Jane Oakes

Treatment outcomes and predictors of drop out for problem gamblers in South Australia: a cohort study

Objectives: Recent prevalence studies in Australia, the USA and Canada have estimated 1-2% of the adult population meet the diagnostic criteria for problem or pathological gambling. The Statewide Gambling Therapy Service (SGTS) provides treatment for problem gamblers in key metropolitan and rural regions in South Australia. The aims of this study were two-fold: to analyse the short and mid-term outcomes following treatment provided by SGTS and to identify factors associated with treatment drop-out. Method: A cohort of treatment seeking problem gamblers was recruited through SGTS in 2008. Repeated outcome measures included problem gambling screening, gambling related cognitions and urge. Treatment drop-out was defined as participants attending three or less treatment sessions, whilst potential predictors of drop-out included perceived social support, anxiety and sensation-seeking traits. Results: Of 127 problem gamblers who participated in the study, 69 (54%) were males with a mean age of 43.09 years (SD = 12.65 years) and with 65 (52%) reporting a duration of problem gambling greater than 5 years. Follow up time for 50% of participants was greater than 8.9 months and, overall, 41 (32%) participants were classified as treatment drop-outs. Results indicated significant improvement over time on all outcome measures except alcohol use for both treatment completers and drop-outs, although to a lesser extent for the treatment drop-out group. A significant predictor of treatment drop-out was sensation-seeking traits. Conclusion: These results will inform future treatment planning and service delivery, and guide research into problem gambling including aspects of treatment drop-out.

Cognitive Behavioral Therapy for Problem Gamblers

This chapter provides an outline of the theoretical framework, assessment process, specific treatment methods, and measurement of treatment outcomes of the Flinders Therapy Service for Problem Gamblers. A case example and outcome data are provided to demonstrate the treatment model and its effectiveness. An overview of treatment outcomes for problem gambling assessing different modalities is discussed.

A Focus Group Study of Predictors of Relapse in Electronic Gaming Machine Problem Gambling, Part 1: Factors that ‘Push’ Towards Relapse

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine problem gambling. In this paper the authors describe part one of a two part, linked relapse process: the ‘push’ towards relapse. In this two-part process, factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behavioural events that ends with relapse when the ‘push’ overcomes ‘pull’ (part one); or as described in part two, continued abstinence when ‘pull’ overcomes ‘push’. In the second paper, the authors describe how interacting factors ‘pull’ the problem gambler away from relapse. This study used four focus groups comprising thirty participants who were gamblers, gamblers’ significant others, therapists and counsellors. The groups were recorded, recordings were then transcribed and analysed using thematic, textual analysis. With the large number of variables considered to be related to relapse in problem gamblers, five key factors emerged that ‘push’ the gambler towards relapse. These were urge, erroneous cognitions about the outcomes of gambling, negative affect, dysfunctional relationships and environmental gambling triggers. Two theories emerged: (1) each relapse episode comprised a sequence of mental and behavioural events, which evolves over time and was modified by factors that ‘push’ this sequence towards relapse and (2) a number of gamblers develop an altered state of consciousness during relapse described as the ‘zone’ which prolongs the relapse.

A Focus Group Study of Predictors of Relapse in Electronic Gaming Machine Problem Gambling, Part 2: Factors that ‘Pull’ the Gambler Away from Relapse

This study aimed to develop an empirically based description of relapse in Electronic Gaming Machine (EGM) problem gambling (PG) by describing the processes and factors that ‘pull’ the problem gambler away from relapse contrasted with the ‘push’ towards relapse. These conceptualisations describe two opposing, interacting emotional processes occurring within the problem gambler during any relapse episode. Each relapse episode comprises a complex set of psychological and social behaviours where many factors interact sequentially and simultaneously within the problem gambler to produce a series of mental and behaviour events that end (1) with relapse where ‘push’ overcomes ‘pull’ or (2) continued abstinence where ‘pull’ overcomes ‘push’. Four focus groups comprising thirty participants who were EGM problem gamblers, gamblers’ significant others, therapists and counsellors described their experiences and understanding of relapse. The groups were recorded, recordings were then transcribed and analysed using thematic textual analysis. It was established that vigilance, motivation to commit to change, positive social support, cognitive strategies such as remembering past gambling harms or distraction techniques to avoid thinking about gambling to enable gamblers to manage the urge to gamble and urge extinction were key factors that protected against relapse. Three complementary theories emerged from the analysis. Firstly, a process of reappraisal of personal gambling behaviour pulls the gambler away from relapse. This results in a commitment to change that develops over time and affects but is independent of each episode of relapse. Secondly, relapse may be halted by interacting factors that ‘pull’ the problem gambler away from the sequence of mental and behavioural events, which follow the triggering of the urge and cognitions to gamble. Thirdly, urge extinction and apparent ‘cure’ is possible for EGM gambling. This study provides a qualitative, empirical model for understanding protective factors against gambling relapse.

