Instructor Outline
Screening and Identifying Process Addictions
TIME: 4.5 Hours
Required Teaching Aids for this module
PowerPoint or Overhead Projector, Handouts and Newsprint of Writing Board
Process Addictions [SLIDE 1]
1. Screening for process addictions, primarily gambling problems are
important for many reasons:
2. Whether or not a causal relationship exists between gambling and other
problems such as family and financial problems, it is clear that significant
associations with gambling problems do exist.
3. It is important to recognize efforts to help clients solve various types of
gambling problems will suffer unless and until gambling concerns are
sufficiently addressed.
4. We encounter individuals with gambling problems in every setting.
5. Thus, it is necessary to be able to identify individuals who would benefit
from referral to specialized services for problem gambling treatment.
6. In addition, it is important to identify those individuals who do not
necessarily meet the criteria for gambling problems, yet are gambling at
levels that place them at risk for problems.
WHAT IS AN ADDICTION? [SLIDE 2]
WARM-UP EXERCISE - GROUP DISCUSSION QUESTIONS:
(Allow 10 minutes for this exercise)
• Divide participants into groups of 4-6 and have participants introduce
themselves to each other.
• Once this is completed, ask the group to respond to the 4 questions on
slide 2.
• Instruct the group to talk briefly about how this affects them and their
clients and how it concerns them.
• Once it is done, lead a brief interactive discussion on what the groups
came up with, asking for some examples.
Review of Training Goals
 To understand what is a process addiction
 To identify key signs and symptoms
 To learn strategies for identification
 To better learn about community resources
TYPES OF ADDICTIONS: [SLIDE 3]
Substance Addictions (requires ingestion of a substance)
Legal drugs
Illegal drugs
Instructor Outline
Screening and Identifying Process Addictions
Over the counter drugs
Tobacco
Caffeine
Food
Process Addictions
Gambling
Exercise
Work
Internet
Pornography
Shopping
Sex
WHAT IS AN ADDICTION? : [SLIDE 4]
Obsession
Addictive behavior is usually quite compelling & consuming
If you’re addicted to something, you can’t stop thinking about it and planning for
the next “fix”.
Negative Consequences
The negative consequences associated with addictions affect many different
areas of a person’s life including:
Relationships
Work
Finances
Mental health
Judgment & behavior
Physical health
Denial
Denial is a defense mechanism people unconsciously set up to protect them from
the realization they have a problem.
Denial takes many forms:
Absolute denying: “I don’t have a problem.”
Minimizing: “It’s not that bad.”
Avoidance: “I don’t want to talk about that.”
Blaming others: “Sure I do it – who wouldn’t if they had my wife/boss/kids, etc.”
Rationalizing: “I’m not as bad as Joe or Jane or who knows who.”
Loss of Control
The point in drug use where the user becomes unable to limit or stop use.
The very mark of an addictive behavior is trying to bring it under control.
Typical examples are attempting to control frequency of use or money spent on
it.
The substance or activity is controlling the person rather than person controlling
it.
Instructor Outline
Screening and Identifying Process Addictions
The idea of self control gets confusing, because some people who are addicted
are able to extent some degree of control for varying periods of time, which only
feeds the illusion there is no problem.
Gambling Quiz? : [SLIDE 5]
Review Slide
OK, to start us thinking more about the topic, I
have a short quiz for you to take. It will take
you about 3 minutes to complete, then we’ll go
over it as a group. It is in your workbook.
(Allow 3 minutes to complete the quiz, then
debrief each question. See the Answer Sheet on slides 6-8.
Ask for volunteers to share their answers, and why they chose their answers.)
Answers
Gambling Quiz? : [SLIDE 6]
Gambling Quiz? : [SLIDE 7]
Gambling Quiz? : [SLIDE 8]
Gambling Definitions (slide 9)
We can see from this quiz that there are myths
about gambling out there – that people have
different ideas about what gambling is, what
makes gambling a problem, why people
gamble, etc. So let’s get some clarity around
some definitions.
I’d like you to work in 3 groups (assign the
groups) and in your groups, define the word or
phrase I give you. You have 5 minutes to come
up with a definition. Then we’ll share them
with the group.
