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Closing a Treatment Gap in Ontario: Pilot of a Tutorial Workbook for Women Gamblers

Roberta Boughton, Farah Jindani, Nigel E. Turner

Abstract


Past research has shown that treatment services for problem gambling are being underutilized in Ontario, especially by women. Our pilot study involves the development of a Tutorial Workbook (TW) designed specifically to address the special issues and treatment needs of women who gamble and develop consequent problems. Investigators tested the effectiveness of the intervention and reviewed comments from women gamblers on the contents and layout of the workbook. The TW study involved 12 modules and required progress update and feedback forms for each. A mixed method analysis was used to evaluate the intervention, with quantitative and qualitative feedbacks indicating that it was well received by participants. The majority reported that the program helped them modify gambling behaviours through increased understanding and awareness of their triggers. They reported feeling better about themselves, improved mood and anxiety levels, feeling less isolated, positive changes in their relationships and hope for the future. Their input provided suggestions for changes to the TW. The TW will serve women seeking self-help materials, including on-line or paper-based support. As such, it expands services to reach a sub-group of women who might not otherwise seek or accept treatment because of a variety of barriers.

Dans des recherches faites précédemment, on a montré que les services de traitement de problèmes liés au jeu compulsif sont sous-utilisés en Ontario, surtout par les femmes. Notre étude pilote a porté sur la conception d’un cahier didactique conçu spécialement pour répondre aux problèmes particuliers et aux besoins de traitement des femmes qui s’adonnent au jeu et développent des problèmes connexes. Les chercheurs ont testé l’efficacité de l’intervention et analysé les commentaires faits par des joueuses pathologiques sur le contenu et la mise en page du cahier. L’étude sur le cahier didactique comprenait douze modules et des formulaires de bilan/retour des progrès à remplir obligatoirement pour chaque module. On a utilisé une méthodologie mixte pour évaluer l’intervention, avec commentaires quantitatifs et qualitatifs indiquant un accueil favorable par les participantes. La plupart ont indiqué que le programme les a aidées à modifier leurs comportements de jeu, car il leur a permis d’acquérir une meilleure compréhension de leurs déclencheurs et d’en prendre conscience. Les participantes ont déclaré se sentir mieux à propos d’elles-mêmes, avoir noté une amélioration de l’humeur et une baisse de l’anxiété, s’être senties moins isolées, avoir observé des changements positifs dans leurs relations et avoir regagné espoir pour l’avenir. Dans leurs commentaires, elles ont fourni des suggestions pour modifier le cahier de travail. Ce cahier sera utile aux femmes qui recherchent des documents d’initiative personnelle, en ligne ou sur papier. Comme tel, cet outil apporte donc un complément aux services déjà offerts afin d’atteindre un sous-groupe de femmes qui autrement pourraient ne pas chercher ou accepter un traitement en raison de diverses barrières.


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References


Albanese, P., Busch, J., Evans, C., Falkowski-Ham, A., Meredith, N., Stark, S., . . . Zahlan, N. (2011). Research report: Examination of the associations between problem gambling and various demographic variables among women in Ontario. Toronto, ON: Ontario Problem Gambling Research Centre.

Ashley O. S., Marsden M. E. & Brady T. M. (2003). Effectiveness of substance abuse treatment programming for women: A review. American Journal of Drug and Alcohol Abuse, 29, 19–53. doi:10.1081/ADA-120018838. Retrieved from: https://numerons.files.wordpress.com/2012/04/4substance-abuse-treatment-programming-for-women.pdf

Benson, H. (1975). The relaxation response. New York, NY: William Morrow & Co.

Bepko C. (Ed.). (1991). Feminism and addiction. New York, NY: Haworth Press.

Blaszczynski, A. (1998). Overcoming compulsive gambling: A self-help guide using cognitive behavioral techniques. London, United Kingdom: Robinson Publishing.

