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Gambling Disorder Symptoms and Treatment

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Gambling is not a new concept, playing a game for money or betting on an outcome that is not guaranteed to end in your favor has been around for ages. The act of gambling predates recorded history as well as modern currency. The first indication that a game resembling gambling existed was in the Old Stone Age, in France, where flat round pebbles painted on each side were probably flipped for heads or tails (Schleifer & Temple, 2009). The idea of it becoming a problem is not new either, a 19th century author states, “gambling vitiates the imagination, corrupts the tastes, destroys the industry,” dramatically emphasizing the destruction that can occur through addictive gambling (Beecher, 1896). Pathological gambling was officially considered mental disorder by the American Psychiatric Association when it was added to the Diagnostic and statistical manual of mental disorders 3rd Edition in 1980 (Lindeman, 2004). Pathological gambling was originally categorized as an Impulse Control Disorder and was given the same vague definition as the other disorders involving impulsivity, which was characterized by an irresistible impulse to perform harmful acts (Lindeman, 2004). Since then, it has evolved into what the Diagnostic and statistical manual of mental disorders (5th ed.) refers to as Gambling Disorder.

The key differences between a gambling addiction and regular gambling are the intensity and persistence that it affects an individual. Regular gambling is intended to be light hearted fun regardless of the outcomes. Responsible gambling can be practiced by only betting what you can afford to lose. Unfortunately, many get caught up in the moment and end up spending more than intended and then feel guilty. That scenario is relatively normal provided the person does not make it a repetitive behavior to the point of indigence. Most people gamble in social situations, which lasts for a limited period of time and people accept their losses. Professional gamblers are different from social and unhealthy gambling in that they have minimal risks and high levels of self-discipline.

In the Diagnostic and statistical manual of mental disorders (4th ed., text rev.), the diagnosis of Pathological Gambling was defined as “persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of” ten different symptoms. The symptoms for Gambling Disorder are similar to the previous diagnosis, Pathological Gambling, except they are rearranged in the DSM-V (2013) 5th ed., reduced to four or more of the symptoms, and specificity of the severity is included.

Gambling Disorder is categorized under substance related and addictive disorders, and in a subcategory of non-substance-related disorders. A person may have a Gambling Disorder if they are needing to gamble with increasing amounts of money in order to achieve the excitement they desire, restlessness or irritability when attempts to reduce or stop gambling are made, repetitive unsuccessful attempts to reduce, control, or quit gambling, and preoccupation thinking about gambling (APA, 2013). Additional symptoms include gambling when feeling distressed, after gambling and losing, lying to hide how much they gamble, jeopardizing or losing significant relationships, jobs, educational, or career opportunities, and relying on others to give them money in desperate financial situations that were created from gambling. To be diagnosed with Gambling Disorder, the person much have clinically significant impairment or distress as demonstrated by the aforementioned symptoms. Additionally, the gambling behavior cannot be better explained by a manic episode. The DSM-V (2013) 5th ed. notes that there are some other behavioral conditions are similar to substance related disorders, but gambling remains the only one with sufficient data to include in the section of addictive disorders (APA, 2013).

The specifiers of gambling disorder determine the severity of the individual’s condition based on how man of the criterion are met. If four or five of the previously listed symptoms are met, then the condition is considered mild, six or seven is moderate severity, and if eight or nine of the criteria are met then the person has a severe Gambling Disorder. The diagnostic features associated with gambling can manifest differently in various cultures and individuals. While it is perfectly normal in some cultures to gamble on games and events, some people take it to an unhealthy level. A cyclical and unrealistic pattern of attempting to chase losses and abandoning all strategy may emerge. People with a gambling disorder may lie to the people in their life, including therapists, family, and close friends to hide how involved they are with gambling. It is also possible that one might commit various crimes to obtain money with which to gamble, including but not limited to embezzlement, forgery, theft, or fraud. Associated features supporting a diagnosis of Gambling Disorder include distorted thinking, impulsivity, excessive energy, competitiveness, restlessness, depression, feelings of helplessness or loneliness, and up to half of people in treatment for gambling have suicidal ideations (APA, 2013).

There are various types of treatment options for all of the different substance-related and addictive disorders, some include religious programs, total institutional facilities, and various modalities of therapy. The recommended course of treatment for gambling depends highly on the individual and the comorbidity of other conditions. The following is an example of a person with Gambling Disorder and a treatment plan for the specific situation, utilizing cognitive behavioral therapy.

