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HELPING PROBLEM GAMBLERS

HELPING PROBLEM GAMBLERS. Tony Ting President Association of Professionals Specialising in Addiction Counselling (APSAC). Scope of Talk. Similarities and differences between substance abuse and pathological gambling,

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HELPING PROBLEM GAMBLERS

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  1. HELPING PROBLEM GAMBLERS Tony Ting President Association of Professionals Specialising in Addiction Counselling (APSAC)

  2. Scope of Talk • Similarities and differences between substance abuse and pathological gambling, • An overview of the core competencies of an addiction counsellor and how to apply the core functions, and • The addiction counsellor certification process.

  3. Pathological Gambling: Comparison to Substance Abuse • Similarities (up to 80%, Custer) • Progressive • Loss of Control • Preoccupation • Cravings • Negative impact on major life areas • Tolerance

  4. Pathological Gambling: Comparison to Substance Abuse • Similarities (up to 80%, Custer) • Withdrawal symptoms • Disruption of family life • Used as a way to escape, gain excitement or euphoria

  5. Pathological Gambling: Comparison to Substance Abuse • Differences (about 20%, Custer) • Gambling is not self-limiting • Behaviour not attributable to intoxication • More intense sense of shame and guilt • Greater denial and stronger defenses

  6. Pathological Gambling: Comparison to Substance Abuse • Differences (about 20%, Custer) • Unpredictable outcome • Fantasies of success • No biological test • Easier to hide

  7. Pathological Gambling: Comparison to Substance Abuse • Differences (about 20%, Custer) • Greater financial problems • Intensity of family anger • Less public awareness and acceptance

  8. The Association of Professionals Specialising in Addiction Counselling (APSAC) • Established in September 1998, APSAC is an independent, not-for-profit body that offers certification to addiction counsellors who meet the internationally established and recognised standards of professional competency. • It offers 4 credentials: • Certified Substance Abuse Counsellor (CSAC) – since 1998 • Certified Clinical Supervisor (CCS) – since 2000 • Certified Master Addiction Counsellor (CMAC) – since 2001 • Certified Gambling Addiction Counsellor (CGAC) – since 2005

  9. APSAC • It is a member of the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse (ICRC), an umbrella body comprising Certification Boards in 44 states, 2 US territories, and 12 foreign countries. Over 35,000 certified addiction professionals currently belong to ICRC Member Boards. • Through its association with ICRC, certified counsellors from APSAC may re-locate and receive reciprocity from member boards in the U.S., Canada, Sweden, Germany, the UK, Puerto Rico, Costa Rica, Iceland, Israel and Bermuda.

  10. Gambling Counsellor Certification • Certification has a dual purpose: • To assure the clients that they are receiving competent care from a trained professional • To establish a standard, and means of assessing achievement of that standard that represents competent care for problem gambling clients.

  11. APSAC’s Certification Model

  12. Certified Gambling Addiction Counsellor (CGAC) 1. Three (3) years (6000 hours) of work experience as an addictions counsellor, including 300 hours of training in the knowledge and skills necessary to perform the 12 core functions of an addictions counsellor, inclusive of 100 hours as a gambling addiction counsellor. 2. 270 hours of education specific to the addictions counselling field, including at least thirty (30) hours of gambling specific training or education and six (6) hours in professional ethics.

  13. Certified Gambling Addiction Counsellor (CGAC) 3. Successful completion of the National Gambling Counsellor Examination administered by Professional Testing Corporation, NY, USA.  4. The certification is valid for two (2) years, after which recertification must be sought with proof of forty (40) hours of continuing education earned over two (2) years.   

  14. The 12 Core Functions Of The Addiction Counsellor

  15. A Certified Addiction Counsellor • An addiction counsellor is a clinician who has demonstrated competence to perform a range of clinical activities and interventions represented by the 12 core functions: • Screening 7. Case Management • Intake 8. Crisis Intervention • orientation 9. Client Education • Assessment 10. Referral • treatment planning 11. Report & Record Keeping • Counselling 12. Consultation.

  16. The National Gambling Counsellor Certification Board’s (USA) Certification Model

  17. Level I Education: Bachelors Degree in 30 hrs Gambling Specific training and education Passing of the National Gambling Counsellor Certification Examination. Level II Education Bachelors Degree 60 hrs Gambling specific training and education Passing of the National Gambling Counsellor Certification Examination Gambling Counsellor Certification

  18. Level I Experience 100 hrs with gamblers and/or family members In an approved setting With minimum of 4 supervision sessions with a Board Approved Clinical Consultant (BACC) Level II Experience 2000 hrs with gamblers and/or family members In an approved setting With minimum of 24 supervision sessions with a Board Approved Clinical Consultant (BACC) Gambling Counsellor Certification

  19. Gambling Counsellor Certification The certification is valid for 3 years, after which recertification must be sought with proof of 60 hours of continuing education: • 30 of the hours must be gambling specific • 30 can be from any behavioural health field (e.g., psychology, counseling, addictions, etc.)

