NCRG Conference: Recovery-oriented Systems Of Care – A National Perspective

Dr. Westley Clark, SAMHSA

To understand the big picture of what constitutes a recovery from a gambling disorder, it is best to look at it from both national and local perspectives. The 13th annual NCRG Conference on Gambling and Addiction kicked off Tuesday morning with a presentation from H. Westley Clark, M.D., J.D., M.P.H., director of the Center for Substance Abuse Treatment (CSAT) in the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA’s mission is to reduce the impact of substance abuse and mental illness in America’s communities.

During the session, Dr. Clark explained SAMHSA’s priority of fostering and developing recovery-oriented systems of care (ROSC). ROSC provides a coordinated network of community-based services and supports that is focused on the individual’s needs. It builds on the strengths and resilience of families and communities to achieve abstinence and improved health, wellness and quality of life for those at risk of developing alcohol and drug problems or other addictions. Dr. Clark noted that ROSC is already being successfully integrated into many treatment programs for gambling disorders.

Dr. Clark noted several benefits of ROSC, such that it does the following.

  • ROSC addresses quality of life issues through a holistic approach decreases the risk of relapse and increases the chances for a successful recovery for pathological gamblers.
  • The system Includes recovery support services in conjunction with clinical treatment help to establish a more continuous treatment response.
  • ROSC focuses on reducing the acute and severe relapses that pathological gambling clients often experience.

He noted that implementation of ROSC continues to evolve and the passage of health care reform will allow for additional support of ROSC programs.

A part of a successful ROSC program is to distribute information to the individual in innovative ways. Dr. Clark discussed that providers are beginning to encourage patients to use health apps for assistance in treat conditions and promoting general wellness. These apps offer health-related services for smartphones, tablets or PCs and can be used for self-monitoring or in collaboration with treatment providers.

Examples of these apps are:

  • Overcoming Gambling Addiction by KoolAppz: This is a written education tool with chapters on relevant topics, including gambling addiction, symptoms of a gambling addiction, phases of gambling addiction, who is a gambling addict and how to stop gambling.
  • Gambling Addiction Help: This app includes a set of audios that patients can listen to in times of need to help them control their urges, impulses, emotions and thoughts.

Additionally, Dr. Clark said that SAMHSA has created and is currently testing a smartphone-based recovery tool the Addiction Comprehensive Health Enhancement Support System (A-Chess). This app will feature online peer support groups, clinical counselors, a GPS feature that sends an alert when the user is near an area of previous drug or alcohol activity, real-time video counseling and a “panic button” that will allow users to place an immediate call for help.

Dr. Clark concluded the session by stating that there still is a lot to be done in this area, including: developing the workforce, developing core principles of effective treatment and improve public perception.

What do you think about ROSC programs and SAMHSA placing it as a top priority? Treatment providers, how does that translate to your practice? Please leave your comments in the section below.

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NCRG Conference: Pre-commitment As A Responsible Gaming Strategy – Is The Smart Card That Smart?

Continuing the theme of “Exploring New Trends in Recovery, Research and Responsible Gaming,” Monday’s NCRG Conference sessions took a close look at responsible gaming strategies. The afternoon session let by Robert Ladouceur, Ph.D., professor emeritus of psychology at Laval University, talked about smart cards and examined whether or not they were effective in encouraging responsible play among gamblers.

Dr. Ladouceur began the session by defining responsible gaming as a set of policies and practices designed to prevent and reduce potential harms associated with gambling. Responsible gaming aims to restrict expenditure to affordable limits. More specifically, the objective is to decrease the incidence of problem gambling.

Dr. Ladouceur provided two options to achieve this goal:

  1. Supply reduction:strategies that are intended to achieve social, health and safety benefits by reducing the availability of gambling
  2. Demand reduction:strategies aimed at motivating users to gamble less overall and/or less per occasion

He noted that the main difference between supply reduction and demand reduction is that the former focuses on external control while the latter focuses on internal control. When developing interventions, Dr. Ladouceur stated that the focus should be on internal controls.

One such strategy is pre-commitment (also known as smart cards), which is a system that enables gamblers to set money and time limits on expenditures prior to the commencement of a session of play. This concept was first introduced by Mark Dickerson in Australia, and his studies indicated that most gamblers lose control while they are gambling, and therefore, gamblers should determine the amount of time and money they will allocate before (rather than during) the gambling session.

