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Pathological Gambling: Diagnosis & Treatment
Gambling continuing education addiction counselor CEUs

Section 1
Gambling Disorder Comorbidity

CEU Question 1 | CEU Test | Table of Contents | Introduction | Gambling
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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On this track, we will discuss pretreatment assessments. Three tools for pretreatment assessment are the diagnostic interview, assessing comorbidity, and the "daily self monitoring diary". 

Pretreatment Assessments

Assessment #1 - The Diagnostic Interview
First, let’s discuss the diagnostic interview.  To cover different aspects related to the history and evolution of the client’s gambling problem, you might find that a diagnostic interview structured specifically for pathological gambling to be helpful.  As you are probably aware, the American Psychiatric Association provides ten diagnostic criteria to facilitate assessment within a semistructured interview. 

The ten APA criteria for pathological gambling are motives of consultation, games that lead to a partial or complete loss of control, history of gambling habits, information on the current gambling problem, consequences of the gambling problem, presence of suicidal ideation, current living conditions, other present or past addictions, presence of prior mental health problems, and personal strengths and resources available.  How might these ten criteria help you structure a diagnostic interview for your client?

Assessment #2 - Assessing Comorbidity
Regarding other present or past addictions, let’s discuss assessing comorbidity.  As you know, comorbidity studies have found a strong association between pathological gambling and substance use disorders, particularly alcohol abuse and dependence.  In treatment facilities for gamblers, thirty to seventy percent of patients are reported to have an addiction to one or more substances. 

Moreover, as you probably also know, there is a high prevalence of affective disorders in pathological gamblers seeking treatment.  Estimates of major depression in these samples ranges from thirty to seventy-six percent.  Suicidal ideation and suicide attempts are also found among pathological gamblers at rates from thirty-six to fifty percent and twelve to sixteen percent, respectively.  Clearly, these high percentages are not found in the general population, but rather among a specific population.  Gamblers who are consulting a professional or who are admitted to a treatment facility. 

Do you expect there to be a significant proportion of pathological gamblers with more than one problem?  And consierations of a second problem complicate the therapeutic process?  Would you agree that if gamblers show signs of severe mental problems, depression or suicidal intention that these problems should be treated as priorities?

Technique:  Initial Steps in Dealing With Suicide and Depression
If your client, like Tom, suffers from depression or has displayed suicidal tendencies, perhaps these initial steps in dealing with suicide and depression might be effective treatment tools.  Tom, age 37, had lost his wife, his job, and was in danger of not having a place to live.  Tom’s gambling had resulted in these losses. 

Tom stated, "I thought I hit bottom after college, but that was nothing.  Now I really know what bottom is.  Why should I even bother living?

Step 1 - First, I ensured that Tom knew whom to turn to and where to go if intense suicidal ideations (i-DEE-ae-sions) surfaced.  Think of your Tom.  What resources might your client have? 
Step 2 - Next, I made a life contract with Tom.  Tom signed a contract with me stating that he would not, do anything to harm himself without first speaking to me. 
Step 3 - Depending on the situation with your client, a third step in dealing with suicide and depression may be to refer the gambler to a doctor to obtain medical or pharmacological monitoring. 

Assessment #3 -  Daily Self Monitoring Diary
In addition to the diagnostic interview and assessing comorbidity, a third effective tool in pretreatment assessment is a daily self monitoring diary.  We’ll discuss the daily self monitoring diary in more detail on the next track.

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

On the next track we will discuss the daily self monitoring diary in more detail. 

Peer-Reviewed Journal Article References:
Corbin, W. R., & Cronce, J. M. (2017). Effects of alcohol, initial gambling outcomes, impulsivity, and gambling cognitions on gambling behavior using a video poker task. Experimental and Clinical Psychopharmacology, 25(3), 175–185.

Dash, G. F., Slutske, W. S., Martin, N. G., Statham, D. J., Agrawal, A., & Lynskey, M. T. (2019). Big Five personality traits and alcohol, nicotine, cannabis, and gambling disorder comorbidity. Psychology of Addictive Behaviors, 33(4), 420–429.

Farstad, S. M., & von Ranson, K. M. (2021). Binge eating and problem gambling are prospectively associated with common and distinct deficits in emotion regulation among community women. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement53(1), 36–47.

Hammond, C. J., Shirk, S. D., Foster, D. W., Potenza, N. B., Kraus, S. W., Mayes, L. C., Hoff, R. A., & Potenza, M. N. (2020). Cannabis use, problem-gambling severity, and psychiatric disorders: Data from the National Epidemiological Survey on Alcohol and Related Conditions. Psychology of Addictive Behaviors34(1), 230–241.

Werner, K. B., Cunningham-Williams, R. M., Ahuja, M., & Bucholz, K. K. (2020). Patterns of gambling and substance use initiation in African American and White adolescents and young adults. Psychology of Addictive Behaviors34(2), 382–391.

Online Continuing Education QUESTION 1
What are three tools you can use in your pretreatment assessment? To select and enter your answer go to CEU Test.

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