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Prior to the start of the12th annual NCRG Conference on Gambling and Addiction, David Hodgins, Ph.D., professor of psychology and adjunct professor in the department of psychiatry at the University of Calgary, led a workshop on how clinicians can incorporate Motivational Interviewing (MI) into their treatment plan for patients with gambling disorders. During this workshop, Dr. Hodgins described the principles of MI, explained MI strategies and discussed how to apply MI in a clinical practice.

Dr. Hodgins began the workshop by providing the definition of MI, as described by William R. Miller and Stephen Rollnick (the inventors of MI): MI is “a directive, client-centered method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.” Dr. Hodgins explained that MI provides clients with a “motivational nudge.” When using MI, counselors should elicit client concerns, explore ambivalence, promote self-efficacy and suggest strategies for the counselor to use to assist the clients in discussing changes to problematic behavior.

Dr. Hodgins stated that there are three components to MI: Spirit; Basic Principles; and Phases of MI.

Spirit

Motivational Interviewing is “all about active listening and resolving ambivalence to change,” said Dr. Hodgins as he emphasized the importance of spirit over technique when interacting with clients. The MI spirit is (1) collaborative: provides a partner-like relationship; (2) evocative: elicits motivation rather than instilling it; and (3) respectful: the responsibility for change is with the client. Dr. Hodgins emphasized the importance of spirit over technique when interacting with client According to Dr. Hodgins, when a therapist increases empathy in their interaction with the client, the result is that clients are usually more likely to stay in treatment and less likely to relapse.

Basic Principles

Next, Dr. Hodgins discussed the four basic principles of MI:

1. Express empathy by listening to the patient;

2. Helping clients appreciate the value of change by exploring the discrepancy between how clients want their lives to be versus how they currently are;

3. Address and move forward despite resistance with the goal of evoking solutions; and

4. Support self-efficacy by helping the patient believe he/she can change.

Of these four basic principles, Dr. Hodgins stated, “Empathy is single-best predictor of success of success in addition counseling.”

Phases

Dr. Hodgins then explained the two phases of MI: (1) building motivation to change by eliciting change talk and exploring ambivalence and (2) strengthen the commitment to change by helping the patient begin to plan for change. He provided several suggestions for evoking and responding to change talk.

Also during the workshop, Dr. Hogins provided several interaction techniques that can be used throughout the process of MI. The techniques are called “OARS” and include:

Open-ended questions

Affirmations

Reflective listening

Summaries

Dr. Hodgins concluded the workshop with a video showing himself and a graduate student role-playing a counseling session and how MI is incorporated into the session.

Continue to visitGambling Disorders 360°for daily updates, on-site reporting about the sessions and audio interviews from leading researchers and industry representatives.

Spirit

Motivational Interviewing is “all about active listening and resolving ambivalence to change,” said Dr. Hodgins as he emphasized the importance of spirit over technique when interacting with clients. The MI spirit is (1) collaborative: provides a partner-like relationship; (2) evocative: elicits motivation rather than instilling it; and (3) respectful: the responsibility for change is with the client. Dr. Hodgins emphasized the importance of spirit over technique when interacting with client According to Dr. Hodgins, when a therapist increases empathy in their interaction with the client, the result is that clients are usually more likely to stay in treatment and less likely to relapse.

NCRG staffConference on Gambling and AddictionConferencecontinuing educationMotivational Interviewingresearchtherapy

Responsible gaming programs typically advise gamblers to set a budget for time and money spent gambling and other self-management techniques designed to avoid problems with gambling. Research is now beginning to examine the types of strategies used by recreational gamblers and people with gambling problems. A new study from Australia demonstrates this trend (Moore et al., 2011).

The authors of this preliminary study were interested not only in how those without gambling problems avoid problematic gambling behavior, but also how people with gambling disorders reduced or stopped their gambling. One of the most recent studies in this literature, to be discussed by Dr. Wendy Slutske at theNCRG Conference on Gambling and Addiction, revealed that a large percentage of Australians who have recovered from a gambling disorder are able to participate in “controlled gambling.” In other words, they are able to gamble without relapse (Slutske, 2009). Understanding their strategies will help inform responsible gaming programs, brief interventions and treatment approaches.

In Dr. Moore’s research with his colleagues, the study sample of 303 gamblers included 63 who qualified as problem gamblers, according to the Problem Gambling Severity Index of the Canadian Problem Gambling Index (CPGI; Ferris and Wynne 2001; Moore et al, 2011). The study participants identified how often they used each of 27 strategies that complete the statement, “To help me limit or manage my gambling, I….”

The total sample, including both non-problem and problem gamblers, rated the following as the top four strategies to limit gambling behaviors:

– ‘Focus on other hobbies’

– ‘Set a target budget for my gambling and stick to it’

– ‘Think about the negative consequences of excessive gambling’

– ‘Keep track of the money I spend on gambling’

Among non-problem gamblers only, the following ranked as their top four strategies:

– ‘Focus on other hobbies’

– ‘Think about the negative consequences of excessive gambling’

– ‘Set a target budget for my gambling and stick to it’

– ‘Keep track of the money I spend on gambling’

The strategies least subscribed to by non-problem gamblers were: cut up my credit cards; get professional help for my gambling; and have myself voluntarily excluded from a gambling venue.

Individuals who met criteria for problem gambling ranked the following management techniques as most used:

– ‘Focus on other hobbies’

– ‘Spend more time with family and friends’

– ‘Think about the negative consequences of excessive gambling’

– ‘Keep track of the money I spend on gambling’

– ‘Talk to family and friends about my gambling’

The lowest ranked techniques for this group were: having myself voluntarily excluded from a gambling venue; ask a friend to look out for me when I’m at a gambling venue; and cut up my credit cards.

