Discharge planning with pathological gamblers: An ongoing process

Criteria for a diagnosis of pathological gambling include gambling related disruption or damage in legal, financial, family, vocational and personal areas. Therefore, discharge planning with a pathological gambler is much more than a placement problem at the end of an inpatient treatment stay. In fact, discharge planning incorporates and continues a holistic treatment approach at the Cleveland Veterans Administration Medical Center, Brecksville Gambling Treatment Program. This paper discusses all areas of the gambler's life which have been disrupted and need to be considered when working on a discharge and recovery plan.     

Individual outpatient treatment of pathological gambling

Recovery from pathological gambling is viewed as a process whereby the pathological gambler chooses to lose an addiction to gambling and maintains that choice while mourning the loss of the gambling. The self-induced and self-escalating addictive crisis leading up to that choice is explored, as is the crisis caused by the loss of the gambling itself. It is proposed that gambling provides the gambler with action, a method of dealing with stress aand avoiding unpleasant affect, and a variety of social, psychological, and existential benefits. The loss of gambling is seen as a complicated and significant one which elicits grief responses similar to those seen in response to other types of major loss. It is proposed that in the individual outpatient treatment of pathological gamblers, the therapist helps the recovering gambler to accept the loss of the gambling and learn to live a rewarding life without it. Four phases of treatment are suggested which correspond to stages of grieving and accepting the loss of the gambling.     

Opportunity realized: Undergraduate education within Departments of Communication

The effort of the Undergraduate Communication Integrative Team¹ resulted in three models for undergraduate education in public relations within departments of communication. One model offered a macro-approach integrating cognitive, behavioral and professional conceptual categories within the general outcomes assessment framework. A second model offered a micro-approach by identifying six core content areas, then indicating the knowledge, behavioral and affective outcomes for each. This micro-model also suggested course titles within which the content might appear and presented suggestions for instruction tactics as well as methods for assessing student learning outcomes. A third model, appropriate to programs with only one course labeled “public relations,” explicated the content, pedagogy and assessment tactics for that introductory course.All of these models fit within a communication context shaped by 10 principles agreed to by the integration team. All the models fit within an interdisciplinary, liberal arts approach to public relations education strongly endorsed by the integration team.     

Public Scholarship and Community Engagement in Building Community Food Security: The Case of the University of Kentucky

The current call for public scholarship and community engagement by universities and disciplinary organizations has created opportunities to develop innovative ways to integrate research, instruction, and outreach. This article discusses a collaboration among scholars at the University of Kentucky and alternative agrifood movement organizations that has evolved as they pursue an alternative agrifood system in Kentucky. This collaboration made instructional programs in sociology and the honors world food issues track places in which both students and instructors can examine “problems” of the conventional agrifood system, conduct research, and develop collaborative relationships with community activists. We draw on Burawoy's discussion of public sociology and its interface with professional, critical, and policy sociologies. Supplementing our discussion with literature from social movements and science studies, we demonstrate how this integrated approach can render sociological knowledge and skills useful as critical support of alternative agrifood movements. We argue that the “experiential classroom” is an excellent site for the critical examination within the agrifood movements of oppositional culture. This, in turn, makes possible students' recognition of injustice in the existing agrifood system.     

The use of key indicators as a foundation for knowledge management: the experiences of Monterey County's Social and Employment Services Department

While effective knowledge management practices are commonly sought by organizations, facilitating the use and ongoing engagement in these practices can be challenging. To this end, one agency developed a strategy for institutionalizing their knowledge management functions by appointing a team responsible for monitoring and implementing knowledge management functions, and creating a report for use as a tool by departments agency-wide. Aimed at increasing transparency both within the agency and with the surrounding community, the report provides an overview of individual departments' programs, goals, recent caseload trends, and latest achievements. The report is made available online and accessible by the general public. This case study describes the development of this team and report, as well as lessons learned and future knowledge management goals for the agency.     