Exposure therapy for problem gambling in rural communities: A program model and early outcomes

OBJECTIVE Rural South Australia contains a higher share of electronic gaming machines and gambling expenditure per capita than metropolitan areas, raising concerns about the risk of problem gambling in these communities. This paper describes the implementation and outcomes of an outreach behavioural psychotherapy (exposure therapy) program for problem gambling in rural South Australia. METHODS A retrospective cohort study design was used for 551 adult treatment-seeking problem gamblers who presented to the Statewide Gambling Therapy Service in South Australia. Fifty-one gamblers were from rural areas and participated in the outreach program. Outcomes were compared between gamblers who participated in either the metropolitan-based or rural outreach program. Outcome measures used: South Oaks Gambling Screen, Kessler Psychological Distress Scale, Work and Social Adjustment Scale, and hours gambled the previous month. RESULTS Sixty-one per cent of clients (n = 551) completed treatment. There was no significant association between service location and number of treatment completers. Significant improvements were recorded across all outcome measures for both groups with small to large effect sizes, and there were no significant differences in outcomes at post-treatment between the groups while controlling for baseline scores. CONCLUSIONS Both metropolitan and rural clients reported significant clinical improvement. Given the risk of problem gambling in rural communities, these early outcomes are encouraging. These findings will inform future treatment planning and service delivery for rural clients, and guide further research into the effectiveness of exposure therapy for problem gambling.

Problem gambling among a group of male prisoners: Lifetime prevalence and association with incarceration

Studies have shown an association between criminal offending and problem gambling; however, research concerning problem gambling among prisoners is limited. Although reported prevalence rates are high among the offending population, different screening tools have been used making them difficult to compare. The purpose of this study was to investigate the lifetime prevalence of both level 2 and 3 problem gambling among a group of incarcerated male offenders in South Australia and to examine the relationship between gambling and current term of imprisonment. The Early Intervention Gambling Health Test (EIGHT Screen) was completed by 105 prisoners. Fifty-five (52%) indicated a lifetime prevalence of problem gambling. One-fifth of all respondents reported their current term of imprisonment was related to gambling. This paper aims to draw attention to the prevalence of problem gambling among Australian prisoners. Implications are discussed with regards to problem gambling, health promotion and rehabilitation, and the importance of screening for gambling-related problems among this high-risk population.

‘I’ll Just Pay the Rent Next Month’: an Exploratory Study Examining Facilitatory Cognitions Among EGM Problem Gamblers

Clinical studies of problem gamblers (PGs) highlight the role of erroneous cognitions during problematic gambling, yet little is known about the role of cognitions in the maintenance of gambling problems. Twenty-nine electronic gaming machine (EGM) PGs engaged in focus groups and in-depth interviews, with a focus on understanding the relapse process in EGM gambling. Three themes and nine subthemes related to facilitatory cognitions were described; (i) creating available money (paying only essential bills, pokies money is not real money), (ii) minimising gambling as a problem (pseudo-control, ignoring harms), and (iii) struggling with overwhelming emotions. This paper expands our understanding of gambling cognitions and argues cognitions activated during problem gambling are more complicated than considered to date. These findings inform current cognitive therapy approaches by identifying a more comprehensive suite of erroneous cognitions. Addressing these cognitions may assist gamblers to maintain critical thinking about their decision to gamble, thus reducing their risk of relapse.