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National Certified Gambling Counselor (NCGC -I)
Dr. Matthew Bruhin will be the instructor for this course. Dr. Matthew J. Bruhin is President of
Matthew Bruhin & Associates, a boutique mental health and addiction treatment practice. He is
also Executive Director of APEX Recovery, a cutting edge, holistic, and integrative residentcial
substance abuse treatment program.
Dr. Bruhin is passionate about his work with addiction and family therapy. Dr. Bruhin is a State
of California Board of Behavioral Sciences, Licensed Marriage and Family Therapist and an
Addiction Specialist, registered and certified by both the Breining Institute and the American
Academy of Health Care Providers. Dr. Bruhin earned his Doctorate in Addiction Psychology
and also earned his MASTERS DEGREE IN Counseling Psychology and holds a Bachelors
degree in Psychology, with a Minor in Addictive Disorders.
Gambling addiction, also known as compulsive gambling, is a type of impulse control-disorder.
Compulsive gamblers can’t control the impulse to gamble, even when they know that the
gambling is hurting themselves or their loved ones. Gambling is all they can think about and all
they want to do, no matter the consequences.
Compulsive gamblers keep gambling whether they’re up or down, broke or flush, happy or
depressed. Even when they know the odds are against them, even when they can’t afford to lose,
people with a gambling addiction can’t “stay off the bet.”
Gamblers can have a problem, however, without being totally out of control. Problem gambling
is any gambling behavior that disrupts your life. If you’re preoccupied with gambling, spending
more and more time and money on it, chasing losses, or gambling despite serious consequences,
you have a gambling problem.

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Course Content

• Learning How to Asses Clients for Problem Gambling
A. Learning how to engage and build a collaborative relationship for future
session
B. Projecting to clients that gambling is “learned behavior”
C. Instilling hope & motivation that change is possible
D. Completing assessment for problem gabling
E. Creating clients treatment plan
F. Creating & Engaging clients into homework
• Teaching Client’s Consequences Associated with Gambling
A. Assessing extent of damage caused by behavior
B. Working to maintain client through treatment
C. Motivating client to work towards recovery
D. Importance of reviewing past week events

• Identifying Cognitive Distortions
A. How to identify & correct cognitive distortions about gambling
1. “Negative Rate of Return”
2. The “Independence of Events” phenomenon
3. “Illusions of Control”
4. Superstitions
5. Chasing Losses
6. Vicious Cycle of Gambling

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• Dealing with Urges & Triggers
A. How to identify techniques to deal with urges to gamble
B. How to identify techniques to deal with triggers to gamble

• Coping with Stress in Recovery
A. Learning to identify life stressors
B. Teaching ways to deal with stressors
1. Avoiding Avoidance
2. Ways to Cope
3. Building Positive Activities

• Dealing with Slip-ups & Relapse
A. Making relapse plan for managing relapse
B. Learning difference between slip & relapse
C. Learn about barriers to continuing success

• Learning about GA & How it Can Help
A. What is the difference between AA & GA?
B. How can a counselor use GA with treatment?

• Working with Families of Problem Gamblers
A. How to handle families in treatment]
B. Ways families can help process
C. Issues that counselors can run into with families and how to cope
D. How to help family sessions stay productive

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Problem Gambling Student Handbook
The first purpose of this student handbook is to provide you with an
easy reference to the primary concepts regarding Problem Gambling, the
diverse yet complimentary theories of how and why Problem Gambling
develops, and the various treatment approaches for individuals, the family,
and the community at large.
The second purpose of this handbook is to stimulate your interest for
further reading, research and understanding. We will pose challenging
questions that require serious thought, and not all questions have definite
answers.
We are going to discuss the concepts, techniques and methodologies
that are of significant value to the individual and family seeking recovery
from problem gambling and to those professionals and peer counselors and
coaches who wish to help facilitate the recovery process.
Academic Addiction is dedicated to accuracy and reliability of
information. We endeavor to avoid completely any hints of fearmongering, exaggeration of conditions, or exploitation of social issues to
advance any agenda other than to provide superior training by continually
striving to be the standard of excellence. – Burl Barer

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Introduction
“Problem gambling is characterized by difficulties in limiting
money and/or time spent on gambling which leads to adverse
consequences for the gambler, others, or for the community."

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We use the term ‘problem gambling” for gambling which gives rise
to any problems for the individual, his or her family, friends, workplace or
the community at large whether or not the problems are severe enough for
a person to be labelled using diagnostic criteria as a “problem gambler” or
“pathological gambler.”
Some experts say there are four types of gamblers:
Social, Professional, Problem, Pathological
Other experts expand slightly on those types, noting that there are
three types of gamblers who, forming the majority, don’t have problems as
a result of gambling. The recreational player, the serious player, and the
professional player.
The recreational player gambles for fun, doesn’t think about it much
except when doing it, has a good time playing the games, and usually will
show financial loss that is not problematic – it is simply the cost of
entertainment.
The serious player is disciplined, strategic, and is not in the game for
fun, stimulation, or excitement. These players are seriously proficient at
games such as poker and blackjack. They have a particular “system” for
playing, stop when not winning, and show a financial gain for their efforts
at the end of the year.

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The professional is exactly what the name implies. They are the
more advanced version of the serious player, and strategic disciplined
gamesmanship, coupled with exceptional knowledge of their game of
choice has given them a lucrative career.
And then you have the 5% of players who manifest “problem
gambling.”
The term “Problem Gambling” covers a wide spectrum of
situations from easily corrected gambling related problems to severe,
even life-threatening problems requiring medical, psychiatric and/or
psychological intervention.
Let’s keep this simple, direct and easy to understand.
The vast majority of people who go to a casino, a card room, play
black jack, poker, gin rummy, Old Maid, go to the race track, or buy a
lottery ticket never have any problems related to gambling. Of those who
do have problem gambling issues, 37 percent prefer playing slot machines,
and 37 percent prefer card games. Less than one percent of problem
gamblers are into lottery games, dice games, and games of skill.
It is not the amount of time someone gambles, or the amount of
money they bet when gambling that defines someone as having moved into

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the realm of Problem Gambling. Perhaps they have the free time, and
plenty of money to do with as they please.
People who don’t have problem gambling issues never gamble
what they can’t afford to lose, they never go chasing after losses
trying to win them back, don’t borrow money to gamble, don’t miss
work because of it, and there is never any negative impact on their
family life, their jobs, relationships or finances because of gambling.
Those who have no gambling related problems have a very difficult
time understanding how someone could become so attached or obsessed or
to use the “A Word”- Addicted to gambling.
As reflected in the definition of addiction provided by the American
Society of Addiction Medicine the concept of addiction has expanded in
recent years to include many types of excessive behaviors that people
compulsively continue despite negative consequences.
Individuals struggling with excessive, immoderate, obsessive or
compulsive behaviors are too embarrassed, ashamed or proud to ask for
help. It is estimated that 80% of people with problem gambling issues
never seek help, and we will discuss the reasons for that. But first of all,
let’s take a look at what may be basic indicators of someone having
problem gambling issues.

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The Lie/Bet Screening Instrument consists of two questions:
1. Have you ever felt the need to bet more and more money?
2. Have you ever had to lie to people important to you about how
much you gambled?
A “yes” response to one of these questions indicates that we should
move on to a more detailed questionnaire.

Here is a simple self-assessment version of a Diagnostic Screen for
Gambling Disorders. It was designed to assist individuals in evaluating
whether to modify or seek help for their gambling behavior. It is based on
the American Psychological Association’s criteria for pathological
gambling.
IMPORTANT: this self-assessment will help you figure out if there
is a problem, but only a professional can diagnose what type of problem.

