Pathological Gambling: Diagnosis & Treatment

On the last track we discussed pretreatment assessments.  pretreatment assessment.  Three tools for pretreatment assessment are the diagnostic interview, assessing comorbidity, and the daily self monitoring diary.  

On this track we will discuss daily self monitoring diaries in more detail.  With the daily self monitoring diary, the gambler rates his or her perception of being in control of his or her gambling as well as their desire to gamble on a scale from 0 to 100. 

Gamblers also specify the number of times they gambled during the day or week, the number of hours they spent gambling, and the amount of money they lost.  Lastly, gamblers are asked to write about the feelings they had throughout the day as well as any context or event that may have provoked their urge to gamble. 

#1  Seven Questions
I find it useful in my practice to ask gamblers to complete a daily observation diary throughout the entire therapeutic process.  Clearly, the gambler records a certain amount of information regarding their gambling in the daily self monitoring diary.  My clients set their diaries up to look like a grid, with the dates listed in a row at the top of the page. 

The left column of the page lists the seven sections of the diary.  These sections ask for the information regarding the pathological gambler’s association with gambling. 

Question #1 - When Tom, from the last track, filled out his daily self monitoring diary, the first section asked to what extent do I perceive that my gambling problem is under control. Below this question was a scale from zero to one hundred. Zero meaning not at all and one hundred meant completely. Each page of Tom’s diary recorded one. 

In one specific week, Tom went from feeling fifty percent in control of his gambling down to zero on a day when he lost money he couldn’t afford to lose. Later in the same week, Tom went back up to feeling sixty percent in control of his gambling. 

Think of your Tom. How much control does your client perceive to have over his or her gambling?

Question #2 - The second question in the daily self monitoring diary rates the client’s desire to gamble each day.  Tom’s diary had a scale below this question similar to the previous scale, with zero meaning a nonexistent desire to gamble and one hundred representing a very high desire to gamble.  Tom found that after losing money, his desire to gamble often decreased significantly.

Question #3 - The third question in the daily self monitoring diary asks to what extent do I perceive myself as being able to abstain from gambling.  Also rated from zero to one hundred, this question can indicate your client’s level of understanding the relationship of his or her ability to abstain and the negative consequences of gambling.

Question #4 - Question four asks did I gamble today.
Question #5 - Question five asks how much time in minutes and hours was spent on gambling.
Question #6- Question six asks the gambler how much money did he or she spend on gambling, excluding wins. 
Question #7 - Question seven asks the gambler to specify his or her state of mind or the particular events of the day.  For example, on a day when Tom lost a significant amount of money gambling, Tom wrote, ‘Very sad.  Stressed.  I lost way more than I can afford!’  The following day, Tom wrote, ‘Stressed.  I need to find a way to come up with two hundred and fifty bucks before the end of the month!’  Several days later, when Tom felt little desire to gamble, he wrote, ‘I had a good day at work.  I need to stay on track.’ 

Think of your Tom.  How might your client benefit from the daily self monitoring diary?

#2  Therapeutic Advantages
There are numerous therapeutic advantages to completing the diary on a daily basis.  For example, I felt that Tom tended to underestimate the extent of his gambling problem. 

--1. The diary helped him become conscious of his gambling problem, of the intensity of his desire to gamble, and of the substantial sums of money he lost. 
--2. Also, the diary helped Tom to monitor his therapeutic progress.  Tom stated, "It makes it easier to realize my progress when it seems that therapy isn’t doing me any good." 
--3. Finally the diary provided me with valuable information about the events of Tom’s week. 

Think of your Tom.  How might you use the daily self monitoring diary in your client’s treatment program?

On this track we discussed daily self monitoring diaries.  With the daily self monitoring diary, the gambler rates his or her perception of being in control of gambling as well as their desire to gamble on a scale from 0 to 100.  Gamblers also specify the number of times they gambled during the day, the number of hours they spent gambling, and the amount of money they lost.  Lastly, gamblers are asked to write about the feelings they had throughout the day as well as any context or event that may have provoked their urge to gamble. 

On the next track we will discuss developing a controlled treatment plan.  We’ll discuss when to use controlled treatment and two steps to developing a controlled treatment plan.  The two steps are establishing a peer group of counselors and making problem gamblers aware of peer counselors as a resource.

Peer-Reviewed Journal Article References:
Ashrafioun, L., & Rosenberg, H. (2012). Methods of assessing craving to gamble: A narrative review. Psychology of Addictive Behaviors, 26(3), 536–549.

Magnusson, K., Nilsson, A., Andersson, G., Hellner, C., & Carlbring, P. (2019). Internet-delivered cognitive-behavioral therapy for significant others of treatment-refusing problem gamblers: A randomized wait-list controlled trial. Journal of Consulting and Clinical Psychology, 87(9), 802–814.

Petry, N. M., Ginley, M. K., & Rash, C. J. (2017). A systematic review of treatments for problem gambling. Psychology of Addictive Behaviors, 31(8), 951–961.

Pfund, R. A., Peter, S. C., Whelan, J. P., Meyers, A. W., Ginley, M. K., & Relyea, G. (2020). Is more better? A meta-analysis of dose and efficacy in face-to-face psychological treatments for problem and disordered gambling. Psychology of Addictive Behaviors, 34(5), 557–568.

Rodda, S. N., Bagot, K. L., Cheetham, A., Hodgins, D. C., Hing, N., & Lubman, D. I. (2018). Types of change strategies for limiting or reducing gambling behaviors and their perceived helpfulness: A factor analysis. Psychology of Addictive Behaviors, 32(6), 679–688.

Wang, L., Tian, M., Zheng, Y., Li, Q., & Liu, X. (2020). Reduced loss aversion and inhibitory control in adolescents with internet gaming disorder. Psychology of Addictive Behaviors, 34(3), 484–496.

Online Continuing Education QUESTION 2
How does the daily self monitoring diary work? To select and enter your answer go to CEU Test.