between you and
gambling. It’s a time game. Distract yourself from gambling long enough so
the feeling goes away, and it does. If you don’t reward this craving then it will
begin to die out sooner and sooner. You will be changing your brain
chemistry and neural pathways. However, it does take time. Be patient and
kind to yourself. This technique works. You have the ability to stop this and
I’ll show you how. So how does this work?
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When people are triggered there is a predictable mental process that moves
you from:
1. Trigger ------ 2. Thought------ 3. More Thoughts ------4. Craving-----5.
Gambling.
The goal for the thought stopping process is to interrupt your thinking
process by snapping a rubber band around your wrist and saying STOP out
loud. Say it out loud at first to condition yourself. Later you can say it to
yourself if you are in public. Do this between "2.Thought" and "3.More
Thought".
The process:
1. Trigger -- 2. Thought--//
or Gambling.
3. STOP
//-- no more Thoughts, Cravings
After utilizing the thought stopping technique it is important to do the
following.
1. Interrupt your thinking and then implement the "Action Card".
2. Aversive Replacements: if you have a tendency to glorify or think of
gambling in an acceptable way, immediately replace these acceptable
images with more realistic images, i.e., thoughts of gambling can be replaced
by words "Winning is Losing'', or "bankruptcy", or "Jail", "Homeless",
"Divorced", "Unemployed". Thoughts of cigarettes can be replaced by
"cancer sticks'' or "coffin nails.''
3. Play out the negative scenario of what will happen if you gamble. Write it
out so you will have it for a future reference and read it 3 times a day.








Winning is losing for me. Even if I win I put the money back in.
If my spouse finds out she/he may divorce me.
I will lose more time and money and leave feeling empty and
ashamed.
I will be living a lie
I will lose sleep
I have bills to pay and will not be able to pay them if I gamble.
I wont be able to trust myself.
My life will only get worse if I continue to gamble.
By doing this you take the power away from the triggers and gain control of
your life. This is like a vaccine to the disease. You will be retraining your
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brain on how to respond to gambling stimuli differently. The less attention
you give it the less bothersome the desire will become. Just like if you have a
fire in a fireplace and stop stoking it with wood then it will burn out. Neglect of
the fire is the same principle as neglecting the thought and desire to gamble.
That desire gets less over time and is easier to manage.
You can do this not only with cravings and triggers but also other negative
self-talk. Remember if you do not change your thoughts then you will not
change your behaviors and you will get the same results. Thought stopping
technique works. Use it.
In conclusion, Cognitive thought stopping is not avoidance but rather sets up
a decision tree. It is making a choice not to dwell on things that can’t be
changed. If you can do something, work toward resolution. Rumination
appears to be the foundation of mood disorders and addictions. Thought
stopping gives the individual control over what they want to think about, not
what they are forced to think about. It allows the individual to enjoy the
moment and take back control of their thoughts.
A dollar picked up in the road is more satisfaction to us than the 99 which
we had to work for, and the money won at Faro or in the stock market
snuggles into our hearts in the same way. ~ Mark Twain
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Change your thinking, Change your world
Mental Martial Arts
Being aware of and in control of your thoughts is
important. Thoughts effect our emotions which
effects brain chemistry which can support triggers
to gamble, cause you to be depressed, cause
you have mastered
all aspects of your life
illness, and cause cravings. What you think will
not just gambling.
determine what kind of a world you live in, your
emotional world, mental world, spiritual world,
I call this
physical health world, you name it. The world is
Mental Martial Arts.
what you think of it. If you have a gambling
problem, in my view, your world or at least part of
Let it begin
it, in my most therapeutic term…most likely sucks.
grasshopper
Let’s change this with the following exercises and
yes, exercises only work if you use them. If you
Stuart Cline
want to run a marathon the only way that is going
to happen is if you do it consistently every day.
These techniques are the same.
If you master your
thoughts
You need to treat yourself differently. For example, if you have a young
daughter, son, niece, grandchild etc. and you witness another child telling
them, in front of you, that they are fat, ugly, stupid, dumb, no good, a loser, a
screw up, a bum, that they will not amount to anything, they’re weak, they
can’t do “it”, they’re a baby etc… what would you do? How would you feel?
Would you step in and stop it? I would hope so. However, we do that to
ourselves. We allow this internal self talk and often believe these lies. I have
been told that we have around 60,000 thoughts a day, If we allow 30% to be
positive and 70% negative, how do you think it will affect the choices we
make compared to 90% of thoughts positive and 10% negative? The answer
is: dramatically. Our thoughts zap our energy, self-esteem and passion for
life. If you have ever beaten yourself up emotionally, been depressed or
knew someone who has been depressed, then you will know that getting out
of bed in the morning is a chore. Your energy is zapped and everything in
your world becomes work. However, if you are doing something that excites
you and are passionate about, time flies and you have all the energy in the
world. This is not work but pleasurable and fulfilling.
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H.A.L.T.S.
Never get too:
- HUNGRY = low blood sugar = low frustration tolerance, irritability,
impulsive
choices, will power weakened
-ANGRY = What the F! attitude, increase in sabotaging abstinence
-LONELY = our best thinking got us to where we are now. Connect with
people
stop isolating. Your addiction wants to have you all to their own.
-TIRED - Less than 6 hours of sleep a night lowers brain function. Meditate,
rest, sleep, and be kind to yourself.
-STRESSED = Financial, work, time management, relationships, Pace
yourself, slow down, say no more, delegate, let go, forgive yourself.
Early on I tell clients to be aware of the Acronym H.A.L.T.S
I encourage people when they first learn about this to use it with every meal.
It seems to be easier to remember at first. Ideally, you want to use this every
time you are irritable, frustrated, triggered to gamble, or have a strong desire
to gamble.
After you have shared H.A.L.T.S. with your client, then
have your client write down 5 actions that they can take when they are
triggered or have a strong desire to Gamble. Have them write it on an index
card or put it on their car dashboard or refrigerator or wallet, somewhere
where they will be reminded of it.
I call this card “The Action Card.” This is the card that will guarantee that if
they follow it, without question, then it will keep them from gambling. It will
build their self-confidence and self-trust each time they say no to the desire
to gamble and all of that means they are taking back their life, and the money
they would have spent on gambling will still be in their bank. Ultimately, it
literally pays for them to say no to gambling because when pathological
gamblers gamble they will often put all of their winnings back into the
gambling establishment. This is where we get the term When Winning is
Losing. Even when they win they play until they put all the money back into
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the casino, race track, bookie, you name it. It goes to the addiction, it goes to
everything but themselves and their future. Pathological gambling is not
about the money. It ultimately is about the action and excitement or escaping
from uncomfortable and unwanted feelings.
The reason for “The Action Card” is to put time and space between the
desire to gamble and the act of gambling. The time you take to distract
yourself from the desire allows your over active amygdala to cool down and
let the desire pass.
Creating “THE ACTION CARD”
These 5 actions need to be specific. You can make up to seven actions but I
do not recommend more than this because the brain can apparently hold
only seven things at a time. I am not sure how true this is, but what I do know
is to not get overwhelmed so you do not do anything. Keep it simple. They
cannot be general like “to have fun”. Why does that not work? Because the
addictive self, when craving, is manipulative and will say gambling is having
fun so let’s do that. The action card is meant to not think about triggers and
distract yourself by taking action in this time of crisis.
Here are some ideas to keep in mind when having your client write the 5
action steps before using. You can use the H.A.L.T.S. for ideas.
Examples:
1.Reach out i.e. call a friend, sponsor, and tell them about craving and
wanting distraction
2. Exercise - Changes brain chemistry and allows for more blood flow to the
brain.
3. Get something to eat if blood sugar is low.
4. Go to a GA meeting.
5. Get rest if you need it.
6. Read a book
7. Take a drive - away from casinos
8. Journal
9. Stress management - scream into pillows, throw rocks, pillows etc.
10. Pray...Let go and Let God.
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Sleep Hygiene Tips
People are meant to spend one third of our lives sleeping. Make this quality
time! If you get less than 6 hours of sleep in a night then your brain will be
functioning at a lower level making you more tired, have cloudy thinking, be
more irritable, more prone to using stimulants like energy drinks and coffee.
Here are some ideas to help you sleep better.









Do not drink caffeinated beverages in the evening. For some people,
eliminating all caffeine (including chocolate) after 12pm can help to
improve sleep significantly.
Sleep on a schedule. Try to go to bed and wake up at about the same
time daily.
Do not nap during the day time. Day time sleep will limit your body’s
ability to be tired at night time.
Make your bedroom into a comfortable sleeping zone. Distractions
like televisions, radio or CD players, and computers can interfere with
sleep.
Do not play video games before you go to sleep.
Exercise during the day will help you sleep at night as well.
Pamper yourself before bedtime; a warm bath, a glass of milk or a cup
of decaffeinated tea can help to get your body and mind into sleeping
mode.
Check with your doctor to make sure that you are not taking any
medications that might interfere with sleep. Sometimes medical
conditions can interfere with sleep.
If you snore or have restless leg syndrome your quality sleep is at risk.
Talk to your doctor and possibly take a sleep test. A sleep Doctor told
me if you put a pair of socks at the end of your bed and they are on
the floor in the morning then you are having disturbed sleep and
possibly restless leg syndrome. Talk to your doctor.
for free information and products to sleep better go to:
Mindaudio1.com
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Coping with Triggers and Cravings
Understand that triggers and cravings are:



Normal
Time limited
They decrease without reinforcement
Identify triggers - People., places, things, times, feelings.
Recognizing your triggers
Triggers lead to an urge (or desire) to gamble. There are basically two kinds
of triggers:
1. Internal (thoughts or feelings)
2. External (situations)
1. INTERNAL -An internal trigger is most likely caused by one of the
following:
• Feelings of uncertainty or helplessness
• Feelings of guilt or shame
• Strong negative feelings such as depression, anger or anxiety
• Personal demands and expectations of yourself.
Gambling can be a way to avoid or escape such uncomfortable or painful
feelings.
Can you think of a recent situation that triggered such feelings for you that
created a desire to gamble?