  20. The Canadian Problem Gambling Certification Board’s Certification Model

  21. Canadian Problem Gambling Counsellor 1. 3500 hours of counselling hours within 5 years prior to application, including 1500 hours of direct client contact with supervision. 2. 800 supervised hours counselling gamblers and significant others within 5 years prior to application. 3. 100 hours of approved gambling specified education. 4. Adherence to the Canadian Problem Gambling Counsellors Code of Ethics. 5. Recertification every 2 years with evidence of 32 hours of approved CE.

  22. Problem & Pathological Gambling COMMUNITY FACTORS * Increased availability * Increased accessibility * Increased acceptability Development of Problem & Pathological Gambling: A Schematic Representation CLASSICAL AND OPERANT CONDITIONING Arousal/excitement: Subjective excitement & Physiological arousal Cognitive schemas: Irrational beliefs & Illusion of control HABITUATION Pattern of habitual gambling established CHASING Chasing wins and losses & Losing more than expected

  23. Types of Gamblers • A Continuum No Gam. Social Gam. Serious Social Gam. Problem Gam. Pathological Gam. Professional Gambler Antisocial Gambler

  24. Types of Gamblers • Social Gambler - Gambles occasionally, for fun, sticks to limits • Serious Social Gambler - Gambles regularly as a hobby, still does not spend more time or money than can afford, sticks to limits • Professional Gambler- Gambles as a way of making a living, a very small number. • Problem Gambler- Beginning to have problems due to gambling. Has 3 or 4 on the SOGS, has 3 or 4 of DSM IV criteria.

  25. Types of Gamblers • Pathological Gambler- Major life problems due to gambling. 5 or more on SOGS, 5 or more of DSM IV criteria) • Anti-social Gambler – gambles as part of antisocial life style. However, can be both ASPD and pathological gambler.

  26. Screening for Gambling Problems

  27. Instruments • DSM-IV • South Oaks Gambling Screen (SOGS) • Lie/bet questionnaire • Gambling Severity Index

  28. SOGS ITEMS • Has a problem with gambling. • Gambles more than intended. • Wants to stop but can’t. • Goes back to win lost money. • Claims to be winning when not. • Hides gambling signs from others. • Peoplecriticize gambling. • Feels guilty about gambling. • Argue about gambling.

  29. SOGS ITEMS • Loses time from school or work due to gambling. • Borrows money from friends, spouse, or household for gambling. • Borrows from banks or credit cards to gamble. • Cashes in stocks/bonds or sells property to gamble. • Writes bad checks to gamble. • Borrows from loan sharks to gamble.

  30. Lie/Bet Questionnaire • Have you ever felt the need to bet more and more money? • Have you ever had to lie to people important to you about how much you gambled?

  31. Case Study

  32. Winning/Social Losing Desperation Hopelessness Progression of Problem Gambling

  33. Case Study - Johnny • Addictions provide a form of escape • He feels lonely & isolated in a new environment • He uses gambling as leisure/ pastime to escape boredom • Addictions always involve pleasure • His gambling habit is reinforced by: • Intermittent rewards feeding his greed • Heightened sense of excitement/ anticipation • Identification with gambling community • Addictions totally control the addict • His cycle of addiction: leisure  Favourite pastime  habit  obsession  addiction

  34. Case Study - Johnny • Addictions are destructive and unhealthy • Life is devastated as evidenced by: • Strained relationship with family & friends (family) • Mounting debts • Inability to fulfill roles as father, husband and worker • Guilt feelings, decreased self confidence • Addicts deny or minimise their addiction • He refuses to give up the addiction, tries to hide it from wife, friends, and employer • Addicts are prone to relapse • He relapses during treatment

  35. Role of the Counsellor • At the 1st Session • Johnny Significant Other • Afraid Angry • Desperate Confused & Hurt • Resigned Determined

  36. Role of the Counsellor • Active / directive • Communicate understanding of gambling problem • Acknowledge his ambivalence • Non-shaming discrimination • Establishing environment of trust and honesty

  37. Role of the Counsellor • Help him deal with pressing problems with strategies that emphasise engagement in the treatment process • Legal conflicts – “I’m about to go to jail…” • Family conflicts – “My spouse is leaving me” • Financial conflicts – “I’m loosing my house…” • Vocational conflicts – “I’m going to lose my job” • Mood stabilization – “ I can’t go on like this anymore”

  38. Role of the Counsellor • Provide Structure • Set Goals, Limits and Boundaries • Help him slow down and focus • Encourage creative problem solving • Non-gambling options • Enhance Motivation • Interpret Johnny’s Defences

  39. Role of the Counsellor • Help Johnny understand meaning of gambling • Encourage self-awareness • Present reality objectively • Confront discrepancies, distortions, irrational thinking • Create structure for recovery • Support systems • Family involvement

  40. Role of the Counsellor • Improve coping mechanism • Meaning of gambling and triggers • Coping skills • Managing cravings

  41. For more information about Addiction Counsellor Certification, please visit our website:http://apsac.org.sg

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