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It might be a problem gambling issue, or it might be something else, or
both or none at all.
1. Have there ever been periods lasting two weeks or longer when
you spent a lot of time thinking about your gambling experiences, planning
out future gambling ventures or bets, or thinking about ways of getting
money to gamble with?*
Yes

No

2. Have there ever been periods when you needed to gamble with
increasing amounts of money or with larger bets than before in order to get
the same feeling of excitement?*
Yes

No

3. Have you ever felt restless or irritable when trying to stop, cut
down, or control your gambling?*
Yes

No

4. Have you tried and not succeeded in stopping, cutting down, or
controlling your gambling three or more times in your life?*
Yes

No

5. Have you ever gambled to escape from personal problems, or to
relieve uncomfortable feelings such as guilt, anxiety, helplessness, or
depression?*

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Yes

No

6. Has there ever been a period when, if you lost money gambling
one day, you would often return another day to get even?*
Yes

No

7. Have you lied to family members, friends, or others about how
much you gamble, and/or about how much money you lost on gambling, on
at least three occasions?*
Yes

No

8. Have you ever written a bad cheek or taken money that didn’t
belong to you from family members, friends, or anyone else in order to pay
for your gambling?*
Yes

No

9. Has your gambling ever caused serious or repeated problems in
your relationships with any of your family members or friends? Or, has
your gambling ever caused you problems at work or your studies?*
Yes

No

10. Have you ever needed to ask family members, friends, a lending
institution, or anyone else to loan you money or otherwise bail you out of a
desperate money situation that was largely caused by your gambling?*
Yes

No

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If you have a family member, friend or employee who would answer
yes to one or more of those questions, they may indeed have problem
gambling issues. Friends and family always ask “Why?” Then they ask
“Can the person be helped, or can they help themselves?”
The second question is easier to answer that the first. The “Why” is
a complex combination of factors that vary from individual to individual,
and the relationships between different factions of society who have some
sort of interest in gambling are complex and multi-faceted as well.
To use an obvious gambling analogy, many different groups
(stakeholders) have a dog in this race.
Public health researchers and social scientists want to minimize the
risks of legal gambling.
Economists, financial institutions and law enforcement are more
about the relationship between legal gambling and bankruptcies, and crime.
Treatment professionals, government agencies and not-for-profit
organizations are worried about resource allocation for the prevention and
treatment of gambling problems, -- in other words, they want their share of
grants and funding.

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Then you have groups who are opposed to legal gambling, and these
folks want to prevent any further expansion and would like to repeal the
laws that have made gambling legal.
Many of these people share the paranoid delusion that the gaming
industry is intentionally cultivating or exploiting “problem gamblers.”
Let’s clear that one up right now.
The gaming industry is an industry built on prudent conservative
business plans and proven marketing principles. Cost/benefit ratios are
continually analyzed, and when it comes to the business of gambling,
nothing is left to chance.
The gaming business, like the entertainment business, is strictly
business. Gaming industry leaders realize that the industry as a whole must
act in a socially responsible manner, like any other business that desires to
be viable in the long run
The gaming industry has invested significantly in research to identify
those who may have gambling problems, and encourage their recovery. If
that sounds contradictory to the industry’s best interests, it isn’t.
94% of their customer base will never have gambling problems, and
94% is more than sufficient for maintaining and increasing profit. Casino
owners and operators are more concerned with maintaining or increasing

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market share than in cultivating income from people with problematic
gambling issues which may involve, on the far end of the spectrum,
dangerous pathologies.
“Moral Entrepreneurs”—people who make their living or increase
their public profile by “cashing in” on threats to the public morals, will
always exaggerate the severity of social issues if doing so leads to them
getting money to address the “crises,” or legislation favorable to their
group or organization–a word of caution, there are certain buzz words that
are used to create moral panics that precede restrictive and punitive
legislation, or to foster prejudice against a segment of the population.
The two most common are “evil” and “epidemic.” The only real
epidemics are contagious physical diseases such as typhoid fever, or small
pox. Anytime social issues are described as an “epidemic” such as a
“compulsive gambling epidemic,” watch out – that means someone is
working an agenda of either seeking money to fight that “epidemic,” or is
promoting legislation appealing to their political base.
Honest and ethical professionals have no reason to lie,
exaggerate or mislead the public. We rely on proven, factual, well
researched methodologies.

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When the family of the person dealing with the issue of problem
gambling have their heads filled with misinformation and unwarranted
suspicions, it creates problems – sometimes more problems than the
gambling.
Allow me to give you an example. Some of you may have read, or
heard politicians or special interest groups repeat with alarm the results of
research by the American Insurance Institute that found that 40% of white
collar crime is caused by gambling.
There is no such thing as the American Insurance Institute, and
there is no such study. It is a complete fabrication. Yet this complete
falsehood has been repeated over and over, even in testimony before the
United States Senate. Someone heard it, and accepted it as fact without
bothering to fact check it. As it turns out, there were no facts to check. The
entire thing is fake.
Where do these fake studies come from? From people who just make
them up knowing that their audience will believe whatever they say, and
not bother to check if it is true or not.
There is, however, a comprehensive research study “White collar
crimes and casino gambling: looking for empirical links to forgery,
embezzlement, and fraud” by Jay S. Albanese, published April 23, 2008

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that validated previous studies that showed that gambling, drugs, “another
lover”, or any other situation are NOT the actual cause of financial crimes
such as embezzlement. The true cause is that the person’s problem was
one that could not be shared.
If you can’t share the problem, you keep it a secret, you don’t
get help.
As with recreational drugs, people are ashamed to come forward and
get help for a problem arising from participating in an illegal activity.
The more gambling is defined as legitimate leisure activity, the
easier it may be for those who gamble excessively to share their problem
and seek help, ultimately avoiding the need to pursue “solutions” to
financial problems such as embezzlement. If an individual believes that he
is ‘not supposed to’ gamble, any problem arising from gambling would be
considered as non-shareable.
If you have to hide it, you’re not going to share about it.
If you know you don’t have to hide it, you will share it, and get
help for it.
The more taboo the problem, the more people hide it instead of
getting help for it.

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Problem Gambling and Problem Drug/Alcohol Use:
There is a significant correlation between problem gambling and
problem alcohol and drug use.
According to the National Epidemiologic Survey on Alcohol and
Related Conditions, of people diagnosed with pathological gambling, 73.2
percent had an alcohol use disorder, 38.1 percent had a drug use disorder,
60.4 percent had nicotine dependence, 49.6 percent had a mood disorder,
41.3 percent had an anxiety disorder, and 60.8 percent had a personality
disorder. These facts lead us to ….
Problem Gambling and Mental Health:
Individuals with problem gambling issues often are found to
have various, easily treated mental health concerns. Among these are
Attention Deficit Disorder, Obsessive Compulsive Disorder, Genetic
Depression and Generalized Anxiety Disorder – all of which respond very
favorably to a combination of medication and evidence based therapy
techniques.
The anxiety disorders share features of nervousness, inhibition,
avoidance, compulsion and severe stress often accompanied by various
bodily symptoms such as palpitations, sweating, shaking, shortness of

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breath, chest pain, nausea, numbness or tingling sensations in the hands,
and dizziness, etc.
Generalized Anxiety Disorder has more to do with being excessively
anxious and worried about things that are beyond one’s control, and
symptoms include restlessness, unusual fatigue, difficulty concentrating,
irritability, muscle tension and sleep problems.
People with anxiety problems often gamble to escape anxiety, or as a
replacement for an old compulsion. There is ample research evidence that
gambling activity is often preceded by, and is a response to, stress and
anxiety.
“Over a lifetime, pathological gamblers had a threefold increase in
anxiety disorders in general, and a six fold increase in obsessive
compulsive disorder (Bland et al., 1993)” -- Samuel Law, Problem
Gambling Institute of Ontario.
Description of Anxiety Disorders
There are people with problem gambling issues who suffer from
Obsessive Compulsive Disorder – a condition treated much as one would
treat depression – anti-depressants plus education and proven therapy.