Please describe that situation in the space below:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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2.EXTERNAL- External triggers are objects, words or images that remind
you of previous gambling experiences. Examples might include a billboard
advertising gambling in Las Vegas, a televised poker game, or the freeway
exit for the racetrack. External triggers can also involve situations that are
associated with gambling. For example, a woman might typically gamble
when her daughter is at a dance lesson or when her husband is out of town.
Can you think of something you experienced, saw or heard recently that
triggered an urge or desire to gamble?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Of the two kinds of triggers, which leads you to gamble?
How have you dealt with this?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
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Dealing with Distorted Thoughts about Gambling
In between the triggering event or urge to gamble gamblers may tell
themselves false statements in order to justify their decision to gamble.
Examples of some of these distorted thoughts about gambling are included
below. Check all the ones that you have used to justify your gambling. Check
the circle that most applies to you.
To feel like a winner
It is exciting
Party atmosphere
I have a system that works
To make money quickly
I am a lucky person
I have my lucky object
Today is lucky
I saw my lucky sign today.
Today is the day my luck
will turn around.
Gambling will solve my
problems
Gambling will make me feel
better
I am not like other people. I
am experienced.
To feel like a big shot
I am a confident person
To be more social
To avoid people
After so many losses it is
my time to win
I am a positive thinker
To not think about problems
To feel more powerful
Fate is on my side
I am doing God’s will.
God does not want me to be
poor.
I want to celebrate
To numb my feelings
I am a more knowledgeable
gambler then most
I deserve to win
The time is right
Bored
Because of depression or
loneliness
I have this special feeling
I have prayed
Anger
To feel pleasure
To be entertained
Out of habit
The challenge
Relaxation
To recover losses
To escape from stress or
anxiety
Others:________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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VALUES LIST
Throughout our lives our values change. The values we had from age 1020 are going to be different then from 20-30, 30-40 and so on. Here is a list
I have with the help from University of New Mexico CASAA’ s program to
formulate what values are important to you currently. This list will give you
a guideline of whether you are living these values in your everyday. Do the
worksheets and come up with your top 5-6 values; more than that people
seem to forget. When you find the values you most connect with today try
the following to help you remember them. Form a saying or phrase with the
first letters of each value to help you remember what they are. For example
if your six values were: Integrity, Acceptance, Health, Adventure, Fun, and
Recovery. The phrase could be something you remember like… I Am
Having A Fun Recovery. I =Integrity, Am= acceptance, H =Health,
A=adventure, F= Fun, R=Recovery. Or use a phrase in which you can
combine the values to help you remember. Example. Accepting Integrity
allows for a healthy fun adventure in recovery.
1. ACCEPTANCE
2. ACCURACY
3. ACHIEVEMENT
4. ADVENTURE
5. ATTRACTIVENESS
6. AUTHORITY
7. AUTONOMY
8. BALANCE
9. BEAUTY
10. CARING
11. CHALLENGE
12. CHANGE
13. COMFORT
14. COMMITMENT
15. COMPASSION
16. COMPLEXITY
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to be accepted as I am
to be accurate in my opinions and
beliefs
to have important accomplishments
to have new and exciting
experiences
to be physically attractive
to be in charge of and responsible
for others
to be self-determined and
independent
to have a balanced life
to appreciate beauty around me
to take care of others
to take on difficult tasks and
problems
to have a life full of change and
variety
to have a pleasant and comfortable
life
to make enduring, meaningful
commitments
to feel and act on concern for others
to have a life full of variety and
Page 85
17. CONTRIBUTION
18. COOPERATION
19. COURTESY
20. CREATIVITY
21. DEPENDABILITY
22. DUTY
23. ECOLOGY
24. EXCITEMENT
25. FAITH
26. FAITHFULNESS
27. FAME
28. FAMILY
29. FITNESS
30. FLEXIBILITY
31. FORGIVENESS
32. FRIENDSHIP
33. FUN
34. GENEROSITY
35. GENUINENESS
36. GOD’S WILL
37. GROWTH
38. HEALTH
39. HELPFULNESS
40. HONESTY
41. HOPE
42. HUMILITY
43. HUMOR
44. INDEPENDENCE
45. INDUSTRY
46. INNER PEACE
47. INTIMACY
48. INTEGRITY
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change
to make a lasting contribution in the
world
to work collaboratively with others
to be considerate and polite toward
others
to have new and original ideas
to be reliable and trustworthy
to carry out my duties and
obligations
to live in harmony with the
environment
to have a life full of thrills and
stimulation
To believe in yourself, purpose, and God
to be loyal and true in relationships
to be known and recognized
to have a happy, loving family
to be physically fit and strong
to adjust to new circumstances
easily
to be forgiving of others (and
myself)
to have close, supportive friends
to play and have fun
to give of what I have to others
to act in a manner true to who I am
to seek and obey the will of God
to keep changing and growing
to be physically well and healthy
to be helpful to others
to be honest and truthful
to maintain a positive and optimistic
outlook
to be modest and unassuming
to see the humorous side of myself
and the world
to be free from dependence on
others
to work hard and well at my life
tasks
to experience personal peace
to share my innermost experiences
with others
Honesty and congruency - Doing
what you say and saying what you
Page 86
49. JUSTICE
50. KNOWLEDGE
51. LEISURE
52. LOVED
53. LOVING
54. MASTERY
55. MINDFULNESS
56. MODERATION
57. MONOGAMY
58. NON-CONFORMITY
59. NURTURANCE
60. OPENNESS
61. ORDER
62. PASSION
63. PLEASURE
64. POPULARITY
65. POWER
66. PURPOSE
67. RATIONALITY
68. REALISM
69. RESPONSIBILITY
70. RISK
71. ROMANCE
72. SAFETY
73. SELF-ACCEPTANCE
74. SELF-CONTROL
75. SELF-ESTEEM
76. SELF-KNOWLEDGE
77. SERVICE
78. SEXUALITY
79. SIMPLICITY
80. SOBRIETY
81. SOLITUDE
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do.
to promote fair and equal treatment
for all
to learn and contribute valuable
knowledge
to take time to relax and enjoy
to be loved by those close to me
to give love to others
to be competent in my everyday
activities
to be conscious and mindful of the
present moment
to avoid excesses and find a middle
ground
to have one close, loving
relationship
to question and challenge authority and
norms
to take care of and nurture others
to be open to new experiences, ideas and
options
to have a life that is well-ordered and
organized
to have deep feelings for ideas, activities,
or people
to feel good
to be well-liked by many people
to have control over others
to have meaning and direction in my life
to be guided by reason and logic
to see and act realistically and practically
to make and carry out responsible
decisions
to take risks and chances
to make intense, exciting love in my life
to be safe and secure
to accept myself as I am
to be disciplined in my own actions
to feel good about myself
to have a deep and honest understanding
of myself
to be of service to others
to have an active and satisfying sex life
to live life simply, with minimal needs
to cope with and face life on life's terms
to have time and space to be apart from
Page 87
82. SPIRITUALITY
83. STABILITY
84. STRENGTH
85. TOLERANCE
86. TRADITION
87. VIRTUE
88. WEALTH
89. WORLD PEACE
others
to grow and mature spiritually
to have a life that stays fairly consistent
to be physically strong
to accept and respect those who differ from me
to follow respected patterns of the past
to live a morally pure and excellent life
to have plenty of money
to work to promote peace in the world
LIST OTHER VALUES IMORTANT TO YOU THAT WERE NOT LISTED ABOVE:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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Page 88
VALUES WORKSHEETS
Name: ____________________________
Date: _______________
HIGH PRIORITY VALUES:
1. _____________________________
2. _____________________________
3. _____________________________
4. _____________________________
5. _____________________________
6. _____________________________
Others: ________________________
. _____________________________
_______________________________
_______________________________
DEFINE YOUR VALUES:
1.__________________________________________________________
____________________________________________________________
____________________________________________________________
2.__________________________________________________________
____________________________________________________________
___________________________________________________________
3.__________________________________________________________
____________________________________________________________
____________________________________________________________
4.__________________________________________________________
____________________________________________________________
___________________________________________________________
5.__________________________________________________________
____________________________________________________________
____________________________________________________________
6.__________________________________________________________
____________________________________________________________
____________________________________________________________
Others:______________________________________________________
___________________________________________________________
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Page 89
Hobbies and Leisure Activities
“It’s not enough to be busy. The question is: What are we busy about?”
-Henry David Thoreau
This following list is to help you come up with new or old activities that you would like to
try. When checking these boxes focus on what you would like to do, not how you are
going to do that right now. Avoid judging yourself while doing this focus on the
possibilities of what you would like to do or are interested in. Fill in the box next to any
of the activities you presently enjoy doing, or that you could spend more time on. Put a
+ beside any that are new activities for you that you feel you might like to try. At the
bottom of this list are blank spaces to write in anything not listed.
 Additional Schooling  Attend 12 meetings/ GA  Decorating
 Music
 Theatre
 web design  scrap booking
 Aerobics  Dining Clubs
 Opera
 Traveling
 Antiquing  Driving
 Painting
 Video Games
 Archery
 Photography
 Visiting Family
 Ballet
 Fishing
 Flower Arranging  Playing Board Games
 Visiting Museums
 Volleyball
 Baseball/Softball
 Basketball
 Flying
 Football  Racquetball
 Volunteering  Boating  Gardening  Reading
 Bowling
 Racing
 Genealogy  Remodeling
 Camping  Going to Art Shows
 Walking
 Watching TV
 Rollerblading
 Weightlifting
 Carpentry  Going to Movies  Running  White Water Rafting
 Ceramics  Golfing
 Sailing
 Climbing  Hang Gliding
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 Windsurfing  Journaling
 Sculpting
 Writing
Page 90
 Coin Collecting  Hiking
 Sewing
 Woodworking
 Computing
 Skiing
 Yoga  yard work
 Hockey
 Concerts
 Horseback Riding  remodeling  Soccer
 Cooking
 Play an instrument  take music lessons
 Take a cooking class
 Build a model  Volunteering
 Housework  Stamp Collecting  Crafts  Karaoke  Swimming
 Crochet/Knitting
 Kayaking
 Karate
 Tai ChI  Cycling
 Target Shooting  Dancing
 Learning a Language
 12 step meetings
 Tennis  other peer support meetings.