Some jurisdictions have proposed implementing mandatory pre-commitment systems, but Dr. Ladouceur questioned whether or not there is sufficient evidence to implement a mandatory pre-commitment system to all inhabitants in a given jurisdiction.

He reviewed several studies on pre-commitment and noted that meaningful conclusions cannot be drawn as to whether or not it was effective. He stated that “although the notion of mandatory pre-commitment appears very compelling and possibly useful, its implementation appears to be dictated by a political rather than a scientific agenda.“

For more from the 13th annual NCRG Conference, make sure to stay tuned to Gambling Disorders 360.

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NCRG Conference: What Does It Mean To Be Recovered From A Gambling Disorder?

On the first day of the 13th annual NCRG Conference on Gambling and Addiction, a session of three notable researchers and clinicians took a close look at the issues surrounding treatment and recovery from a gambling disorder.

Lia Nower, Ph.D., J.D., associate professor and director of the Center for Gambling Studies at Rutgers University, began the session by discussing some of the difficulties associated with measuring recovery from pathological gambling. For example, the standard definition of a gambling disorder requires a cluster of symptoms but not a time frame. For example, a person who experiences three symptoms in the same weekend and a person who experiences three symptoms in their life are categorized in the same way. Another issue in defining a gambling disorder is that gambling “consumption” is not as easily classifiable as substances, such as alcohol, that can be standardized by weight or volume. While there are several ways that gambling researchers try to define consumption there is no easily understood standard as with other substance use disorders.

Next, Jody Bechtold, LCSW, NCGC-II, a nationally recognized gambling counselor, discussed recovery from a clinical perspective, noting that for clinicians, it is very hard to answer the question of what it means to be fully recovered. She explained that recovery may look different depending on the severity of the gambling disorder. For some pathological gamblers, complete abstinence from gambling behaviors may be the best way to prevent relapse. However, for problem gamblers, recovery could be defined either as abstinence or controlled gambling, but maybe changing the game or other factors. Counselors should take a multidisciplinary treatment approach with a goal to achieve better than pre-crisis states of well-being. She concluded by offering a definition of recovery: being accountable and responsible in all major life areas on a regular and consistent basis.

Finally, Harold Wynne, Ph.D., head of Wynne Resources, ended the session discussing several screening and diagnostic issues, including:

  • Issue 1: We are not really sure what pathological gambling is: a disease, a social problem or a social disease.
  • Issue 2: If we are not really sure what pathological gambling is, how can we screen for and diagnose the condition?
  • Issue 3: We tend to treat the symptoms and not the “pathological gambling disease.”
  • Issue 4: We tend to define pathological gambling recovery as being free some symptoms.
  • Issue 5: Recovery should be redefined as improvement in the overall health of the individual – not just the absence of pathological gambling symptoms.

What do you think it means to be recovered from a gambling disorder? Share your thoughts in the comments below. For more recap posts from the NCRG Conference, make sure to stay tuned to Gambling Disorders 360˚.

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NCRG Pre-conference Workshop: Acceptance And Commitment Therapy (Act)

Before the official start of the 13thannual NCRG Conference on Gambling and Addiction, Mark Dixon, Ph.D., professor and coordinator for the Behavior Analysis and Therapy Program at Southern Illinois University, and Alyssa Wilson, Ph.D., assistant professor of social work at Saint Louis University, led a two-hour preconference workshop that focused on Acceptance and Commitment Therapy (ACT).

ACT is a unique evidenced-based psychological intervention that uses acceptance and mindfulness strategies together with commitment and behavior change strategies to increase psychological flexibility. It is considered a second generation cognitive behavioral therapy (CBT) model and is based on behavioral principles on the nature of language and cognition.

Dr. Dixon noted that there is a growing body of literature on the effectiveness of ACT, adding that these studies have shown it is more effective than CBT. ACT is an alternate to CBT that focuses on acceptance of thoughts rather than suppression of thoughts.

