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Pathological Gambling: Diagnosis & Treatment
Gamblingcontinuing education psychologist CEUs

Section 10
Online Interventions for Pathological Gambling

CEU Question 10 | CEU Answer Booklet | Table of Contents | Gambling
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

One group of people who are undoubtedly affected by the explosion of technology are problem gamblers. The promotion of gambling by companies using communicative technologies is rife, and the chance to experience gambling has rocketed. Where once gambling was the province of the high — street bookies or casino, it now spreads across interactive TV, websites such as 888.com and PartyPoker.com, and mobile phone texting. The European Bank report on online gambling revealed that it has grown to '$9.2 billion globally since 1995 and is expected to generate a 22 per cent annual growth rate between 2003 and 2008'.

Gambling is one of the hidden addictions. Where alcoholism or drug use can be obvious, the addicted gambler is adept at concealing the problem. The Gaming Board of Great Britain states that about four per cent of British adults have gambled online in the past two years. This indicates that where, say, a stay-at-home mother was previously unable to feed her addiction because of responsibilities at home (and gambling outlets are traditionally a male environment anyway), she is now able to log on and get into serious debt while she is cooking dinner. In particular, a recent newspaper article outlined how women are changing the world of poker — the recent winner of the Pot Limit Hold 'Em World Championship, Xuyen Pham, states: 'I am a housewife. I have three kids to look after'. Yet when not playing live tournaments, the 36-year-old mother logs on to play poker from 8pm to 6am before doing the school run and then going to bed.

However, where there are technological opportunities to gamble, there are also technological opportunities to seek help. Pioneering methods of therapeutic intervention are www.GamblingTherapy.org, developed by the Gordon House Association (GHA) and Datasmith Ltd. I first came across these organizations while writing a report on the use of technology for problem gambling for the Gambling Industry Charitable Trust (now the Responsibility in Gambling Trust).

The Gordon House Association provides residential treatment for problem gamblers, originally a nine-month program. The development of their online software came about as a method of post-residential support and outreach for their clients. It is a mark of the scheme's success that where ex-residents once had to relocate to somewhere near the residential homes to receive post-residential support, they are now able to gain this support remotely from anywhere. The residential program has already been shortened by a month because of the effectiveness of the outreach support, and the GHA's Chief Executive, Kevin Farrell-Roberts, states that the target is to get the residential program to a six-month stay, allowing them to reach a 50 per cent higher capacity. Not only that, but the support that can be offered by the technology before clients enter the residential program means that more of them are likely to have homes to return to post-treatment (problem gamblers at this level have usually lost their home and families, and many are ex-offenders because of turning to crime to fund or recoup their losses).

Pilot study online
Gambling Therapy.org and the GHA have conducted a pilot study of the development of their service, which includes secure email facilities, texting, chat, webcams, booking systems and sessions, a community page for visitors to leave their stories and links to further resources. It employs a tier system of help, starting with a volunteer advisor/assessor (an ex-resident keen to 'give something back' to the organization and whose contribution is considered part of their ongoing care plan). This advisor assesses the needs of the visitor — who might in fact be family or friends of the gambler — and signposts them to the most appropriate help, using their own experiences to make suggestions for coping strategies (although it should be noted that this does not include self-disclosure). Originally, this part of the software enabled the advisor/assessor to handle multiple calls simultaneously, but this facility was deemed too exhausting for the helper and was subsequently dropped. There have also been instances of abusive visitors, and the system was developed to cope with this by a process of warnings, then blocking the visitor where necessary to a 'soft landing' such as the community rooms or links to other resources. International clients, such as ex-pats and the forces, are an unexpected group of problem gamblers that can be offered help.

The difference between this organization’s services and others is the development of specialized chat software, loosely referred to as 'conversational software'. This was developed to echo as closely as possible the dynamics of face-to-face counseling, including: 1. The client seeing the counselor via webcams (to read body language); 2. The option of either party using voice rather than text; 3. Art and drawing whiteboard options; 4. and the use of the conversational (text) software that allows the counselor to 'interrupt' the client and prevent the client from deleting those words or phrases the client may inadvertently use that can provide the counselor with valuable dues as to how the client is really feeling when in denial or avoidance.

Both counselors using this system are trained BACP members. However, I would welcome empirical evidence of the advantages and/or disadvantages of using such a system, particularly with reference to the theoretical body of evidence that there is for chat systems. There is also a role for an observer/supervisor to give guidance and support to the advisor/assessor when they are online to the visitor. The logic behind this is to make sure that the volunteer keeps safe and does not get emotionally involved or affected by the issues the visitor brings up, as well as helping when the volunteer is unsure of the appropriate response to the visitor.

From an ethical point of view, it is important to remind members that BACP offers concrete guidance to those involved in the provision of counseling, psychotherapy and supervision over the Internet, now in its 2nd edition. The work of GHA and GamblingTherapy.org responded to a demand for technological solutions to problem gambling brought about by the gaming industry offering the technological means of allowing (potential) clients to gamble. Similar innovations are being researched worldwide in providing virtual casinos and other gambling environments to allow clients to work on their resistance to gambling for money and chasing losses without having to face the physical possibility of the gambling taking place.

The GamblingTherapy.org software is undoubtedly well implemented and effective, but issues remain for the profession in considering what monitoring is needed for online services in general, including methods of supervision, in whatever modality: videoconferencing; email; Internet Relay Chat (IRC); mobile phone texting; and Internet Enabled CBT Programs (IE-CBT). Organizations such as this one and the Samaritans can (and do) offer crisis support, allowing clients to remain anonymous, but without assessment criteria to take into account the wider psychological problems of the potential client On the other hand, lives are saved daily by these services being offered in an online or mobile capacity. The telephone helpline has evolved, as has the provision of counseling and psychotherapy itself.

Therapeutic intervention that is now offered to the problem gambler, particularly in relation to the explosion of online gambling, is a classic example of how this addiction is evolving. GamblingTherapy.org tells me that where gamblers were once advised to cut up credit cards as part of their recovery, they are now advised to cut up the phone line that enables their internet connection…

- Anthony, Kate, Counseling problem gamblers online; CPJ: Counseling & Psychotherapy Journal, Jul2005, Vol. 16, Issue 6
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #3
The preceding section contained information regarding online interventions for pathological gambling.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 10
What four innovations allow the Gordon House Association’s “conversational software” to echo the dynamics of face-to-face counseling? Record the letter of the correct answer the CEU Answer Booklet

 
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