 Other (specify):
Other hobbies not listed:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
What have you always wanted to do, but have not?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Pick 3 hobbies that you can put attention to and/or do this week?,
______________________________________________________________________
______________________________________________________________________
_____________________________________________________________________
What are the road blocks hat prevent you from doing what you have always wanted to
do? How can you get around
them._________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Notes:________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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Time Management
Name ______________________
Date:__________
There are 168 hours in a week. Write out how you spend those hours and draw them in
this pie chart. The goal is to account for all 168 hours in your week.











______ Family time
______ Leisure/entertainment
______ School
______ Work
______ Exercise
______ Shower, dressing,
grooming, brushing teeth
______Church, spiritual
Other.
_______________________
_______________________
_______________________
_______________________








______ TV
______ Gambling
______ Talking on the phone
______ Sleep
______ Driving
______ Reading
______ Yard work
______ Internet




__________________________
__________________________
__________________________
__________________________
Notes________________________________________________________
_____________________________________________________________
___________________________________________
______________________________________
__________________________________
______________________________
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Prochaska-Diclemente's
Stages of Change
The 6 stages of change are:
1. Precontemplation:
You do not believe you have a problem with your behavior
Counselor objective is to increase awareness and focus on thoughts, not
behavior.
2. Contemplation:
You are considering changing your behavior. You are on the fence about
whether you really have a problem that needs changing.
Counselor objective is to work through ambivalence.
3. Preparation:
You are beginning to understand how your behavior is negatively affecting
your life and at this point seriously considering no longer engaging in your
behavior.
Counselor objective is to help client create treatment goals and appropriate
treatment.
4. Action:
You apply what you prepared for and make changes to no longer engage in
your behavior.
Counselor objective is to assist client in the treatment process.
5. Maintenance:
You are no longer doing the problem behavior. You are applying techniques
to prevent relapse and exploring ways to improve your quality of life.
Counselor objective is to assist client in maintaining treatment.
6. Relapse:
You re-evaluate what you learned and review the stages of contemplation,
preparation and action while not giving up on your goal.
Counselor objective is to help client in returning to change strategies.
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Introduction to Healing Meditation
Meditation has shown a variety of health benefits to implementing it in to your
life. It helps with anxiety, frustration, depression, anger, and decreasing
stress to name a few benefits. Meditation calms the emotional mind and
allows for the creative thoughtful part of the brain to become more active. So
often in this busy world we focus on everything but calming our thoughts and
mind. Addiction has us focusing outside of ourselves and our lives get out of
balance. We become more disconnected and mistrustful of our inner voice.
The following Healing meditation will help center you and allow you to
reconnect with your intuitive self. The positive effects of meditation will build
each time you do it regularly. Just as when you exercise a muscle, the more
you exercise it the stronger it becomes, the more you meditate the easier it is
to get back into this transcendent, healing state.
Preparation:
Find a quiet place to sit, you can put on calming music or include a healing
aroma of incense, jasmine, or an aroma that is calming for you. If you use the
same aroma and or sounds it is easier to train your brain to get into this
relaxed state much faster. Ideally it is best to meditate before a meal. Avoid
caffeine or stimulants before meditating. Wear comfortable clothes if
possible.
Mind set before meditating.
If during the meditation you hear a sound, a phone ringing, a dog barking or
a clock ticking allow it into your meditation. Do not resist the noise. Allow it
into you as if you are a sea sponge on the bottom of the ocean allowing the
water to flow in and through you without resistance. Make it a part of your
meditation.
To begin,
find a comfortable chair to sit down on. Have your back straight and both
feet flat on the floor. Breath in deeply down through your lungs and down into
your belly. Place your hand on your stomach at first to make sure you are
raising you belly up and down. Often when people are stressed we tense up
and breathe with shallow breaths only raising our chest and not belly. This
causes an accumulation of stale air in your body. The Hindus call deep
breathing the breath of life. By breathing in deeply you are breathing in life
deeply. No longer just surviving but now consciously living. Do your best to
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Page 94
breath in for the same amount of time you are breathing out to create a
rhythm.
Scan your body from your head to your toe for any tension or tightness you
may be carrying. Breath into any areas of stress or tension and breath out
relaxing this part of your body. You may imagine the stress just falling to the
earth and neutralizing the energy or imagine that you are sending the stress
back to where it came from. It is no longer for you to hold onto. Allow your
body to let go and relax. If your body is relaxed your mind will follow.
NEXT
Close your eyes and put your focus on the space between your eyes. The
reason for this is because your mind will naturally wander. If it happens don’t
stress. When you find your mind wandering your mind’s eye will leave this
spot between your eyes. When you become aware of losing focus recommit
and put your attention back to your third eye area and focus on breathing
again. The more you do this the easier it is to stay focused for longer periods
of time.
The HEALING mantra:
Now that you are relaxed, breathing in deeply and having your attention on
your third eye (quietly in your mind - not out loud) while breathing in say the
Mantra “HEAL” and when you breath out say “ING”. The intention while
doing this is to imagine your whole mind, body and spirit being healed. And,
so it is.
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Limiting access to money
Money to a gambler is like alcohol to and alcoholic. If an alcoholic had a pint
of vodka in his pocket it is only a matter of time before he drinks it. The same
is true for pathological gamblers.
People who have successfully stopped gambling say that getting their money
under control is key. Often it is helpful to have someone who they trust in
charge of their money.
___ Make sure checks are automatically deposited in your bank account.
___ Take someone with you when making bank deposits.
___ Make clear plan to pay off your debts (starting with the most urgent)
___ Give paychecks to spouse or partner immediately
___ Limit the amount of money you can withdraw in a week (by making
arrangements with your bank).
___ Stay busy on pay day. Plan a non gambling activity.
___ Tell family and friends not to lend you money.
___ Have someone else pay your bills.
___ Have someone you trust pick up the mail so you do not get triggered by
casino’s sending free credit for you to play, as well as having you receive
checks and/or bills.
___ Keep a record of all money spent and earned (budgeting).
___ Arrange for someone to co-sign all of the checks that you write.
___ Let a significant other now about incoming money like tax refund or a
check from a side job.
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Section 6
Documentation
Documentation Do's and Don'ts
A legal perspective
This list is from a retired Lawyer who became a compulsive gambling
counselor in Illinois. This retired lawyer gave this information at a local
college for Ceu’s in 2005. I was in attendance. Name of instructor unknown
Good documentation can help you defend yourself in a malpractice lawsuit,
and it can also keep you out of court in the first place. You have to make sure
your documentation is complete, correct and timely. If it's not, it could be
used against you in a lawsuit. Here are some tips to help improve your
charting:
Do this in documentation
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*Check that you have the correct chart before you write.
*Chart a patient's refusal to allow treatment or take a medication. Be sure to
report this to your manager and the patient's physician.
*Write "late entry" and the date and time if you forgot to document
something.
*Write often enough to tell the whole story.
*Chart preventive measures, such as side rails.
*Chart contemporaneously (contemporaneous notes are credible).
*Write legibly, offering concise, clear notes reflecting facts.
*Chart what you report to other healthcare providers.
*Chart solutions as well as problems.
*Document your observations. Write only what you see, hear, feel, or smell.
*Encourage others to document relevant information that they share with
you.
*Document circumstances and handling of errors.
*Chart your efforts to answer your patients' questions.
*Chart patient/family teaching and response.
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Avoid this in documentation
*Chart a verbal order unless you have received one.
*Chart a symptom (for instance: c/o pain), without also charting what you did
about it.
*Wait until the end of the shift and rely on memory.
*Ever alter a record. If you make an error, do mark through it with one line,
indicate you are making a correction, and initial (or sign) and date.
*Document what someone else said they heard, saw, or felt (unless the
information is critical--then quote and attribute).
*Write trivia: "a good shift." (What does that mean?)
*Be imprecise. Avoid terms like "large amounts" and "appears."
*Write your opinions, such as that the patient is fat or lazy.
*Blanket chart or pre-chart. It is considered fraud to chart that you've done
something you didn't do.
Greatness is what happens on the verge of death...of defeat .It is the fight for life. It
changes you, pushing you to edges that were not there previously. What you do to
overcome death is what creates greatness in spite of fear. The key is to move past
the fear and do.
Letting go of gambling is the letting go of a destructive part of yourself. Gambling
can kill relationships, dreams, hopes, and you. Overcoming problem gambling takes
courage and builds character. It is an act of greatness.
It is beginning.
Welcome to your new life.
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Intake Form
ref #__________________
Referral: _______________________________________ ___________
Todays
Date: ____/____/____
DOB:______/______/______
Time:____:_____ am/pm
NAME: ________________ _______________ ____ SS#____________
First
Last
MI
Address:
(Physical)
____________________________________________
____________________________________________
(Mailing)
____________________________________________
____________________________________________
Telephone:
Best Times:
LV Msg - OK ( )
(Home)
(
) ________________________ ______ am/pm _______
(Work)
(
) ________________________ _______am/pm
(Cell)
(
) ________________________ ______ am/pm ________
Household Composition: (Who lives with you.)
Age:
_______
Relationship:
_________________________________
____________________
_________________________________
____________________
_________________________________
____________________
_________________________________
_____________________
Emergency contact : ___________________________ # ______________
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Patient Confidentiality
State and Federal laws protect your confidentiality. All charts and information
is kept in a locked file and will be seen only by your therapist and/or
treatment team.
In accordance with Federal guidelines, the following information is provided
to you upon admission.
Federal Law and Regulations protect the confidentiality of patient records
maintained by this program. Generally, the program may not say to a person
outside the program that a person is in treatment unless:
1. The Patient consents in writing OR
2. The disclosure is allowed by court order.
Violations of the Federal Law and Regulations are a crime. Suspected
violations may be reported to appropriate authorities in accordance with
Federal Regulation.
Federal Law and Regulations do not protect any information about a crime
committed by a patient. This also includes suicidal threats or intent to harm
another person.
Federal Law and Regulations do not protect any information about suspected
child abuse or neglect from being reported under State Law to appropriate
state or local authorities. When such a disclosure is made, reports to the
appropriate authorities must be made within 36 hours.
(Sec42 U.S.C. 290dd-3 and 42 U.S.C. 290 ee-3 for Federal Law and 42 CFR
part 2 for Federal Regulations).