On Being Attracted to the Possibility of a Win: Reward Sensitivity (via Gambling Motives) Undermines Treatment Seeking Among Pathological Gamblers

Unfortunately, only a small percent of pathological gamblers seek the professional help they need. In the current study, we test the idea that individual differences in reward sensitivity should predict whether a pathological gambler has sought treatment—the odds of treatment seeking should decrease as reward sensitivity increases. This hypothesis rests on the proposition that reward sensitive pathological gamblers should find treatment seeking aversive because doing so would remove a route to reward. We also tested those motivations to gamble that are positively reinforcing (social affliction and self-enhancement) as a possible mechanism by which reward sensitivity undermines treatment seeking—we did not anticipate negatively reinforcing motivations (e.g., coping) to be a mechanistic variable. Ninety-two pathological gamblers completed a large-scale survey that contained the variables of interest. As predicted, pathological gamblers were less likely to have sought treatment as reward sensitivity increased. Moreover, this relationship was mediated by social affiliation motivations to gamble, but not self-enhancement or coping motives. Reward sensitive gamblers did not wish to seek treatment to the extent that they were motivated to gamble for the social interactions it provides—seeking treatment would cut this avenue of affiliation with others. In light of these results, we suggest health care professionals take reward sensitivity into account when trying to promote treatment seeking, to say nothing of the social affiliation motives that underlie the reward sensitivity-treatment seeking link.     

Subtypes of Problem Gamblers,Sociocultural Factors,and Availability of Gambling

Finnish treatment-seeking gamblers were examined in light of predominant problem gambler subtype models. “Psy science” oriented problem gambler subtypes were found to be considerably influenced by gambling cultures and treatment traditions in the countries from which the mainstream problem gambler research originates. Thus, models that emphasize the psychopathology of the individual might cause some friction when applied to countries like Finland with a quite particular gambling culture and addiction treatment system that traditionally functions on a social work basis. It is suggested that specialists helping problem gamblers should acquire local knowledge with which to complete psychiatrically oriented scientific knowledge.     

The development and evaluation of a natural helpers' training program to increase the engagement of urban,Latina/o families in parent-child interaction therapy

Latina/o immigrant children are at increased risk for developing conduct disorders, and are simultaneously less likely to access services. Natural helpers are uniquely positioned to promote effective parent training programs to address service disparities in these communities. This study describes one effort to train natural helpers to increase engagement in parent-child interaction therapy (PCIT), an evidence-based parent training program. An academic-community partnership prompted the development and evaluation of this natural helpers training program. Five natural helpers were trained to recruit Latina/o families into PCIT, address barriers to treatment, and support parents' skill development. Over the course of training, natural helpers increased their knowledge of PCIT and their ability to use and model treatment targeted parenting skills. Additional consultation was necessary to improve the natural helpers' abilities to conduct behavioral observations of parent skill use and provide feedback on these skills. Natural helpers expressed overall satisfaction with PCIT and the training program. Suggestions for incorporating natural helpers into PCIT services are discussed based on the strengths and challenges identified from the evaluation of this training program.     

Abstracts

This paper describes a design for a course which aims to develop advanced practice skills in supervision and consultation for qualified social workers. The course model is based on an understanding of reflective learning developed chiefly by Donald Schon and recently discussed in this journal by Nick Gould. Some of the processes, risks and dilemmas for course members, course tutors and seconding agencies that are inherent in the course are explored through examples of reflection-in-action drawn from recent courses. Implications for the use of this approach with social workers' managers operating within a hierarchical organisational structure are explored.

The experiential element of the course, based on course members' work as consultant and consultee with another course member, will be developed more fully in a subsequent paper.

The potential usefulness of the course is discussed in relation to developing advanced practice in professional supervision, accrediting experienced practice teachers and, in an adapted form, enabling social work practitioners to develop a range of advanced practice skills.     

Problem Gambling and Comorbid Psychiatric and Substance Use Disorders Among Drug Users Recruited from Drug Treatment and Community Settings