Boughton, R., & Falenchuk, O. (2007). Vulnerability and comorbidity factors of female problem gambling. Journal of Gambling Studies, 23, 323–334. doi:10.1007/s10899-007-9056-6

Boughton, R. (2003). A feminist slant on counselling the female gambler: Key issues and tasks. e-Gambling: The Electronic Journal of Gambling Issues, 8, 1–22. Retrieved from: http://www.collectionscanada.gc.ca/eppp-archive/100/202/300/e-gambling/html/2003/no8/archive/pdf/EJGI-Issue8/EJGI-Issue8-clinic-boughton.pdf

Boughton, R., & Brewster, J. (2002). Voices of women who gamble in Ontario: A survey of women’s gambling: Barriers to treatment and treatment service needs. Toronto, ON: Ontario Ministry of Health and Long Term Care.

Bowen, S., Chawla, N., & Marlatt, A. (2011). Mindfulness based relapse prevention for addictive behaviors: A clinician’s guide. New York, NY: The Guilford Press.

Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper (Ed.), The APA handbook of research methods in psychology: Vol. 2. Research designs (pp. 57–91). Washington, DC: American Psychological Association.

Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848. doi:10.1037/0022-3514.84.4.82. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.331.8033&rep=rep1&type=pdf

Brown, S., & Coventry, L. (1997). Queen of hearts: The needs of women with gambling. problems. Melbourne, Australia: Financial and Consumers Rights Council.

Burns, D. D. (1999). The feeling good handbook. Revised edition. New York, NY: Plume.

Byrne, G. (1999). Free yourself: A program for people with addictive gambling behaviours, Revised edition. Warrandyte, Australia: Author.

Carlbring, P., Nilsson-Ihrfelt, E., Wari, J., Kollenstam, C., Buhrman, M., Kaldoa, V., . . . Andersson, G. (2005). Treatment of panic disorder: Live therapy vs. self-help via the Internet. Behaviour Research and Therapy, 43, 1321–1333. doi:10.1016/j.brat.2004.10.002. Retrieved from: http://web.comhem.se/u22779327/16/kbt.pdf

Carlbring, P., & Smit, F. (2008). Randomized trial of Internet-delivered self-help with telephone support for pathological gamblers. Journal of Consulting and Clinical Psychology, 76, 1090–1094. doi:10.1037/a0013603

Carlson, L. E., & Brown, K. W. (2005). Validation of the Mindful Attention Awareness Scale in a cancer population. Journal of Psychosomatic Research, 58, 29–33. doi:10.1016/j.jpsychores.2004.04.366. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.690.1881&rep=rep1&type=pdf

Charlesworth, E. A., & Nathan, R. G. (1991). Stress management: A comprehensive guide to wellness. New York, NY: Random House.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 386–396. doi:10.2307/2136404. Retrieved from: http://www.psy.cmu.edu/~scohen/globalmeas83.pdf

Copeland , M. E. (2000). The loneliness workbook: A guide to developing and maintaining lasting connections. Oakland, CA: New Harbinger.

Crisp, B. R., Thomas, S., Jackson, A., Thomason, N., Smith, S., Borrell, J., . . . Holt, T. A. (2000). Sex differences in the treatment needs and outcomes of problem gamblers. Research on Social Work Practice, 10, 229–242.

Cunningham, J. A. (2005). Little use of treatment among problem gamblers. Psychiatric Services, 56, 1024–1025. doi:10.1176/appi.ps.56.8.1024

Dickerson, M., Hinchy, J., & Legg England, S. (1990). Minimal treatments and problem gamblers: A preliminary investigation. Journal of Gambling Studies, 6, 87–102. doi:10.1007/BF01015751

Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. New York, NY: Viking Press.

Dow Schüll, N. (2012). Addiction by design: Machine gambling in Las Vegas. New Jersey: Princeton University Press.

