Pathological gambling Barriers to treatment and the experience of self-ch.ppt

1、Pathological gambling: Barriers to treatment and the experience of self-changeJachen C. Nett and Sina Schatzmann,Gambling Prevention and Research: From Legislation to Action Centre du Jeu Excessif, Lausanne 1st-2nd March 2005,University of Applied Sciences Berne School of Social Work (HSA Berne) Ins

2、titute for Social Planning and Social Management (ISS),1st March 2005,HSA Berne, ISS,2,Proceeding,Brief description of the study goals and applied methods description of the sample definitions and classification Selected results with respect to processes of self-change barriers to treatment Open for

3、um (questions & discussion),1st March 2005,HSA Berne, ISS,3,Studys title: Casino legislation und self-recovery“ from problem gambling,Central goals of the research project: To explore the situation and perspectives of past and current problem gamblers in Switzerland with special reference to the imp

4、lementation of the new casino legislation and to processes of “self-recovery” from pathological gambling To get information about how the different prevention activities instigated by the casinos are valued by exponents of the target group To create a baseline data set for the longitudinal observati

5、on of individual self-change processes among problem gamblers,1st March 2005,HSA Berne, ISS,4,Used data base,Telephone interviews with people who are affected by past or current gambling problems (february 2002 - march 2003) Recruitment of the sample (N=64) : by mediation of a psychiatrist in Zurich

6、 by Media calls (German speaking part of Switzerland) by large-scale distribution of flyers (German speaking part of Switzerland),1st March 2005,HSA Berne, ISS,5,Applied instruments,Introductory questionnaire Questionnaire version A (for former problem or pathological gamblers) Questionnaire version

7、 B (for current problem or pathological gamblers) Applied scales: SOGS Gambling Screening (Lesieur & Blume, 1987), CAGE Alcohol Screening (Ewing, 1970), NODS Gambling Screening (Gerstein et al., 1999), KFG Petrys & Bauligs (1996) short questionnaire about gambling behaviour, Items of the Geneva-prev

8、alence-study of Osiek et al. (1999), Items of Klingemann (1988a/b),1st March 2005,HSA Berne, ISS,6,Definitions of the central terms,Problem gamblers: SOGS 3 (life-time), pathological gamblers: SOGS 5 (life-time) Current problem/pathological gambling = gambling behaviour with currently negative conse

9、quences , former problem/pathological gambling = no or gambling behaviour with currently no negative consequences after having had gambling problems before Processes of self-change = self initiated changes in the perception, attitude, and practice of ones gambling behaviour Auto-remission = a substa

10、ntial (self initiated) change in the gambling behaviour, i.e. a clear turning away from excessive and uncontrolled gambling.,1st March 2005,HSA Berne, ISS,7,Characteristics of the sample,7 women, 57 men Mean age: 43 (range: 26 to 70) are of Swiss nationality Singles (41%) and divorced/separated (28%

11、) individuals are overrepresented in the sample Educational level is comparable with standard population (lowest level is underrepresented) Income: 61% earn between CHF 4000 and 9000 Unemployed subjects are overrepresented (22%) 61 of the 64 subjects interviewed show life-time prevalence of problem

12、or pathological gambling (mean SOGS score = 9.9) Main type of game played: 50 Slot-machine players, 10 table players (casino) and 4 other kind of gambling,1st March 2005,HSA Berne, ISS,8,Gambling behaviour,Classification of the interviewed problem (n=2) and pathological gamblers (n=61) according to

13、the following criteria: showing currently a highly pathological gambling behaviour (n=15) being at the stage of giving up gambling (n=22) showing a controlled gambling behaviour (n=12) definitely (?) having quit gambling (n=14),1st March 2005,HSA Berne, ISS,9,Gambling careers: an overview,1st March

14、2005,HSA Berne, ISS,10,Most successful recovery attempt (failed),Multiple recovery attempts in the past (up to 50) Mean age: 35.6 years Mean duration: 1 years Reasons of failure: discontinuation of social support, incitation to re-entry by fellow gamblers, situational changes, overwhelming temptatio

15、n,1st March 2005,HSA Berne, ISS,11,Successful recovery,Mean age: 39 years About 5 years after peak of gambling Reasons of success: admitting the existence of gambling problems, high degree of negative consequences, professional help seeking, situational changes Coping with the temptation to gamble a