ACT uses mind and body interventions to help change behavior patterns. The goal of ACT is to increase psychological flexibility by changing how we relate to thoughts and feelings rather than change their content. To do this, ACT focuses on six principles:

  • Contact with the Present Moment:Contact and awareness of the here and now, where the client is in their own thoughts and feelings
  • Acceptance:Willingness to accept everything good, bad and uncomfortable about the situation
  • Diffusion:De-literalizing language (learning to not tie words with emotions)
  • Self as Context:Separating yourself from your thoughts; words do not define a person (i.e. the label “pathological gambler” does not define who you are as a person, but you are a mom/dad, brother/sister, etc.)
  • Values:The goals we set for ourselves and what is most important to each person, along with the understanding that values are different for each indiividual
  • Committed Actions:Focusing on value-based behaviors

During the second half of the workshop, Dr. Wilson showed attendees how they can apply ACT with their patients. She led attendees through several exercises they can use to help their patients realize that pathological gambling does not define them as a person and learn how to make decisions based on their values.

For more information about the 13th Annual NCRG Conference on Gambling and Addiction, please visit theNCRG website, and stay tuned to this blog for updates.

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Connect With The NCRG Online For Conference Updates

The13th annual NCRG Conference on Gambling and Addictionbegins this Sunday, Sept. 30 and runs through Tuesday, Oct. 2 at the Sands Expo and Convention Center at the Venetian Las Vegas.

If you can’t make it to the event, we still want you to be a part of the conversations that are taking place! There are three ways you can stay updated on everything that’s happening at the NCRG Conference:

  1. Gambling Disorders 360°:Keep up with all the breaking news from the event by subscribing to the NCRG’s blog for daily updates, on-site reporting about the sessions and audio posts from leading researchers and industry representatives.
  2. Twitter:The NCRG’s Twitter account (@theNCRG) will feature conference updates and live-tweeting from events and sessions, including: the conference welcome address, the Scientific Achievement Awards luncheon, “Screening and Brief Intervention: So You Want to Implement an Evidence-Based Practice?” “The Science of Recovery” and “Roundtable on Online Gambling: Regulating Responsible Gaming on the Internet.” For a full list of sessions, you can view theNCRG Conference schedule.The NCRG’s tweets will include the hashtag #NCRGConference to make it easier for you to find the latest insight from conference sessions. Attendees who would like to tweet what they learn at the NCRG Conference should also use the #NCRGConference hashtag.
  3. Facebook:The NCRG team will also be active on Facebook (www.facebook.com/theNCRG), posting updates and pictures from the conference. If you are attending the conference and want to share your photos with us, send them to Amy Kugler atakugler@ncrg.org.

The NCRG team is excited for this year’s conference and looks forward to seeing participants who will be attending in person. If you can’t make the NCRG Conference, we hope you will participate online.

For more information on the NCRG Conference, visithttp://www.ncrg.org/public-education-and-outreach/conference.

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Redefining Recovery From Gambling Disorders: The Iowa Gambling Treatment Program

In the public health and recovery arena, there has been a shift in how mental health professionals understand how to best help those who want treatment for gambling disorders. As a guiding principal of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services, the principles of “recovery-oriented systems of care” are redefining treatment methods for behavioral health agencies. Thanks to Mark Vander Linden, executive officer for the Iowa Gambling Treatment Program, and his team at the Iowa Department of Public Health, this new definition of recovery is providing a new framework to help those with gambling disorders across the state. Their collective efforts serve as a model for public health officials about how to collaborate with key stakeholders to make sure the needs of a community are met in terms of problem and pathological gambling recovery services.

According to Vander Linden, a recovery-oriented system of care is “not a brand new concept, but is a rethinking of how to organize services that the state provides to problem and pathological gamblers.” This approach to treatment is person-centered and self-directed, allowing the individualto rely on their strengths and build on the resilience of their family, community and other support systems.

“In recovery-oriented systems of care, patients are encouraged to take responsibility for their own health,” said Vander Linden. “It also helps eliminate the obstacles that stand in their way, some being very tangible problems.”
Research shows that only 12 – 15 percent of those diagnosed with pathological gambling seek formal treatment. Common barriers to following through with treatment include the inability to afford treatment due to a lack of money or health insurance, a lack of access toresources and ambivalence about changing problematic behavior.

