joint session - dr. sally gainsbury, ken winters, and alfonso fernandez
TRANSCRIPT
Dr. Sally Gainsbury, Dr. Ken Winters andMr. Alfonso Fernandez
Senior Lecturer, Centre for Gambling Education & Research
Department of Psychiatry, University of Minnesota
CEO, AMS Media
Alternative treatments for problem gambling
Sally Gainsbury
Centre for Gambling Education and Research, Southern Cross University
Presentation at New Horizons in Responsible Gambling
Vancouver, February 4, 2015
Achieving treatment & responsible gambling objectives
Internet & mobile technology:
1. Assist people with gambling-related problems
2. Facilitate responsible gambling
• A comprehensive system
• Customisable for specific needs and populations
• Country/Province-wide access
• Evaluation & updates
Evidence-based
Value for money
Constant connectivity
Internet & mobile technology
• Online screening with automated feedback
• Self-directed online CBT• With therapist support (email, chat, phone, face-to-face)
• Brief interventions & prevention resources• Online
• SMS
Online treatment options
Face-to-face counselling
e.g., video conferencing
Online counselling: Email, video conferencing, chat
Treatment with therapist support
Self-directed interventions
Structured online CBT
Customized SMS
Brief interventions
Online peer-support forum
Peer support
Support:GP, counsellors, telephone or online chat
Treatment and responsible gambling principles
Build capacity & sustained solutions tailored to community needs
• Integrated treatment and prevention options
• Allow individuals to seek help in the way they wish
• Help-seeking is cyclical
Promote innovation through technology & leveraging existing programs
• New online interventions
• Working with existing support services
Promote simple pathway to support
• One entry point, many options
• Customised support recommendations
• Province-wide access
• Value for money• Time efficient
• Greater uptake
• Builds on existing programs
Early intervention
Prevention isn’t about ‘help’
• Evidence gap – encouraging uptake of responsible gambling resources and tools
• Brief online tools
• Stay in control
• Integrated into wider support services
Options to suit users
Layer low, medium, and high intensity interventions
Communication is key
Integrate with professionals, community and local organisations
Best practice
• Preliminary research support
• Efficacy of funding• Program evaluation
• Demonstrate performance & value for money
• Incorporate best practice
• Build research capacity
Conclusions• Face-to-face treatment is still important
• But support can be more inclusive
• Full range of options to suit diverse needs
• Ongoing funding needed for development, evaluation & updates
• Continue to build capacity to improve ongoing support services
Thank you, questions?
Dr Sally GainsburySenior Lecturer, Centre for Gambling Education & Research
Southern Cross University
Email: [email protected]
Website: http://works.bepress.com/sally_gainsbury/
@DrSalGainsbury
Screening, Brief Intervention and Referral to Treatment
(SBIRT)To Address Problem Gamblers
Ken Winters, Ph.D.Department of Psychiatry
University of [email protected]
New Horizons in Responsible Gambling Conference
Vancouver, BCFebruary 4, 2015
Source: Linda Sobell
Who Am I?
• Problem gambling researcher since early
1990’s– Applied research projects include treatment outcome
studies and development of GAMTOMS
• SBIRT researcher in the last decade
• At the risk of being over-simplistic, the keys
to treating a problem gambler:
• Develop a therapeutic alliance with the person.
• Help him/her to break the functional value of their
gambling.
General Views of Any Counselling
Program to Address Problem Gambling
General View of SBIRT
Gambling Involvement and Response
Intensive
Treatment
Adapted from Broadening the Base of Alcohol Treatment (IOM)
PreventionBrief
Intervention
~85-90% ~1%~5-10%
SBIRT
Screening, Brief Intervention, Referral to Treatment
Prob Identif. Next step Referral
Screening Probable? BI or More Assess Treatment?
Assessment Definitive? Treatment Continuing Care?
SBIRT
Screening, Brief Intervention, Referral to Treatment
Prob Identif. Next step Referral
Screening Probable? BI or More Assess Treatment?
Assessment Definitive? Treatment Continuing Care?
SBIRT
Screening, Brief Intervention, Referral to Treatment
• Many favorable screening tools available (good resource: www.ncrg.org)
• Lie/Bet
• BBGS
• MAGS
• NORC Diagnostic Screens (4- and 17-item versions)
• PGSI (screen of the CPGI)
• SOGS
SBIRT
Screening, Brief Intervention, Referral to Treatment
BI “Sweet Spot”
Intensive
Treatment
Adapted from Broadening the Base of Alcohol Treatment (IOM)
PreventionBrief
Intervention
~85-90% ~1%~5-10%
SBIRT-T
Common Elements of Brief Interventions
• Motivational interviewing
• Normative feedback
• Decisional balance
• Negotiated goals
DECISIONAL BALANCE EXERCISE
Pros“What do you like about gambling?
What are the good things about ugambling?
What else?” (Ask again until nothing else.)
Cons
“What don’t you like as much about gambling?
What are the not-so-good things ?
What else?” (Ask again until nothing else.)
DECISIONAL BALANCE EXERCISE
More probing
“If you were to stop gambling, what would be the good things that might happen?
What would be the bad things? “
“If you were to continue to gamble, what would be the good things that might happen?
What would be the bad things? “
SBIRT
Screening, Brief Intervention, Referral to Treatment
• Efficacy: Small body of research
• Effect sizes in the “moderate range” (singles and
doubles, not home runs)
• Not clear if harm reduction effective over the long
term
SBIRT
Favorable outcome
Minimal/no change
Problem worsens
Support
recovery
Refer more
services
Conduct booster or
refer more services
Multi-screen red flags Refer more
assessment
Summary
• The SBIRT approach is an
emerging and promising set of
tools to address those with a
gambling problem.
• Evidence-based and evidenced-
informed models from the drug
abuse literature can be
harnessed for the PG field.
• Apply a PG-focused SBIRT to
clients in drug treatment and
mental health clinics.
ScreeningBrief Intervention
Referral to Treatment
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