International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL

International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/

Gambling Disorder: An Overview with Emphasis on Psychological Treatments

Audrey F. Ashubwe

Dedan Kimathi University of Technology Email: [email protected]

Pamela W. Miano

Dedan Kimathi University of Technology Email: [email protected]

Abstract

Gambling disorder is also referred to as “The Hidden Addiction’’. Gambling is defined simply as wagering for money and was previously thought to be an adult disorder. Recent studies show that it is twice as rampant in adolescents as it is in adults. The prevalence of gambling at Kisii University Eldoret campus student population in Kenya has been shown to be high and about 60% of students have gambled at least once while attending this University. Gambling Disorder has been found to exist with other mental health disorders like anxiety disorders, mood disorders, Substance Use Disorders, etc. This comorbidity further complicates its treatment. In Kenya examples of sports betting and lotteries which act as strong lures for gambling are Mcheza, Sports pesa, Lotto, Bet yetu, Pambazuka e.t.c. These promise great financial rewards. The three subtypes of gambling identified by Blaszczynski and Nower are the behaviourally conditioned, the emotionally vulnerable and the biologically vulnerable. Five motives have also been proposed for the same. Treatment of this disorder involves pharmacological and psychological treatments. This paper reviews the available literature on the psychological treatments for Gambling Disorder. Some of the effective psychological treatments for Gambling Disorder include Cognitive Behavioural Therapy, Motivational Interviewing, Solution Focused Therapy, Group therapy, Self Help treatment and Harm reduction.

Keywords: Gambling disorder, Psychological treatments, Adolescents, Youth

Introduction a Gambling Disorder diagnosis, one must exhibit at least four of the nine gambling The Diagnostic and Statistical Manual of related problems listed in the DSM-5 for a 12 Mental Disorders (DSM-5) recognizes months period. The specifications for this Gambling Disorder and classifies it under the disorder are episodic/ persistent, stages of Non – Substance Related Disorders. It is the remission and current severity (APA, 2013). first addiction classified in the DSM-5 that is According to the American Psychiatric behavioural. It is currently also referred to as Association (APA) (2000), pathological Problem Gambling (Chu & Clark, 2015). For gambling typically involves constant and

1 | P a g e 23 April 2018 e-ISSN No: 25904272 International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/ repeated maladaptive gambling behaviour. with gambling disorders are preoccupied This causes significant harmful financial, with gambling, they continue to engage in it psychosocial, physical and legal despite the repeated losses and often attempt consequences (APA, 2000). Simply defined, to recover their losses. This causes them to lie gambling is wagering for money to their friends, family and peers about their (Derevensky, 2015) and is referred to as a activities; and their efforts to reduce hidden addiction (Derevensky & Gilbeau, gambling result in depression and anxiety. 2015). This is because gambling is exciting and the Gambling was previously thought to more the adolescent wagers, the greater the be an activity that only adults engaged in. adrenaline rush that they experience Studies in the last 50 years have shown that (Derevensky & Gupta, 2004). this is no longer the case. Adolescents too are Betting is not only prevalent among continuously taking part in gambling adolescents, but it is also a growing concern (Derevensky, 2012). Studies have shown that amongst university students with a large the rate of pathological and problem number of students between the ages of 18 gambling in adults is almost two times less and 24 engaging in gambling behaviours. than it is in adolescents. In addition, the Koross (2016) conducted a study to earlier the age at which one starts to gamble, investigate the popularity of betting among the more severe the negative consequences as Kenyan university students, their motives for well as the chances of continued gambling betting and whether it had an influence on later in life (George & Mulari, 2005). their behaviour. The findings indicated that Adolescents gamble in regulated or licensed betting was prevalent among university venues despite being under age and not being students and their main motives were to attain allowed to do so. They are also involved in money and for enjoyment purposes. An effect unregulated gambling which they do with on the students' behaviours was also noted in their peers (Derevensky, 2012). Gambling the study such as spending lots of time behaviour in adolescents ranges from non – gambling rather than attending classes as disordered through to recreational or social well as incurring debts to finance their gambling to gambling that is compulsive, gambling. Amongst university students, problematic, pathological and disordered ownership of mobile phones provides an easy (Derevensky & Gilbeau, 2015). Typically, route to sports betting due to increased adolescents engage in gambling activities accessibility to online sites. Some students that include playing cards for money, board spend their University tuition fees on betting games, betting on games with their peers, and as a result of losing bets, there have been playing video games, sports wagering etc. An dire consequences such as failing to sit for increasing number are now using their smart- examinations, discontinuation of one’s phones or the internet as a platform to gamble university education or in some instances (McBride & Derevensky, 2012). It is an committing suicide (Koross, 2016). incapacitating disorder that affects many Peltzer and Pengpid (2014) different areas of ones’ life. Those who suffer conducted a cross-sectional study to from it have an increased risk of death investigate the gambling behaviour of through suicide (George & Mulari, 2005), university students across 23 low and middle steal money from their parents and shoplift income and emerging countries. Findings (Derevensky & Gupta, 2004). Adolescents indicated that there are several risk