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Affective disorders such as OCD, Bi-Polar, Anxiety, ADD, and
Depression are more common among gamblers who play slot machines and
other games where there is little or no skill factor.
You light up my Brain!
Recent studies have shown that the brains of some compulsive
gamblers “light up” in the exact same area and the exact same way as they
would if the gambler had taken a central nervous stimulant such as
methamphetamine.
Don’t let the word “methamphetamine” scare you – people often
forget that amphetamines and methamphetamines are legal prescription
medications deemed safe for children as young as six years of age when
prescribed as part of appropriate medical treatment, primarily for Attention
Deficit Disorders or narcolepsy.
There is considerable research strongly linking compulsive
gambling to attention-deficit disorder (ADD). And what is the treatment
for ADD? Either amphetamines or methamphetamine, by prescription, plus
therapy.
For some people with undiagnosed ADD, gambling is a both a
symptom and a self-medication as it stimulates that same areas of the brain
as would the medication.

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In some cases, the problem gambler is self-medicating their ADD
by gambling – a method far more expensive than a doctor’s
prescription.
Not all people with problem gambling issues have those related
mental health issues or corresponding problematic relationships with
recreational drugs, including alcohol.
Problem Gambling and Suicide:
Gamblers who contemplate suicide have had suicidal thoughts on
average ten years before they ever started gambling, and the suicidal
thoughts are related to pre-existing mental health disorders, long standing
substance use disorders and or problem drinking, rather than gambling.
There are three theories of Problem Gambling:
The Disease Model, the Social Learning/ Cognitive Behavioral
Model, and the Psychodynamic Model.
The Disease Model is the one favored by Gamblers Anonymous
and by the Gaming Industry. You will find the phone numbers of the local
Gamblers Anonymous prominently posted throughout casinos, encouraging
people experiencing gambling problems to call Gamblers Anonymous.
The basic concepts of the Disease Model is that problem
gambling in a condition that you either have or do not have. It is not

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something caused by the presence of casinos, slot machines or race
tracks. The disease is progressive and will only get worse, and there is
no way to reverse it.
If you have it, you will lose control, try to quit on your own but fail,
and eventually hit bottom. The only way out of this condition is to never
ever gamble no matter what because if you do, all the symptoms will come
back full force.
In the Disease Model, treatment is often a combination of medication
to treat compulsions and impulsive behavior, or anti-depressants for those
dealing with depression and suicidal tendencies, plus therapy with a trained
professional psychologist and the support of Gamblers Anonymous, a 12Step program based on the 12-Steps of Alcoholics Anonymous.
G.A. is not treatment for anything, nor does it claim to treat any
medical or psychological condition. Treatment for problem gambling is
considered an “outside issue” upon which G.A. has no opinion. Treatment,
according to G.A. is the realm of doctors and scientists.
For those of us who treat clients with problem gambling issues,
and develop appropriate treatment plans, it is important for us to
understand how the individual sees the problem. If their view is consistent
with the Disease Model, they will embrace it and benefit from it.

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If the individual seeking help does not think of the problem in the
same terms, he or she is likely to resist participation. That means that the
disease model approach is NOT going to be of value to them.
When developing a treatment plan we must match the
individual to the appropriate approach. The counsellor, coach or
therapist must have an understanding of whether the gambler thinks about
his or her problem in a way that matches the disease model. If not, don’t
use it.
While the disease model is the most widely used model in the United
States of America, and has been around longer than any other model, it also
has the least amount of research validation.
It is of interest that almost every web site or treatment center dealing
with Problem Gambling says that it is “progressive” – it will go from bad
to worse to horrible, that there is no way to reverse it, and you are doomed,
more or less, unless you abstain.
Saying something over and over again doesn’t make it true, and there
is significant research indicating that problem gambling does not always
follow a progressive pattern.
Rather, it tends to be episodic in nature, and “problem gambling”
may manifest itself in a sudden evening of financial risk taking, or go on an

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uncharacteristic gambling binge, and then go back to non-obsessive, noncompulsive, completely responsible gaming behavior. And then, along
comes another “episode” of irresponsibility. In that case, we should
endeavor to find out what triggers that irresponsibility. In this situation, it
is obvious that gambling is a symptom, not the problem that needs to be
dealt with.
The Social Learning & Cognitive Behavioral Model asserts that
gambling is leaned and reinforced behavior. Counsellors working within
the social learning model focus on empowerment and solutions rather than
past or hidden problems.
The cognitive-behavioral model is based on the theory that
behavior is initiated, maintained (or discontinued), based on principles of
learning, and what people interpret and believe about events that go on
around them.
Cognitive Behavioral therapy is the most research validated and
proven effective method of helping people with problem gambling
issues.
The Psychodynamic Model proposes that personal problems
such as problem gambling are an attempt at self-healing or a strategy of
resolving unconscious emotional conflicts beyond the person’s control.

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The individual gambles to ease their emotional pain, and they have an
unconscious desire to lose – in fact, for the problem gambler, it’s all about
loss, not winning.
Under this admittedly non-scientific theory, problem gamblers wish
to be punished, they feel inadequate and create, while gambling, a fantasy
world in which they are important and respected. This may sound a bit far
out, kinky or peculiar, but there are plenty of kinky, far out and peculiar
people in this world – and you may be one of them,
A related concept of this model is that the person has mood swings
from arousal to depression, and that gambling is an attempt to regulate
mood swings.
This theory, despite sounding “way out” has made a significant
contribution to problem gambling treatment because there really are many
gamblers dealing with the emotional impact of loss, and the fantasy of
importance, respect and power that people with gambling problems often
confirm that they have when gambling.
“Problem gambling is simply a means of acting out one’s deeper
emotional addiction to painful, unresolved inner conflict. If, for some
reason, problem gamblers weren’t able to gamble, they would act out their

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inner conflict in other ways, perhaps through substance abuse, job failures,
or relationship problems.” -- PETER MICHAELSON
What we are going to do in this seminar, is discuss the techniques
and methodologies that are of significant value to those who seek recovery
from problem gambling.
As a matter of public policy and professional ethics, therapist,
counsellors, doctors and recovery coaches are more concerned with
forming alliances with clients that empower them to effectively overcome
gambling problems than we are in the origins of the condition. .
On the topic of problem gambling, the vast majority of research
study and treatment ideas came from the United States. The USA is not the
only country in the world, nor the only culture.
Australian research now defines problem gambling as a broadly
social and public health issue rather than an addiction or disordered
behavior originating in the individual.
The medical model used in the USA defined problem gambling by
the behavior of the individual The Australian Model defines problem
gambling by the consequences of the behavior.
In the Australian model,”… it is generally accepted that gamblingrelated problems are situated in a broader context of environmental, social,

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political and economic factors, and that problem gambling can emerge as
a result of a confluence of factors incorporating both the individual
gambler and the wider gambling and social environment. The risk factors
associated with problem gambling have been identified as a combination of
many factors.” -- Problem Gambling and Harm – Gambling Research,
Australia 2005
One of those factors being that gambling policies and decisions
made by governmental bodies were all driven by revenue imperatives at the
expense of consumer protection.
State and local governments have introduced a range of harm
reduction measures, including regulations regarding certain aspects of
game design that may be deceptive regarding odds of winning, as well as
treatment and rehabilitation of individuals.
We mention what is happening in Australia as preface to pointing out
a current shift in North America in defining problem gambling, although
the reasons for the shift are entirely different.
There has been a shift in definitions of problem gambling away from
problem gambling as a medical or mental disorder, and instead focusing on
the harmful consequences. Why would we do that when medical or mental

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health concerns are proven to be a most significant factor affecting those
consequences?
At first, that wouldn’t seem to make sense. But a closer examination
of the situation reveals a matter of overwhelming importance: For millions
of people in a variety of cultures and sub-cultures, the stigma of mental
health issues and/or addiction is so severe that if seeking help for
gambling related problems labeled them as “gambling addicts,” the
harm of such labeling would be far worse than the harm from problem
gambling.
Sadly, they are correct. Extensive research validates that the harm of
stigma, social distancing, exclusion and prejudice, often combined with socalled “tough love,” is more harmful to an individual than even the most
extreme forms of actual addiction, including Heroin addiction..
We have a long and tragic history of shaming, blaming,
pushing people with behavioral problems away, isolating
them, and threatening them – all things that increase stress,
anxiety and actually make the illness stronger.