Dow Schüll, N. (2002). Escape mechanism: Women, caretaking, and compulsive machine gambling. (Working Paper No. 41). Berkeley, CA: Centre for Working Families, University of California, Berkeley. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.124.3163&rep=rep1&type=pdf

Dowling, N. A., Smith, D., & Thomas, T. (2007). A comparison of individual and group cognitive-behavioural treatment for female pathological gambling. Behaviour Research and Therapy, 45, 2192–2202. doi:10.1016/j.brat.2006.11.003

Fehmi, L., & Robbins, J. (2007). The open-focus brain: Harnessing the power of attention to heal mind and body. Boston, MA: Trumpeter Books.

Ferris, J., & Wynne, H. (2001). The Canadian Problem Gambling Index: Final report. Submitted for the Canadian Centre on Substance Abuse. Ottawa, ON: Canadian Centre on Substance Abuse. Retrieved from: http://www.problemgambling.ca/EN/ResourcesForProfessionals/pages/problemgamblingseverityindexpgsi.aspx

Fisher, J. (2011). Psychoeducational aids for working with psychological trauma. Oakland, CA: Centre for Integrative Healing. Retrieved from: http://www.janinafisher.com/flipchart-3.php

Forth-Finegan, J. (1991). Sugar and spice and everything nice: Gender socialization and women’s addiction: A literature review. In Bepko C. (Ed.), Feminism and Addiction (pp. 19–48). New York, NY: Haworth Press.

Gainsbury, S. M., & Blaszczynski, A. (2011). Online self-guided interventions for the treatment of problem gambling. International Gambling Studies, 11, 289–308. doi:10.1080/14459795.2011.617764. Retrieved from: http://epubs.scu.edu.au/cgi/viewcontent.cgi?article=1716&context=tourism_pubs

Gainsbury, S. M., Hing, N., & Suhonen, N. (2014). Professional help-seeking for gambling problems: Awareness, barriers and motivators for treatment. Journal of Gambling Studies, 30, 503–519. doi:10.1007/s10899-013-9373-x

Gilbert, P. (2009a). The compassionate mind: A new approach to life’s challenges. Oakland, CA: New Harbinger Publications.

Gilbert, P. (2009b) Introducing compassion focused therapy. Advances in Psychiatric Treatment, 15, 199–208. doi:10.1192/apt.bp.107.005264

Goleman, D. (1995). Emotional intelligence: Why it can matter more than IQ. New York, NY: Bantam Books.

Lisansky Gomberg, E. S.S. J. (1987). Shame and guilt issues among women alcoholics. Alcoholism Treatment Quarterly, 4, 139–155.Lisansky Gomberg, E. S. (1988). Shame and guilt issues among women alcoholics. Alcoholism treatment quarterly, 4(2), 139-155. doi:10.1300/J020v04n02_09

Grant, J. E., & Kim, S. W. (2002). Gender differences in pathological gamblers seeking medication treatment. Comprehensive Psychiatry, 43, 56–62. doi:10.1053/comp.2002.29857

Hanson, R., & Mendius, R. (2009). The practical neuroscience of Buddha’s brain happiness, love and wisdom. Oakland, CA: New Harbinger Publications.

Haskell, L. (2003). First stage trauma treatment: A guide for mental health professionals working with women. Toronto, ON: Centre for Addiction and Mental Health.

Hodgins, D. (2000, June). Promoting the natural recovery process through brief intervention. Paper presented at the 11th International Conference on Gambling and Risk Taking, Las Vegas, NV.

Hodgins, D. C., & Marachuk, K. (1997). Becoming a winner: Defeating problem gambling: A self-help manual for problem gamblers. Calgary, AB: Addiction Centre, Calgary Regional Health Authority.

Hodgins, D. C., Currie, S. R., & el-Guebaly, N. (2001). Motivational enhancements and self-help treatments for problem gambling. Journal of Consulting and Clinical Psychology, 69, 50–57. doi:10.1037/0022-006X.69.1.50

Hodgins, D. C., Currie, S. R., Currie, G., & Fick, G. H. (2009). Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better. Journal of Consulting and Clinical Psychology, 77, 950–960. doi:10.1037/a0016318

Hudson, W. W. (1992). The WALMYR Assessment Scales scoring manual. Tempe, AZ: WALMYR Publishing.

