joint session - dr. sally gainsbury, ken winters, and alfonso fernandez

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: sally.gainsbury@scu.edu.au

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 Minnesotawinte001@umn.edu

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

THANK YOU!

winte001@umn.edu

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