Thus, fearful of stigma and labeling, those who would benefit from a
supportive and victorious therapeutic alliance are denied recovery from

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problem gambling. Hence, by not using terms such as “Gambling
Addiction” and not saying “problem gamblers are mentally ill” we make it
easy for those experiencing problem gambling issues to say “Hey, I’m
having a bit of a problem here” and not suffer the stigma and social
distancing that is worse than problem gambling.
Those of us who work with clients who come to us with Problem
Gambling concerns know that it is the relationship with the client, more
than anything else that determines success. Because a powerful dynamic
collaboration is imperative, we need to know how to engage and build that
relationship. Thankfully, there is cutting edge research showing us evidence
based therapy relationships
THE THREE THINGS UPON WHICH YOU AND THE
CLIENT MUST AGREE
 The reason the client is seeking help
 The client’s anticipated outcome of the collaboration
 The way you two will work together to achieve the goal.
It is of utmost importance that the client perceives the two of you as
having formed an alliance. Whether you call it a team or a partnership, the
concept is true collaboration.

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The correlation between alliance and outcome increases as treatment
progresses over time, but by the third or fourth session, the strength of the
alliance gives you a reliable indication of how things are going to go.
The stronger the alliance, the greater the success. The weaker the
alliance, the more likely the client will drop out before completion.
The client and you may have different views on the strength of the
alliance. It is the client’s view that is most important, although you have
significant influence on how they view the strength of the collaboration. It
is important to monitor the health and viability of your alliance periodically
as you advance towards the goal.
There are things you can do that build and protect the alliance.
Building a strong alliance requires that you fully integrate the
client’s individual strengths, expectations, needs, and abilities into the
therapy.
Maintaining the alliance depends to a critical degree on you never
becoming defensive should the client manifest negativity or hostility.
THREE CORE CONDITIONS FOR A STRONG
THEREPEUTIC RELATIONSHIP
1. Empathy
2. Communicate an unconditional positive regard for the client

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3. Be genuine. This is called “congruence” Being your authentic self with
no pretense.

These three core conditions foster a strong therapeutic relationship
and create an atmosphere where the client feels safe, and doesn’t feel
judged.
We don’t fix the client. We collaborate with them in bringing out
their own ability to address and resolve issues in their own best interest.
The client is the change-maker, they are responsible for making
changes occur, and all work done by the counselor, coach or therapist is
aimed at fostering the natural self-actualizing capabilities within the client.
Empathy
Empathy is defined by famed psychologist Carl Rogers as the
“…sensitive ability and willingness to understand the client’s thoughts,
feelings and struggles from the client’s point of view.”
It is important to make efforts to understand your clients’
experiences and to demonstrate this understanding through responses that
address the client’s needs as the client perceives them.

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Empathy is more than parroting back the client’s words, or reflecting
back only the content of what they say. Rather, the idea is to “tune in” to
the emotional component as experienced by the client.
You express empathy in many ways including very direct responses
that let the client know you understand their experience, and responses that
validate the client’s perspective of the experience. The aim is to help bring
the client’s inner and outer experience vividly “to life’ -- – not just the nuts
and bolts of a past event, but the heart and soul of it as the client
experienced it then, or experiences it now, and what influence it has on
their choices and behavior..
As Dr. Robert Hare said of those without empathy, “they know the
words, but not the music.”
Remember: Just because you understand the client, doesn’t mean the
client feels understood. Empathy is inseparable from all other aspects of the
client relationship. There is a power in authenticity, having an honest high
regard for your client, and having a sincere and heartfelt interest in their
well-being.
The secret of success, said comedian George Burns, is absolute
authentic sincerity. Once you learn to fake that, you’ve got it made.
Empower the Client

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The basic process used to empower the client is as follows:
1.

Expression of Feelings: the client is encouraged to discuss what they
feel is troubling them.

2.

Reflecting the Client’s Problem and Situation: You communicate back to
the client the core message that they gave you, proving that you were
paying attention and understand what they said. Reflecting leads to

3.

Clarification of Client’s Problem and Situation: The client decides what
changes to make to achieve personal growth.
When these conditions exist, the clients are encouraged to \
1 Explore their situation
2 Discover what concerns them
3 Identify ways they can make positive changes in their lives.

Remember to ask open questions: Avoid, if possible, close-ended
questions that lead to limited or one-word responses. Use open-ended
questions that create conversation and allow for exploration of issues.
A valuable technique used in reflective listening is to keep the
conversation moving through extending what people are saying – continue
the sentence or paragraph that they started.

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We want to keep people talking and expressing their thoughts,
feelings, attitudes and opinions. In doing so, and responding with sincere
interest and empathy, the clients are assured that you are listening to them
and understanding what they are saying.
Reflectively listening also implies that you are honestly interested in
the person and their topic. Avoid saying anything that would shut them
down or embarrass them. Don’t give advice, warnings, or agree or
disagree. Don’t shame them, blame them, judge them or give them lectures
on morality or show any signs of disapproval or approval when they tell
you about the hookers they picked up at the casino after hitting the jackpot,
renting a room, and snorting hundreds of dollars’ worth of cocaine off their
backs while having sex with them atop the bureau drawers before
stumbling home with wide eyes and an empty wallet.
You can, however, be empowering. That means you verbally
acknowledge your client’s strengths. Affirming peoples’ strengths and
effective strategies helps to promote or increase self-efficacy.
• Constantly summarize information: Summarizing is a technique to
help clients collect information, to link different pieces of information
presented at different times, and as a transitional summary to mark a shift
in focus. Summarizing is a skilled technique that helps people by framing

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multiple pieces of information in a coherent and chronologically organized
story. The story is used to help clients reflect on what they have said and to
increase awareness of discrepancies and linkages between destructive
behaviors and outcomes.
The key to change is getting clients to initiate self-motivation
statements. People are more likely to change if they argue for the
change themselves
An effective technique for eliciting self-motivational statements is to
have individuals discuss and write down the good (i.e., pros) and bad (i.e.,
cons) associated with gambling. A partial goal of this task is to openly
acknowledge some of the benefits, as seen through the clients’ view, of
continued gambling.
The other goal is to compare the costs versus the benefits of
continuing to gamble at their current level. This can be accomplished by
using a simple table (i.e., form) with two columns. The first column is the
pros of the behavior, such as the pros or benefits of gambling. The second
column is the cons of the behavior, such as the negative consequences of
gambling.
If the list of pros or benefits is larger than the list of cons or negative
consequences, the pro behaviors are more likely to occur or continue to

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occur and the opposite will be true if the list of cons or negative
consequences is larger than the pros. Writing down the lists helps clients to
organize and visualize the issue they are struggling with.
There may be times when, despite your best efforts, you space out
or lose your concentration while a client is telling you of a significant life
event. They say something that requires a response, and you have no idea
what they were just saying. What do you do?
Think of the last thing you remember them talking about before
you lost your connection, and say “I want to go back to what you said a
minute ago about….” Have them explain that a bit more, and then
continue.
This accomplishes three things: you get reconnected, the client has
further opportunity to clarify something of importance, and safeguarding
your alliance.
Gambling is learned behavior
No one is born knowing how to consciously do anything. We learn
just about everything. As adults, or at least by an age of supposed
“maturity” to one cultural degree or another, we develop behavioral habits
and preferences based on a simple formula that some folks call “The
Chinese Restaurant Model.”

