Problem Gambling Awareness Month 2019: Tips for Behavioral Health Professionals

March is Problem Gambling Awareness Month (PGAM). This grassroots campaign encourages Affiliate Members of the National Council on Problem Gambling (NCPG), organizational and individual members, state health agencies, gambling companies, recovery groups, healthcare organizations and providers to hold conferences, air public service announcements, host screening days, run social media campaigns, and any other activities that will raise public awareness of problem gambling and the fact that services are available for treatment, recovery and prevention. This year’s theme is “Awareness + Action” #AwarenessPlusAction.

What does PGAM mean for professionals in Behavioral Health?

“Awareness Month” national observances often bring to mind the need for making the public more “knowledgeable” of behavioral health issues by focusing on education and information. Activities frequently consist of professionals and organizations presenting basic facts about behavioral health difficulties to people, families, and workers in other fields for increasing general knowledge, identifying problems, and getting people to resources that can help them. Other activities help people to understand how effective treatment for behavioral health disorders is and how entering treatment and sustained recovery can lead to lives that are every bit as healthy, happy, and fulfilling as those who have never faced having a behavioral health disorder. In addition to educating people, awareness days and months also raise hope, encourage support, and help eliminate stigma. A great deal can be accomplished through simply increasing the knowledge of the general public about behavioral health disorders.

However, according to Oxford English Dictionaries, another definition of awareness involves “concern about and well-informed interest in a particular situation or development,” and behavioral health professionals might look at awareness a little bit differently with that definition in mind. Why not pair your professional knowledge of problem gambling with your genuine concern and interest, and begin taking action? There are very good reasons to do so according to the research:

  • Problem gambling has a high correlation with other behavioral health disorders (Lorains, et. al., 2011; Jacob, et. al., 2018; Petry et.al. 2005; Sacco, et. al. 2008).
  • Problem gambling is often a “hidden” disorder, whether by its lack of overt signs and symptoms or by purposeful concealment (Ladouceur, 2004).
  • Problem gambling is often linked with suicide (Battersby, et. al., 2006; Black et. al., 2015; Ciarrocchi, 1987; Kausch, 2003a; Kausch, 2003b; Petry and Kiluk, 2002).
  • Substituting problem gambling for another behavioral disorder happens frequently enough to be a serious issue (Spunt, 2002; Widyanto and Griffiths, 2006; Boughton and Falenchuk, 2007).
  • Research suggest that people with co-occurring problem gambling and other behavioral disorders are less responsive to treatment (Crockford and El-Guebaly, 1998).
  • Current research suggests that in most cases a substance use disorder precedes problem gambling (Crockford and El-Guebaly, 1998; Cunningham-Williams, et al, 2000).

To help professionals take action, here are some tips for keeping gambling disorder in mind no matter what aspect of behavioral health is within your scope of practice:

  • Know what Gambling Disorder is from a mental health perspective. Most people understand that gambling disorder involves betting something of value on a game of chance. While most people think of casinos, slot machines, and card games as “gambling,” fewer people -even some professionals- are aware that bingo, lottery tickets, and even the stock market can be considered gambling and can result in significant impact on the lives of those who gamble, their loved ones, and their friends. Criteria developed in the DSM 5 can help define and identify Gambling Disorder.
  • Screen your clients for gambling disorder. Regularly. Research shows that gambling disorder may not evolve until the person is well into recovery from another behavioral health disorder. Therefore, screening in the initial stages of treatment, which is very important for determining co-occurring disorders, is not enough (Crockford and El-Guebaly, 1998; Cunningham-Williams, et al, 2000). Screening provides an opportunity to refer the person who meets initial criteria to a trained clinical professional for a face-to-face evaluation.
  • Use recommended Screening Tools. Many have been developed for initial screening for gambling disorder, such as the Brief Biosocial Gambling Screen (BBGS), the DSM-5 Gambling Disorder Criteria, and the NORC Diagnostic Screen for Gambling Problems Self-administered (NODS-SA). Additional information on screening tools can be found in the Gambling Disorder 2019 Toolkit that was developed for the NCPG by Cambridge Health Alliance Division on Addiction. 
  • Advocate for programs and services that will help those with gambling disorder and their loved ones and friends. If advocacy is unfamiliar to you, join with others who “know the ropes” such as the NCPG. You may even decide to attend Problem Gambling Advocacy Day scheduled for Wednesday, April 10, 2019 in Washington, DC to become more engaged, network with other advocates, and educate federal legislators about gambling disorder.
  • Educate clients and others in your practice or other spheres where you have influence by making information available and bringing it to the level of conversation in the course of your daily work activities. This can be as simple as providing a list of NCPG resources or by contacting your state Affiliate for  state-specific resources, self-help resources, support resources for family and friends, and treatment resources.