Dominique, a 21 year old male, sought counseling for gambling after three years attending school at Bum Fuck University (BFU). During the initial intake, Dominique outlined his background and presenting problems. Dominique was raised in a two parent home, and often witnessed his parents being physically violent with each other, when they were not drinking or partying. Dominique said it was not abnormal because they never hit him and they were actually ‘cool’ parents because they let him take beer in his room and play in an online casino. He stated they encouraged him to go to college and would not allow him to return home on vacations, claiming he needed his independence. As an alternative, Dominique began driving the four hours to New Orleans and gambling during the breaks from school. He made several friends that would allow him to stay weekends and holidays near the casinos. Despite not stating it as an immediate issue, Dominique illustrated how he was depressed whenever he was not in New Orleans. He explained that when he first made trips to gamble, he just used the money left over from student loans. In the last two years, Dominique’s gambling increased to the extent that he maxed out five credit cards and used all of his student loans, including book money on gambling. This year, Dominique has missed several classes because he was either in New Orleans or sleeping off the long nights. He stated that his school friends did not like him missing classes and tried to convince him to stop. Dominique revealed that he used play flag football with a group of friends two or three times a week. However, recently he has not had any desire to join them. Dominique admitted to losing several friends after lying about his gambling, claiming that he had stopped, begging them for money, and then spending it all in New Orleans. Dominique reported he really did try to stop a few times, but each time ultimately decided that it was better for his mental health if he continued. He illustrated that without the rush he gets from gambling, he often feels empty and hopeless. However, this year the feelings of worthlessness increased so much that when he did attend class, Dominique explained he had trouble concentrating and would rather be in bed hiding from the world. His primary reason for attending therapy is that his friends forced him because they do not love him. Dominique believes that if his parents, friends, or cousins loved him, they would give him money. He explained his attendance in therapy is only to satisfy his friends in order for them to give him money. Dominique also explained that he often thinks of death as an effort to escape the world, which was another factor that led his friends to ‘force’ him to attend therapy. Dominique stated he did not have a specific plan to commit suicide, only that the idea of death seems like a peaceful alternative to life.

The differential diagnosis for Dominique is 312.31 Gambling Disorder, 296.23 Major Depressive Disorder, and the World Health Organization Disability Assessment Schedule (WHODAS) was not administered. The development and course of his Gambling Disorder took place over several years. Dominique began gambling online as a teenager, and abusing alcohol at a young age. This behavior aggregated with his depression, which has worsened throughout his college years. Dominique reported feeling intensely sad at various times throughout his past, but gambling always made him feel better. The diagnostic criterion met to diagnose Dominique with Gambling Disorder included needing to gamble with increasing amounts of money, repeated unsuccessful attempts to stop gambling, gambling when he felt depressed, relying on others to provide money with which to gamble, and lying to hide how much he gambles. All of these culminated to the point of Dominique’s gambling behavior causing significant impairment and distress. Dominique also met the criteria for a diagnosis of Major Depressive Disorder because he exhibited depressed mood nearly every day, markedly diminished interest in activities he used to enjoy, hypersomnia, feelings of worthlessness, and recurrent thoughts of death. The determination not to administer the WHODAS was made based on previous scholastic performance and no apparent disability in psychological functioning.

The treatment plan developed for Dominique is based on the Cognitive Behavioral Therapy modality. Treatment goals:

Dominque will attend classes regularly and complete course assignments.

Dominique will identify, value, and state his feelings, thoughts, and wants.

Dominique will learn coping mechanisms for stressors and depressive symptoms.

Dominique will identify triggers for gambling and develop realistic alternatives.

Therapy should consist of approximately 6 to 12 sessions over 3 to 5 months. In the second session, Dominique agreed to the treatment plan and was willing to resume attending classes at BFU. The first goal in the course of treatment for Dominique is first behavioral activation, agreeing to attend his courses meant that he would not be leaving for New Orleans during the week. The second goal for Dominique will include learning to identify the automatic thoughts that he has when he wants to gamble as well as throughout the course of his days. This goal will be met when he has consistently demonstrated recognition of his thoughts, feelings, and wants. Dominique’s third goal will be achieved by learning and implementing healthy coping mechanisms for daily stressors and depressive symptoms. Dominique’s fourth goal will be reached when gambling no longer causes him clinically significant distress. This will be accomplished through a collaborative effort of identifying instances, or triggers, that make the urge to gamble stronger and countering those impulses with realistic alternatives.

If you or a loved one suffer from gambling addiction contact me today. (918) 732-9730

Equality in Solution Focused Brief Therapy

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The way I speak on this blog, I allow my words to flow freely and may say things potentially offensive. This is okay because blogging and therapy are very different creatures. I think the coolest thing that could happen from writing this blog post is that others will begin dialogue in the comments section.

To be able to work with a diverse population and be effective in achieving treatment plan goals is something that many counselors desire. I feel like SFBT will increase my efficacy when working with various populations that have different backgrounds than me.

I have probably come across another single bisexual Hispanic female that was raised in poverty with a mentally ill mother and are now part of the middle class. While others may share my upbringing and lens of the world, the fact is that most people sitting across from me have an entirely different lens through which they see the world. The freedom that SFBT allows is for me to explore the world through each consumer’s lens and each individual’s experiences.