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You try it. You like it. You keep going back.
You like it because you have a rewarding experience.
Operant Conditioning.
Operant conditioning says “When we reward a behavior, it
increases. When we punish a behavior, it decreases.”
On the surface, the simplicity of this concept makes it appear to
make sense. However, the “sense” of it only works when we understand
that “punishment” and “reward” can be the same thing: personal attention.
When that is the case, punishment increases the behavior.
If the only predictable and instant personal attention a person
receives from family or society is punishment for misbehavior, punishment
becomes the reward, and the negative behavior increases in direct
proportion to the punishment/reward/attention.
The more you punish someone for lying, the more they will lie.
The more a liar is rewarded for telling the truth, the less they
will lie.
So, we need to redefine “punishment” and “reward” in the context of
reinforcing learned behavior. In behavior modification, or breaking
established behavior patterns the punishment is to ignore the behavior, but
reward the absence of it.

37

In fact, the fastest way to destroy any relationship is to ignore the
other person. There is nothing more rejecting and hurtful than being
ignored.
Getting back to our Chinese Restaurant Model –
We try it. If we enjoy it, the pleasure is our reward, so we go back
again. If we try it and don’t like it. We don’t go back.
People with gambling problems learned that gambling was fun
probably the first time they played and won. According to the principles of
operant conditioning, rewarded behaviors will increase. Gambling is an
activity where the reward (winning) is immediate.
If you hit a jackpot when you first walk into the casino and sit down
at a machine, that instant reward makes a huge positive impression on your
brain.
So what? Everyone has that same instant reward experience if they
play a slot machine and win, so who are those few people who have
gambling problems?
The Three Pathways to Problem Gambling
There are three basic types of folks with gambling problems, and
they have three separate pathways that get them to Problemville

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. Each begins gambling for different reasons. Once they start, all
three types of gamblers undergo the repetition and reward learning process.
Here's how each pathway works.
•The first type of person is really perfectly fine. They are not
impulsive, compulsive, obsessive, nor are they ADD with an S.U.D or an
STD. They are just having good clean fun.
What sends them on the path to problem gambling is that they are
superstitious, believe in “luck” as some sort of independent “power” that
can be manipulated, and they believe that they have a deep personal
relationship with the slot machine similar to the relationship that some
Christians imagine they have with Jesus.
These people are not mentally ill nor are they idiots – they simply
believe idiotic things. These people, however, are the easiest people to
treat because all they need to recover is to correct their absurd beliefs. In
fact, these folks may recover without any professional help.
•The second type starts off with problems – these people are
emotionally vulnerable anxious, depressed, have poor problem solving
skills, and are easily stressed out. They were unhappy kids, and are even
unhappier adults. The reason they are depressed and anxious could be the
result of childhood trauma, genetic defects in the brain, of perhaps a brain

39

injury such as mom running over their head with the car – it doesn’t much
matter – the point is these are not happy people.
They turn to gambling for escape, to relax, to feel normal and alive.
Like the first group, they become conditioned by the jolt of excitement that
betting brings. As long as they are gambling, they have a respite from the
emotional pain. That may be delightful and useful, but if the gambling is
actually causing more depression and more anxiety that in turn requires
more gambling, these tragic individuals may need more intensive
treatment, including medications for their depression and anxiety.
•The final type of impending pathological gambler is a real mess.
This person is highly disturbed, has plenty of brain problems, most of them
inherited. He or she is also impulsive, irritable, probably drunk or stoned,
is easily bored, hyperactive, has difficulty paying attention, and also has
difficulty committing suicide successfully.
The fact that they have tried to kill themselves and failed is not good
for their self-image, which is already pretty murky. They gamble for thrills
and adventure and are probably pissed off that it isn’t all that exciting,
despite all the bells whistles and false alarms of things that look like they
“almost won.”

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No one is happy when these folks come around, and although they
go on wild gambling binges, casinos would rather they stayed home
because their attitude and demeanor are a real buzz kill and give
responsible gaming a bad rap.
Because this groups’ problems involve medical, psychiatric,
psychological and emotional issues, in addition to sharing the same type
of silly superstitions as the other groups, these are the most difficult to
treat. Not impossible, only more difficult
There are two things all three groups have in common: all of them had
to “learn” to gamble irresponsibly. This learning process is often termed
Learning by reward. The second thing all of them in common are
“cognitive distortions” – a fancy way of saying they believe stuff that is
complete nonsense.
Learning by Reward.
Anticipation of a random reward is a delightful treat and
encourages both eagerness and patience.
If the reward is predictable, you become complacent. If the reward
never happens, why bother? But if you know it’s coming – the reward, the
jackpot – the free bonus games – but you don’t know when, that is what

41

makes you keep on playing... “One more” and “one more” and “just one
more” because maybe the next pull is the one with the reward.
Cognitive Distortions.
Pathological gamblers – the folks at the far end of Problem Gambling
--have more distortions than those who are not Pathological Gamblers.
Here are typical types of “Cognitive Distortions” (believing nonsense)

 MAGNIFICATION OF SKILL This is when the gambler thinks
they have better skill than other gamblers – especially skill at games
that require no skill at all such as slot machines. When they lose, they
believe it is because the machine is cold. When they win they believe
it is because of their superior skill.
 SUPERSTITIONS – Examples: (a) if I chop off the paw of a dead
rabbit and put it on a key chain, and put that in my pocket, a slot
machine in Las Vegas will pay me more money more often. (b) If I
wear my lucky underwear, the Yankees will win the World Series. (c)
The reason I didn’t win is because I forgot to tug three times on my
left earlobe before hitting “spin.”
 Gambler’s Fallacy: “My luck HAS to change! I’ve been losing, so
my big win must be real close!” Oh, yeah? WHY? Here is a simple
example of Gambler’s Fallacy.

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This coin has landed heads-up nine times in a row. Therefore, the odds
of it landing tails-up next time are increasing. In fact, after landing heads
up nine times in a row, it will probably land tails-up next time it is
tossed. Right? That makes sense, doesn’t it? No. It doesn’t make sense
at all. In fact, that is Gambler’s Fallacy.
The truth is that when a coin is tossed, the odds of it landing heads or
tails are 50/50. Period. That’s it. It doesn’t matter how many times the
coin is tossed. Each toss is its own event. Past results have nothing
to do with what will happen next.
It is the same for slot machines. Each spin is a singular event with no
ties or relationship to anything that has gone before. This is not a topic
where opinions differ. There is only fact and fiction. The fact is that the
machine has no memory of what happened on the previous spin, nor
does it even know you are playing it. It is a machine. .
 Luck/Perseverance, is a form of magical thinking that has nothing to do
with reality. Problem gamblers exhibit a strong level of belief that sheer
continuation in gambling (luck perseverance) results in success. They
also tend to believe that “luck” is personal rather than a situational
characteristic.

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 Illusion of Control, which reflects an individual's perception that his/her
behavior influences chance occurrences, which, of course, it doesn’t.
(Differences in cognitive distortions between pathological and non-pathological gamblers with preferences for
chance or skill games.Myrseth H1, Brunborg GS, Eidem M.)

Operant conditioning – the reward that conditions you – has given
therapists several effective modes of treatment.
The basic idea is to reward people for making healthier, recoveryoriented choices. However, the rewards must have some value, and the
reward must be substantial.
There was a fellow whose wife came up with operant conditioning to
get her husband to stop smoking. Every time he wanted a cigarette, she
would perform oral sex on him. The only problem was that after sex, he
always wanted a cigarette. While he indeed quit smoking, neither one of
them ever got anything else done.
The Process of Change
The accomplishment of anything depends on a three-part process of
knowledge, volition, and action. Knowing what needs to be done isn’t
enough. Thinking about it isn’t doing it. Volition is the decision to do
something, but that too is useless without action—without actually doing it.