2 | P a g e 23 April 2018 e-ISSN No: 25904272 International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/ behaviours associated with gambling among lower socioeconomic class tend to have university students. These risk behaviours higher rates of gambling (van Wormer & included tobacco use, sexual risk behaviour, Davis, 2013). In lifetime prevalence rates of not always abiding to driving speed limits pathological gambling among African and engaging in physical fights. Comorbid Americans, Whites and Hispanics are about mental health disorders such as PTSD 0.9 %, 0.4% and 0.3% respectively (APA, symptoms and depression were also noted. 2013). Research findings from the United In adults, absenteeism at work, loss of States, Norway, Canada, The United jobs, poor performance in the workplace and Kingdom and Australia reveal that 63 – 82% family problems are common outcomes of 12 – 17 year olds are involved in gambling (Grant, Odlaug & Scheribe, 2014). Other each year (Monaghan, Derevensky, & Sklar, problems include legal problems, debt and 2008). Typically, a child will have their first bankruptcy as well as psychological distress gambling experience at the age of 12 years. (Petry, Stinson & Grant, 2005) That is at a slightly younger average age than that at which they begin the use of tobacco, Prevalence alcohol or other drugs (Jacobs, 2004).

The lifetime prevalence of pathological Co-Morbidity gambling in the US has been estimated at 0.42 % (Petry, et al, 2005) which is close to Gambling Disorder is a heterogeneous the prevalence reported in Western European condition; primarily because many countries (Costes, Pousset, Eroukmanoff, Le individuals with Gambling Disorder have Nezet, Richard, Guignard, Beck & Arwidson, other coexisting mental health disorders 2011). According to the DSM-5, the which include anxiety, substance use, mood prevalence rate of Gambling Disorder in the disorders (Felicity, Lorains, Cowlishaw & general population is approximately 0.4% - Thomas, 2011), Antisocial Personality 1.0 %. In females it is about 0.2% while in Disorder and Impulse Control Disorder males it is about 0.6% (APA, 2013). (Chou & Afifi, 2011). In a study on university Derevensky (2012) indicates that male students, comorbid mental health disorders adolescents appear to be engaged more such as PTSD symptoms and depression actively in gambling than their female were also noted (Peltzer & Pengpid, 2014). counterparts. The likelihood of older The presence of these comorbid adolescence taking part in gambling is also psychological conditions further complicates higher than that for younger adolescents. the clinical picture of individuals with Females tend to begin gambling later in life. Gambling Disorder. However, they have been shown to progress faster into addiction (George & Mulari, Different Types of Games 2005). In addition, ones’ socioeconomic Not all the gambling games have the same status (SES), ethnicity, and close physical structure and therefore addiction potential. proximity to the locations in which gambling The traditional lotteries are considered less occurs, influence the prevalence as well as addictive, the scratch card lotteries as the attractiveness of each type of gambling moderately addictive while the slot machines activity (Derevensky, 2012). Those from a are considered to be highly addictive since

