Conceptualizing and Treating Problem Gambling as a Family Issue

Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians' experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic-based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.     

Correlates of Depressive Symptom Severity in Problem and Pathological Gamblers in Couple Relationships

Problem and pathological gamblers (PPG) often suffer from depressive symptoms. Gambling problems have negative consequences on multiple aspects of gamblers’ lives, including family and marital relationships. The objectives of the current study were to (1) replicate the results of studies that have suggested a stronger and more significant relationship between gambling and depression in PPG than in non-problem gamblers (NPG) and (2) explore specific correlates of depressive symptom severity in PPG in couple relationships. Variables demonstrated to be significantly correlated with depressive symptoms in the general population were selected. It was hypothesized that gender, age, gambler’s mean annual income, perceived poverty, employment status, clinical status (i.e., problem or pathological gambler versus non-problem gambler), trait anxiety, alcoholism, problem-solving skills, and dyadic adjustment would be significant predictors of depressive symptoms. Sixty-seven PPG were recruited, primarily from an addiction treatment center; 40 NPG were recruited, primarily through the media. Results revealed that PPG reported significantly greater depressive symptoms than did NPG. Further, elevated trait anxiety and poor dyadic adjustment were demonstrated to be significant and specific correlates of depressive symptom severity in PPG. These findings contribute to the literature on depressive symptomatology in PPG in relationships, and highlight the importance of the influence of the couple relationship on PPG.     

Adapted Couple Therapy (ACT) for Pathological Gamblers: A Promising Avenue

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.     

THE INTEGRATIVE PSYCHOTHERAPY ALLIANCE: FAMILY,COUPLE AND INDIVIDUAL THERAPY SCALES*

The therapeutic alliance concept has been confined primarily to the literature on individual psychotherapy. This paper formally introduces the concept into the family and marital therapy domain and presents various clinical hypotheses about the nature of the alliance and its role in familyand marital therapy. A systemic perspective is brought to bear on the concept within individual psychotherapy. A new, integrative definition of the alliance is presented that conceptualizes individual, couple and family therapy as occurring within the same systemic framework. The implications of this integrative-alliance concept for family, couple and individual therapy research are examined. Three new system-ically oriented scales to measure the alliance in individual, couple and family therapy are presented along with some preliminary data on their methodological characteristics.     

Internet Poker Websites and Pathological Gambling Prevention Policy

Despite the widespread increase in online poker playing and the risk related to excessive poker playing, research on online poker websites is still lacking with regard to pathological gambling prevention strategies offered by the websites. The aim of the present study was to assess the pathological gambling-related prevention strategies of online poker websites. Two keywords (“poker” and “poker help”) were entered into two popular World Wide Web search engines. The first 20 links related to French and English online poker websites were assessed. Seventy-four websites were assessed with a standardized tool designed to rate sites on the basis of accountability, interactivity, prevention strategies, marketing, and messages related to poker strategies. Prevention strategies appeared to be lacking. Whereas a substantial proportion of the websites offered incitation to gambling such as betting “tips,” few sites offered strategies to prevent or address problem gambling. Furthermore, strategies related to poker, such as probability estimation, were mostly reported without acknowledging their limitations. Results of this study suggest that more adequate prevention strategies for risky gambling should be developed for online poker.     

Family,marital, and occupational satisfaction for recovering pathological gamblers

This paper describes the efforts of a private gambling treatment program to conduct a retrospective study of pathological gamblers treated in a publicly supported residential program. The Johns Hopkins Center for Pathological Gambling treated approximately 100 pathological gamblers nationwide from 1979 to 1983 in its residential component. Twenty-six gamblers were assessed regarding their recovery status with specific focus on family, marital status and occupational satisfaction. It was hypothesized that the more satisfied patients would display lower frequencies of gambling and that gambling frequency was dependent upon the level of satisfaction. Thirty-one percent of these gamblers reported abstinence. Regression analyses indicated that the recovery of pathological gamblers as measured by frequency of gambling is significantly influenced by job satisfaction, and moderately influenced by marital status and family life satisfaction. Consequently, these factors should be addressed by mental health professionals in research and treatment of pathological gambling.     