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Most people never get to the follow-through stage of action, especially
when it comes to changing long-established behavior.
There are many theories of behavior change, and all of them offer
useful insights. The Stages of Change model shows that behavior change
occurs gradually, going through progressive stages. While the process is a
bit more complex in reality and the stages overlap, you can get the basic
idea easily enough by reading the following.
Pre-contemplation. The person is uninterested, unaware, or
unwilling to make a change. He or she is not even thinking about changing
and may react defensively to any suggestion that a change in behavior is
needed.
In this stage, the process of engaging the individual in his or her own
process of change is very important. Enlist their opinion, value their views.
The days when client’s needs and perspectives were ignored are far behind
us. The increase in availability of information, developments in new
technology, and changes in public attitudes mean that clients want to
interact differently with their treatment providers. In this stage, a simple
friendly comment, such as “perhaps you would consider reducing your
gambling bankroll by 25% -- not losing that money might be as rewarding
as winning it.” (Said with smile. No recrimination, no negativity)

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Contemplation. The person is considering changing, weighing the
pros and cons of the change. If he or she being asked to give up something
enjoyable, the sense of loss is an honest consideration.
Preparation. They are preparing to make the change. Indicators that
they are preparing to greatly modify their gambling patterns might be if
noticed if they play penny slots instead of dollar machines, and selected
penny slot machines with 20 lines of play rather than 50 lines.
Action. Any action taken toward the desired behavior change should
be praised.
Maintenance. If they continue the behavior change for six months,
that is significant.
The stages of change are not always linear. They are components of
a cyclical process that varies for each individual. For this and many other
reasons, individualized care is imperative.
Motivational Interviewing and Practices
Motivational interviewing (MI) is a non-confrontational, cognitivebehavioral intervention that is used to help people become more aware of
any behavior that needs to be modified and to increase internal motivation
to address the problem (Miller and Rollnick, 2002).

46

Motivational Interviewing was specifically designed to help
individuals progress through the first three stages of cognitive change –
pre-contemplation, contemplation, and determination. The technique was
designed to help people move into the action phase of change.
A key component of Motivational Interviewing is to show or bring to
the client’s attention discrepancies between their gambling behavior and
other more valued aspects of clients’ lives.
The purpose of developing a discrepancy is to illuminate how the
behaviors, such as irresponsible gambling, is at odds with the more valued
aspects of the persons’ life, such as obtaining and maintaining a job.
Many individuals in the early stages of change are unable to see fully
the connection between problem gambling and the consequences (results)
of their problematic behavior.
To create a discrepancy, we need to first understand what is
important to clients or what they value. The next step is to compare the
two conflicting goals for clients using their own language and value
system. Examples of potential conflict can include:
Wanting to continue betting on the horse races while wanting to
improve the relationship with a partner who lives in fear of financial
devastation as a result of the client betting on horse races.

47

wanting to gamble and also wanting to save up money for a car.
wanting to spend all spare time in the casino and wanting to be
more involved in their children’s lives.
Therapists, counselors, coaches and even family members need to
not attempt to impose their values on the client. Take the time to
understand what clients really value as opposed to what they have been told
to say or report is valuable.
When creating discrepancies, present the potential conflict in a
subtle and matter-of-fact manner. Simply highlight the conflict as a basic
question for clarification, such as “I thought you wanted to save up some
money to get a car, will your ongoing gambling interfere with you
achieving this goal”; “will your gambling Friday night affect your
depression, or can you feed the slots without feeling sad or ashamed the
next day?”
The goal is to simply illuminate the discrepancies in the clients’
own thinking and planning process. It is helpful to keep a list of goals
that clients would like to work on and to highlight these goals when clients
indicate that they would like to use their time and money to repeat
established patterns of problem gambling.

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An important component of Motivational Interviewing that
differentiates it from more traditional treatment interventions is that
confrontation is avoided rather than created.
Use reflection rather than confrontation to deal with, roll, or go with
resistance. Through the process of reflection, you create opportunities to
further explore the clients’ reasons for resistance or ambivalence.
If we are arguing with clients, we are not using motivational
interviewing. We must constantly avoid any direct argument. Rolling
with resistance is a useful technique for keeping people engaged while they
work through their own ambiguity. By avoiding a direct argument, we can
keep people talking and communicating.
Below are three examples of how this technique can work while
working with clients who are not cognitively ready to address their
problems.
Let’s look at some common client statements, the confrontational
approach, and then the preferred “Rolling with Resistance” approach.
Rolling with resistance
Client statement “I don’t have a gambling problem. Everyone else is
the problem.”

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Confrontational approach: “You just threw your entire savings
account away chasing after gambling losses, you were fired from your job
for missing work; and your wife is ready to leave you. Face it --you have a
gambling problem.”
Rolling with Resistance approach: It sounds like a lot people have
been hassling you about your gambling. Can you tell me what other
people have been saying or what are some of the issues that led you to
coming into treatment?
“I don’t want to take the medications; they don’t work and I don’t
like taking them.”
“You have been diagnosed with ADD and Obsessive/Compulsive
Disorder. You need to take the medication as prescribed by the doctor; the
medications will help you”
It sounds like your frustrated with the medications and that they
are not working as you had hopped, can you tell me more about the
medications that you don’t like or what is not working?
The purpose of rolling with resistance is to better understand the
clients’ position or perspective. Instead of challenging clients, explore
the issues with them, so that both parties have a better understanding

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of the problem and why clients may still be unaware of the severity of
the problem.
The essence of motivational interviewing is to nurture and
promote self-efficacy in the process of change.
Clients are more likely to change or to attempt to change if they feel
that they have the capacity and power to do so. Self-efficacy is how people
view their own capacities and strengths.
MI is used to increase self-efficacy by allowing individuals to
develop successful strategies for changing their behaviors. This can be
accomplished by examining clients’ past successes and reminding them of
these experiences as they take on new activities and behaviors.
Self-efficacy can also be accomplished by helping people take and
achieve baby steps that promote positive learning experiences
The key theme of motivational interviewing is to work with
people where they are in their readiness to change and not where you
think they should be.
The Process of Effective Treatment.
Most people with problem gambling issues, often coupled with other
troublesome mental health issues including immoderate use of recreational
drugs feel overpowered and helpless. They yearn for hope and a sense of

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empowerment. An important aspect of effective treatment includes
empowering patients to see themselves in partnership with their physician,
strengthening their physical, emotional, and mental health.
An important aspect of effective treatment is individualized
cognitive behavioral therapy, also known as CBT. This therapy is a
form of psychotherapy that emphasizes the important role of thinking
in how we feel and what we do.
There are several approaches to cognitive-behavioral therapy,
including rational emotive behavior therapy, rational behavior therapy,
rational living therapy, cognitive therapy, and dialectic behavior therapy.
All of these cognitive-behavioral therapies are based on the idea that
our thoughts cause our feelings and behaviors, not external things like
people, situations, and events.
Even if a situation remains unchanged, how we respond to that
situation can change. We can choose our response, making a conscious
decision to respond in ways that are in the best interest of our health
and happiness.
In conjunction with CBT, there is another therapy proven valuable in
treating adolescents and substance misuse clients. Motivation enhancement
therapy (MET) has been thoroughly researched in the field of substance

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misuse, most especially with young people, and has proven to be
exceptionally effective at enhancing an individual’s motivation to make
positive changes in behavior.
An effective treatment must help clients address, identify, and
describe the personal meaning of their behavioral problem.
Are they self-medicating, filling up an inner emptiness, numbing
feelings related to a trauma, or all of the above?
Unless clients understand what they are actually doing on a deep
level, they will chronically relapse.
A responsible comprehensive treatment program takes all aspects
into consideration for the ongoing health and well-being of the client.
Dealing with Triggers for Problem Gambling
Once you recognize the situations or events that trigger a desire to
gamble, you can “outsmart” the triggers by having a damage control plan
in place.
Common Gambling Triggers






Getting money (payday)
feeling bored, restless, angry, depressed or lonely
money worries or rising debts
drinking or taking other drugs
reading the sports section and daily market figures
passing places to gamble, TAB, pubs, clubs, casino
spending time with friends who gambling

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 Regular gambling times.
Once you’ve identified your triggers, you will find it easy and rewarding to
work out (1) Protection, and (2) Damage Control.
For example if getting paid is your trigger, you outsmart it by
arranging to have you pay split into two accounts – a savings account with
no ATM access, and your regular bill-paying account.
Set up automatic payment of your regular monthly bills such as gas,
electricity, telephone, auto payment and rent from your bill-paying
checking account. This way your bills always get paid first!
When you get off work on payday, the first thing you do is go
directly to the grocery store and buy groceries or those store cards that are
used only at the grocery store. Now you know that you have your grocery
needs covered till next payday, you also know your bills are paid. What a
relief!
As for the other triggers, there is a simple way to keep them from
having an impact. It is called DSEI-30. That means Do Something Else
Instead for thirty minutes.
Triggers give up after a half hour. So, DSEI for a half hour, and you
usually have the trigger defeated.