3 | P a g e 23 April 2018 e-ISSN No: 25904272 International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/ they use the variable reinforcement schedule the risk factors for individuals also differ. and immediate feedback (Beck, Richard, However, whatever the risk factors, they are Guignard, Le Nézet, & Spilka, 2015). the same as those often associated with other addictive and mental health disorders (APA, Psychological theories and reasons for 2013). The developmental period of Gambling adolescence is a period that is associated with behaviour that is likely to involve risk taking Binde (2012, p. 84) identifies five motives for (Chambers, Taylor & Potenza, 2003). Studies gambling: the dream of hitting the jackpot, indicate that most adolescents will take part social rewards, intellectual challenge, mood in gambling to some degree if a chance is change and the chance of winning. Some of presented (Gupta & Derevensky, 2000). the theories that have suggested reasons for Twin studies by Slutske, Zhu, Meier gambling include the behavioural theories and Martin (2010) indicate that the influence which indicate that gambling is as a result of of genetic factors in the risk of developing positive reinforcements. Slot machines seem Disordered Gambling could be more than to be designed to use operant conditioning. that of environmental factors. Experiencing Players are rewarded occasionally with small trauma at an early age and being genetically prizes and this motivates them to keep predisposed has been found to make some playing. The initial win keeps them playing individuals neurologically vulnerable to the despite later loses in the hope that the next disorganizing consequences of addiction. time they shall win. They eventually get Cumulatively, these effects can lead to hooked to the game and regardless of whether changes in the structure of the brain, its they win or lose (van Wormer & Davis, function and response to further stress. These 2013). According to the psychoanalytic individuals are therefore more vulnerable to theories, gambling is viewed as self - addiction. There is rapid neuroplasticity in punishment because of the high risk frequent the adolescent brain which facilitates losses. This is as a result of unresolved guilt learning but also makes the brain vulnerable or immature and childlike behaviour that an to high risk behaviour and brain damage that individual uses to try and delay autoerotic results from the same (Winters & Arria, satisfaction (Escandon & Galvez, 2013). The 2011). Another reason for the inability of Cognitive-Behavioural theories (CBT) adolescents to resist peer pressure and propose that problems are caused and engage in risky behaviour like gambling, is perpetuated by maladaptive thinking and that the prefrontal cortex which is associated individuals’ bad habits (van Wormer & with self- awareness, novelty seeking and Davis, 2013). judgment is not fully mature until after the age of 20 years (van Wormer & Davis, 2013). Risk Factors In addition, dopamine has been implicated in making some individuals susceptible to In order to understand the complexity of Gambling Disorder. When the brains of non- problem gambling, clinicians need to adopt a addicted control group were compared with bio-psycho-social-environmental outlook. It those of the addicted individuals, it was is now recognized that not all adolescents that found that winning causes less activation in are involved in gambling develop the the pleasure regions of the addicted disorder in the same way. This suggests that individuals. Also noted was the increase in

4 | P a g e 23 April 2018 e-ISSN No: 25904272 International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/ activation in men of dopamine pleasure many youth indicate that their first circuit when playing video games which was experience in gambling was with a family absent in women (Linden, 2011). This could member at home (Lussier, Derevensky, explain the differences between males and Gupta & Vitaro, 2013). For others, gambling females in their preferred modes of gambling. is used for socialization, as a way to relieve Studies by Parker, Summerfeldt, stress and boredom (Derevensky & Gilbeau, Kloosterman, Keefer and Taylor (2013) 2015). Other risk factors are discussed in indicate that having a learning disorder puts detail later during the discussion of the adolescents at a doubled risk of developing different developmental pathways for disordered gambling compared to those who Gambling Disorder. do not have learning disorders. In addition, if adolescents have other psychiatric, medical Protective Factors or substance use disorders, they are at high risk of developing problem gambling (Wilber Resilience and family cohesion have been & Potenza, 2006). Furthermore, maladaptive identified as protective factors for adolescent beliefs are risk factors in problem gambling. gambling (Dickson, Derevensky & Gupta, Adolescents have wrong beliefs that they can 2008). Positive social bonding (school control themselves at the slot machines or connectedness and family cohesion), social that gambling involves some skill and personal competence are believed to be (Delfabbro, Lamos, King & Puglies, 2009). the resource factors that may reduce the Faregh and Derevensky (2011) indicate that chances of youth engagement in gambling there is a risk of children with ADHD (Lussier et. al., 2013). developing Gambling Disorder. Adolescents have resorted to gambling because of the Screening and Assessment perception they have that it is an easy way of getting wealth without having to work hard Some of the instruments that can be used to for it. A number of adolescents even assess gambling addiction are the DSM-5 indicated that their preferred vocation is to (APA, 2013), Canadian Adolescent become a professional gambler (McBride & Gambling Inventory (CAGI), (Wiebe, Derevensky, 2012). Wynne, Stinchfield & Tremblay, 2007), The earlier the age at which one starts South Oaks Gambling Screen – Revised for to gamble, the higher the risk of developing a Adolescents (SOGS –RA), (Winters, gambling problem. Socially, it has been Stinchfield & Fulkerson, 1993), DSM IV – J shown that the onset of gambling is increased (Fisher, 1992) and DSM IV- MR –J (Fisher, in individuals from low socioeconomic status 2000), Gambling Activities Questionnaire backgrounds especially the impulsive youth (Gupta & Derevensky, 1996), The Lie/ Bet (Auger, Lo, Cantinotti & Loughlin, 2010). questionnaire (Johnson, Hamer, Nora, Tan, The environmental risk factors for youth Eistenstein & Englehart, 1988) and Twenty developing problem gambling are low social Questions of Gamblers Anonymous (Parker bonding, neighborhood, peer, family, social et. al., 2012). and personal competence. Children with a The Pathways Model of Gambling parent who has a gambling problem, poor parental discipline and supervision contribute Blaszczynski and Nower (2002) suggest that to youth gambling problems. Furthermore, there are pathways through which Gambling