__________________________________
Signed
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Date
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Progress Notes
Client Name:__________________________________
Date of Session:______________
Time:_______________________
Present For Session:
_________________________________________________________________________
□ No Show □ Called after 24 hours not excused □ Excused □ Counselor rescheduled
Client/family involvement: ___ Participatory
____Engaged
___Passive ___Resistant
Presenting Problems/Behaviors/Affect:
___ Happy
____Sad
___Labile ____Flat ___Anxious ___Angry, ___Depressed,
___ Physical Aggression ___Sexually Provocative ____ Gambling issues, ____Sleep
problems,
___ Suicidal Ideation
___Oppositional
____ Defiant
___ C/D Issues ____
Other______________________
Treatment interventions: ____ Problem Gambling ____Coping Skills ___ Relaxation
___ Relapse Prevention ___Talk ___Art Therapy ___Cognitive Behavioral
___ Anger Management ____ Psychotherapy ____ C/D Education ___Other___________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Evaluation/ plan- What needs to be worked on, in or by, next session:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Signature:____________________________________________________
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DATE COMPLETED: ______________
PATIENT SELF-ASSESSMENT GAMBLING HISTORY
IDENTIFYING INFORMATION
Name: _______________________________ Age: ____ Marital Status: ___
Ethnicity _____________________________
Referred by: _____________________________________
Physician Name: _______________________________________________
Presenting Problems/Stressors:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Current living situation, who is in the household, and are they supportive of
treatment?
_____________________________________________________________
_____________________________________________________________
FAMILY OF ORIGIN/SPIRITUAL/CULTURAL
Born and raised in:
_____________________________________________________________
_____________________________________________________________
Were you adopted?  yes
 no
Did you spend time in a foster home?  yes  no
Describe your spiritual orientation:
_____________________________________________________________
_____________________________________________________________
What cultural practices/rituals/traditions do you follow?
_____________________________________________________________
_____________________________________________________________
Family belief:
_____________________________________________________
Practicing: □ Yes □ No
Who did you grow up with?
_____________________________________________________________
_____________________________________________________________
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How often did your family move while growing up and before leaving home?
___________________________________________________________
PARENTS/OTHER CARE GIVERS
(include step parents or foster family)
Father’s name: ___________________________________
Occupation: __________________Age: _____ Natural parent? □ Yes □ No
Has or does father have or had a problem with: □ Gambling , □ Alcohol or
Drugs, □ Other addictions? ,□ In recovery? If yes for what.
___________________________________________________________
Mother’s name: ____________________________________
Occupation: __________________Age: _____ Natural parent? □ Yes □ No
Has or does mother: □ Gamble , □ Use Alcohol or Drugs, □ None □ In
recovery? If yes from what.
_____________________________________________________________
How is your relationship with your father: □ Poor
□ Fair
□ Good
How is your relationship with your mother: □ Poor
□ Fair
□ Good
How were you disciplined as a child?
_____________________________________________________________
Brothers/Sisters (include step and half brothers and sisters):
Name: ______________________ Age: ____ □ Brother □ Sister
Name: ______________________ Age: ____ □ Brother □ Sister
Name: ______________________ Age: ____ □ Brother □ Sister
Name: ______________________ Age: ____ □ Brother □ Sister
Name: ______________________ Age: ____ □ Brother □ Sister
□
□
□
□
□
Attitude of siblings toward your gambling:
□ Supportive □ Unsupportive
Attitude of siblings toward your seeking counseling :
□ Supportive □ Unsupportive
Your relationship with your brothers and sisters: □ Poor □ Fair □ Good
Do any of the following have or had trouble with gambling, substance abuse
or other addicitons? : □ parents □ Grandparents □ Aunts : □ Uncles
□ Brother □ Sister
□ other?
Explain:_______________________________________________________
_____________________________________________________________
_____________________________________________________________
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PAST HISTORY OF ABUSE
History of physical abuse: □ Yes □ No
Were you: □ Victim □ Perpetrator of the abuse? Domestic violence?
Explain:_______________________________________________________
_____________________________________________________________
History of sexual abuse: □ Yes □ No
Were you: □ Victim □ Perpetrator of the abuse?
Explain:_______________________________________________________
_____________________________________________________________
History of emotional abuse: □ Yes □ No,
Were you: □ Victim □ Perpetrator of the abuse?
Explain:_______________________________________________________
_____________________________________________________________
Gambling or other addictions:
Have you in the past abused or been addicted to any of the following
 Prescription pills  Pornography  Internet  Cell phone
 Food  Sex  Hoarding  Video games
 Work
 Alcohol  Marijuana  Stimulants example Meth, cocaine
 Opiates  Benzodiazepines ex. valium, xanex Compulsive spend
 Love
 internet gambling  Cutting
 Adrenaline
 Reading  Nicotine  Non-prescription pills
 Power
 Anger
 Danger  Getting tattoos
Do you feel you may have a problem with any of the following now?
 Prescription pills  Pornography  Internet  Cell phone
 Food  Sex  Hoarding  Video games
 Work
 Alcohol  Marijuana  Stimulants example Meth, cocaine
 Opiates  Benzodiazepines ex. valium, xanex  compulsive spending
 Love  internet gambling  Cutting  Adrenaline
 Reading  Nicotine  Non-prescription pills  Power
 Anger
Road Rage  Danger  Getting tattoos
Have you had any treatment for gambling? When? Where?
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Explain._______________________________________________________
_____________________________________________________________
_____________________________________________________________
Have you has any treatment for alcohol or drug abuse or other addictions?
What was the treatment for? When? Where?
Explain._______________________________________________________
_____________________________________________________________
_____________________________________________________________
How much caffeine do you consume a day? Include soda, teas, coffees, and
energy drinks.
_____________________________________________________________
_____________________________________________________________
CURRENT FAMILY
Name of Significant Other: _____________________ Age: ____ How many
years with S.O.? ___
Relationship with S.O.: □ Poor □ Fair □ Good
Does S.O.: Gamble? ____, abuse
Attitude of S.O. toward your treatment: □ Supportive □ Unsupportive, does
not know?___
How many times have you been married? _____ Divorced? _____ Date of
last divorce: ________
Have you ever been separated due to gambling? □ Yes □ No
Other significant relationships:
_____________________________________________________________
_____________________________________________________________
CHILDREN (include step children)
Name: ____________________________
Name: ____________________________
Name: ____________________________
Name: ____________________________
Name: ____________________________
Age: _____ □
Age: _____ □
Age: _____ □
Age: _____ □
Age: _____ □
Son
Son
Son
Son
Son
How is your relationship with your children?
□ Poor
□ Fair
□
□
□
□
□
Daughter
Daughter
Daughter
Daughter
Daughter
□ Good
GAMBLING HISTORY
Which gambling facility do you play at? Casino? Race Track?
_____________________________________________________________
_____________________________________________________________
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Which gambling facility do you play at the most?
_____________________________________________________________
Gambling: Age of 1st gambled ________ Age of regular gambling:________
Age of problem gambling: _______
Past 12 months: How often did you gamble?
Daily?______Weekly?______Monthly____
How many hours per
visit?_________________________________________________________
_____________________________________________________________
Consequences of gambling has it effected: □ Family □ Significant Other □
Friends □ Domestic violence □ Legal □ Job loss □ Financial □
suicide attempt □ Counseling □ Health issues
Have you had education on problem gambling?:
_____________________________________________________________
_____________________________________________________________
Prior abstinence from gambling: How long? ________ When? _________
What triggered relapse?
_____________________________________________________________
_____________________________________________________________
ACTIVITIES ASSESSMENT
What are your hobbies?
_____________________________________________________________
_____________________________________________________________
What are your employment, training or educational goals in life?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
What have you always wanted to do but have never done or not been able to
do?
_____________________________________________________________
_____________________________________________________________
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SOCIAL FUNCTIONING
Would you say you have □ many friends □ average # of friends □ few
friends □ no friends
How many close friendships? ____ Do your friends Gamble? □ Yes □ No
How many long-term friendships? ____ Are your friends supportive of you
not gambling? □ Yes □ No
SEXUAL FUNCTIONING
Sexual orientation: __________
Do you have any concerns about your sex life? □ Yes □ No
Explain:
_____________________________________________________________
_____________________________________________________________
MENTAL HEALTH HISTORY
Do you have a history of mental health or emotional problems (indicate
treatment and treatment response):
□ Yes □ No
Explain:
_____________________________________________________________
_____________________________________________________________
Have you ever been diagnosed with: Bi-polar ____, depression____, anxiety
_____, ADD____, ADHD_____, PTSD ______, Borderline personality BPD
____, Other?
Explain?______________________________________________________
_____________________________________________________________
_____________________________________________________________
Has anyone in your family been treated for Mental Health or emotional
problems?
□ Yes □ No , explain
_____________________________________________________________
_____________________________________________________________
Have you ever thought about hurting yourself or others?
□ Yes □ No
Did you think of a method? □ Yes □ No
Explain:
_____________________________________________________________
_____________________________________________________________
Have you ever attempted suicide? □ Yes □ No
If yes how many times? when? Method?
_____________________________________________________________
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_____________________________________________________________
_____________________________________________________________
What are your strengths?
_____________________________________________________________
_____________________________________________________________
To whom to you feel closest?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Have you had significant loss in your life?
□ Yes □ No
Specify
(deaths, job or health loss, accident, financial, relationships, what years?
etc.)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
What stressors or losses have you had in the past 2 years?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
EDUCATION/TRAINING/EMPLOYMENT HISTORY
Level of education/training ________________________________________
Any problems at school? □ Yes □ No
Are you currently
□ Employed □ Unemployed □ Student □
Disabled □ Retired
Employer’s name:
_____________________________________________________________
How long there?
_____________________________________________________________
How do you feel about your job?___________________________________
Co-workers? __________________________________________________
Working Conditions? ____________________________________________
Do you want to stay there? □ Yes □ No
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What are your most important skills and talents?
_____________________________________________________________
_____________________________________________________________
MILITARY SERVICE
Branch of service: ___________ From: ________ To: _______ Were you in
combat? □ Yes □ No
Rank: ______________ Type of discharge: _____________________
Date: ________________
LEGAL HISTORY
Have you ever been arrested? □ Yes □ No
How many times? ______ For what? When?