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The DSEI can be watching a movie, going for a walk, or actually
doing some fitness enhancing exercises. It has been proven that ten
minutes of healthy exercise can reduce cravings for drugs, alcohol or
gambling by 50%.
In the words of fitness expert Felicia Lawson, “Exercise can work
quickly to elevate depressed mood in many people. Although the effects
may be temporary, they demonstrate that a brisk walk or other simple
activity can deliver several hours of relief.”
When you encounter a trigger, you have power over it – no doubt
about it. DSEI-30 tricks the trigger every time.
Another trick when encountering a trigger is to take in a slow deep
breath through your mouth, hold it, and let it out through your nose. That
influx of oxygen to your brain, and the focus of concentration on your
breathing, diffuses the trigger. Another victory for you!
What about a slip/relapse?
People always do exactly what they want to do, sooner or later.
Even if the result of the action is not pleasant, if the trigger to engage in
what you enjoy (short term pleasure) is strong enough, you are going to do
it. That last thing you want to do is punish someone for relapsing. If you

55

punish someone for gambling, they will only want to gamble more,
especially if they are an adult.
This relates to a long-standing rule – if a woman discovers that her
husband has a mistress, she must never ask him to choose between the two
He will almost always choose the mistress. Why? Simple. If he chooses
the wife, she will forever hold the past over his head, continually put him in
a subservient position to her and he will be miserable. He knows that, and
therefor chooses the mistress as she will not be in a power position over
him.
It is the same with any behavior you enjoy that someone else wants
to curtail. If you also wish to curtail that activity, stop it completely, or
moderate it, then you are in collaboration, but if someone wants to “fix”
you, “reform you” then it becomes a game as to how outsmart the person
trying to do so.
The person who wants to not be controlled by triggers or
compulsions will, with the help of a therapist or treatment professional,
regard the slip or relapse as a learning opportunity, and they will devise
even more clever and effective ways of circumventing the negative
potential of a slip or relapse.

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There are many wise people in recovery from Problem Gambling
who intentionally put up behavioral fences – real life “borders” that keep
them from straying into danger zones. These “fences” or “behavioral seatbelts” include such things as intentionally limiting their access to cash, and
voluntarily requesting to be placed on a casino exclusion list.
It is important that the cash access limitations and the casino
exclusion be 100% voluntary. If not, the person is likely to rebel.
The Voluntary Exclusion Program is available to any individual who
wants it, and only that individual can sign up for it. No one can force you
to ask for a Voluntary Exclusion – that’s why it is called “Voluntary.”
The program offers individuals the ability to ban themselves from a
casino facility for one year, five years or their lifetime. The Voluntary
Exclusion Program demands the following:
A participant agrees to refrain from entering a casino facility.

The participant’s name shall be included on a list of persons excluded
from all casino facilities.

The participants and their personal information is confidential.

The casino operator is required to make all reasonable attempts to
stop all direct marketing efforts to participants.

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A casino operator will not cash a check or extend credit to a program
participant.
There are consequences if you enroll and do enter a casino. You can

be charged with trespassing and you will be forced to forfeit any winnings.
The Voluntary Exclusion Program only applies to the State in which
you sign up. Some folks put enroll in the program in several states if they
have a past history of problem gambling in those states.
The Casinos also actively do their part beyond the Exclusion
Program. A variety of approaches by casinos promote responsible gaming
including, customer awareness campaigns, employee training programs
financial restriction programs, written procedures for recognizing
and managing these issues, and ongoing monitoring and review to gauge
the effectiveness of these programs.
In many states, each casino is required to prominently display the
Problem Gambling Helpline number on all collateral materials, player
cards and ATM machines. Some states require that the helpline number
appear in all print, broadcast and electronic advertising and marketing, and
promotional materials must be reviewed and approved by State agency
responsible for ensuring the consistency of the Problem Gambling
message.

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Gambling is often used to avoid or escape from especially painful
feelings (shame, guilt, helplessness, depression) or from some problem in
life that seems unsolvable.
Gambling as Avoidance
While gambling, some people feel they are escaping their
problems…even temporarily. While gambling, they don’t have to think
about anything. Of course, the same thing can be accomplished much less
expensively by watching the Cartoon Network.
Problem Gambling creates problems other than, and in addition to,
the original problems that the person wanted to avoid.
Avoidance, as a way of coping with problems, is habit-forming.
People develop a repertoire of different ways they avoid dealing with
uncomfortable or difficult situations. Unresolved situations do not resolve
themselves. Problems that require personal attention will patiently wait for
you, quite often growing larger and larger the longer they wait.
However, no problem is as big close up as it looks from far away.
The sooner you avoid avoidance, the sooner you deal with the
problem with same dexterity as you deal cards, the sooner it is resolved.
If you have been using your gambling to avoid or escape from some
underlying problem, and if you have stopped (or gained control of) your

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gambling, you now have a choice: You can find other ways to avoid or
escape problems, or you can confront them, and find healthy ways to deal
with them.
Strategies:
Which of the following strategies might be helpful?
 Talking to a friend, family member or therapist
 Writing, keeping a journal or diary
 Learning to relax, through meditation, yoga, or breathing
 Getting regular exercise
 Attending Gamblers Anonymous or other support group meetings
 Learning anger management
 Having sex every time you want to gamble
BOREDOM
Many gamblers have a problem with boredom, especially when they
have recently stopped or cut down. Now that they have more time
on their hands, they wonder what to do with themselves instead of
gambling. This can be very exciting – and, for some people, a bit
uncomfortable. Now that all their time isn’t being used up gambling
they can try new things. You might make a list of fun things you
would enjoy doing if you knew how to do them – activities or
hobbies unrelated to gambling. Perhaps there was something they
used to do before they started gambling – something that isn’t either
a felony or misdemeanor – that they would enjoy doing again, or a
new activity that they have always wanted to try.

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Family Issues
The #1 impact on the family with problem gambling is financial.
Depending upon the actual financial damage, or the exaggeration of
damages based on “what if” worst case scenarios which has the family
upset over things that have not happened, is the degree to which the family
members feel betrayed, angry, suspicious or get all wound up.
These feelings make it harder to solve problems. And here is where
one danger far exceeds all others – the danger that the person who is
dealing with issues related to problem gambling may experience isolation
from his loved ones.
Wives or husbands or significant others may not want to be
emotionally or physically close to the person who, more than ever, needs
closeness, acceptance, and love. Even close friends may turn away over
unpaid debts.
Such erroneous justifications for withdrawing support and affection
include “He must experience the consequences of his actions. He must take
responsibility and face the music.”
Usually this is said by people who confuse punishment with
consequences. If you stick your finger in a light socket, the consequence
will be a life-threatening electric shock. That is cause and effect.

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Punishment is not a natural consequence of behavior. Committing
crimes against society may result in criminal charges, and there are
consequences to being found guilty. If voicing your opinion on a
controversial issue results in you being beaten within an inch of your life,
that is NOT a natural consequence of voicing your opinion,
Your spouse threatening to leave you because you played gin rummy
last week and lost ten dollars is NOT a consequence of gambling. It is the
consequence of marrying a control freak.
Families may have unreasonable expectations of progress or
behavior change, and the stress upon the person recovering from problem
gambling may be almost unbearable. If there is harsh judgement and icy
isolation coming from those who supposedly love you, the fact that you can
sit in a bar, a dope house or a casino and get more support and
understanding from complete strangers than you do from those who know
you, is an excellent motivator to stay away from home, do more dope,
drink and gamble.