After a comprehensive evaluation of their services in 2011, the Iowa Gambling Treatment Program determined that implementing a recovery-oriented system of care required them to increase the tools and resources for clinicians and the general public. “We wanted to expand the view of what ‘treatment’ looks like for these individuals,” said Vander Linden.

One way that Iowa is accomplishing this goal is through their recovery support services program, which includes a broad array of community-based resources designed to enhance the client’s recovery. For example, some who struggle with pathological gambling also experience unmanageable debt. Iowa’s recovery support services menu includes housing assistance so a patient can keep utilities running at their residence and gas cards to help them travel to counseling appointments. The Iowa Gambling Treatment Program also offers Electronic Recovery Support Messaging, which sends encouraging and informative emails to the person in recovery to help improve their health, life quality and wellness.

Iowa’s shift to a recovery-oriented system of care required the collaboration of key players throughout the state. In 2011, the Iowa Department of Public Health released a survey of adult Iowan’s gambling behaviors and attitudes. This report illustrated that the state’s public health leaders needed to engage key stakeholders in cooperative efforts, including convening these groups for education and prevention programs.

“The work doesn’t start and end with the treatment providers who are only focused on clients with a gambling disorder. It also includes treatment providers who have patients with substance use disorders, Department of Justice personnel and other community mental and public health organizations who see this issue played out among their clients,” Vander Linden said.

The 2011 report also emphasized the need to highlight resources for those who want to learn how to gamble responsibly. The Iowa Gambling Treatment Program’s website, www.1800betsoff.org, houses information about tips for responsible gaming and includes a budget calculator to understand how much a person can potentially lose when gambling, based on the odds of a particular game. Website visitors also can find a guideline of what to expect if someone should call the 1-800- BETS-OFF helpline. In addition to its website, the Iowa Gambling Treatment Program created a YouTube channel with short videos explaining the many resources it offers.

For more information, visit the Iowa Gambling Treatment Program’s website or YouTube channel at www.youtube.com/1800betsoffiowa. Vander Linden also will present at the 13th annual NCRG Conference on Gambling and Addiction about the Iowa Department of Public Health’s efforts to implement recovery-oriented systems of care. For more informationon that event, please visitwww.ncrg.org/conference.

This profile of Mark Vander Linden and the Iowa Gambling Treatment Program was originally published in the summer 2012 edition of Responsible Gaming Quarterly. To read or download a full copy of this issue, you can visit theNCRG website.

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Guest Post: NCRG Conference Update: Using Research To Educate About Online Gambling

Simo Dragicevic, BetBuddy

Today’s Gambling Disorders 360˚ post comes from Simo Dragicevic, president and CEO of Bet Buddy. Dragicevic will present findings from his latest research on gambling disorders and responsible gaming for those who gamble online at the13thAnnual NCRG Conference on Gambling and Addiction. Dragicevic’s plenary session, titled “New Research: Educating Online Players about the Risks Associated with Gambling,” will take place on Monday, October 1 from 3:15 – 4:15 p.m. PST, and the NCRG’s social media team will be sharing the highlights of his talk in real-time onTwitter(@theNCRG, #NCRGConference). For more information on the NCRG Conference or to register, visit theNCRG Conference website. To learn more about Bet Buddy, you can visit their website or watch Dragicevic’sinterview with Cass Business School.

Today is an exciting time for the gaming industry regarding Internet gambling. Cumulative investment in technology research and development over the last decade has created powerful technology platforms, analytical capabilities and skilled resources. In parallel, the research and academic community’s understanding of gambling disorders is also growing. Combining this rich pool of research together with technology and analytical capabilities is allowing us to gain deeper insights into players’ behaviors and help those players to make more informed decisions about their health and behaviors. Ultimately, this knowledge helps to make regulated gambling markets safer environments for vulnerable players.

I am very excited to have been invited to speak at the13thNCRG Conference on Gambling and Addiction.The above trends have been at the heart of what my colleagues and I have been working on passionately. My plenary session will focus on the following areas:

  • Examining new research using large internet casino and poker player data sets
  • Demonstrating how new software applications are applying insights from peer-reviewed research to identify problematic gambling behaviors and educate gaming operators and players.