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Disorder develops. Each of these isolates escape from feelings of anxiety or depression specific predisposing factors as well as (Koross, 2016). Emotionally vulnerable consequences as a result of gambling. The gamblers have been found to be abusers of model identifies the following three subtypes drugs prior to developing Gambling of gamblers; the behaviourally conditioned, Disorder. They use both the drugs and the emotionally vulnerable and the gambling as a means of providing arousal or biologically vulnerable. escape from their aversive emotional states Pathway 1: The Behaviourally Conditioned (Jacobs, 2004). Individuals of this subtype Gamblers. are more resistant to treatment because there These gamblers do not have any previous are underlying emotional issues that need to psychopathology. They are regular gamblers be addressed as the gambling problem is who may gamble occasionally while at other tackled (Allami & Vitaro, 2015).They have times they gamble excessively. Conditioning symptoms of depression, are dependent on plays a role in their gambling pattern and so substances and anxious as they chase their do their distorted cognitions about winning. losses. The substance abuse also needed to be They also gamble because of poor decision addressed and this makes treatment more making and not because of lack of control complex than that for Pathway 1 individuals (Gupta, Nower, Derevensky, Blaszczynski, (Gupta et. al, 2013). Faregh, & Temcheff, 2013). The reasons Pathway 3: The Biologically Vulnerable these individuals begin gambling are related Gamblers. to socialization, entertainment and Individuals in this group have similar excitement (Allami & Vitaro, 2015).This is biological and psychosocial vulnerabilities to similar to the type of gamblers known as those in Pathway 2. However, the differences casual social gamblers who gamble mostly between the two are that in addition, for recreational purposes (Koross, 2016). individuals in this subgroup have antisocial Individuals with this subtype respond well to personality behaviours and traits, a number of treatment and are good candidates for maladaptive behaviours, are impulsive and prevention strategies (Allami & Vitaro, show attention deficits (Gupta et. al, 2013). 2015). This relates to the type of gambler referred to Pathway 2: The Emotionally Vulnerable as the antisocial gambler, who gambles to Gamblers. make money and also tends to scam people in These individuals have vulnerabilities to the order to do so (Koross, 2016). Brain regions same ecological risk factors and processes of that are associated with control of impulse are conditioning as those of Pathway 1. However affected. There is suggestion of genetic in addition, these individuals often are vulnerability because these individuals also members of dysfunctional families, have have a history of antisocial behaviour in their experienced major traumas in their lives and families (Allami & Vitaro, 2015). These have depression and / or anxiety (Gupta et. al, individuals display behavioural problems 2013). These gamblers therefore gamble in that are not related to the type of gambling an attempt to cope with their emotional that they are involved in (Blaszczynski, Steel, problems (Allami & Vitaro, 2015). This is & McConaghy, 1997). Furthermore, similar to the type of gamblers known as individuals in this group are involved in drug escape gamblers for whom gambling abuse and experimentation, criminality that is produces a numbing effect that helps them not related to gambling as well as have poor

