Removing barriers to

accessing treatment
Sonya Sabbatino
ISTITUTO WATSON
www.iwatson.com
Torino

info@iwatson.com sonya.sabbatino@iwatson.com
 Classifying the Evidence
Practice Guidelines for Treating Gambling-Related Problems

An Evidence-Based Treatment Guide for Clinicians

Strength of Evidence Interventions

• Cognitive Behavioral Therapy

Strong evidence • Behavioral Therapy

Moderate Evidence
• Relapse Prevention

• Psychodynamic Psychotherapy
• Aversion Therapy
Weak Evidence • 12-step (e.g., Gamblers
Anonymous; self-help)
• Self-Exclusion (self-help)

David A. Korn, Howard J. Shaffer

Developed by the Massachusetts Council on Compulsive Gambling January, 2004
 Minimal Interventions
range from
 Motivational Interviewing:
A directive, client-centred method for enhancing
intrinsic motivation to change by exploring and
resolving ambivalence (Miller & Rollnick, 2002)
 Self Help Manuals:
- Cognitive–behavioral/self-control strategies such as
selfmonitoring,
- Functional analysis,
- Goal setting, and
- Selfreinforcement.
 Dickerson and Weeks (1979)

 Found that the use of a Self-Help

Manual significantly reduced gambling
alone or in conjunction with a single in-
depth motivation interview.
 Miller and Rollnick (1991) :

 Present evidence that a Motivational

Interviewing approach may maximize
the benefit of a Brief Intervention and
help engage people with addictive
behaviors in therapy by overcoming
ambivalence and clarifying goals, thus
increasing opportunity for positive
change.
 Motivational Enhancement and Self-Help
Treatments for Problem Gambling
(Hodgins, Currie, el-Guelaby, 2001)

 1 month follow up: Motivational Enhancement

Telephone Intervention + Self Help Workbook (not the
Workbook Only)
Only had better outcomes than part. in
Wait List Control
 3 & 6 month follow up: Motivational Interview+ Self
Help Workbook showed better outcomes than
Workbook Only
 12 month follow up: The advantage of the
Motivational Interview + Self Help Workbook group
was found only for part. with less severe gambling
problems

RESULTS: 84% PARTECIPANTS (N=102) REPORTED A

SIGNIFICANT REDUCTION IN GAMBLING OVER A 12
MONTH FOLLOW UP PERIOD
Minimal treatment 24 Month
outcome
 Brief Motivational Treatment for
Problem Gambling: A 24 Month Follow Up
(Hodgins, Currie, el-Guelaby, 2004)

 Motivational Enhancement Telephone Intervention + Self

Help Workbook compared with Workbook Only

 No differences in the number of partecipants reporting 6

month abstinence

 Motivational Intervention + Self Help Workbook gambled

fewer days, lost less money, and had lower South Oaks
Gambling Screen scores

RESULTS: SUPPORT EFFECTIVENESS OF A BRIEF

TELEPHONE AND MAIL BASED TREATMENT FOR PROBLEM
GAMBLERS
 Randomized trial of Internet Delivered Self Help
With Telephone Support for Pathological Gamblers
(Carlbring, Smit 2008)

 THE GOAL:
GOAL Test an Online alternative to the effective
therapies to lower the barriers for help seeking

 N=66 partecipants – pathological gamblers

 Wait list Control compared with 8 Week Internet based

CBT program with minimal therapist contact via e-mail and
weekly telephone calls of less than 15 min. (average time
spent on each part.= 4 h)

RESULTS: FAVORABLE CHANGES IN P.G., ANXIETY,

DEPRESSION (not severe), QUALITY OF LIFE.
Follows up at 6-18-36 months indicated that treatments
effects were sustained.
 Studies conclusions
 Significant reduction in gambling.
 Support for Stepped Care Model.
 Motivational enhancement helpful.
 No gender differences.
 Media recruitment is an effective way to attract
problem gamblers not seeking treatment
particularly women.
 Results promising. More evidence needed for
distance treatment trough help online, telephone,
video conferencing and workbooks
 What’s interesting?

The Minimalist Approach

 Favorable outcomes in changing gambling behavior,
although research is needed to replicate the findings

 Cost effective to the consumer and for those who are

providing the service.

 Considering the cost of health care and the possibility the

individual might lack insurance coverage, this approach
could be a valuable first step in treatment of pathological
gambling.

 If the gambler does not respond favorably to this

treatment approach, the treatment professional should
offer the client a more intensive intervention.
An overwiew on Workbooks
 Freedom from Problem Gambling
http://www.uclagamblingprogram.org/clinical_drug_trials.html

 This self-help workbook for problem gamblers,

developed by the UCLA Gambling Studies
Program, is a tool for assisting people who are
motivated to stop gambling or reduce their
problems associated with gambling.
 The workbook is under evaluation for
Effectiveness and is NOT a substitute for
professional help.
 5 chapters, each of which focuses on a
different aspect of gambling. The chapters
are further divided into sections or topics that
contain several paper exercises.

Timothy W. Fong M.D., Richard J. Rosenthal M.D.

Office of problem Gambling
California Departement of Alcohol & Drug Abuse
Version 1.1, March 2008
 How to Quit or Reduce Your Gambling:
Self-Help Workbook
http://www.problemgambling.ca

 Studies have shown that most clients attend

treatment an average of 6 times, which is why
this Program has been structured so that the
bulk of the treatment can be completed in about
6 weeks.

 This Workbook summarizes the most effective

ways to help someone trying to overcome a
gambling habit. Each of the Treatment Topics
includes a short description, some information to
think about, and an exercise to work on.

Tony Toneatto, Ph.D., Barbara Kosky, M.A.Sc., Gloria I. Leo, M.A.

Copyright © 2003 Centre for Addiction and Mental Health
 Gambling Behaviour Self-Study Workbook
http://www.responsiblegambling.org/

5 chapters containing:

 An overview, information on the topics, and exercises

to complete
 An invitation to record daily activities as a way of
tracking progress
 A checklist to help review work and help decide if
ready to move on.
RESPONSIBLE GAMBLING COUNCIL
ADDICTIONS FOUNDATION OF MANITOBA
 Workbooks utility
in my experience
Patients Type of € Spent SOGS Treatment
gambling Monthly

Men, 28 Totogol 600,00 9/20 1 hour Weekly

years sessions:
Motivational
enhancement + UCLA
Workbook
Men, 50 Slot 2.000,00 9/20 1 hour Weekly
years Machines sessions:
CBT + UCLA
workbook
Men, 30 Slot 2.000,00 10/20 1 hour Weekly
years Machines sessions:
CBT + UCLA
workbook
 Results
Patients Total 1 Year Time Conclusions
hours of Follow Up Spent
treatment Gambling
Men, 28 8 Controlled Once in a Motivational
years gambling Week
enhancement helpful
Gamblers reported the
utility of reading the
Men, 50 12 Abstinence 0 manual and following
years the strategies.
WB useful in relapse

Men, 30 20 Abstinence 0
prevention
years
 Thanks for Attention
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Sonya Sabbatino