Selecting a Treatment Program for Pathological Gambling

by Randee McGraw

In the past several months, I have received many telephone calls at the Illinois Institute for Addiction Recovery inquiring about treatment programs that have “Gambling Treatment Tracks.” I have also been asked to give recommendations for treatment centers, either because people were looking for something closer to home or because we happen to have no beds available. This article contains the 10 questions I ask a prospective referral source for pathological gamblers, along with my answers to the questions. A treatment center that offers a program for pathological gambling needs to answer these 10 questions successfully before I will refer people to them. Please keep in mind, the answers given here represent my opinion. The consumer needs to make the final decision on where they seek treatment for themselves or loved ones.

1. Do you treat gamblers with chemical addicts?

If yes, how do you treat gamblers differently? Gamblers need to have their own groups, reading assignments and “step” work. Because they have a higher rate of suicide than chemical addicts, gamblers need to be assessed for suicide potential. They may experience a “marked reduction of options” within the first 48 hours of abstinence from gambling. The gambler may see himself/herself worth more money dead than alive. For the gambler, suicide can be seen as the ultimate “bailout.” Unlike with treatment of the chemical addict, the gambler’s drug of choice — a.k.a. money — needs to be addressed throughout treatment and recovery. If gamblers are being treated with chemical addicts, they should always have non-gamblers as roommates. This will help them focus on similarities rather than differences.

2. How does your treatment program define gambling?

Use definition of gambling from Gamblers Anonymous. “Gambling, for the compulsive gambler, is defined as follows: any betting or wagering, for self or others, whether for money or not, no matter how slight or insignificant, where the outcome is uncertain or depends upon chance or ‘skill’ constitutes gambling.”

3. What percentage of your staff have had a minimum of 21 hours of gambling-specific training.

In my opinion, any counselor with an addictions credential must have a minimum of 21 hours of gambling-specific training.

4. How do you address the financial issues?

A financial assessment needs to be conducted with every gambler. A list of people the gambler has borrowed money from (“bailouts”) needs to be made. Conferences should be held with them or letters sent to them by the gambler informing them he/she is a pathological/compulsive gambler, and they are not to give him/her any money at all, because “giving money to a gambler is like giving cocaine to a cocaine addict.”

If a Gamblers Anonymous Pressure Relief Group is not available, then a treatment program needs to have a financial counselor to work with gamblers and their families. Prior to leaving treatment, all gamblers need to develop a budget, repayment and restitution plan, and need to turn over financial control to someone else. If the gambler comes from a wealthy family, a trust fund should be set up so the gambler does not inherit a lump sum of money. A lump sum of money could trigger the “Big Win” mentality or “Magical Thinking” of the gambler. These are significant relapse indicators for pathological gamblers.

5. How do you protect the client from gambling while in treatment?

Card games, sports pages and stock market reports, pool tables, and competitive games should be removed. The treatment facility should not send patients out to meetings or functions where gambling occurs (e.g., door prizes, drawings to see who will speak and 50/50 raffles). If vending machines are available for clients/patients, make sure no item sold has sweepstakes advertised on them.

6. How do you prepare gamblers to return to communities that have few or no G.A. meetings?

Because as high as 50 percent of gamblers also have a past or present chemical addiction, it is appropriate to have all gamblers sign a “no chemical use” contract. By doing so they have demonstrated a desire not to drink or use, and they qualify for other 12-step programs. They do need to be informed about how to present themselves in meetings other than G.A. (e.g., “My name is _____ and I have a desire not to use or drink.”) They then say whatever they want to say related to recovery but avoid talking about gambling.

7. How do you view bankruptcy and consolidation loans?

Bankruptcy and consolidation loans are bailouts, and at the beginning of treatment, the gambler needs to contract with the treatment provider not to file bankruptcy or obtain any loans.

8. How do you address family issues?

Family conferences need to be held early and often. There must be no secrets from the significant other.

9. How do you get reimbursed for treatment?

Most insurance companies will not pay for a diagnosis of pathological gambling. They will often pay for outpatient treatment for another DSM-IV diagnosis exacerbated by pathological gambling (e.g., outpatient treatment for depression exacerbated by pathological gambling). A treatment center may be willing to provide outpatient services and a sleeping room so the client can stay in a safe place for at least the first 48 hours of treatment, or so the client can remain in treatment if he/she is from out of town.

10. How do you address the gambler’s relationship with the casino and complimentary items (“comps”) gamblers receive from casinos.

It is very important for the gambler to ban themselves from the casino. This a relapse-prevention activity. The actual process of banning oneself from a casino is very therapeutic . Because “comps” feed into the gambler’s “Big-Shotism,” it is imperative this is addressed early in treatment.

In conclusion, when choosing a treatment center for pathological gambling, you also need to take into consideration the professional credentials of their staff. In my opinion, the treatment center should employ or have a consulting agreement with the following:

A physician addictionist.
A licensed clinical psychologist.
A psychiatrist.
A registered nurse.
A master’s prepared counselor.
A certified gambling counselor.
A certified therapeutic recreation specialist.
A financial counselor.
A music/art therapist.

I hope this information is of benefit to you when referring pathological gamblers. If I can be of any personal assistance, please do not hesitate to call me at 1-800-522-3784.

(Reference 1. Gamblers Anonymous, “Combo Book,” pg. 14, Gamblers Anonymous International Service Office, (1994).

Randee McGraw is the manager of the Illinois Institute for Addiction Recovery at Proctor Hospital.

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