Explain,_______________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Are there any charges against you presently? □ Yes □ No For what?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
How many of these offenses involved Gambling? _____Alcohol ______
Drugs______ Are you on probation? □ Yes □ No
P.O.’s name:
_____________________________________________________________
Attorney’s, and or probation officers name:
_____________________________________________________________
Have you ever had your driver’s license suspended or revoked? □ Yes □ No
Have you ever written bad checks knowing no money was in the bank to
cover the check? Yes____, NO____
Was it to cover gambling? Yes____, NO____
FINANCIAL
Who/what is your source of income?
_____________________________________________________________
_____________________________________________________________
Who takes care of the family finances?
_____________________________________________________________
_____________________________________________________________
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How do you feel about that?
_____________________________________________________________
_____________________________________________________________
Do you have difficulty managing money?
□ Yes □ No
Does gambling play a part? □ Yes □ No
Compulsive spending? □ Yes □ No
Are debts causing you legal, financial or family problems? □ Yes □ No
Are you behind in paying bills, mortgage, rent, car, insurance, child support,
Schooling? To what extent?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
MEDICAL
Are you currently taking any medications? Please list name, amount, and
what it is for.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
What supplements are you taking example- vitamins, minerals?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
MOTIVATION
What is you motivation for coming to counseling?
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Are there other issues besides Gambling that you would like to work on
during your counseling? Explain.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_______________________________
Signature
gamblingnomore.com
_____________
Date
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Section 7
TREATMENT GOALS and PLANS
Possible Treatment Goals:
1.
2.
3.
4.
5.
6.
7.
8.
Stop Gambling
Harm reduction
Psychiatric assessment –due to suicidality or harm to others.
Financial counseling
Anger management
Stress management.
Connect to GA support groups.
Help the gambler develop a problem solving style through use of
solution‐focused interventions.
9. Scheduling
10. Increase self‐esteem by setting short term attainable goals Develop
relaxation skills to reduce impulsiveness and stress management.
11. Gambler must look at positive aspects of life
12. Find alternative sources of pleasure and excitement Let go of
unresolved grief
13. Help the gambler to accept his/her feelings as a guide rather than as
something to be avoided
14. Develop a realistic restitution plan if needed.
15. Implement family therapy to repair the damage of the dishonesty and
neglect
16. Find new leisure activities and hobbies.
17. Reach out and connect with support system.
18. Arrange for follow‐up treatment and help
Compulsive Gambling treatment plans.
Identified Problem: Compulsive gambling – “I would like to stop gambling”
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Measurable goal: Utilize cognitive methods to control trigger thoughts and
reduce impulsive reactions to those triggers. Use action plan.
Intervention: Teach the client thought stopping techniques for gaining
control over impulsive urges and actions. Help client create action plan when
triggered.
Identified Problem 2: Environmental stressors is trigger –Stress
management.
Measurable goal: Teach positive behavioral alternatives to cope with
stress.
Intervention: .Will help support and educate client on problem solving
identified stressors and learning new coping skills.
Identified Problem 3: physical pain is trigger
Measurable goals: Encourage client to be consistent in managing known
treatments for
pain management.
Intervention: Will encourage and support client to schedule activities and be
consistent
with pain management schedule.
Identified Problem 3: Minimal support system
Measurable goals: Encourage client to attend GA meetings and build
leisure activities.
Intervention: Will encourage and support client to attend GA meetings and
will provide location and times list for these meetings. To encourage and help
client find 3 hobbies and or leisure activities. They will incorporate at least
one a week.
Identified Problem 2: Sleep Problems - “I do not sleep well.”
Measurable goal: learn new coping skills to deal with the issues that trigger
client to gamble
Intervention: Will teach client relaxation technique, as well as healthy sleep
habits.
Identified Problem 3: “Keeping gambling a secret”
Measurable goals: To be more honest about gambling behavior. Client will
attend and participate in GA meetings as well as be honest with group
members.
Intervention: Will encourage and support client to go to meetings. Will
educate client on the benefits of compulsive gambling support groups, and
the importance of being honest
Identified Problem: Financial stressors - Creditors are calling due to debt
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Measurable goal: Have client make a budget and plan for long term
finances, and call creditors to be more accountable.
Intervention: Will help client find resources who specialize in financial issues
to help client gain control over finances.
Identified Problem: Compulsive Spending
Measurable goal: Utilize cognitive methods to control trigger thoughts and
reduce impulsive reactions to those triggers.
Intervention: Teach the client thought stopping techniques for gaining
control over impulsive urges and actions.
Identified Problem- Client has impulse control problem, and craves
gambling regularly.
Measurable goals- Write down and become aware of triggers. Learn new
coping skills on how to cope with urges.
Intervention- I will help him identify triggers as well as finding new coping
skills to deal with triggers. We will work on Relapse Prevention book. I will
support him by phone when needed.
Identified Problem- Loneliness and Boredom.
Measurable goals- Get more involved with activities involving people. Look
into volunteering, Join a community sports group. Attend counseling weekly.
Help client find new hobby or leisure activity.
Intervention- To encourage and help client schedule week in order to avoid
boredom. I will be available for phone support as well.
Identified Problem- Unaccountable free time is a trigger
Measurable goals-Find things to do, work on garden, call supportive friend
and get together, work on house, exercise.
Intervention- Plan activities before the weekend to reduce triggers. Help
client write down and have more structure in life by scheduling free time.
Identified Problem: “ Anxiety and guilt over gambling behavioral and its
impact on her and her husbands lives.”
Measurable goal: Use relaxation exercises to control anxiety and reduce
consequent impulsive behavior.
Intervention: Teach breathing technique, progressive relaxation, and
meditation technique. Encourage her to relax when she feels uncomfortable.
Identified Problem- Client isolates himself from friends and family when
gambling and craving to gamble. This is a trigger for gambling.
Measurable goals- Have client attend GA meetings and get a sponsor that
he has to be honest with, and call when he is triggered. Attend counseling
weekly.
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Intervention- Client has a list of GA meetings. I will be available for phone
support as well.
Identified Problem- Client abusing alcohol more
Measurable goals- Work on doing the 12 steps for GA and Alcohol
Anonymous. Bring into sessions.
Intervention- Educate client about cross addictions, and relapse prevention
as well as encouraging and increasing social support
Identified Problem: Since she has cut back on gambling she has been
having vivid violent past sexual abuse traumas resurfacing.
Measurable goals: Reduce violent dreams during week, journal, talk about
experiences in counseling,
Intervention: I will support her by phone, and encourage her to go to sexual
abuse support groups. I will also help her learn stress reduction techniques
to help her stay in the moment. .
Identified Problem: Client has self harm thoughts.
Measureable goals: Client needs to build up social support including 12 step
meetings. Client has numbers to call if feels she will self harm. Talk with
therapist about triggers that cause self harm and learn new coping skills.
Intervention: I will help client challenge cognitive distortions as well.
Identified Problem: Client has budgeting problems may lose house, and
truck due to lack of payment due to gambling debt..
Measurable goals: Refer client to free service to help her budget her
finances in a more manageable way
Intervention: Follow up with client to make sure she went to referral, and is
following suggestions.
Identified Problem: Client is grieving over own divorce, and death of sister.
This is a trigger to gamble and become more depressed.
Measurable goal: Attend GA,12 step meetings, grief groups, attend
counseling weekly. Write down coping skills to deal with grief. Journal.
Educate client about the cycle of grief.
Intervention: Encourage client to attend support groups to create support
network. Encourage client to journal about emotions that come up, and talk
about entries when appropriate. Help client stay more in the moment when
appropriate.
Identified Problem 2: Loneliness and boredom are trigger for her
Measurable goal: Find an activity with people that she enjoys in order to
meet new people. Example, start a job she enjoys, sign up for art class that
she enjoys. .
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Intervention: Encourage client to take a risk and start something new that
will help her meet new people. I will help her work through blocks that limit
her from doing this.
Identified Problem 3: Client has difficulty asking for what she needs in
relationships which becomes a trigger for gambling
Measurable goals: Client will verbalize her needs with her friends,
counselor, and family, and will also find ways of getting her needs met even if
friends and family wont. Journal about this.
Intervention: I will help client clarify her hopes, wants and needs so she will
increase her awareness and ability to be heard. I will help her over come
blocks and fears that she may have in doing this.
Identified Problem : “I want to learn what I can do to regain respect and
trust that I have had all my life”
Measurable goal: Verbalize a clear connection between impulsive behavior
and negative consequences to self and others. Client will be better at doing
what she says she will do.
Rebuilding Trust
Do what you say and say what you do + Consistency + Time = Trust
People new in recovery know that family and friends do not trust them. If
your client implements the equation above then they will begin to rebuild
trust with those they have hurt.
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Section 9
Substances to be aware of in recovery
An amino acid supplement called N-acetyl cysteine appears to ease
compulsive gambling and may also relieve other addictive behaviors. Sixteen
of 27 problem gamblers reported fewer urges after taking increasing doses of
NAC for 8 weeks in a University of Minnesota School of Medicine study.
Afterward, nearly everyone who continued taking the compound avoided
gambling. While most who stopped taking it returned to betting. The amino
acid appears to normalize levels of glutamate, a chemical that may be out of
balance in specific areas of addicts’ brains. –Julian Kesner
FEBRUARY 2008 Psychology Journal
Unsafe Drugs for Recovering Persons
Cross addictions are common among people dealing with pathological
gambling as well as other addictions. Here are medications to be aware of
when in recovery of addiction. Brain chemistry is a factor with a substance
addiction or behavioral addiction like pathological gambling. The medications
below alter brain chemistry and thus have the potential to trigger a relapse.
Always check with your doctor first about taking medication and its potential
for addiction.
The following is a partial list of medications and preparations that are
generally considered to be unsafe for those who are recovering from
addictions:
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ANY PREPARATION WHICH CONTAINS ALCOHOL (ETHANOL)
This includes most cough preparations and mouthwashes, e.g., NyQuil, Robitussin,
Listerine, and Scope. Non-alcoholic beer should also be avoided because it contains a
small amount of alcohol.