The authors summarized the findings: “Overall, strategies concerned with setting limits on bet size and time spent gambling, reminding oneself of the negative consequences of gambling and distraction with other activities were the most frequently used techniques, with about half the sample employing these at some time or other. Most of these techniques involve some kind of cognitive restructuring—thinking about gambling in a different way, either to attempt to reduce its attraction or to try to rein in that attraction” (Moore et al., 2011, p. 13). The researchers recommend future research focused on the use of these strategies among larger samples.

References

Ferris, J., & Wynne, H. J. (2001). The Canadian problem gambling index: Final report. Available from www.ccsa.ca/pdf/ccsa-00805-200.pdf.

Moore, S.M., Thomas, A.C., Kyrios, M., & Bates, G. (2011). The Self-Regulation of Gambling.Journal of Gambling Studies. [Epub ahead of print]

Slutske, W.S., Piasecki, T.M., Blaszczynski, A., & Martin, N.G. (2010). Pathological gambling recovery in the absence of abstinence.Addiction,105(12), 2169-2175.

NCRG staffResearch UpdateAustraliagamblingproblem gamblingresearchresponsible gamingself-regulation

The National Center for Responsible Gaming (NCRG) announced today that Mark S. Gold, M.D., and David Takeuchi, Ph.D., have joined the NCRG Scientific Advisory Board (SAB). These two distinguished researchers and professors will help to enhance the Scientific Advisory Board’s ability to ensure that the NCRG follows rigorous standards in awarding grants, monitor the work of the NCRG Centers of Excellence in Gambling Research and advise the NCRG on funding initiatives and educational activities. The NCRG is the only national organization devoted to funding peer-reviewed research on gambling disorders and creating public education initiatives to help increase the understanding of pathological and youth gambling and find effective treatment methods of gambling disorders and youth gambling.

Dr. Gold is the Donald Dizney Eminent Scholar, distinguished professor and chair of psychiatry at the University of Florida College of Medicine. Prior to assuming the position as chair, he was a professor in the departments of psychiatry, community health and family medicine, neuroscience and anesthesiology. He is also a member of the McKnight Brain Institute. Dr. Gold is a researcher and inventor who has worked for nearly 40 years to develop models for understanding the effects of tobacco, cocaine and other drugs on the brain and behavior. His translational research models have led to new treatment approaches for those with addictions.

Dr. Takeuchi is the associate dean for research and a professor of sociology in the School of Social Work at the University of Washington. He is well-known for his research on social inequalities and health, and his research focuses on investigating the social structural and cultural contexts that are associated with different outcomes, especially among racial and ethnic minorities. Dr. Takeuchi was recently awarded the University of Washington’s Marsha L. Landolt Distinguished Graduate Mentor Award for his exceptional work with graduate students.

NCRG staff spoke about the board members with Linda Cottler, Ph.D., M.P.H., chairwoman of the NCRG Scientific Advisory Board and chair of the department of epidemiology at the College of Public Health and Health Professions at the University Of Florida College Of Medicine., and Glenn Christenson, chairman of the NCRG Board of Directors:

“I am very pleased to welcome Drs. Gold and Takeuchi to the NCRG’s Scientific Advisory Board,” said Cottler. “Their expertise in addiction and the role of psychiatry in community health settings will bring great insight to the board and an added depth to the research that the NCRG funds.”

“The work of the NCRG Scientific Advisory Board is vital to the life of the organization,” said Christenson. “Their knowledge of gambling disorders and addiction research, combined with their guidance in evaluating complex research designs, can truly help elevate the field of research on gambling disorders to a new level.”

For more information on how the NCRG funds research and the stringent firewalls in place to ensure the integrity of research projects, view the NCRG funding chart athttp://www.ncrg.org/assets/files/NCRG_Firewall_Chart_2011.PDF.

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As children across the country start back to school this fall, the NCRG is partnering with Young Minds Inspired (YMI) to create a new educational program titled “Know the Odds.” This resource will be used to encourage teachers and parents to help students understand the warning signs of problem gambling and the facts about underage gambling. The program was developed based on the NCRG’s brochure “Talking with Children about Gambling” and will be distributed to middle and high school students in 418 schools as they begin the school year.

“Know the Odds” arrived in schools on September 6 in three communities: Las Vegas, N.V., Atlantic City, N.J., and Biloxi, Miss. Training materials in the teacher’s kit include a program guide, classroom posters and handouts for students and parents that meet both national education standards and practical classroom needs. The NCRG’s brochure “Talking with Children about Gambling” also is included to help parents understand how to address underage gambling with their children. All materials are free of charge for the schools.

“The NCRG is excited about this partnership and the potential it holds for getting youth gambling information in the hands of parents, teachers and students,” said Glenn Christenson, chairman of the NCRG. “With an estimated 70 percent of Americans aged 14 to 19 years gambling in 2009, these issues need to be highlighted by educators and addressed by families to assist their children.”

“Talking with Children about Gambling” was developed in consultation with the Division on Addictions at Cambridge Health Alliance, a teaching affiliate of Harvard Medical School. The publication provides a clear explanation of the warning signs for youth gambling and relevant approaches that parents can take to help their children and address the issue. To download a free copy of the brochure, visithttp://www.ncrg.org/public_education/talking-with-children.cfm.

NCRG staffICRG Newsadolescentseducationgamblinggambling disordersNCRG partnershipsprogramsschoolsunderage gamblingyouth gambling