Some of the worst things a counselor can say in my opinion include “get over it,” “I understand,” and “it will get better with time.” Who the hell am I to say with any accuracy that the proverbial ‘it’ will always get better with the passing of time?! With good intentions, clinicians have the ability to enhance potentiation or do serious damage. The most appealing piece of SFBT is it has not been found to cause any harm.

Occasionally I speak before thinking, a good example of that is when I told a coworker that he did not strike me as a “male man,” at which time he informed me he was very much a manly man and did all sorts of manly things like working on cars and watching sports. Can you imagine if I put my foot that far in my mouth in a session with a consumer?! By allowing the consumer to set the language for the session, nothing said will be offensive because I can use their language. I can ask questions with curiosity without saying something potentially indelicate.

“Solutions need not be directly related to the problems they are meant to solve.” -Steve de Shazer

Evolving Into The Solution Focused Brief Therapy Mindset

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Prior to meeting anyone in the field, my understanding of Solutioned Focused Brief Therapy was that it is a modality. That’s it. I honestly did not know what to expect. Arriving in Colorado for the SFBT Training with Teri Pichot, I noticed awesome new landscapes that I had never experienced before. My hope for SFBT is that it would be one more tool in my box of therapy knowledge. I thought it was right alongside Cognitive Behavioral Therapy, Motivational Interviewing, Dialectical Behavior Therapy, etcetera. I was WRONG. This new type of therapy is much more than just another way of therapy, it is a new way of thinking and approaching consumers.
Most clinicians are taught from a problem solving point of view, this is also true for myself. Learning to focus on solutions instead of problems is proving to be very difficult, but I am confident it is doable. I am currently attending the 2016 Annual SFBT Expo, where I am meeting a multitude of clinicians all with their own experiences of SFBT.
The more I hear, see, and practice the principles of SFBT, the more of a reality I see with consumers. Almost fully licensed, (I just have to submit my hours) I have decided the areas of focus I am interested in include substance abuse, trauma, lgbt issues, prison inmates, and life adjustments such as divorce, moving, work stress, weight loss, etcetera.
I am not yet sure how to fulfill all of my interests while working primarily with chemically dependent consumers, but I am determined and willing to work weekends. My best hopes for the next year is to implement the solution focused mindset effectively with consumers and with myself.
“Problem talk creates problems – Solution talk creates solutions”
Steve de Shazer (1940-2005)

Passed the NCE!

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Good news world: I recently passed the National Counselor Examination!!! I have to say Howard Rosenthal is still relevant! I used his audio exam guides that were passed down to me by other counselors. Registering for the NCE was probably the most difficult piece of the testing process. Over a month the confirmation email sat in my inbox, registration just a click away. I had waited years to get to this point and when it came I wanted nothing more than to never click that link. A little voice in my head saying “what if you fail? what if you’re not meant to be a counselor? what will you do?” kept me from registering for what felt like an eternity.

Then one night while working late a coworker was asking if I’d taken the test. I lowered my head and said “I haven’t even registered yet”. That night I made a commitment to register for the test before anymore excuses about being busy came up. On a Thursday morning I registered for an 8am Saturday testing time. That meant I had less than 2 days to brush up on everything I was sure to have forgotten. Aside from Rosenthal’s super test review, the anxiety reduction techniques is probably what calmed me enough to take the exam.

Advice for future testers:
-Find the testing location BEFORE the day of your exam. (I went to the wrong building initially).
-Take breaks throughout the exam! The clock stops and you can get up and run around, stretch, get some water, or just take a mental break.
-Utilize all of the relaxation techniques you teach clients.
-Finally, take the test as soon as you can into your supervision process. This will allow you enough time to re-take the test if needed without having to reapply for licensure.

8 CACREP Areas

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This post will be a brief overview of the 8 Counsel for the Accreditation of Counseling and Related Educational Programs (CACREP) areas that the NCE is developed from: professional orientation, research and program evaluation, appraisal, lifestyle and career development, helping relationships, group counseling, human growth & development, and social & cultural foundations.

Professional orientation consists of the various aspects of the counseling profession. Essentially, being knowledgeable about the different types of licenses available, accreditation, ethics, legal responsibilities, and roles of a counselor.

Research and program evaluations is exactly what it sounds like. Research and evaluations are a prominent factor in the counseling profession and if you conducted your own research this section should be relatively easy. Review the different types of experiments, components of scientific designs, and a few prominent influences that are important including Occam’s Razor and where that came from. For the record, it came from a fellow named William of Occam’s, a 14th century theologian and philosopher and suggests that we interpret results in the simplest way.