BENZODIAZEPINES AND OTHER TRANQUILIZERS
Valium (Diazepam), Librium(Chlordiazepoxide), Librax, Limbitrol, Tranxene (Clorazepate),
Dalmane, Serax (Oxazepam), Xanax (Alprazolam), Klonopin (Clonazepam), Halcion
(Triazolam), Ativan (Lorazepam), Versed (Midazolam), Miltown, Equanil, Equagesic, Soma,
Restoril (Temazepam), Doral (Quazepam), Dalmane (Flurazepam), ProSom (Estazolam)
and others.
BARBITURATES AND OTHER SEDATIVES
Phenobarbital, Nembutal, Seconal, Fiorinal, Esgic, Donnatal, Doriden, Placidyl, Chloral
Hydrate, Sonata, and others.
OPIATES
Morphine, Demoral (Meperidine), Dilaudid (Hydrocodone), Dolophine (Methadone),
Percodan, Duragesic (Fentanyl), Tylox, Synalgos-DC, Codeine (Tylenol #3, etc.), Talwin,
Darvocet, Wygesic, Lortab, Lorcet, Nubain, Stadol, Ultram (Tramadol), OxyContin
(Oxycodone), Perocet (Oxycodone and Acetaminophen), Vicodin, and others.
AMPHETAMINES AND OTHER STIMULANTS
Dexedrine, Benzedine, Fastin, Lonamin, Tenuate, Ephedrine, Ritalin, Cylert, Adderall,
Meridia, and others.
DECONGESTANTS OR WEIGHT-CONTROL PREPARATIONS
That contain ephedrine, pseudoephedrine, or phenylpropanolamine.
SLEEP AIDS
Ambien and Ambien CR (Zolpidem); Lunesta (Eszopiclone)
Always read the labels on medications look for ingredients under
“Active” and “Inactive ingredients”
Here is a list of 11 traits that a person in recovery swears by:
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11 Keys to sobriety
1. Keep it simple
2. Humility –Have a beginners mind and willingness to learn
3. Set goals - One day at a time and say the Serenity Prayer daily
4. Easy does it – Focus on and celebrate progress not perfection.
5. Live with integrity – We teach people how we want to be treated.
We are defined by the consistency of our words and actions. Be clear.
6. Continue to improve yourself by learning every day.
7. Move toward what you want in life. Find your passions. If it is scary
feel the fear and do it anyway
8. Feel and express yourself in a healthy and responsible manner
9. Boundaries - Know “no” – Know when to say no
10. Say yes to life. Try new experiences regularly.
11. Have Fun - Play
Anonymous.
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A quote many find helpful saying throughout the day
Serenity Prayer
Higher power grant me the serenity to
accept the things I cannot change, the
power to change the things I can, and the
wisdom to know the difference.
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Section 9
Glossary
Common terms used.
Gambling
Basically gambling is risking something of value on the outcome of an event
before it happens. People usually gamble because they hope to gain
something of larger value. Gambling includes everything from slot machines,
betting on a sporting event, buying a lottery or a scratch ticket to playing
Bingo. Gambling, for most people, is a recreational activity.
Problem Gambling
Problem gambling is gambling that contributes to emotional, family, legal,
financial or other problems for the gambler and the people around them.
These gamblers meet 3-4 of the criteria for Pathological Gambling but do not
meet the 5 criteria to be diagnosed for Pathological Gambling.
Pathological Gambling:- also known as compulsive gambling.
Pathological gambling is characterized by a loss of control over gambling,
deception about the extent of involvement with gambling, family and job
disruption, theft, and chasing losses (American Psychiatric Association
[APA], 1994). People meet at least 5 of the 10 criteria in the DSM-IV for
Pathological Gambling
Bail outNeeding and receiving money from people or institutions to relieve a
desperate situation caused by gambling. Problem Gamblers need
consequences and to feel the stress that gambling is causing them. Bail outs
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enable gamblers to continue. Often family’s enable and they need guidance
and education in seeing their role in this compulsion.
Codependency
“A pattern of behavior in which those who are in a close relationship with an
addict become in turn dependent upon that persons addiction. The codependent builds his or her needs and life around the dependent person’s.
the addict is addicted to the drug , but the co-dependent is addicted to the
addict. The addict may also be co-dependent. “
Miiney J. Al, Eisenburg Arlene, Eisenburg Howard, The Recovery Book,
Workman Publishing, New York 1992
Co-occurring disorders:
is the term used to describe two or more disorders occurring in a single
individual at about the same time.
Cravings
Cravings affect the Mental, emotional, and physiological of the problem
gambler. It is a state of desire or tension that motivates client to gamble.
The brains amygdala that deals with strong emotions gets lite up and
activates the primal fight or flight response to problem gamblers.
Triggers
Triggers can be people, places, things, time of day, smells, sounds basically
anything that reminds the person of gambling. If they think about a trigger for
too long it can turn into a craving which changes brain chemistry and often
takes more time for the desire to calm down.
Cross-addiction
This occurs when an individual who is addicted to one drug switches to
another substance or process addiction in the hope of avoiding dependence
and then becomes dependent on the drug as well. This can happen with
different substances and/or process addictions. For example alcohol to
cocaine, alcohol and gambling, Gambling and porn etc..
Denial
A self deception that prevents a person from admitting to themselves or to
someone else the destructive nature of their thoughts and/or behaviors
Disease Definition
“Disease is an abnormal state of physiology reflected in signs and symptoms
that progress in a predictable way in a predictable response to treatment.”
Larry King April 2010 - Dr. Drew Pinskey
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Disease model
A model of recovery whereby problem gambling is believed to be largely
determined by biological factors. It is understood to be primary, progressive,
chronic, fatel, and treatable. This model is supported by Gamblers
anonymous.
Enabling
Doing something for someone they could do themselves. This refers to any
behavior direct or indirect, no matter how well meaning, that allows the addict
to continue with their compulsive behaviors. Including gambling, alcohol use
etc…
Helping
Doing something for someone that they could not do for themselves and/or
by themselves. Example- helping neighbor carry a couch, helping high
school student learn algebra.
Pressure-relief groups
A feature of GA, composed of people who have a longer history of recovery
and who volunteer to assist new comers with legal and financial problems.
Process addictions
Process addictions are addictions that do not involve a substance going into
the body to create a high, but still have the same effect as someone who did.
These behaviors involve continuing the behavior like gambling even after
there are negative consequences. People’s lives become unmanageable,
and out of control. The behavior is primary in their life often giving up hobbies
and friends, the behavior gets worse over time, It is a lifelong issue, and is
treatable. Some process addictions include: gambling, porn, internet, video
games, adrenaline seeking, sex, love, and work.
Lapse
Is a temporary state of returning to acting on the addictive behavior.
Example, Person gambles 1 time for 3 hours after being abstinent for 6
months. Then does not gamble again.
Relapse
Implies more extensive, pervasive, longer return of symptoms or problem
behavior. After abstaining from gambling for months the person returns to
gambling for a period of days or longer. His behaviors fall back into the
addictive thinking and behaving, for example, lying, stealing, spending
money that was allotted for other expenses like food, car payment, mortgage,
electrical bills etc...
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Section 10
Problem Gambling Internet Resources
This list of Websites has been compiled to offer more resources for problem
gambling. Some of these sites refer to research on problem gambling, some
refer to self-help groups, and others are sites of organizations that focus on
raising the awareness and education level of the general public around
problem gambling.
Gamblers Anonymous
www.gamblersanonymous.org
This site will show Gambling anonymous meetings in your area. I encourage
counselors to give this to their clients early in treatment.
Gam-Anon - www.gam-anon.org – To support family members and loved
ones living with or affected by a problem gambler.
Bettors Anonymous - www.bettorsanonymous.org
Debtors Anonymous - www.debtorsanonymous.org
Online GA meetings
http://cghub.homestead.com/pst.html
This site can help you get support on the internet.
Gamblock
www.gamblock.com
Gamblock is a great site that blocks access to the internet on the world wide
Web. It helps problem gamblers help themselves by using this site.
Gamblock is another tool clients to use as a preventative measure not to
gamble.
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National Council on problem gambling
www.ncpgambling.org
National Council on problem gambling is a helpful website for locating
nationally qualified therapists who are certified to treat problem gambling.
This site has a link to most of the state councils. Check your state problem
gambling council for state certified counselors.
Responsible Gambling
www.responsiblegambling.org
An informative site with many articles on problem gambling.
The Safe@play Slot Machine Tutorial
http://www.gameplanit.com/
This is a fully functional slot machine set to the same general specifications
as slot machines in North America. Modules allow you to explore how slot
machines really work, from the fundamentals to the advanced. This site
allows for you to evaluate whether you may be at risk or may have a
gambling problem.
Want to Stop Gambling
http://www.wanttostopgambling.com/
The goals of this website are to provide all the different ways you can stop
gambling. It offers a help guide, access to chat rooms, and different places
you can receive counseling worldwide. This site has been created by a
problem gambler to help other problem gamblers.
Female Gamblers
www.femalegamblers.info:
This site is focused on helping women problems gamblers.
Information for counselors and problem gamblers
www.Gamblingnomore.com
Getting past Gambling
http://www.gettingpastgambling.com/
A site to share experiences, find support for those who want to stop
gambling.
Safe Harbor Compulsive Gambling Hub http://www.sfcghub.com/cgsfl.html
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Compulsive gambling Room
I Stopped Gambling
http://www.istoppedgambling.com/
Gam Care
http://gamcare.org.uk/forum/index.php?tid=2272
This is a site that allows forum members to talk ‘live’ with others. You can ask
questions, share advice and support with other people working on
overcoming their or somebody else’s gambling problem.
Harvard Medical School, Division on Addictions - www.hms.harvard.edu/doa
Massachusetts Council on Compulsive Gambling www.masscompulsivegambling.org
Massachusetts Department of Public Health/Bureau of Substance Abuse
Services (includes state compulsive gambling treatment centers) www.state.ma.us/dph/bsas/
University of Minnesota Gambling Research www.cbc.med.umn.edu/~randy/gambling
The WAGER - www.thewager.org
freecreditrepoprts.com
problemgambling.com
Luckyday.com
gamblershelp.com
kidsdontgamble.com or org
wannabet.com
12 Step Groups
Alcoholics Anonymous (AA)
(aa.org)
Al-Anon.org (al-anon.org) For family members of addicts.