6 | P a g e 23 April 2018 e-ISSN No: 25904272 International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/ interpersonal relations (Gupta et. al, 2013). counsellor needs to keep this in mind as they There is poor treatment outcome with plan for the treatment of an adolescent. individuals in this subgroup. They do not In addition, when conducting adhere to treatment and respond poorly to any interventions in the youth, Jacqueline Wallen intervention given the severity of their (1993) in her developmental theory suggests problem (Blaszczynski & Nower, 2002). that one must proceed differently; that is, more slowly than they would with adults Treatment (Wallen, 1993). Moreover, different approaches may be necessary for different Very few pathological gamblers and those adolescents depending on their level of that are at risk of developing Gambling maturation and development. Treatment for a Disorder seek treatment despite the fact that 14 year old would differ from that of an 18 it is available. Paradoxically, those who seek year old (Wilber & Potenza, 2006). Some treatment often do so for other comorbid individuals may need to be admitted into a disorders (Winters & Kushner, 2003). hospital or institution so that they are away Reasons for not seeking treatment included from the situations that tempt them to denial and shame associated with having a gamble. Education on values is helpful as a gambling problem. Furthermore, a number preventive measure (Escandon & Galvez, would like to resolve the problem by 2013). themselves while others do not trust the Since the causes of Gambling therapists that they go to (van Wormer and Disorder are varied, there is no single Davis, 2013). Another possible reason would treatment approach that will work universally be the focal point of the clinicians tend to be for all individuals that require help focussing on teenagers’ with other comorbid (Blaszczynski & Nower, 2002). In the disorders such as substance abuse than treatment of adolescence and youth, there are gambling addiction (Wilber & Potenza, no specific treatments that have been 2006). Clinical support suggests that empirically validated. Therefore, treatments disordered gambling is an episodic disorder used are similar to those that are used for as opposed to the progressive and continuous adults. Some of the approaches include nature that it was previously thought to be. psychological, pharmacological, addiction This could be another reason why many based models biological/ genetic, self - help youth do not seek treatment; they could be models (Ladouceur, Fournier, Lafond, correcting their behaviours in between the Boudreault, Goulet, Sévigny, Simoneau, & gambling episodes (Derevensky & Gilbeau, Giroux, 2015) and Motivational Interviewing 2015) (Pasche, Sinclair, Collins, Pretorius, Grant Gambling Disorder appears to begin and Stein, 2013).This paper focuses on the in early adolescence; the Identity vs. Role psychological treatment approaches to confusion stage (12 -17 years). According to Gambling Disorder. They include:- Erickson’s psychosocial theory of development, if the crisis at a particular stage 1. Cognitive – Behavioural Therapy is not resolved or its resolution is put on hold, (CBT). the individuals’ maturity level becomes inconsistent with their chronological age (van Cognitive behavioural techniques have been Wormer & Davis, 2013). An addiction found to be effective in the treatment of

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Gambling Disorder and many therapists Emphasis should also be on relapse prefer to use CBT (Derevensky & Gilbeau, prevention and contingency management 2015). Rash and Petry (2014) conducted a (van Wormer and Davis, 2013). systematic review of psychological However for adolescents, in addition, it is treatments for Gambling Disorder. Their necessary to help them understand their findings indicated that cognitive-behavioural erroneous cognitions, laws of probability and interventions were the most common independence of events. Focus should also be amongst extensive therapies. on underlying motivations that lead to CBT advocates that the situation can be gambling which include anxiety, depressive changed by a change in thinking which can symptoms, somatic disorders, personal, lead one to behave differently. For problem academic and family problems, high risk gamblers it can be applied in the following taking, mood disorders, poor coping skills ways:- etc. Most importantly, the reduction of a) Reinforcement: problem gamblers can barriers to accessing treatment must be be rewarded during periods of considered before establishing Best Practices abstinence. (Derevensky & Gilbeau, 2015). CBT can also b) Modelling: a problem gambler who be used in group therapy to treat Gambling joins a group like Gamblers Disorders. Anonymous is likely to be motivated to abstain from gambling or maintain their 2. Motivational interviewing (M I) recovery when they interact with other group members that have abstained for According to Hodgins and Diskin (2008), M a long time. These group members I is the treatment of choice for a gambling model the benefits of abstinence. addiction counsellor. One of the reasons c) Conditioned responding: when problem would be client who seeks therapy urgently gamblers are helped to identify wants to straighten out their lives and be free potential triggers and devise ways to of the problems brought about by gambling. diffuse them, they are likely to abstain They are therefore highly motivated to from gambling. change. Thus, M I is often quite effective d) Cognitive factors: the ABC model can with such a population. Motivational be used to challenge cognitive Interviewing targets the ambivalence that distortions of individuals with clients with Gambling Disorder often Gambling Disorder. By re-evaluating experience towards change. It addresses the their beliefs, they can change the problems of these individuals thereby consequences of maladaptive thoughts. increasing their motivation to change as well e) Relaxation training and desensitization as making them self-efficacious in tackling help individuals with Gambling problems. It has also been used successfully Disorder to prepare mentally to in individuals that have gambling problems overcome the temptation to gamble. and do not meet the criteria for Gambling Disorder (Rash & Petry, 2014). The aim for A counsellor can also use CBT to teach using MI for these individuals is they will not individuals with gambling disorder progress to Gambling Disorder (Yau & intrapersonal and interpersonal coping skills Potenza, 2015). Studies by Josephson, either in individual or in group therapy. Carlbring, Forsberg and Rosendahl (2016)