There are a multitude of tools for those who wish to participate in PGAM, including a toolkit with templates for everything from press releases to Tweets, logos and graphics for websites and print materials, a Gambling Disorder Screening Day Toolkit, and directions for getting a State Issued Proclamation, as well as a place to email them for posting on the NCPG website. There are many reasons and ways for both professionals in behavioral health and others to combine Awareness + Action for Problem Gambling Awareness Month for all of March and beyond. For additional information, check the CASAT OnDemand Resources and Downloads page.

References

Battersby, M., Tolchard, B., Scurrah, M., & Thomas, L. (2006). Suicide ideation and behaviour in people with pathological gambling attending a treatment service. International Journal of Mental Health and Addiction, 4(3), 233-246. doi:10.1007/s11469-006-9022-z

Black, D. W., Coryell, W., Crowe, R., McCormick, B., Shaw, M., & Allen, J. (2015). Suicide ideations, suicide attempts, and completed suicide in persons with pathological gambling and their First‐Degree relatives. Suicide and Life‐Threatening Behavior, 45(6), 700-709. doi:10.1111/sltb.12162

Blaszczynski, A., & Farrell, E. (1998). A case series of 44 completed gambling-related suicides. Journal of Gambling Studies, 14(2), 93-109. doi:10.1023/A:1023016224147

Boughton, R., & Falenchuk, O. (2007). Vulnerability and comorbidity factors of female problem gambling. Journal of Gambling Studies, 23(3), 323-334. doi:10.1007/s10899-007-9056-6

Crockford, D. N., & el-Guebaly, N. (1998). Psychiatric comorbidity in pathological gambling: A critical review. Los Angeles, CA: SAGE Publications. doi:10.1177/070674379804300104

Cunningham-Williams, R. M., Cottler, L. B., Compton, W. M., Spitznagel, E. L., & Ben-Abdallah, A. (2000). Problem gambling and comorbid psychiatric and substance use disorders among drug users recruited from drug treatment and community settings. Journal of Gambling Studies, 16(4), 347-376. doi:10.1023/A:1009428122460

Jacob, L., Haro, J. M., & Koyanagi, A. (2018). Relationship between attention-deficit hyperactivity disorder symptoms and problem gambling: A mediation analysis of influential factors among 7,403 individuals from the UK. Journal of Behavioral Addictions, 7(3), 781-791. doi:10.1556/2006.7.2018.72

Kausch, O. (2003a). Patterns of substance abuse among treatment-seeking pathological gamblers. Journal of Substance Abuse Treatment, 25(4), 263-270. doi:10.1016/S0740-5472(03)00117-X

Kausch, O. (2003b). Suicide attempts among veterans seeking treatment for pathological gambling. The Journal of Clinical Psychiatry, 64(9), 1031-1038. doi:10.4088/JCP.v64n0908

Ladouceur, R. (2004). Gambling: The hidden addiction. The Canadian Journal of Psychiatry, 49(8), 501-503. doi:10.1177/070674370404900801

Lorains, F. K., Cowlishaw, S., & Thomas, S. A. (2011). Prevalence of comorbid disorders in problem and pathological gambling: Systematic review and meta‐analysis of population surveys. Addiction, 106(3), 490-498. doi:10.1111/j.1360-0443.2010.03300.x

Petry, N. M., & Kiluk, B. D. (2002). Suicidal ideation and suicide attempts in treatment-seeking pathological gamblers. The Journal of Nervous and Mental Disease, 190(7), 462-469.

Petry, N. M., Stinson, F. S., & Grant, B. F. (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: Results from the national epidemiologic survey on alcohol and related conditions. The Journal of Clinical Psychiatry, 66(5), 564-574. doi:10.4088/JCP.v66n0504

Sacco, P., Cunningham-Williams, R. M., Ostmann, E., & Spitznagel, E. L. (2008). The association between gambling pathology and personality disorders. Journal of psychiatric research, 42(13), 1122-30.

Spunt, B. (2002). Pathological gambling and substance misuse. Substance use & Misuse, 37(8-10), 1299-1304. doi:10.1081/JA-120004186

Widyanto, L., & Griffiths, M. (2006). ‘Internet addiction’: A critical review. International Journal of Mental Health and Addiction, 4(1), 31-51. doi:10.1007/s11469-006-9009-9

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