25 June 2012

Gamcare - Working with Problem Gamblers

"If he does not play to win, he does not play to systematically lose either, rather for those breathtaking moments at which everything - absolute gain, ultimate loss - becomes possible" Marc Valleur

I recently attended a 2 day training event in Brighton entitled "Working with Problem Gambling" with GamCare Clinical Training Officer Trevor David.

My training was funded by GamCare as I have recently become an Associate Counsellor for Steven James Counselling, a counselling agency in Poole, Dorset, who are in turn, a partnership agency of GamCare. [please note that I have taken a break from working via GamCare with effect from June 2015 although am still seeing people with gambling issues privately]

Gamcare was founded in 1997 and is a charity that provides information, advice, support and free counselling for the prevention and treatment of problem gambling. They also engage in ongoing research around the issue of problem gambling and work with gambling companies to develop responsible policies.

So, some facts and statistics we learned were:

  • 73% of adults in Great Britain gamble each year
  • Over 1 billion pounds is staked each week
  • After the National Lottery, scratchcards are the most popular gambling activity
  • 14% of the population used the internet to gamble in the past year

Training focused on problem gambling and pathological gambling. In 2010 approximately 0.9% of the GB population met the DSM IV Pathological Gambling criteria up to around 450,000 people. In the USA the proportion is 3.5% and in Hong Kong it's 5.3%. Canada and New Zealand are at 0.5%.

So with the focus on problem gamblers we learned that:

  • Gambling can be used as emotion management - to dispel difficult or threatening feelings and emotions
  • Problem gamblers often believe that they are an expert in what they do
  • They have distorted beliefs about the likelihood of winning money back
  • There is persistence even when losing, and a tendency to "chase losses"
  • There is  toleration of associated costs (financial, personal, social)

There is a risk of suicide with problem gamblers - 13% reported an attempt, and 26% of pathological gamblers had attempted, so this is an important part of the assessment process and shows the necessity of support.

I was relieved that we weren't told exactly how to run the sessions but given background information about gambling and tools to incorporate in our existing practice, including existing models of problem gambling, tips on how to work with inevitable ambivalence and an introduction to Motivational Interviewing which fits in very well with my person-centred/existential leanings. MI is "a collaborative, person-centred form of guiding to elicit and strengthen motivation for change".

The 2 day course was jam-packed with information - there was so much to learn delivered in a variety of teaching methods. What helped enormously was Trevor David's teaching style which, whilst professional and informative, had a distinct edge of sharp humour, self-disclosure and humanity. Since learning that latest neurology states that when we learn, the recall of new facts is enhanced by the presence of certain degrees of emotion during learning” (Antonio Damasio 2000)I have appreciated being taught in a vivacious way that doesn't reply only upon academic fact being imparted.

I see gambling as a form of addiction, not dissimilar to addiction to substances. In the case of gambling, the person is addicted to the neuropeptides and neurotransmitters (the body's natural chemicals) that are released when gambling, whether they win or lose (see quote at the start of this blog post!). The person suffers withdrawal symptoms when they try to stop this behaviour. The cells of their body are used to receiving certain levels of these chemicals and when they stop, their body's homeostatis is sent out of kilter. The unconscious, survivalist part of the brain sends messages to say "get those chemicals" and highjacks the thinking part of the brain (the frontal lobe) into making decisions that will restore the homeostatis - i.e. we will engage in behaviour to ensure we get those certain chemicals we're used to by partaking in gambling. This model of addiction to our own chemicals can help explain why people may struggle with anger, stay in abusive relationships, or not be able to stop worrying.

I also share some of the ideas of the psychodynamic approach to gambling which says that gambling behaviour is a reenactment of an unresolved conflict. This may make sense to you when you consider that there is often a cycle of low self-worth, followed by gambling until one has nothing left, followed by a further dip in self-worth. Why would somebody carry on doing the very thing they are ashamed of, that is getting them into financial and relationship trouble, if there wasn't some pay off in the wretchedness they suffer after the event? The same applies to people with problems with substances.

The GamCare helpline is open daily from 8am 'til midnight:

0808 8020 133

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