Appraisal is a big fancy word for assessing things. In therapy that usually means people. There are different tests, to name a few: projective tests, intelligence tests, personality tests, achievement tests, aptitude tests, interest inventories, and informal assessments (like journaling). It’s important to know the tests that are frequently used by clinicians, who in history influenced or created them, good practices for interpreting results, and non-testing approaches to appraisal.

Lifestyle and career development includes several theories and influential people. One of the real big theories is the Trait and Factor theory, which has a model that matches an individual to a position. The big names with trait and factor are Parsons, Williamson, and Patterson. The nemonic I use for their names is trait and factor matches ‘people with places,’ and each persons name fits right in. Other big names in occupational theories include Roe, Brill, tend Holland…all structural/personality theorists. A few more names (because history is important) are Hoppock, Azrin, Krumboltz, Crites, Schlossberg, Tiedemand, and O’Hara.

Helping relationships entails learning a lot of different studies that help you understand the process of counseling and consulting. This area consists of several models and understanding the practical applications of them. For the NCE, being familiar with the goals, techniques, and people associated with the following therapies will cover a lot of ground: Psychoanalytic, Adlerian, Existential, Person-Centered, Gestalt, Reality, Behavior, Cognitive Behavior, Feminist, and Family Systems.

The group counseling area involves learning about purposes, development of stages, methods, dynamics, roles and leadership styles. Some big names in group therapy are Moreno, Pratt, Davis, Slavson, Lewin, and Window. I really don’t have a lot of knowledge in this area, a major resource I use is the massive amounts of literature written by Gerald Corey.

Human growth & development is following the lifespan from birth to death. There are theories of development for individuals, families, personalities, and neurological behaviors. There are several individuals that contributed theories including Festinger, Erikson, Jung, Kegan, Kelly, Kohlberg, Lewin, Loevinger, Maslow, Murray, Pavlov, Perry, Piaget, Rogers, Sullivan, and Thorndike. Sounds like a lot of names, but they all in their own way contributed to our understandings of human lives.

Social & cultural foundations focuses on theories surrounding multicultural, social justice, trends and diversity in groups around the world. A counselor’s role includes promoting and appreciating various social and cultural aspects of societies attitudes, beliefs, and experiences. Some key words/concepts with social & cultural foundations include: proxemics, prop inquiry, contextualism, mores, folkways, ecological culture, ethnocentrism, acculturation, assimilation, white privilege, emic and etic viewpoints, autoplastic, and alloplastic views, and congruity theory.

After writing these short blurbs, I begin to wonder if each might be a good blog post.

Ref:
Council for accreditation of counseling and related educational program (CACREP): The 2001 Standards (2005). Section II: Program objectives and curriculum (pp. 6-13).

Quizlet,NCE,www.quizlet.com

Introducing: Kat!

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Albert Einstein said “A question that sometimes drives me hazy, am I or the others crazy?”

This is my first blog post so I’ll begin by giving a little background on myself and interests.

Since childhood, I had always been fascinated with mind body connections. I used to be a shy, reserved person, only comfortable in specific areas where I felt confident. Later I would learn to adapt to my surroundings, where ever they may be.

My first job was at a bowling alley. There I learned important life skills such as dipping fingers in pickle juice before touching something hot, patience when interacting with customers, and balancing down the lanes to retrieve bowling balls.

About half way into my bachelor’s degree I decided to join the Navy Reserves. I knew I wanted to continue my education as well as join the military. The reserves provided the opportunity to do both. Picking my job in the reserves was limited, I had to pick by what was available at the reserve center in my area. Wanting to step out of my comfort zone and explore something new, I chose to be an aircraft structural mechanic. The school I attended, was fun at times, but mostly I learned how mechanically inclined I am NOT. The first time I held a torque wrench, I held it in the wrong hand, upside down. After 2 years I was able to change my job to something I knew well, paperwork. Now I am a yeoman, which is essentially a secretary. I know how to format correspondence, write awards, evaluations; all in an office, which I have learned over the years I can navigate around just about any administration. I also learned I had a gift for talking with shipmates about their personal problems, and then keeping it confidential. My contract in the Navy will soon end and I intend to dedicate more time to psychology.

Throughout my undergraduate education I searched within myself to decide what would engage and entertain me enough to make a career. I am a firm believer in not doing anything that is not enjoyable. Talking/listening and writing for hours on end sounded perfect for me. I graduated with a Masters of Science in Psychology and moved to Tulsa to pursue LPC licensure. Currently I am under supervision and one day plan to go into private practice. Working as an inpatient therapist I am exposed to a myriad of difficult psychiatric problems. Learning is an ongoing process for me, and I look forward to what I will learn in the coming years here in Tulsa.

With this blog I intend to explore topics that are relevant to the National Certification Exam, psychology in general, and various therapeutic topics.
Please comment, I welcome constructive feedback and ideas for topics to write about.