Pathological gambling: Implications for therapeutic recreation practice

Therapeutic Recreation Journal, Fourth Quarter 1999 by Carruthers, Cynthia

Pathological gambling is a growing problem in American society. Information on pathological gambling is almost nonexistent in the therapeutic recreation (TR) literature despite the fact that the incidence of pathological gambling is most prevalent with individuals who have psychiatric disorders or who abuse substances. Both of these client groups are frequent recipients of TR services. Pathological gambling can be devastating in its consequences to the individuals with the addiction, their families, and their communities. This paper provides information on pathological gambling that is relevant to TR professionals. Diagnostic criteria and sub-types of pathological gamblers are presented. Factors that influence the development, maintenance, and recovery from pathological gambling are discussed. Implications for TR practice are addressed.

KEY WORDS: Pathological Gambling, Treatment Issues, Programming, Recover.y, Therapeutic Recreation

Introduction

With gamblers I was seeing an addiction without any drug ... one that's absolutely as virulent and destructive as drug addiction. (Shaffer, Harvard University, as quoted in Bems, 1997, p. IA)

Pathological gambling is a growing problem in American society. Forty-eight states now have some form of legalized gambling, and the diversity of gambling options is increasing in most states (Walker & Dickerson, 1996). As availability and options for gambling expand, there is an attendant growth in problem and pathological gambling (Volberg, 1996). Pathological gambling can be devastating in its consequences to addicted individuals, their families, and their communities.

Information on pathological gambling is almost nonexistent in the therapeutic recreation JR) literature. This lack of information occurs despite the fact that the incidence of pathological gambling is most prevalent with individuals with psychiatric disorders (Shaffer, Hall, & Vander Bilt, 1997) or who abuse substances (McGurrin, 1992). Both of these client groups are frequent recipients of TR services.

Many of the treatment needs presented by clients who gamble pathologically are within the TR scope of practice, including deficits in self-esteem, coping skills, decision-making, social and relationship skills, as well as cognitive distortions (Carruthers, 1995; Hood & Krinsky, 1996, 1997/98), boredom proneness, and sensation seeking (Coyle & Kinney, 1990). In addition, the initial motivation for much gambling behavior is fun (Chantal, Vallerand, & Vallieres, 1995) and excitement (Bruce & Johnson, 1995). Many treatment programs serving individuals who gamble pathologically acknowledge the importance of helping the recovering client create a reinforcing nongambling lifestyle, including enjoyable leisure involvements (Walters, 1994b). If TR specialists are to be able to develop effective protocols for the multidisciplinary treatment of clients who gamble pathologically, it is essential that they acquire information on relevant treatment issues and interventions.

The purpose of this paper is to provide information on pathological gambling applicable to TR professionals. First, diagnostic criteria and sub-types of pathological gamblers are presented. Second, factors that influence the development, maintenance, and recovery from pathological gambling are discussed. Finally, implications for TR practice are addressed.

Diagnostic Criteria and Types of Gamblers

Pathological gambling is a complex disorder. Individuals who gamble pathologically share many problems that are reflected in the diagnostic criteria of the disorder. In addition, however, subtypes of gamblers with different motivations, gambling practices, and responses to treatment may exist. To complicate the matter further, dual diagnoses are very common among clients who gamble pathologically.

Prevalence

The Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) reports that the prevalence rate of pathological gambling is between t-3% of the adult population. According to a recent meta-analytic study conducted by Harvard University Medical School, the prevalence rate of pathological gambling among individuals with psychiatric problems is much higher at 14% (Shaffer et al., 1997). This meta-analysis also indicated that approximately II million Americans are problem gamblers, and 4.4 million of these individuals (1.1% of the adult population) gamble pathologically. It is a problem that is growing. A comparison of pathological gambling rates prior to and after 1993 indicates that the reported prevalence of pathological gambling has increased by over 50% (Shaffer et al.). Other studies have also reflected dramatic increases in pathological gambling in the 1990s due to a proliferation of new gambling opportunities, such as riverboat gambling and reservation casinos (Volberg, 1996). The prevalence of pathological gambling reflects clearly the availability of gambling opportunities within a community and geographic region (Hunter & Preston, 1996).