Treatment for compulsive gambling starts with recognizing there is a problem. Denial is common among those who are addicted and the compulsive gambler is no different.
Even though they can be shown how their habit has shaped and harmed their lives, they can often point to a “big win” as justification. Motivation is critical and many of those in treatment are only there because their spouse, or employer, or a court has insisted on it. Before treatment can help, the gambler has to believe there is a real addiction that requires treatment.
Informal Support Groups
There are two tracks available for treatment and both may be used simultaneously. The first is an informal support group, similar to Alcoholics Anonymous. The twelve-step program in Gamblers Anonymous (GA) is free and gives the addict access to a large support group of peers who understand the problem. The atmosphere is non-judgmental and supportive.
The second track is based on cognitive-behavioral therapy. It seeks to change the way the gambler sees his problem and his situation. Unhealthy beliefs and rationalizations are confronted. Patients are taught techniques to fight urges and deal with stressors (financial and emotional) that lead to compulsive acts. The goal is to change the way gambling is understood by the patient in order to alter behavior.
An advantage of cognitive-behavioral therapy over group support is that it is individualized and can address other life issues that might be acting as triggers. The main disadvantage is cost and the unfortunate mislabeling of therapy as something appropriate only for the weak or those who have a mental disorder.
Treatment will also attempt to limit the material supports that allow gambling to occur: Money; Time; Venue – these are all required for the activity.
Maintenance is important so that the gambling compulsion doesn’t reemerge. GA is an excellent resource and a way to give back to others. Beyond this, attention must be paid to avoid tempting situations and give up access to funds – at least in the short term. Cultivating relationships that promote accountability and finding enjoyable interests that replace gambling are also important.
One of the key triggers for this addiction is stress. Problem gamblers are able to get lost in their compulsion and the artificial, stress-and-relief cycle of gambling is a way to escape unmanaged stress in their lives. Stress will arise. Techniques to manage stress have to be learned and practiced.
photo by Mary Helen McNally