Ibáñez, A., Blanco, C., Moreryra, P., & Sáiz-Ruiz, J. (2003). Gender differences in pathological gambling. Journal of Clinical Psychiatry, 64, 295–301.

Jacobs, D. (1993). Evidence supporting a general theory of addictions. In W. R. Eadington & J. A. Cornelius (Eds.), Gambling behavior and problem gambling (pp. 287–294). Reno, NV: University of Nevada Press.

Jaffe, A. (2012). Can’t get in: Barriers to addiction treatment entry: Half of those who want addiction treatment don’t find it. Psychology Today. Retreived from: https://www.psychologytoday.com/blog/all-about-addiction/201203/cant-get-in-barriers-addiction-treatment-entry

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Deltacorte Press.

Katherine, A. (2002). Boundaries: Where you end and I begin: How to recognize and set healthy boundaries. New York, NY: Fireside Books.

Kausch, O., Rugle, L. & Rowland, D. Y. (2005). Lifetime histories of trauma among pathological gamblers. Journal of Clinical Forensic Medicine, 12, 258–263. doi:10.1080/10550490500419045

King, A. (1999). Diary of a powerful addiction. Tyndall, MB: Crown Publishing.

Ladouceur, R., Sylvain, C., Boutin, C., Lachance, S., Doucet, C., & Leblond, J. (2003). Group therapy for pathological gamblers: A cognitive approach. Behaviour Research and Therapy, 41, 587–596. doi:10.1016/S0005-7967(02)00036-0. Retrieved from: http://isiarticles.com/bundles/Article/pre/pdf/73175.pdf

Ladouceur, R., & Walker, M. (1996). A cognitive perspective on gambling. In P. M. Salkovskis (Ed.), Trends in cognitive and behavioral therapies (pp. 89–120). West Sussex, UK: John Wiley.

Ledgerwood D. M, Petry N. M. (2006). Posttraumatic stress disorder symptoms in treatment- seeking pathological gamblers. Journal of Traumatic Stress, 19, 411–416. doi:10.1002/jts.20123

Linehan, M. M. (1993). Skill training manual for treating borderline personality disorder. New York, NY: Guilford Press.

Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety and stress scales (2nd ed.). Sydney, Australia: Psychology Foundation of Australia.

MacMillan, H. L., Fleming, J. E., Trocmé, N., Boyle, M. H., Wong, M., Racine, Y. A., . . . Offord, D. R. (1997). Prevalence of child physical and sexual abuse in the community: Results from the Ontario health supplement. JAMA, 278, 131–135. doi:10.1001/jama.1997.0355002006303. Retrieved from: https://www.attorneygeneral.jus.gov.on.ca/inquiries/cornwall/en/hearings/exhibits/Nico_Trocme/pdf/Prevalence.pdf

MacPherson, H. (2004). Pragmatic clinical trials. Complementary Therapies in Medicine, 12, 136–140. doi:10.1016/j.ctim.2004.07.043

Mark, M. E., & Lesieur, H. R. (1992). A feminist critique of problem gambling research. British Journal of Addiction, 87, 549–565. doi:10.1111/j.1360-0443.1992.tb01957.x.

Retrieved from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1992.tb01957.x/pdf

Mason, M. (1991). Women and shame: Kin and culture. In C. Bepko (Ed.), Feminism and Addiction (pp. 175–194). New York, NY: Haworth Press.

Maté, G. (2009). In the realm of the hungry ghosts: Close encounters with addiction. Toronto, ON: Vintage Canada.

Montagnes, J. M. (2006). Stop spinning your wheels: A manual on reality therapy, choice theory and lead management. Toronto, ON: Montagnes & Associates Consulting.

Najavits, L. M. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. New York, NY: The Guilford Press.