16、gain: active distraction, cognitive coping, repression,1st March 2005,HSA Berne, ISS,12,Recovery attempts vs. successful recovery,Different motivation to quit: Problem gamblers who fail to quit have less severe problems than problem gamblers who succeed in quitting Different quitting plans: Problem

17、gamblers who fail to quit have less strict quitting plans than problem gamblers who succeed in quitting Different life events in the past twelve months before quitting: Problem gamblers who fail to quit and problem gamblers who succeed in quitting do not differ in the number of life events they expe

18、rienced in the past twelve month before quitting. However the character of live events differs: Especially the actual or threatening loss of close social relationships seems to contribute to a successful quitting,1st March 2005,HSA Berne, ISS,13,Experience with addiction related intervention,Objecti

19、ve criteria for not having experienced such an intervention: Life-long: No contact with any addiction related institution or with another institution, for which an explicit addiction related benefit has been mentioned Before remission: During the two years before remission no more than one contact t

20、o any institution and no experience at all with in-patient institutions Former problem gambler who accomplish both of the criteria would therefore count as auto-remitted individuals.,1st March 2005,HSA Berne, ISS,14,Experience with addiction related intervention,Objective classification: 20 cases sh

21、ow no experience of any addiction related intervention Among these, there are 10 “objectively auto-remitted“ cases 44 cases show some experience of an addiction related intervention Subjective perception of such interventions: 33 individuals report on no significant effects of the intervention Accor

22、dingly, 18 cases count as “subjectively auto-remitted“,1st March 2005,HSA Berne, ISS,15,Experience with addiction related intervention,Objective auto-remission rate: 53%, subjective auto-remission rate: 76.5% Individuals without any experience with addiction related intervention suffer from less sev

23、ere gambling problems than those with such an experience Social pressure“ as a motivation to quit is mentioned more often by auto-remitted gamblers (n=10) than by those who recovered with professional support (n=16). The latter group more often refers to the omission of gambling possibilities“ as a

24、motivation to quit,1st March 2005,HSA Berne, ISS,16,Experience with intervention,Problem gamblers interviewed reported following intervention experience: Out-patient psychiatric therapy Out-patient psychological therapy Social services and welfare institutions In-patient psychiatric therapy Self-hel

25、p-groups, addiction counseling, financial dept counseling, alcohol or drug clinic, family counseling,1st March 2005,HSA Berne, ISS,17,Objective barriers to treatment,Lack of gambling specific treatment options Lack of knowledge by some professional helpers,1st March 2005,HSA Berne, ISS,18,Subjective

26、 barriers to treatment,Denial of gambling problems Overestimation of ones own capabilities No supposed benefit from professional help Fear/Shyness Pride Lack of knowledge of available professional help,1st March 2005,HSA Berne, ISS,19,Main lessons,Most important barrier to treatment: denial of gambl

27、ing problems (How can professional helpers counter this barrier?) Auto-remission of problem gambling seems to be a fairly common fact in Switzerland (How can professional helpers support and learn from this group of former gamblers?),1st March 2005,HSA Berne, ISS,20,Literature,Ewing, J.A. (1984). De

28、tecting alcoholism: the CAGE questionnaire, JAMA, 252, 1905-1907. Gerstein, D. et al. (1999b). NORC DSM-IV Screen for gambling problems (NODS). In: D. Gertein et al. (Eds.). Gambling impact and behavior study. Report to the national gambling impact study commission. National Opinion Research Center

29、at the University of Chicago. pp.18. Klingemann, H.K. (1988a). Autoremission bei Alkohol- oder Opiateabhngigen: Narratives Lebenslaufinterview. Lausanne: Schweizerische Fachstelle fr Alkoholprobleme. Klingemann, H.K. (1988b). Autoremission bei Alkohol- oder Opiateabhngigen: Fragebogen fr das telefon

30、ische Screeninginterview. Lausanne: Schweizersiche Fachstelle fr Alkoholprobleme. Lesieur, H.R., & Blume, S.B. (1987). The south oaks gambling screen (SOGS): a new instrument for the identification of pathological gamblers, Am J Psychiatry, 144, 1184-1188. Osiek, C., Bondolfi, G., & Ferrero, F. (1999). Etude de prvalance du jeu pathologique en Suisse. Dpartement de psychiatrie, Hpitaux Universitaires de Genve. Petry, J. &