Little is known about gambling rates of drug users recruited from drug treatment compared with those recruited from the community. We use the Diagnostic Interview Schedule (DIS) to provide lifetime prevalence estimates of problem gambling (i.e., at least one gambling problem) and DSM-III-R pathological gambling (i.e., at least four gambling problems) and describe the association between gambling and psychiatric disorders for drug users recruited from drug treatment settings (n = 512) and from the community (n = 478). We also report the relative risk of being a recreational and problem gambler in this sample. The sample was first interviewed in 1989–90 as a partof two NIDA-funded St. Louis-based studies. The prevalence of problem gambling in the overall sample was 22% and the prevalence of pathological gambling was 11%. There were no statistically significant differences in problem and pathological gambling rates for subjects recruited from drug treatment and those recruited from the community. The conditional prevalence rates, that is, the rate of problem and pathological gambling only among gamblers were 27% and 13.5%, respectively. Major findings indicate that problem gambling was associated with Antisocial Personality Disorder (ASPD), even after controlling for recruitment source and socio-demographic characteristics. In fact, when examining the temporal order of these disorders, we found that pathological gambling was always secondary to ASPD, occurring on average 11.4 years after the onset of ASPD. Problem gamblers, compared with everyone else, were more likely to be male, African-American, recruited from drug treatment, have ASPD and be dependent on illicit drugs. Multinomial logistic regression analysis predicted the relative risk of being a recreational and problem gambler (compared with a nongambler) in this sample according to socio-demographics, ASPD, and dependence on illicit drugs. Results imply that screening for gambling problems will need to be broad-based among drug users.     

Delabeling and relabeling in Gamblers Anonymous: Problems with transferring the Alcoholics Anonymous paradigm

Exploratory data from both structured and unstructured interviews with members of Alcoholics Anonymous and Gamblers Anonymous, as well as additional data from previous observations, suggest that the recovery rate of A.A. is higher than that of G.A.. Since the programs are virtually the same an examination of the social context of the labeling process reveals that the more readily available use of the medical model for both the alcoholic and the significant others of the alcoholic are likely significant differences between the compulsive gambler and the compulsive drinker.An embryonic version of this paper was presented at the Second Annual Conference on Gambling, Lake Tahoe, August 1975. The authors thank Henry Lesieur, Robert Custer, and the anonymous reviewers ofThe Journal of Gambling Behavior for their comments and suggestions. We give special thanks to Dan, Howie, Jeanne, Berdell, Barbara, John, Swede, Happy Jack, Nancy, Skip, and many other anonymous members of G.A. and A.A. for their help and cooperation in this study.     

Compulsive gambling: Structured family intervention

Family intervention has been an effective procedure for getting alcoholics into treatment for more than twenty years. Now this technique is being used with compulsive gamblers. Because the gambling disorder is so easy to hide, the patient seems to be further into the illness by the time the family seeks help. Furthermore, because the gambling offers intermittent rewards, the denial in both the patient and family appears to be stronger than found with most alcoholics.During the intervention it is important to tell the compulsive gambler why the help of a professional was sought; what changes have been observed by family members and friends as a result of his/her gambling; how family relationships have been affected; what is feared will happen if he/she doesn't get help; and what each family member hopes will happen once the gambler is in recovery.Most concerned persons enter family interventions with the sole purpose of getting the gambler into treatment. However, since this is a family disease, ethically the primary goal of family intervention needs to be to getsomeone into treatment, if not the individual suffering with the disease then one or more of those concerned persons suffering from it.     

The prevalence of problem and pathological gambling: A critical analysis

Prevalence of pathological gambling refers to the percentage of cases of pathological gambling occurring in the community at a given time. Prevalence studies conducted in different principalities throughout the world are reviewed, and it is found that none of them conforms to this definition of prevalence. The major error in all but the most recent surveys conducted is identified as the use of questions which ask whether gambling-related problems have ever occurred rather than whether they are currently occurring. This error will lead to an over-estimation of the prevalence of pathological gambling in society. The second major error identified in nearly all studies involves the accuracy of the screens being used to assess whether or not an individual is a pathological gambler. Concerns about the efficiency of the South Oaks Gambling Screen have not yet been satisfactorily resolved. None-the-less, the widespread use of the South Oaks Gambling Screen has made a valuable contribution to international comparisons of prevalence studies. Future work that explores the emerging relationship between levels of personal expenditure on gambling, types of gambling product and gambling-related problems are recommended.     

Autism,employment, and the role of occupational therapy

The purpose of this article is to review the existing literature to generate guidelines for the role of occupational therapy in employment for persons with autism. Previous research about strengths and barriers to employment, and types of employment commonly offered to persons with autism are reviewed. The supported employment model is identified as the most productive approach for use with this population. The four approaches to the supported employment model and the best practice contributions of several innovative supported employment programs are discussed. The interdisciplinary team approach is best to assist persons with autism to gain employment and ensure success on the job. The role of the occupational therapist as a beneficial team member in assessment, job development, job placement and training, and supported employment is outlined.     