Our session will look at three studies that Bet Buddy and GTECH G2 have been collaborating on since 2010. The first study, which was published inInternational Gambling Studiesin 2011, builds on the work undertaken at the Division on Addiction, Cambridge Health Alliance, a division of Harvard Medical School. Specifically, this work replicated Braverman and Shaffer’s (2010) clustering analysis of Internet sports player data using data from online gamblers playing casino games.

The second study is focused on describing Internet casino and poker self-excluders’ gambling behavior. The participants included more than 240,000 GTECH G2 Internet casino and poker players from the regulated European markets. For example, we compared the demographics and player behaviors (e.g. betting patterns such as amount of time spent gaming, games played, losses, etc) of those who self-excluded from Internet gambling and compared them to the control group.

The third study explains how we have used the insights from the previous studies to build models to predict self-exclusion events for Internet gamblers using statistical classification algorithms.

During the plenary session, we also will discuss the evolution of responsible gaming software in the gambling industry as well as how the innovation curve drives new product development in gaming, drawing on UK-based research undertaken by GamCare, Salford University and Bet Buddy that was recently presented at the Responsible Gambling Council’s Discovery 2012 conference in Toronto. We will also explain how Bet Buddy and GTECH G2 are using insights from peer-reviewed research to build new data-driven analytics software products (a type of ‘big data’ solution, to use a current technology buzz word) that can analyze large quantities of personal and machine generated data to track and predict player behaviors. This analytics software also allows us to interpret these insights to educate both gambling operators and gamblers about the risks associated with gambling. The demonstration will be of interest to the regulatory, academic, clinical, treatment and gaming industry communities, and also to those interested in how to execute data-driven research and who want to understand the challenges and opportunities associated with productizing such research. I look forward to seeing you there!

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Register Today For The Next NCRG Webinar On September 19

Save the date and register today for the latest NCRG Webinar Series session on September 19! Wendy S. Slutske, Ph.D., 2011NCRG Scientific Achievement Award winnerand professor at the University of Missouri – Columbia, is leading the upcoming training, titled “Path to Recovery: Is Controlled Gambling Possible for Pathological Gamblers?” The webinar will be held on Wednesday, September 19, 2012 from 2 to 3 p.m. EST. The session is free to attend, participants will earn one CEU and registration is now open on the NCRG’s website.

Abstinence from gambling has been the only acknowledged treatment goal in most pathological gambling interventions. However, a new study from Australia challenges the notion that abstaining from gambling is the only path to recovery. Dr. Wendy Slutske will discuss research that found 90 percent of those in the recovery group participated in some form of gambling in the past year. She will explore the implications of this finding for treatment and interventions.

Christine Reilly, senior research director for the NCRG, will be moderating the discussion. If you are unable to attend on the day of the webinar but would like to submit questions for Dr. Slutske, you can leave them in the comments section below or email Amy Kugler atakugler@ncrg.org.

This session has been approved forone hour of continuing educationby:

  • NAADAC, the Association for Addiction Professionals (provider # 737)
  • The California Foundation for Advancement of Addiction Professionals (provider # OS-02-26-1111)
  • The National Board for Certified Counselors (Provider 6474)
  • The NCRG is also approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. The NCRG maintains responsibility for this program and its contents.

As last year’s NCRG Scientific Achievement Award winner, Dr. Slutske brings a wealth of knowledge and expertise to this session. She is regarded as one of the world’s leading experts on behavioral genetics of gambling disorders, and her current work is a groundbreaking project on recovery from gambling disorders. A recent finding is that a large number of people who recover from gambling problem are able to continue to gamble without symptoms of a gambling disorder. These findings and more will be presented on September 19, so make sure to register today!

Have a comment or question about the upcoming session of the 2012 NCRG Webinar Series? Leave it in the comments below.

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Nationally Renowned Speakers Will Address New Trends In Addiction Research And Treatment At The NCRG Conference

The13thannual NCRG Conference on Gambling and Addictionis a month away, and many engaging speakers are set to present on emerging research and applications for addictions, gambling disorders and responsible gaming from September 30 to October 2 at the Sands Expo and Convention Center in Las Vegas. Make sure to register by September 10 to receive the discounted rate of $295 for the main sessions and $45 for pre-conference workshops! You can visitwww.ncrg.org/conferenceand click on the registration page for more details.