Pathological gambling: Marital-familial factors,implications, and treatments

The literature relating marital/familial factors to pathological gambling is reviewed. It is pointed out that numerous authors who focus on individual factors note the existence of marital problems in their patients. Additionally, improvements in the marriage often follow successful treatment for pathological gambling. Marital therapy has proven to be an effective intervention for this problem in many cases.The material in this article was abstracted from the author's chapter on pathological gambling which was prepared forThe Addictions: Differential Treatments, edited by L'Abate, Farrar, and Serritella (in preparation).     

Dostoevsky and Freud: Autonomy and Addiction in Gambling

In this paper the modern ideal of “autonomous” or “pure” gambling is put forward in an analysis of Dostoevsky's gambling behavior, his novel The Gambler (1866) and Freud's psychoanalysis of Dostoevsky. The significance of The Gambler lies in the way conceptions of gambling are related to the social conditions of gamblers. Furthermore, the author demonstrates that Dostoevsky and Freud express contradictory views on gambling addiction. While Dostoevsky primarily appreciated roulette as a means of making money, Freud mistakenly interpreted this as a “pathological passion”. In different ways, however, both approaches toward excessive gambling presuppose and reinforce “gambling‐for‐its‐own‐sake” – Le jeu pour le jeu.     

Problem Gambling and Delinquent Behaviours Among Adolescents: A Scoping Review

Despite many studies indicating an association between problem gambling and delinquent behaviours among adolescents, there has been no effort to systematically analyze the state of the literature on this relationship. To fill this gap, we conducted a scoping review of the literature published between 2000 and 2016 on problem gambling and delinquent behaviours among adolescents. We searched twelve databases and reviewed reference lists to identify eligible studies. Search terms included a combination of medical subject headings and keywords for gambling, youth, and delinquency, which were combined with the Boolean operator “AND”. 1795 studies were identified through the literature search. Nine studies were eligible for inclusion. All of the studies were conducted in North America, with primarily male participants, and most of the data were cross-sectional. No qualitative studies met the inclusion criteria. Screening tools used to measure problem gambling were inconsistent, making comparisons across studies difficult. We found a consistent moderate to strong association between problem gambling and delinquent behaviour. Only one study presented associations by socio-economic status and none considered gender, sex or ethnic differences. Studies in the review showed that problem gambling is associated with both violent and non-violent behaviours among adolescents. These associations may suggest that problem gambling and delinquent behaviours have common risk factors and reflect a syndrome of risky behaviours best targeted through prevention and treatment that is holistic and considers the context in which the youth is situated. Further research is warranted to better understand the relationship between problem gambling and delinquent behaviours.     

Interactional Dynamics in Alcohol-Complicated Marital Relationships: A Study From India

This study seeks to understand differences in the interpersonal dynamics of couples living in alcohol-complicated and alcohol-free marital relationships in India. An ex-post facto cross-sectional design was used to compare 150 wives of alcoholics with an equal number of wives of nonalcoholics, who were administered standardized instruments to assess marital adjustment and family interaction pattern. Analyses show that wives of alcoholics have lower levels of marital adjustment and a poorer family interaction pattern across various domains, in consonance with the Western literature on these issues. Covariates analyzed included four variables such as type of family, type of marriage, consanguinity, and wife's occupational status. Implications for de-addiction programs in India are discussed and the need for couple/family-based therapy is emphasised.     

Gambling in children and adolescents

The topic of adolescent gambling is attracting growing interest, but there has still been little controlled or systematic research into the area, and much of what has been written would best be described as “armchair theorizing.” The literature concerning pre-adult gambling behavior falls into three general categories: (a) direct and indirect studies concerning adolescent gambling; (b) studies of the economic socialization of children, and (c) consideration of gambling as play and games as precursors to gambling. This paper presents an overview of the literature examining each of these three categories. Special emphasis is placed upon the playing of fruit machines, as it is this activity which is currently regarded as the biggest problem concerning young gamblers, particularly in the U.K. Recommendations for future research are discussed, particularly for work using a functional/behavioral analysis model to determine the variables which influence how adolescents “learn” to gamble.     