US Gambling circa 1973 (slide 10)
Gambling has changed greatly in America over the past 33 years.
In 1973 only 1 state had legalized casino gambling and several states has
legalized lotteries.
The Atlantic City casinos didn’t open till 1976.
US Gambling circa 1999(slide 11)
The US government has only studied gambling & problem gambling twice – 1976
& 1999 in America over the past 33 years.
By 1999 legalized gambling had expanded to all but 3 states:
Hawaii (has tourism)
Utah (has Mormons)
Tennessee (was the “buckle” of the bible belt; approved a state lottery in 2004)
Instructor Outline
Screening and Identifying Process Addictions
US Leisure Expenditures circa 1973 (slide 12)
According to the National Gambling Impact Study Commission Report
In 1999, Americans spent $47.2 B on all forms of entertainment.
In 1999, Americans spent $50.9B on LEGAL gambling
It is estimated by the FBI, an equal amount is wagered ILLEGALY (primarily
sports and Internet)
US Legal Expenditures Gambling circa 1999 (slide 13)
Private casinos are the most popular form of legalized gambling
Surprisingly, lotteries account for approximately a third of legalized gambling (for
example in RI 80% of the $285 the Lottery netted last year came from the VLTs
[video lottery terminals – slot machines operated by the RI Lottery])
Tribal casinos such as Foxwoods & Mohegan Sun account for 13% (fastest
growing sector)
Pari-mutuels has been losing market share over the past 30 years (includes
horse & dog racing, JaiAli, etc.)
Other includes charitable gambling such as churches & social or civic
organizations
RI Gambling circa 2006 (slide 14)
Read slide
Gambling has changed greatly in RI since out state constitution was amended to
create the RI State Lottery in 1974
Types of Gambling (slide 15)
Read slide
2 types of gambling:
1. Skill requires some level of knowledge or skill, preferred by males,
especially young males
2. Chance or Luck requires no skill or knowledge, preferred by females &
elders
Who do people gamble (slide 16)
5 primary reasons all begin w/letter “E”.
Review slide
Why people gamble
1. Excitement
2. Entertainment
3. Escape (forget about their problems for a while)
4. Economics (they want the money)
5. Ego (the person’s pride or reputation is on the line)
Instructor Outline
Screening and Identifying Process Addictions
RI Gambling trends (slide 17)
Key point gambling is RI’s 3rd leading source of state revenue after sales tax &
income tax (11%).
Continuum of I Gambling (slide 18)
Gambling occurs on a continuum
Group A may be either based on religious beliefs of family of origin experience
What is gambling (slide 19)
Read slide
Well now consider definitions of gambling based on the continuum
Let’s look at some formal definitions that we can all work
from.
•
Every time you risk money or an object of value on a game with the hope
of winning more, you are gambling.
Gambler’s Anonymous definition (slide 20)
Gambler’s Anonymous definition of gambling: “Any betting or wagering for self or
others, whether for money or not, no matter how slight or insignificant, where the
outcome is uncertain or depends upon chance or “skill”, constitutes gambling.”
(Gambler’s Anonymous, March 1994, Handbook)
Social gambling (slide 21)
Social Gambling: people who gamble in social settings & have no ill effects from
gambling. There is a continuum in this category:
 people who gamble occasionally, with the emphasis
on the social context vs. the gambling & who can take
or leave the gambling experience, to
 others who gamble more heavily, with more of an
emphasis on the gambling than the social
interactions.
(Massachusetts Council of Compulsive Gambling Fact Sheet)
Problem gambling (slide 22)
Problem Gambling: is the term used to cover the entire range of harmful
gambling involvement. That is, gambling that results in some kind of negative
impact on the person’s life or on the lives of the gambler’s family, friends, and/or
co-workers. It can be an occasional impact or an ongoing and serious situation.
Pathological gambling (slide 23)
Read slide
Instructor Outline
Screening and Identifying Process Addictions
The DSM-IV gives us a set of criteria, or
warning signs, we can look for as help to
determine if someone has a problem with
gambling. They are listed on slides 24 & 25.
DSM-IV Definition of pathological gambling: “Persistent and recurrent
maladaptive gambling behavior that disrupts personal, family or vocational
pursuits”.