Here are a few of the speakers you won’t want to miss:

  • H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM, is director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services, where he leads the agency’s national effort to provide effective and accessible treatment to all Americans with addictive disorders. Dr. Clark will offer a national perspective on recovery-oriented systems of care based on his efforts to implement this model in his position at SAMHSA.
  • Alexandre B. Laudet, Ph.D.,is a nationally recognized expert in addiction recovery. Her federally funded research over the past 15 years has focused on understanding what helps people with drug and/or alcohol problems quit drinking or getting high and how they stay in recovery. She leads the Center for the Study of Addictions and Recovery at the National Development and Research Institutes, Inc. In her plenary session, Dr. Laudet will explain the science of recovery and the research that examines the components, patterns, paths and predictors of long-term recovery from addiction.
  • A. Thomas McLellan, Ph.D.,is the CEO and co-founder of the Treatment Research Institute (TRI) and an experienced substance abuse researcher. From 2009 to 2010, he served as science advisor and deputy director of the White House Office of National Drug Control Policy (ONDCP), a congressionally confirmed presidential appointment to help shape the nation’s public policy approach to illicit drug use. With more than 35 years of experience in addiction treatment research, Dr. McLellan will report on the experience of taking an evidence-based treatment and adapting it to actually fit and self-sustain in a medical and a school environment.
  • Robert Ladouceur, Ph.D.,is professor emeritus of psychology at Université Laval. He is one of the leading international authorities on gambling disorders, publishing more than 200 articles on topics such as cognitive therapy, the effectiveness of responsible gaming programs, youth and adult population studies and other aspects of gambling addiction. Dr. Ladouceur will explain the latest research on a pre-commitment strategy that gamblers can use to reduce excessive gambling.
  • Mark A. Lipparelliis chairman of the Nevada Gaming Control Board, to which he was appointed in January 2009. Lipparelli will bring his experience in the gaming industry to a panel discussion of the best practices in, newest technologies for and relative necessity of regulating responsible gaming in the online environment.

For a full list of NCRG Conference speakers and their biographies, visit theNCRG Conference speaker page. To register, visit theNCRG Conference registration page. We look forward to seeing you in Las Vegas!

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“21 Is A Must” – Colorado Youth Educate Peers About Responsible Gaming

This March, the Problem Gambling Council of Colorado (PGCC) and the Colorado Lottery joined forces to help students showcase their creativity and educate the community about gambling disorders and responsible gaming through the first “21 is a Must” scholarship contest. High school and college students from across the state were invited to create a poster educating youth about the age requirement for gambling and the warning signs of problem gambling. Entrants competed for two scholarships: the first-place winner received a $2,000 award and the runner-up was awarded $1,000.

“The creativity, originality, content and style of the entries exceeded our expectations, as did the educational value of the submissions,” said Lois Rice, PGCC board member and executive director of the Colorado Gaming Association. “The excellence of these entries made it extremely difficult to select a winner.”

While only in its first year, 14 students entered the contest, and the first-place scholarship went to Hannah Byerly from Trinidad State Junior College; Kelly Carter from Colorado State University received the second place scholarship. Byerly’s entry included a student who was standing on the side of the road, with a sign stating “Don’t Bet Your Future.” “When adolescents are making the choice to gamble underage, they are betting more than they think,” Byerly said.

The winning posters were reproduced and distributed in educational marketing materials throughout Colorado during the American Gaming Association’s (AGA) Responsible Gaming Education Week (RGEW) from July 30 – Aug. 3. This annual event was created by the AGA to promote the industry’s ongoing efforts to educate employees, patrons and the public about responsible gaming. It also provides gaming companies and problem gambling associations across the country with an opportunity to expand their existing efforts to address the issues of underage and problem gaming.

‘We work diligently with our partners in the gaming community to constantly reinforce the age requirements for participating in gaming activities and to educate the public about problem gambling,” said Matt Robbins, Community Relations Specialist for the Colorado Lottery and PGCC Board member. “The poster contest is a great way to engage young people in this effort, and we’re proud to be involved. Given the success of this year’s program, we look forward to next year’s contest.”

This article was originally published in the summer 2012 edition of Responsible Gaming Quarterly. To read or download a full copy of this issue, you can visit theNCRG website.

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