O’Connor, J., Ashenden, R., Quigley, R. P., Raven, M., Allsop, S., & Peckham, J. (2000). Current “best practice” interventions for gambling problems: A theoretical and empirical review. Melbourne, Australia: Department of Human Services (Victoria).

O’Connor, J., & Fergusson-Stewart, A. (1989). The gambler’s guide to cutting down or giving up. SA Health Publications.

O’Connor, J. (2004). The gambler’s guide to cutting down or giving up. Adelaide, Australia: Department of Human Services.

O’Grady, C. P., Skinner, W. J.W. (2007). A Family Guide to Concurrent Disorders. Toronto: Centre for Addiction and Mental Health.

Peterson, J. S. (2001). Anger, boundaries and safety. Gabriola Island, BC: The Haven Institute Press.

Poole, N., & Dell, C. A. (2005). Girls, women and substance use. CCSA= CCLAT.

Poole, N. & Greaves, L. (Eds.) (2012). Becoming trauma informed. Toronto, ON: Centre for Addiction and Mental Health.

Potenza, M. N., Steinberg, M. A., McLaughlin, S. D., Wu, R., Rounsaville, B. J., & O’Malley, S. S. (2001). Gender-related differences in the characteristics of problem gamblers using a gambling helpline. American Journal of Psychiatry, 158, 1500–1505.

doi:10.1176/appi.ajp.158.9.1500. Retrieved from: http://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.158.9.1500

Problem Gambling Institute of Ontario (PGIO) (2012). How to quit or reduce your gambling: Self help workbook. Toronto, ON: The Institute. Retrieved from: https://www.problemgambling.ca/EN/GettingHelp/Pages/SelfHelpWorkbook.aspx

Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (1994). Changing for good: A revolutionary six-stage program for overcoming bad habits and moving your life positively forward. New York, NY: William Morrow & Co.

Raylu, N., Oei, T. P., & Loo, J. (2008). The current status and future direction of self-help treatments for problem gamblers. Clinical Psychology Review, 28, 1372–1385. doi:10.1016/j.cpr.2008.07.005

Roberts, T. (2009). The mindfulness workbook: A beginner’s guide to overcoming fear and embracing compassion. Oakland CA: New Harbinger Publications.

Russell, D. W. (1996). UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66, 20–40. doi:10.1207/s15327752jpa6601_2. Retrieved from: https://www.iscet.pt/sites/default/files/imce/ucla_loneliness_scale_version_3._reliability_validity_and_factor_structure.pdf

Sanchez-Craig, M., Leigh, G., Spivak, K., & Lei, H. (1989). Superior outcome of females over males after brief treatment for the reduction of heavy drinking. British Journal of Addiction, 84, 395–404. doi:10.1111/j.1360-0443.1989.tb00583.x

Shelley, K. (2010). I have a choice: Cultivating better relationships and greater personal happiness. Available through personal contact with author at Kent@bmts.com.

Slutske, W., Blaszczynski, A., & Martin, N. (2009). Sex differences in the rates of recovery, treatment-seeking, and natural recovery in pathological gambling: Results from an Australian community-based twin survey. Twin Research and Human Genetics, 12, 425–432. doi:10.1375/twin.12.5.425. Retrieved from: https://genepi.qimr.edu.au/contents/p/staff/Slutske_TRHG_Oct09_425-32.pdf

Slutske, W. S., Zhu, G., Meier, M. H., & Martin, N. G. (2011). Disordered gambling as defined by the Diagnostic and Statistical Manual of Mental Disorders and the South Oaks Gambling Screen: Evidence for a common etiologic structure. Journal of Abnormal Psychology, 120, 743–751. doi:10.1037/a0022879

Stroebel, C. F. (1985). QR: The quieting reflex. New York, NY: Berkley Publishing Group.