Help with Additional Gambling Related Problems
Families recovering from the harm of Problem Gambling may
require help in practical issues such as financial management, budgeting,

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and other basic aspects of life impacted by gambling. Part of your role
may be connecting them to available services.
Low-Risk Gambling
Not everyone who experiences negative effects from gambling and
recognizes these negatives is going to commit to abstinence. It may be, for
them, an honestly undesirable concept that they equate with punishment
rather than healing. For those people, if they are far from the compulsive
gambler diagnosis, establishing low-risk gambling protocols may be a
reasonable and valuable approach.
Low-risk gambling means people:





Limit how much time and money they spend gambling
Accept their losses, and don’t try to win them back
Enjoy winning, but they know it happened by chance
Balance gambling with other fun activities
Don’t gamble to EARN MONEY or pay debts
Don’t gamble when their judgment is impaired by alcohol or

other drugs
 Never borrow money or use personal investments or family
savings to gamble
 Don’t gamble to escape from problems or feelings
 Don’t hurt their job, health, finances, reputation or family
through gambling

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If these standards seem contrary to your usual gambling profile, or
that of your friend or family member, low-risk gambling is most likely not
going to work.
Absolute Honesty
Recreational game players do NOT gamble to make money. They
don’t gamble in anticipation of big wins. They are simply paying to enjoy
playing a game that they find fun to play. They may enjoy playing slots
where they can win free games, even though they may not win any money
over all. The recreational gambler isn’t chasing losses because they didn’t
lose anything. They paid for a fun experience. If they leave the casino with
the same amount they came in with, they are very happy. If they leave with
less, they are still happy. Non-Problem gamblers are not chasing wins or
losses.
If you think of gambling as a way to make money, or as a way to
make up for losses, you are not ready to play the game.
Paying money to play a game is no different than paying money to
rent a row boat on a little pond. You may have fun, you may not. You may
enjoy the exercise, and if the boat owner gives you a bit of your money
back just for the heck of it, that’s nice but not expected. No one rows the

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boat in a circle expecting the row boat to pay their bills or get back the
money they spent last week on another row boat.
A slot machine is simply an electronic row boat with flashing lights
and noises. You rent it and take yourself for a little ride. You pay for the
experience of the ride. Oh, every so often, for no reason whatsoever, some
rower gets his money refunded. Usually they use it to rent the row boat
again. That’s all there is to it.

Support Groups
Gamblers Anonymous:
“GAMBLERS ANONYMOUS is a fellowship of men and women
who share their experience, strength and hope with each other that they
may solve their common problem and help others to recover from a
gambling problem.
The only requirement for membership is a desire to stop gambling.
There are no dues or fees for Gamblers Anonymous membership; we are
self-supporting through our own contributions. Gamblers Anonymous is
not allied with any sect, denomination, politics, organization or institution;
does not wish to engage in any controversy; neither endorses nor opposes

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any cause. Our primary purpose is to stop gambling and to help other
compulsive gamblers do the same.”
“We learned we had to concede fully to our innermost selves that we
are compulsive gamblers. This is the first step in our recovery. With
reference to gambling, the delusion that we are like other people, or
presently may be, has to be smashed. We have lost the ability to control our
gambling. We know that no real compulsive gambler ever regains control.
All of us felt at times we were regaining control, but such intervals usually brief -were inevitably followed by still less control, which led in
time to pitiful and incomprehensible demoralization. We are convinced that
gamblers of our type are in the grip of a progressive illness. Over any
considerable period of time we get worse, never better. Therefore, in order
to lead normal happy lives, we try to practice to the best of our ability,
certain principles in our daily affairs.”
Gamblers Anonymous is an excellent adjunct to therapy, and the
support of other people who share your concerns is wonderful. They are
available 24/7, and have online meetings and phone support as well.
Not everyone, however, is comfortable with 12=Step programs, and
there are alternatives to G.A. that may be more to your client’s liking.

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Remember, choosing the appropriate support group is up to the client, not
to you.
SMART Recovery is an alternative to Gamblers Anonymous (GA) as
well as other 12-step programs. This program using concepts of CognitiveBehavioral Therapy as the essential foundation of their program of support
and self-help.
SMART Recovery’s potential effectiveness for assisting individuals
to find relief from problem gambling is supported by research. SMART
Recovery provides its members with tools and support that they can use to
help them recover from addictive gambling behaviors as well as other
negative and unwanted behaviors.
1. Enhancing & Maintaining Motivation to Quit – Helps you identify
and keep up with your reasons to stop gambling. Why do you want to stop what will keep you focused on that goal?
2. Coping with Urges – Dealing with urges is part of recovery.
SMART has tools designed to help our members cope with urges.
3. Managing Problems – We frequently turn to our addictive
behaviors (like gambling addiction) to either escape from or avoid
addressing problems. SMART Recovery participants learn problem-solving
tools to help them manage challenges along the way.

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4. Lifestyle Balance – SMART give members skills to help balance
both short and long-term goals, pleasures and needs that were once out of
balance.
If you would like to GET STARTED right away, you can join the
online support community where you can read, share and learn from their
worldwide network of members at any time of the day or night. Be sure to
CHECK out our Gambling Addiction support forum there.
http://www/smartrecovery.org
Another resource is Gamblingtherapy.org -- an online support
service for people outside Great Britain with gambling problems and those
affected by others gambling. Their online services include a Live Advice
Helpline, Forums, Group therapy as well as email support in other
languages. They also have a resources database to look for other options.
For more details please explore their website.
www.gamblingtherapy.org
There is much to learn about obsession and compulsions, the matrix
in which they develop, the role of genetics, environment and other factors.
In the USA we continue focusing on the individual who, for whatever
variety of reasons, experiences harm to themselves and those connected to
them because of gambling.

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In other countries, the focus is not on the individual but on the harm
of problem gambling itself with the individual being one aspect.
Advancements in medicine, brain imaging and ongoing research in
sociology and psychology give us great hope in alleviating problem
gambling if not entirely, at least greatly reduce it.
Even though problem gambling affects only a small percentage of
those who play games of chance, that percentage is comprised of real
people and their families.
While those of us who work with individuals and families to resolve
their anxieties and despair, renew hope, and encourage recovery, at least we
know that others are working on the big picture of stigma reduction and
harm minimization.
HARM REDUCTION
Responsible gambling and harm minimization programs have shared
goals. Specifically, the aims of harm minimization are:
 To prevent vulnerable individuals from developing gambling
problems.
 To reduce the current prevalence of problem within the
community.

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 To reduce the negative social and health consequences
associated with problem gamblers for individuals, their
families and their communities.
 To maintain a reasonable level of enjoyment from gambling
by recreational gamblers.
 To ensure that the livelihood of those associated with the
gaming industry is not unnecessarily compromised.
The basic assumptions inherent in the harm-minimization/reduction
approach are that:
 Gambling is a recreational activity that is common among
individuals and within the community.
 Many individuals are able to engage in gambling without
negative consequences to their lifestyle or to the community.
 A proportion of participants, family members and others
suffer significant harm as a consequence of excessive
gambling.
 Complete prohibition is not a realistic option.
 Harm reduction involves individuals at risk reducing
gambling to a safe level of the behavior.
 Harm reduction implies that safe levels of participation are
possible. According to Marlatt (1998), there are three basic
harm minimization strategies that can be applied:
1. Education of individuals or groups.
2. Modifying the environment.
3. Implementing changes to public policy

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Through the combined efforts of all who find gaming of
interest, may it become recognized and appreciated as a
simple recreational pastime rather than a metaphor for any
number of unresolved personal issues.

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