The acquisition,development, and maintenance of fruit machine gambling in adolescents

In the U.K., the major commercial gambling activity in adolescents is the playing of slot machines (commonly known as “fruit machines”). Over the past few years, the negative effects of “fruit machine addiction” have been reported by various helping organizations (e.g. Gamblers Anonymous) and the national press, including allegations of attempted murder, suicide and prostitution as well as a wider incidence of petty crime. Fifty adolescent fruit machine players from a ‘user population’ participated in a face-to-face interview and questionnaire study examining factors in the acquisition, development and maintenance of gambling behaviour. Nine adolescent males were deemed to be pathological gamblers as measured by the American Psychiatric Association DSM-III-R diagnostic criteria, and a number of serious consequences were reported including gambling debts, truancy and stealing.     

Health Outcomes in Individuals with Problem and Pathological Gambling: An Analysis of the 2014 North Carolina Behavioral Risk Factor Survey System (BRFSS)

Problem and pathological gambling refers to subclinical and clinical levels of maladaptive gambling, respectively, and is associated with specific sociodemographic characteristics as well as a number of poor health outcomes. We examined such demographic, physical health, mental health, and health-related behaviors in a sample of 7045 low-risk gamblers and 244 problem/pathological gamblers. Participants completed the 2014 North Carolina Behavioral Risk Factor Surveillance System telephone survey. Using the National Opinion Research Center’s Diagnostic Screen for Gambling Disorders-CLiP, participants were categorized as either “problem/pathological gamblers” or “low-risk gamblers.” Problem/pathological gamblers were younger, more likely to be male, of ethnic minority status, unmarried, and of lower education than low-risk gamblers. No physical health variables differentiated the groups but problem/pathological gamblers reported experiencing significantly more adverse childhood experiences and engaging in significantly more tobacco and alcohol use compared to low-risk gamblers. Moreover, gender moderated relationships between gambling group and several of the alcohol use variables such that male problem/pathological gamblers exhibited greater alcohol use behavior than male low-risk gamblers but no such relationship was present in females. Overall, this study expands the current knowledgebase on disordered gambling and highlights the need to assess disordered gambling in public health samples. Clinical implications are discussed.     

Relationships Between Perceived Family Gambling and Peer Gambling and Adolescent Problem Gambling and Binge-Drinking

The study systematically examined the relative relationships between perceived family and peer gambling and adolescent at-risk/problem gambling and binge-drinking. It also determined the likelihood of at-risk/problem gambling and binge-drinking as a function of the number of different social groups with perceived gambling. A multi-site high-school survey assessed gambling, alcohol use, presence of perceived excessive peer gambling (peer excess—PE), and family gambling prompting concern (family concern—FC) in 2750 high-school students. Adolescents were separately stratified into: (1) low-risk, at-risk, and problem/pathological gambling groups; and, (2) non-binge-drinking, low-frequency-binge-drinking, and high-frequency-binge-drinking groups. Multinomial logistic regression showed that relative to each other, FC and PE were associated with greater likelihoods of at-risk and problem/pathological gambling. However, only FC was associated with binge-drinking. Logistic regression revealed that adolescents who endorsed either FC or PE alone, compared to no endorsement, were more likely to have at-risk and problem/pathological gambling, relative to low-risk gambling. Adolescents who endorsed both FC and PE, compared to PE alone, were more likely to have problem/pathological gambling relative to low-risk and at-risk gambling. Relative to non-binge-drinking adolescents, those who endorsed both FC and PE were more likely to have low- and high-frequency-binge-drinking compared to FC alone or PE alone, respectively. Family and peer gambling individually contribute to adolescent at-risk/problem gambling and binge-drinking. Strategies that target adolescents as well as their closely affiliated family and peer members may be an important step towards prevention of harm-associated levels of gambling and alcohol use in youths.     