Narcotics Anonymous (NA) (na.org)
Cocaine Anonymous (CA) (ca.org)
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Marijuana Anonymous (marijuana-anonymous.org)
Women for Sobriety (WFS) (womenforsobriety.org)
Nicotine Anonymous (nicotine-anonymous.org)
Crystal Meth Anonymous (CMA) (crystalmeth.org)
Methadone Anonymous (methadoneanonymous.info)
Gamblers Anonymous (GA) (gamblersanonymous.org)
Sex and Love Addicts Anonymous (SLAA) (slaafws.org)
All Addictions Anonymous (alladdictionsanonymous.com)
xa-speakers.org (xa-speakers.org) A collection of recordings from speaker
meetings, conventions and workshops of 12-step groups, such as AA, NA,
and Al-Anon.
websites dealing with suicide
www.suicidology.org
www.bereavedbysuicide.com
www.siblingsurvivors.com
www.nami.org
www.sprc.org
www.afsp.org
1-800-273-TALK
National Suicide Prevention Lifeline
Clinician survivor listserve
Email Vanessa McGann to be added (vlmcgann@aol.com)
Online support group
Email Karyl Chastain Beal
(karylcb@bellsouth.net)
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Government Agencies
National Institute of Alcohol Abuse and Alcoholism
niaaa.nih.gov
National Institute of Drug Abuse
nida.nih.gov
National Clearinghouse for Alcohol and Drug Information (ncadi.samhsa.gov)
Substance Abuse & Mental Health Services Administration
www.samhsa.gov
National Institute of Mental Health
nimh.nih.gov
Smoke Free
smokefree.gov
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State Problem Gambling Resources
From the National Council on Problem Gambling
Arizona Council on Problem Gambling
2432 West Peoria Ave., Suite 1111
Phoenix AZ 85029-4732
Tel: 602-212-0278
Fax: 602-212-1725
Email: azccg@azccg.org
Website: www.azccg.org/
California Council on Problem Gambling
800 S. Harbor Blvd., Suite 255
Anaheim, CA 92805
Tel: 714-765-5804
Fax: 714-765-5807
Email: info@calproblemgambling.org
Website: www.calproblemgambling.org/
Problem Gambling Coalition of Colorado
11757 West Ken Caryl Ave.
#F-181
Littleton, CO 80127
Tel: 303-662-0772
Fax: N/A
Email: info@problemgamblingcolorado.org
Website: www.problemgamblingcolorado.org
Connecticut Council on Problem Gambling
47 Clapboard Hill Rd., Suite 6
Guilford, CT 06437
Tel: 203-453-0138
Fax: 203-453-9142
Email: ccpg@ccpg.org
Website: www.ccpg.org
Delaware Council on Gambling Problems
100 W. 10th Street, Suite 303
Wilmington, DE 19801
Tel: 302-655-3261
Fax: 302-984-2269
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Email: topdog@dcgp.org
Website: www.dcgp.org
Florida Council on Compulsive Gambling
901 Douglas Avenue, Suite 200
Altamonte Springs, FL 32714
Tel: 407-865-6200
Fax: 407-865-6103
Email: fccg@gamblinghelp.org
Website: www.gamblinghelp.org
Illinois Council on Problem Gambling
401 Sangamon Avenue
Springfield, IL 62702
Tel: 217-698-8110
Fax: 217-698-8234
Email: icpg@illinoiscouncilpg.org
Website: www.icpg.info
Indiana Council on Problem Gambling
309 West Washington Street, Suite 234
Indianapolis, IN 46204
Tel: 317-632-1364; 1-866-699-4274
Fax:317-632-1434
Email: jllong@indianaproblemgambling.org
Website: www.indianaproblemgambling.org
Iowa Council on Problem Gambling
726 S. 17th St
Ft. Dodge, IA 50501
Tel: 515-576-7261
Fax: 515-955-7628
Email: johnh@cfrhelps.org
Website: N/A
Kansas Coalition on Problem Gambling
2209 SW 29th St.
Topeka, Kansas 66611-1908
Tel:
785-266-8666
Fax:
785-266-3833
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Email:cwalters@parstopeka.com
Website: www.ksproblemgambling.org
Kentucky Council on Problem Gambling
P.O. Box 4595
Frankfort, KY 40604-4595
Tel: 502-223-1823
Fax: 502-227-8082
Email: kmstone@mis.net
Website: www.kycpg.org
Louisiana Association on Compulsive Gambling
324 Texas Street
Shreveport, LA 71101
Tel: 318-227-0883
Fax: 318-221-0005
Email: reecemiddleton@helpforgambling.org
Website: www.helpforgambling.org
Maine Council on Problem Gambling
211 Marginal Way # 775
Portland, ME 04101
Tel: 207-775-4357
Fax: N/A
Email: MECPG05@hotmail.com
Website: N/A
Maryland Council on Problem Gambling
503 Maryland Avenue
Baltimore, MD 21228
Tel: 410-375-1421
Fax: 410-788-8599
Email: ncpgambling@aol.com
Website: N/A
Massachusetts Council on Compulsive Gambling
190 High Street, Suite 5
Boston, MA 02110
Tel: 617-426-4554
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Fax: 617-426-4555
Email: gambling@aol.com
Website: www.masscompulsivegambling.org
Michigan Association on Problem Gambling
5651 Bunker Road
Eaton Rapids, MI 48827
Tel: 517-242-0655
Fax: N/A
Email: jherriff@gmail.com
Website: www.michapg.com
Minnesota
Northstar Problem Gambling Alliance
2233 North Hamline Avenue, Suite 435
Roseville, MN 55113
Tel: 612-424-8595
Fax: 651-636-6757
Email: cp@northstarproblemgambling.org
Website: www.northstarproblemgambling.org
Mississippi Council on Problem and Compulsive Gambling
141 Executive Drive, Suite 4
Madison, MS 39110
Tel: 601-853-8351
Fax: 601-853-8355
Website: www.msgambler.org
Missouri Council on Problem Gambling Concerns
5128 Brookside Blvd.
Kansas City, MO 64112-2736
Email: moprobgamb@aol.com
Tel: 816-531-7133
Website: N/A
Montana Council on Problem Gambling
P.O. Box 50071
Billings, MT 59105
Tel: 406-252-9076
Fax: N/A
Email: donna@mtcpgambling.com
Website: www.mtcpgambling.com
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Nebraska Council on Compulsive Gambling
119 West Mission Avenue, Suite G
Bellevue, NE 68005
Tel:
402-292-0061
Fax:
402-291-4605
Email: ExNCCGJB@aol.com
Website: www.nebraskacouncil.com
Nevada Council on Problem Gambling
4340 S. Valley View Blvd., Suite 220
Las Vegas, NV 89103
Tel: 702-369-9740
Fax: 702-369-9765
Email: carol@nevadacouncil.org
Website: www.nevadacouncil.org
Council on Compulsive Gambling of New Jersey
3635 Quakerbridge Rd., Suite 7
Hamilton, NJ 08619
Tel: 609-588-5515
Fax: 609-588-5665
Email: don@800gambler.org
Website: www.800gambler.org
New Mexico Council on Problem Gambling
P.O. Box 10127
Albuquerque, NM 87184-0127
Tel: 505-897-1000
Fax: 505-897-1115
Email: kandaceabq@qwest.net
Website: www.nmcpg.org/
New York Council on Problem Gambling
119 Washington Avenue
The Dodge Building
Albany, NY 12210-2292
Tel: 518-427-1622
Fax: 518-427-6181
Email: jmaney@nyproblemgambling.org
Website: www.nyproblemgambling.org
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North Carolina Council on Problem Gambling
PO Box 36573
Greensboro, NC 27416
Tel: 336-681-8516
Fax: 336-632-0385
Email: NCCouncilPg@aol.com
Website: www.nccouncilpg.org
Ohio Council on Problem Gambling
13425 Detroit Avenue, Suite 2
Lakewood, Ohio 44107
Tel: 216.228.3500
Fax: 216.228.5818
Email: lweigele@sbcglobal.net
Website: www.ohiocpg.org
Oklahoma Association on Problem and Compulsive Gambling
300 W. Gray, Ste. 102
Norman, OK 73069
Tel: 405-801-3329
Fax: 405-801-3330
Email: wharwell@oapcg.org
Website: www.oapcg.org
Oregon Council on Problem Gambling
P.O. Box 304
Wilsonville, OR 97070-0304
Tel: 503-685-6100
Fax: 503-783-0665
Email: info@gamblingaddiction.org
Website: www.oregoncpg.com
Council on Compulsive Gambling of Pennsylvania
1233-B Wharton St
Philadelphia, PA 19147
Tel: 215-389-4008
Fax: 215-389-1408
Email: Ccgofpa@aol.com
Website: www.pacouncil.com
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Rhode Island Council on Problem Gambling
PO Box 6551
Providence, RI 02940
Tel: 401-248-5606
Fax: 401-722-2020
Email: ricpgnet@ricpg.net
Website: www.ricpg.net
Texas Council on Problem and Compulsive Gambling
The Meadows Building
5646 Milton Street, Suite 432
Dallas, TX 75206-3902
Tel: 972-490-1007
Fax: 972-490-9337
Email: cvorkoper@sbcglobal.net
Website: N/A
Vermont Council on Problem Gambling
P.O. Box 62
Bellow Falls, VT 05101
Tel: 802-463-9557
Fax: 802-463-9557 (Please call first)
Email: vcpgjm@comcast.net
Website: www.vcpg.org
Evergreen Council on Problem Gambling
1929 Fourth Avenue East
Olympia, WA 98506
Tel: 360-352-6133
Fax: 360-352-4133
Email: info@evergreencpg.org
Website: www.evergreencpg.org
The Problem Gamblers Help Network of West Virginia
405 Capitol Street, Suite 1003
Charleston, WV 25301
Tel:304-344-2163
Email:Steve@1800gambler.net
Website: http://www.1800gambler.net
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Wisconsin Council on Problem Gambling
1423 Kellogg Street
Green Bay, WI 54303
Tel: 920-437-8888
Fax: 920-437-8995
Email: wcpgamble5@new.rr.com
Website: www.wi-problemgamblers.org
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Section 11
Problem Gambling Contact information for Inpatient
Treatment
United States
Valley Hope
Chandler, AZ
Affiliated Therapy Center
Scottsdale, AZ
(480) 991-9818
Arizona Win Way
Tempe, AZ
(480) 967-2946
Contact Behavioral Health
Services
Tucson, AZ
(502) 293-1277
(800) 572-9925
LaFontera Center, Inc.