Suurvali, H., Cordingley, J., Hodgins, D., & Cunningham, J. (2009). Barriers to seeking help for gambling problems: A review of the empirical literature. Journal of Gambling Studies, 25, 407–424. doi:10.1007/s10899-009-9129-9

Suurvali, H., Hodgins, D., Toneatto, T., & Cunningham, J. (2008). Treatment seeking among Ontario problem gamblers: Results of a population survey. Psychiatric Services, 59, 1343–1346. doi:10.1176/appi.ps.59.11.1343. Retrieved from: http://stoppredatorygambling.org/wp-content/uploads/2012/12/Suurvali-2008.pdf

Thomas, A., & Moore, S. (2003). The interactive effects of avoidance coping and dysphoric mood on problem gambling for female and male gamblers. eGambling: The Electronic Journal of Gambling Issues, 8. doi:10.4309/jgi.2003.8.16. Retrieved from: 10.4309/jgi.2003.8.16

Toneatto, T., Blitz-Miller, T., Calderwood, K., Dragonetti, R., & Tsanos, A. (1997). Cognitive distortions in heavy gambling. Journal of Gambling Studies, 13, 253–266. doi:10.1023/A:1024983300428

Toneatto, T., Kosky, B., & Leo, G. (2003). Treatment program for people affected by problem gambling: How to quit or reduce your gambling: Personal workbook. Toronto, ON: Centre for Addiction and Mental Health. Retrieved from: https://www.problemgambling.ca/EN/Documents/TGmanualWebRevisedfinal.pdf

Toneatto, T., Vettese, L., & Nguyen, L. (2007). The role of mindfulness in the cognitive-behavioural treatment of problem gambling. 19, Journal of Gambling Issues, 91–100. doi:10.4309/jgi.2007.19.12. Retrieved from: http://jgi.camh.net/index.php/jgi/article/view/3764/3731

Toneatto, T., & Wang, J. J. (2009). Community treatment for problem gambling: Sex differences in outcome and process. Community Mental Health Journal, 45, 468–475. doi: 10.1007/s10597-009-9244-1

Trevorrow, K., & Moore, S. (1998). The association between loneliness, social isolation and women’s electronic gaming machine gambling. Journal of Gambling Studies, 14, 263–284. doi.org/10.1023/A:1022057609568

Tse, S., Campbell, L., Rossen, F., Chong-Wen, W., Jull, A., & Jackson, A. (2013). Face-to-face and telephone counseling for problem gambling: A pragmatic multisite randomized study. Research on Social Work Practice, 23, 57–65. doi:10.1177/1049731512466150. Retrieved from: http://www.academia.edu/25285300/Face-to-Face_and_Telephone_Counseling_for_Problem_Gambling_A_Pragmatic_Multisite_Randomized_Study

Turner, N. E., Stinchfield, R., McCready, J., McAvoy, S., & Ferentzy, P. (2016). Endorsement of criminal behavior amongst offenders: implications for DSM-5 Gambling Disorder. Journal of Gambling Studies, 32, 35–45. doi:10.1007/s10899-015-9540-3

Underhill, B. L. (1986). Issues relevant to aftercare programs for women. Alcohol Health & Research World, 11, 46–47, 73.

Wallace, B. A. (2006). The attention revolution: Unlocking the power of the focused mind. Boston, MA: Wisdom Publications.

Westphal J. R. & Johnson, L J. (2003). Gender differences in psychiatric comorbidity and treatment seeking among gamblers in treatment. eGambling: The Electronic Journal of Gambling Issues, 8. doi:10.4309/jgi.2003.8.17. Retreived: http://jgi.camh.net/index.php/jgi/article/view/3622/3582

Wilke, D. (1994). Women and alcoholism: How a male-as-norm bias affects research, assessment, and treatment. Health & Social Work, 19, 29–35. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.931.4204&rep=rep1&type=pdf

Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: freeing yourself from chronic unhappiness. New York, NY: The Guilford Press.

Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41. doi:10.1207/s15327752jpa5201_2




DOI: http://dx.doi.org/10.4309/jgi.v0i36.3986

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