Attentional Bias in Problem Gambling: A Systematic Review

Attentional bias has been the subject of extensive empirical investigation in connection with chemical addictions, and it has been demonstrated in users of several different substances. The findings show that substance users seem to notice and attend to substance-related stimuli more readily than non-substance-related stimuli. Less is known, however, about attentional bias in pathological gambling. This systematic review investigates the existing empirical evidence on attentional bias in problem and pathological gamblers. Eleven studies were identified and evaluated following a literature search. Key findings are that problem and pathological gamblers seem to exhibit attentional bias toward gambling-related stimuli across different measuring paradigms, although some negative findings were reported. Recommendations aimed at improving research on this topic include better validation of measures, the inclusion of manipulations of craving level, and adding variations in gambling severity as a variable, as well as gambling preference. Research on therapeutic procedures aimed at reducing attentional bias is also recommended.     

Predictability in Pathological Gambling? Applying the Duplication of Purchase Law to the Understanding of Cross-Purchases Between Regular and Pathological Gamblers

The objective of this study is to explore the gambling participations and game purchase duplication of light regular, heavy regular and pathological gamblers by applying the Duplication of Purchase Law. Current study uses data collected by the Australian Productivity Commission for eight different types of games. Key behavioral statistics on light regular, heavy regular, and pathological gamblers were computed and compared. The key finding is that pathological gambling, just like regular gambling, follows the Duplication of Purchase Law, which states that the dominant factor of purchase duplication between two brands is their market shares. This means that gambling between any two games at pathological level, like any regular consumer purchases, exhibits “law-like” regularity based on the pathological gamblers’ participation rate of each game. Additionally, pathological gamblers tend to gamble more frequently across all games except lotteries and instant as well as make greater cross-purchases compared to heavy regular gamblers. A better understanding of the behavioral traits between regular (particularly heavy regular) and pathological gamblers can be useful to public policy makers and social marketers in order to more accurately identify such gamblers and better manage the negative impacts of gambling.     

Growing Up in a “WE” Family

SUMMARY

When couples choose to parent as a unit (the couple as WE) rather than as autonomous individuals, they and their children both benefit. The current article details some ways that parents can further expand their “couple as WE” into a “family as WE” with active parents and socially perceptive children. The article also discusses ways that family members can start and maintain a family dialogue.     

Barriers to the Development of Marital Health as a Health Field*

The development of Marital Health as a bona fide health field is posited as the most viable means for obtaining funding for training, research and treatment concerning the marital dyad equal to such funding now available for other health fields. Obstacles to this development include (1) the failure to differentiate between the concepts of “healthy marriages” and “marital health as a health field,” (2) the erroneous assumption that marital health already exists as a health field, (3) the preindustrial myth of naturalism, and (4) criticisms of the health model that are based on the search for value-free models and terminology.     

Marital Quality Ten Years After the Transition to Parenthood: Implications of the Timing of Parenthood and the Division of Housework

Using a sample of 180 dual‐earner, nondivorced couples, this study explored how the timing of parenthood and the division of housework are related to husbands' and wives' marital quality during the childrearing years. Hypothesized to be “at risk” for negative marital evaluations were early first‐birth couples who divided tasks in a less‐traditional manner and delayed first‐birth couples who divided tasks in a traditional manner. Analyses revealed that husbands and wives in the “risk” groups evaluated their marriages more negatively, suggesting that congruence between behaviors, background, and attitudes is important for marital quality. In addition, early first‐birth couples evaluated their marriages more poorly than did the “on time” or “delayed” couples. Wives' gender‐typed attitudes emerged as a significant covariate in the analyses but did not account for the effects of the timing of parenthood and the timing of parenthood × the division of housework interactions.     

Marital Therapy,EMDR, Herman's Model of Recovery from Trauma The Journey of One Woman and Her Family

Judith Herman (1992, page 183) delineates a three stage model of recovery from trauma: 1) Safety, 2) Remembrance and Mourning, 3) Reconnection. She criticises current treatment methods for their failure to make a difference in the “constrictive symptoms of numbing and social withdrawal … and marital, social and work problems do not necessarily improve”. Family therapy has been criticised often for insufficient focus on emotion and general sensations. This case analysis will illustrate how these shortcomings can be successfully addressed with the use of marital counselling and EMDR. The use of multiple treatment approaches contributed to one client's resolution of recent trauma due to a car accident, of past crises due to marital infidelity and early childhood abuse, with significant changes for her in her current family as well as in her family of origin. Theoretical implications for “family therapy” are raised.