Tucson, AZ
(520) 792-0591
Sierra Tucson
Tuscon, AZ
(800) 842-4487
West Center
Tucson, AZ
(520) 318-6423
Suzanne Graupner Pike, Ph.D.,
CCGC
CA, San Diego
www.sandiego-rx4gambling.com
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Suzanne Koch, LPC
CA, San Diego
(619) 405-6180
The Heartskober Manor
CA, Southern
(800) 994-0899
State of Connecticut Gambling
Treatment Program
MIddletown, CT
(860) 344-2244
Intervention Center
Washington, DC
(800) 422-3213
(301) 946-3213
Algamus (Main Treatment
Program)
Anna Maria, FL
(407) 244-9558
Renaissance Institute
Boca Raton, FL
(561) 241-7977
Gordon Recovery Center
Cherokee, IA
(712) 225-5856
Family Service
Council Bluffs, IA
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(712) 322-1407
Jennie Edmundson Hospital
Council Bluffs, IA
(800) 990-6667
Central Iowa Gambling Treatment
Program (CIGTP)
Windsor Heights, IA
(800) 341-3576
www.cigtp.org
Eastern Iowa Center For Problem
Gambling
Davenport, IA
(888) 703-2535
(319) 322-2535 Clinton
(319) 242-3880 Marion
(319) 377-0480
Gordon Recovery Center
Denison, IA
(712) 263-5065
Gateway Centers for Addiction
Treatment
Des Moines, IA
(800) 247-0764
(515) 321-6498
Iowa Gambling Treatment
Program
Des Moines, IA
(800) BETSOFF
(238-7633)
or outside Iowa:
(800) 522-4700
The Gambling Treatment Program
at SASC
Dubuqe, IA
(888) 771-6771
gamblingnomore.com
Community and Family Resources
Fort Dodge, IA
(515) 576-7261
Gordon Recovery Center
Harlan, IA
(712) 755-3161
Gordon Recovery Center
Ida Grove
(712) 364-2438
Gordon Recovery Center
LeMars, IA
(712) 546-7868
The Gambling Treatment Program
at SASC
Manchester, IA
(319) 927-9131
Allen Memorial Hospital Gambling
Treatment Program
Waterloo, IA
(800) 303-9996
(319) 235-3550
Gordon Recovery Center
Onawa, IA
(712) 423-1467
Gordon Recovery Center
Sioux City, IA
(712) 234-2300
Northwest Iowa Alcoholism and
Drug Treatment Unit, Inc.
Spencer, IA
(712) 262-2952
Allen Memorial Hospital Gambling
Treatment Program
Waterloo, IA
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(800) 303-9996
(319) 235-3550
Renz Addiction Counseling Center
Elgin, IL
(847) 742-3545
Illinois Institute for Addiction
Recovery
at Proctor Hospital
Peoria, IL
(309) 691-1055
Southlake Center for Mental
Health
Merrillville, IN
(219) 769-4005
Palmetto Addiction Recovery
Center
Rayville, LA
(800) 203-6612
Compulsive Gambling Center, Inc.
Baltimore, MD
(410) 332-1111
Intervention Center
Kensington, MD
(800) 422-3213
(301) 946-3213
CCAIRU, Inc., Gosnold Counseling
Center
Brockton, MA
(508) 584-5280
(800) 584-5109
Mt. Auburn Hospital Center for
Problem Gambling
Cambridge, MA
(617) 499-5194
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Kit Clark Senior Services
Dorchester, MA
(617) 825-5000
(617) 825-9891 (TTY)
Stanley Street Treatment &
Resources, Inc.
Fall River, MA
(508) 679-5222
CCAIRU, Inc., Gosnold Counseling
Center
Falmouth, MA
(508) 563-2262
Cooley Dickinson Hospital
Florence, MA
(413) 586-8550
Franklin Medical Center, Beacon
Recovery Center
Greenfield, MA
(413) 773-2377
Lowell House, Inc.
Lowell, MA
(978) 459-8656
Project Cope, Gambling Treatment
Lynn, MA
(781) 581-9270
Center for Health & Human
Services, Inc.
New Bedford, MA
(508) 990-8345
New Bedford Child & Family
Services
New Bedford, MA
(508) 996-8572
(508) 984-5566
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Center for Health & Human
Services, Inc.
Plymouth, MA
(508) 746-6737
Bay State Community Services,
Inc.
Qunicy, MA
(617) 471-8400
Dimock Community Health Center
Roxbury, MA
(617) 442-8800 x1286
CAB Health & Recovery Services
Salem, MA
(978) 745-8890
Sloan Clinic/Bay State Health
Systems
Springfield, MA
(413) 794-8409
St. Vincent Hospital
Worcester, MA
(508) 798-6107
Henry Ford Medical Center
West Bloomfield, MI
(248) 661-6100
Upper Mississippi Mental Health
Center
Bemidji, MN
(218) 751-3280
Gamblers Intervention Services
Duluth, MN
(218) 722-2273
Vanguard, Project Turnabout
Granite Falls, MN
(612) 564-4948
gamblingnomore.com
Fairview Riverside Compulsive
Gambling Program
Minneapolis, MN
(612) 672-4429
Gamblers Choice, Intervention
Institute
Minneapolis, MN
(612) 331-1006
Project Gamestar, Central
Minnesota Mental Health Center
St. Cloud, MN
(612) 252-5010
Mary Dahnert, M.A., L.M.F.T.
Resilience Treatment
Chaska, MN
www.resiliencecounseling.com
(612) 750-3376
COPAC
Brandon, MS
(800) 446-9727
Trimeridian - Custer Center
Las Vegas, NV
(702) 369-8491
Lutheran Social Services of North
Dakota
Minot, ND
(888) 423-8968
(701) 235-7341
The Center For Problem Gambling
Albany, NY
(518) 462-6531
Parkside Behavioral Healthcare,
Inc.
Boardman, OH
(216) 294-5445
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VA Medical Center
Brecksville, OH
(440) 526-3030 ext.7986
Parkside Behavioral Healthcare,
Inc.
Columbus, OH
(888) 4PARKSIDE
(614) 471-2552
Parkside Behavioral Healthcare,
Inc.
Columbus, OH
(614) 294-5445
Linn-Benton Gambling Treatment
Services
Albany, OR
(541) 967-3819
Clatsop County Mental Health
Astoria, OR
(503) 325-5722
Regional Gambling Addiction
Treatment Services
Bend, OR
(541) 317-3141
Harney Counseling & Guidance
Burns, OR
(541) 573-8376
Gambling Treatment Services
Coos Bay Office
Coos Bay, OR
(541) 888-7037
Polk County Mental Health
Dallas, OR
(503) 623-9289
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Mid-Columbia Center for Living
The Dalles, OR
(541) 296-5452
Gambling Treatment Services
Gold Beach Office
Gold Beach, OR
(541) 469-1213
Josephine County Mental Health
Conklin House
Grants Pass, OR
(541) 474-5367
Washington County Health &
Human Services
Hood River, OR
(541) 386-2620
Mid-Columbia Center for Living
Hood River
Hood River, OR
(541) 386-2620
Klamath County Human Services
Klamath Falls, OR
(541) 882-7291
Center for Human Development,
Inc.
La Grande, OR
(541) 962-8800
Yamhill County Mental Health
Services
McMinnville, OR
(503) 434-7527
Regional Gambling Addiction
Treatment Services
Medford, OR
(541) 776-7355
Page 141
Lincoln County Health & Human
Services
Newport, OR
(541) 265-4179
Malheur County Mental Health
Ontario, OR
(541) 889-9167
Clackamas County Mental Health
Oregon City, OR
(503) 655-8401
(503) 316-9745
Serenity Lane
Salem, OR
(503) 588-2804
Columbia Communtiy Mental
Health
St. Helens, OR
(503) 397-5211
Regional Gambling Addiction
Treatment Services
Pendleton, OR
(541) 278-5411
A.C.E.S. Counseling Center
Gambling Helpline and Meridian
Program
Springfield, OR
(800) 877-2STOPNOW
(541) 741-7107
Network Project Shop
Portland, OR
(503) 239-5952
Tillamook Family Counseling
Tillamook, OR
(503) 842-8201
ChangePoint Diversion
Portland, OR
(503) 253-5954
Belmont Center for
Comprehensive Treatment
Philadelphia, PA
(215) 456-8000
Behavioral Health Clinic, OHSU
Portland, OR
(503) 494-4745
Tualatin Valley Centers
Portland, OR
(503) 645-3581
Douglas County Mental Health
Roseburg, OR
(541) 440-3532
Network Addictions
Salem, OR
gamblingnomore.com
Algamus (South Carolina Branch)
Rock Hill, SC
(800) 818-4491
Keystone Treatment Center
Canton, SD
(800) 992-1921
Jones & Kinner Our Consulting
Services, Inc.
Flandreau, SD
(800) 692-2515
Page 142
Section 12
References
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Addiction and Change: How Addictions Develop and Addicted People
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Al-anon faces Alcoholism. Second addition, Al-Anon family group
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Amen, G. Daniel MD, The Brain and Behavior, A Comprehensive Clinical
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Amen G. Daniel, Magnificent Mind at Any Age: Natural Ways to Unleash
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This book gives a questionnaire with 60 questions to help you diagnose 6
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useful.
Amen G.,Daniel, Change Your Brain, Change Your Body: Use Your Brain to
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Amen, Daniel MD, the video and book Change your Brain Change Your Life
Ann Fields MA, CADCIII,CGACII Portland Oregon 2004 who wrote the
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Bradshaw, John, Family Secrets: What You Don't Know Can Hurt You, 1995
Bradshaw, John, Healing the Shame that Binds You (Recovery Classics,
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Cermack, Timmen L. evaluating and treating Adult Children of Alcoholics,
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Do They Have Bad Days in Heaven? Surviving the Suicide Loss of a Sibling
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Eades John M. Gambling Addiction: The Problem, the Pain and the Path to
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Gamblers Anonymous. (2001). Suggestions for coping with urges to gamble.
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Hodgins, D. C., & Makarchuk, K. (1998). Becoming a winner: Defeating
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