Pathological gambling: A parsimonious need state model

The model proposed attempts to integrate the growing data base on pathological gamblers in a parsimonious manner. The model focuses on psychological observations, although it recognizes the parallel importance of physiological phenomena. The model is based on two recurring observations with pathological gamblers: Gambling satisfies recurring and often intensified needs for the gambler; and pathological gamblers vary tremendously on a number of dimensions. The model suggests that attempts to understand pathological gambling must focus on sub-types of pathological gamblers. Two sub-types, are discussed.     

A co-worker approach to working with families

Summary The co-worker approach offers workers additional armamentarium in working with families. Such advantages may never become manifest unless the workers both recognize possible limitations inherent in team endeavor and develop and even maximize the use of the co-worker relationship.The impact of the co-worker approach, as compared with other approaches, offers both personal and professional advantages. Personally, the worker engages in a continuing educational, self-awareness, and self-enhancing activity that contributes to his growth as a professional and as a person. The joy of relationships, mutual and reciprocal, is a part of this personal enhancement. Professionally, the promotion of therapy through examination and testing of new knowledge and skills based upon another professional's confirmation enhances the professional aspects of therapy. The use of co-workers further develops new styles of working with and in family constellations.     

Determinants of individual fertility and contraceptive use: a review and synthesis of the literature

This discussion, which reviews the fertility determinants literature from a sociopsychological or individual perspective, summarizes literature addressing the determinants of individual fertility, i.e., an individual's decision to use or not use an effective contraceptive method. Complete or definite answers about fertility determinants do not exist, but enough is known to provide an overview. From the 259 articles, monographs, and books examined and classified, 6 main classes of determinants were formed and analyzed: demographic; sociopsychological; experiential or behavioral; informational, including knowledge about reproduction and birth control; husband and wife interaction; and environmental. Gaps in the existing literature about these determinants are identified and a sociopsychological model integrating existing knowledge is proposed. In general, the following groups of individuals have relatively high fertility and/or relatively low or ineffective contraceptive use: low socioeconomic status, adolescents and people aged 40 and older, Catholics and highly religious, rural, many siblings, unemployed women or working women who do not attach great importance to their careers; and ethnic minorities. Sociopsychological determinants of fertility and contraceptive use have been classified into 2 groups: personality traits and values and attitudes. In general, the evidence linking values and attitudes to fertility-related behavior is stronger than personality traits, but some promising work in the personality area is being conducted. In general an early age at 1st marriage related to higher fertility, and duration of marriage positively associated with fertility as is a younger age at 1st birth. In general, there is a positive correlation between contraceptive knowledge and contraceptive behavior. Certain aspects of the husband/wife relationship, including the allocation of roles and responsibilities between husband and wife and the scope and frequency of their communication--are related to their fertility and contraceptive use. The extent to which family planning programs contribute to fertility decline, over and above the effects due to modernization and development, remains unanswered empirically. The following gaps in the literature were observed: the need for more research on the role of the male partner in determining fertility and contraceptive use, the experiential or behavioral determinants of fertility and contraceptive use, employment history, environmental aspects, and integration of the area into theoretical framework(s) capable of empirical verification.     

The self-exclusion program: legal and clinical considerations

In recent years, attention focused on compulsive gambling,¹ and its causes and cures, has increased at a notable rate. Among the measures taken to help the compulsive gambler is the voluntary² self-exclusion program which is either in place or being considered in various states.³ Although the programs differ from jurisdiction to jurisdiction, the basic premise is that the gambler requests that he be banned from the gaming establishment and/or removed from its mailing list. This article examines this new concept primarily from a legal perspective. The self-exclusion program represents a state-created legal entity constructed upon a clinical foundation. It prominently includes several clinical references to mental health principles. Of necessity, there appear some analogies to the field of substance abuse; these have provided at least a starting point for more particularized study and research in the fledgling field of compulsive gambling treatment.     

Does it Work for Them — Does it Work for Us? Evaluating a New Model of Team Practice

This article describes a change in team practice from a model targeted at individual families to a combined model that supplements family therapy with group programs for children. Unacceptably long waiting lists for family counselling services, high levels of stress in clinicians, and consumer dissatisfaction motivated this change. Robust quantitative data and a qualitative analysis of the project confirm that the change has made a positive impact and the new treatment model deserves to be continued. The article concludes that internal team changes are insufficient in a treatment context which requires more profound changes beyond the boundaries of the team.