Fall 1996

In our previous article we discussed who comes for treatment of pathological gambling. We will now turn our attention to the treatment providers and what happens in treatment. Starting in mid-1992, the state began its support of six outpatient treatment programs for pathological gambling. When the state began support of these programs it was not known if there would be a rush or a trickle of pathological gamblers seeking treatment. As it turned out, there was an initial trickle that has built to an average of about 20 admissions per month across the six programs.

These six programs have many similarities in their approaches to treating pathological gambling. They are modeled after treatment approaches that have worked with other addictions, namely chemical dependency. This model typically includes a disease concept of pathological gambling, a treatment goal of abstinence, use of Gamblers Anony-mous (GA) steps, structured group therapy, family therapy, individual therapy, educational activities such as lectures and homework assignments, and attendance at GA meetings. The goals of treatment are for the clients to abstain from gambling along with improving other areas of their lives, such as marital, family, and vocational functioning. Primary treatment typically lasts for about two months of evening sessions, with aftercare lasting up to a year or two.

When clients enter treatment they are assessed to determine if they have a serious gambling problem that requires formal treatment. This assessment includes completing questionnaires and answering questions in an interview. The client then moves on to formal treatment which typically involves group sessions with other gambling clients. In these group sessions, clients talk openly and honestly about their gambling addiction and focus on how gambling has affected their lives and the lives of those around them. Clients are taught about the addiction of gambling and are taught skills to avoid gambling.

Clients are typically asked to attend therapy sessions (typically held in the evening), not gamble during treatment, include family members in their treatment, complete homework assignments, develop a financial plan that may involve repayment of debts, and attend GA meetings. For those programs that use the 12-steps of GA, clients usually work through the first five steps during treatment and are encouraged to continue to work through the remaining seven steps after formal treatment through involvement in GA group meetings in the community.

In addition to these six state supported treatment programs, there are also a number of other mental health practitioners in the state who provide treatment specifically for pathological gambling. Information about these providers and other resources can be obtained from the Minnesota Compulsive Gambling Hotline at 1-800-437-3641. The next article will address the question of whether treatment is effective.

—Randy Stinchfield, PhD and Ken Winters, PhD, University of Minnesota Medical School