DSM-IV criteria Pathological gambling (slide 24)
Read slide
Need 5 of 10 criteria
Less than 5 is problem gambling
DSMIV Criteria
Persistent and recurrent maladaptive gambling behavior as indicated by 5 or
more:
1. preoccupied with gambling
2. needs to gamble with increasing amounts of money to achieve desired excitement
3. repeated unsuccessful efforts to control gambling
4. restless or irritable when trying to cut down or stop
5. gambles as a way of escaping from problems or of relieving a dysphoric
6. after losing, often returns another day to get even
7. lies to others to conceal extent of involvement with gambling
8. has committed illegal acts to finance gambling
9. has jeopardized or lost significant relationship, job, educational or career
opportunity due to gambling
10. relies on others to provide money to relieve a desperate financial situation
caused by gambling
B. The gambling behavior is not better accounted for by a Manic Episode.
Ask Trainees : What questions do you have about these
definitions?
Asking Questions [Slide 26]
Ask clients questions about both the frequency and quantity of gambling for
important reasons.
First Rule…ASK
» “Do you gamble?”
» “How often do you gamble?”
Instructor Outline
Screening and Identifying Process Addictions
Why Ask? [slide 27]
• We ask questions about gambling because it is:
– Legal
– Socially acceptable
– Readily accessible
– Common
– Sensitive
– Related to a continuum of risk
Defining At – Risk [Slide 28]
• Differs by age
• Differs by gender
• Differs by mental health status
• Differs by health/medication status
• Differs by family history of gambling
CAGE adapted for gambling (slide 29)
Review a brief screening tool for gambling
1. Have you ever attempted to Cut down on your gambling?
1. Has anyone ever Annoyed you or gotten on your nerves by telling you to cut down or
1. Have you ever felt Guilty about your gambling?
1. Have you ever felt the need to gamble when your Eyes opened?
CT 4 Questions Screening (slide 30)
CT 4 Questions Screening (slide 31)
Another screening tool developed in CT
Problem Gambling Screen for Individual (slide 32)
Review Tool
• When gambling stops being fun. There’s hope, there’s help. Please read
further to see some of the symptoms of problem gambling and answer our
questions to help determine if gambling has become a problem for you or
someone you know.
• Do you know someone who displays these problem gambling symptoms?
1. Preoccupied with gambling.
2. Unable to stop gambling.
3. Brags and boasts about gambling & exaggerates wins.
4. Minimizes losses.
5. Increases the size of bets.
6. Has unexplained financial difficulties.
7. Is restless or irritable with severe mood swings when not gambling.
8. Gambles to "feel better".
Instructor Outline
Screening and Identifying Process Addictions
Problem Gambling Screen Family or Significant Other (slide 33)
•
Whether it’s a spouse, a friend, a member of your family, or even you, the
answers to these questions can help you realize if gambling has become a
problem.
1.
2.
3.
4.
Is gambling making your home life unhappy?
Are you reluctant to use "gambling money" for normal expenditures?
Do you ever feel remorse after gambling?
After losing, do you feel you must return as soon as possible and win back
your losses?
5. Do you gamble to escape worries and troubles?
6. Does gambling keep you from sleeping?
7. Do arguments, disappointments or frustration create an urge to gamble?
8. Does gambling make you careless about your welfare or that of your
family?
9. Do you gamble longer than you had planned?
10. Do you gamble until your last dollar is gone?
11. Do you gamble to get money with which to pay debts or otherwise solve
financial difficulties?
12. Do you borrow to finance your gambling?
•
If you or someone you know shows these symptoms, there is hope.
Problem gambling is a treatable illness. With proper treatment, a problem
gambler can begin the recovery process and regain control of his/her life.
[Slide 34]
Step I - Ask about gambling
• Gambling Preference
• Frequency (wagers per week and per occasion)
• Most wagered in a 24 hour period
• Any big wins
• Borrowing to gamble
• CAGE
• Men & women: Score 1 or more on CAGE
Step II - Assess for gambling problems (is gambling impacting?)