8 | P a g e 23 April 2018 e-ISSN No: 25904272 International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/ found that MI was more useful than gains in reducing gambling. However, Cognitive Behavorial Group therapy (CBGT) Gambling Anonymous is not usually a in the treatment of individuals in whom desirable resource for many seeking help Gambling Disorder is comorbid with risky with gambling addictions and thus overall alcohol intake. commitment is low.

3. Solution Focused Therapy (SFT). 5. Self – help treatment SFT has been found to treat Gambling Studies by Suurvali, Hodgins, Toneatto and Disorder. According to SFT, addiction Cunningham (2008) indicate that only about affects people differently. It is therefore 29% of those with problem gambling have important to help individuals define how they sought formal assistance for their problem. conceptualize their problems and the goals However, when informal assistance for that they need to have in order to bring about example the use of internet or self-help books change. Some techniques used by SFT was availed, the number seeking treatment include the use of miracle questions, coping rose to approximately 53%. A study by questions and scaling questions. Therapists Hodgins, Currie and el-Guebaly (2001) highlight past successes and strengths and showed that using a self-help treatment avoid addressing issues that were previously workbook or manual combined with considered problematic (van Wormer & telephone interviews from a clinician who is Davis, 2013). specialized in dealing with gambling problem would yields a decrease in gambling habits. 4. Gamblers Anonymous These results are noted up to two years after treatment ended. A Cognitive Behavioural Group treatments for Gambling Disorder are approach created by Centre quebecois based on the treatments that are used for d’excellence pour la prevention et le alcoholism, with members attending group traitement du jeu (CQEPT) at Universite therapy and Gamblers Anonymous meetings. level called JEu me questionne (JMQ) is an Gamblers Anonymous also apply the disease example of such an approach. The phone model similar to Alcoholics Anonymous interviews use principles from the Motivating approach and thus view gambling as a life- Interviewing approach. Other self-help long affliction (Rash & Petry, 2014). This is materials include video and audio materials a cost effective method of delivering (Ladouceur et al, 2015). Self-help treatments treatment. Adolescents get to learn from may reach a wide range of people seeking other members’ experiences. Gambling treatment other than those professionally Anonymous (GA) groups use the 20 delivered as there are less perceived obstacles gambling questions to assess whether one is such as stigma and cost (Rash & Petry, 2014). a compulsive gambler (van Wormer & Davis, 2013). 6. Harm reduction approach Rash and Petry’s (2014) review indicated that early dropout was common except for This approach recommends that youth need those with more severe gambling or to be aware of the risks that are associated interested in abstinence. With those who with gambling. They also need to be helped combined Gambling Anonymous and to develop skills in critical thinking that helps professional treatment, there were greater

9 | P a g e 23 April 2018 e-ISSN No: 25904272 International Journal of Psychotherapy, Counselling and Psychiatry: Theory Research & Clinical Practice (Volume III) URL: http://ijpcp.com/ them remain in control whenever the risk factors that make one susceptible to situation they are in. At risk, youth need to be become addicted. Gambling Disorder is now identified and programs that target harm aligned with substance use disorders in the reduction developed at community as well as DSM 5 (it was previously under Impulse school levels. Also, parents need to monitor Control Disorders in the earlier DSM their children when using the internet and be publications) thus indicating that more sensitive to the marketing strategies used to professionals would need to consider it as an lure youth to gambling (van Wormer & addiction in their treatment (APA, 2000, Davis, 2013). 2013; Rash & Petry, 2014).

Conclusion References

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