Pathological gambling: Implications for therapeutic recreation practice

Therapeutic Recreation Journal, Fourth Quarter 1999 by Carruthers, Cynthia

As previously discussed, individuals who gamble pathologically bring an array of potential issues to treatment. Some of these issues, such as physical and sexual abuse, are beyond the scope of direct practice of TR specialists. It is extremely important that TR specialists do not address issues that exceed their professional training (American Therapeutic Recreation Association, 1990; National Therapeutic Recreation Society, 1990). However, it behooves the TR specialist to be aware of these issues as they may affect an individual's response to TR interventions.

Many of the problems presented by pathological gamblers, however, can be addressed appropriately through TR interventions. The remainder of this paper will discuss the TR interventions that may be most salient in the treatment of the pathological gambler. The interventions presented are not the exclusive domain of TR; however, there is an expectation by the profession that TR specialists have the knowledge and skills necessary to implement them (Kinney & Witman, 1997). Again, the reader is cautioned that every individual who gambles pathologically brings different issues to treatment, and interventions should address the specific needs of each client.

Stress Management

Stress is a common cause of relapse (Walters, 1994b). It is very important for individuals to acquire the ability to handle "high risk" situations that might threaten their recovery, such as social pressure to gamble, anxiety, interpersonal conflict, financial pressures, and boredom (Marlatt, 1996). Therefore, it is essential that TR specialists provide individuals recovering from pathological gambling with the stress management skills necessary to maintain recovery. First, pathological gamblers may need to acquire the cognitive skills necessary to regulate their affect and manage feelings of anxiety, fear, and depression (Walters, 1994b). Second, they must acquire confidence in their ability to respond to the challenges in their lives, and to cope effectively with their day to day responsibilities and relationships (Sylvain et aL, 1997). Third. they may need to learn alternative methods to modulate the discomfort of hypoarousal or hyperarousal (Blaszczynski & Silove, 1995).

One stress management approach to the regulation of affect is cognitive therapy. Through cognitive therapy, TR specialists can help clients learn to identify the negative, irrational thoughts that may be contributing unnecessarily to their stress, and replace them with more rational, positive thoughts (Carr-uthers, 1995). Cognitive therapy is based on the premise that excessive and uncomfortable emotional reactions and self-defeating behaviors are created by maladaptive thinking (Beck et at., 1993). According to Blaszczynski and Silove (1995), most cognitive therapies share the following assumptions: thoughts affect feelings and behaviors, thoughts can be brought to conscious awareness and evaluated, dysfunctional or irrational thoughts can be modified, and the modification of thoughts should result in changed behaviors. TR specialists can teach their clients about the relationships between thoughts, feelings, and behaviors; help them to identify the cognitive distortions and irrational beliefs that interfere with their recovery and enjoyment of life; and encourage them to replace these distortions and beliefs with realistic and rational beliefs (Carruthers; Hood & Krinsky, 1996).