• Psychological Functioning
• Educational /Vocational /Financial
• Legal History
• Social History
• Physical History
Step III- Advise Appropriate Action
Problem Gambling
Instructor Outline
Screening and Identifying Process Addictions
• Assess readiness to change
• Provide options
• Encourage abstinence
Gambling Problems or at Risk for Developing Problems
• Assess readiness to change
• Advise to cut down
• Provide options
Step IV- Monitor and Assist
Comparing Problem gambling to SA (slide 36)
• Similarities
1.
2.
3.
4.
5.
6.
7.
•
Loss of Control
Preoccupation
Negative impact on major life areas
Tolerance
Withdrawal Symptoms
Self-help groups
Bio/psycho/social/spiritual disorders
Differences
1. Gambling is not self-limiting
2. Behavior not attributable to intoxication
3. More intense sense of shame and guilt
4. Greater denial and stronger defenses
5. Unpredictable outcome
6. Fantasies of success
7. No biological test
8. Easier to hide
9. Greater financial problems
10. Intensity of family anger
11. Less public awareness and acceptance
Case Study Vignette #1 (slide 37)
• Divide the group into small groups of 3-4. Assign each group a vignette.
Allow 5 minutes for the groups to read the vignettes and answer the
questions. Go around and hear from each group. Encourage brief large
group discussion.
What is going on for this young man - what behaviors do you notice?
Borrowing money beyond his means
Thinks he can still beat the odds and win
Not owning up to responsibilities
What, if any, consequences has he or is he experiencing?
In debt
Lowered self-esteem because he owes people money
Instructor Outline
Screening and Identifying Process Addictions
Betting is becoming a burden for him
Case Study Vignette #2 (slide 38)
• Divide the group into small groups of 3-4. Assign each group a vignette.
Allow 5 minutes for the groups to read the vignettes and answer the
questions. Go around and hear from each group. Encourage brief large
group discussion.
What is going on for this person - what behaviors do you notice?
Chasing losses
In denial about a problem - doesn’t feel meetings are important or necessary
What, if any, consequences are being experienced?
In debt
Case Study Vignette #3 (slide 39)
• Divide the group into small groups of 3-4. Assign each group a vignette.
Allow 5 minutes for the groups to read the vignettes and answer the
questions. Go around and hear from each group. Encourage brief large
group discussion.
What is going on for this woman - what behaviors do you notice?
Keeping her gambling secret
Has stopped gambling and is in treatment
What, if any, consequences has she or is she experiencing?
Lost family retirement money and more
Has endangered her relationships with her husband and children
She feels guilty and often considers suicide - loss of self-esteem
Case Study Vignette #4 (slide 40)
• Divide the group into small groups of 3-4. Assign each group a vignette.
Allow 5 minutes for the groups to read the vignettes and answer the
questions. Go around and hear from each group. Encourage brief large
group discussion.
What is going on for this person - what behaviors do you notice?
Boasting about wins
No fears, concerns
Tries to solve financial problems through gambling
Continues betting, using borrowed money
What, if any, consequences are being experienced?
Still in debt after winning $5,000.00
Case Study Vignette #5 (slide 41)
• Divide the group into small groups of 3-4. Assign each group a vignette.
Allow 5 minutes for the groups to read the vignettes and answer the
questions. Go around and hear from each group. Encourage brief large
Instructor Outline
Screening and Identifying Process Addictions
group discussion.
What is going on for this man - what behaviors do you notice?
Betting on office pool to feel part of the group
Loner at work
What, if any, consequences has he or is he experiencing?
None
GA (slide 42)
Local RI gamblers Anonymous meetings [slide 43]
Other 12 Step Resources (slide 44)
Also as a handout
RI Problem Gambling resources (slide 45)
Treatment Resources
RI Hospital Problem Gambling Treatment Program (slide 46)
National Council on Problem Gambling (slide 47)
National Problem Gambling Awareness week poster 2006 campaign (slide
48)
QUESTIONS? : [SLIDE 49]
CLOSING EXERCISE: [SLIDE 50]
• Something I liked?
• Something I’ll use?
• This training will help me?
• Something more I wanted more of?
Suggested Articles or Readings [slide 51]
Suggested Websites [slide 52]
Do as Handouts
Closing