Consults: Seeking Help for Gambling Addiction - New York Times

Is treatment for gambling addiction different than for other addictions? What’s the best way to get the compulsive gambler to stop? What can family members do to encourage treatment, and to protect themselves? These are among the questions recently posed by readers of the Consults blog.
Dr. Timothy Fong, co-director of the gambling studies program and an associate professor of psychiatry at the University of California, Los Angeles, responds. For more information, see Dr. Fong’s earlier responses in “When Is Gambling an Addiction?” and the U.C.L.A. Gambling Studies Program Web site.
Treatment of Gambling Addiction vs. Other Addictions


Overcoming Gambling Addiction



Q.
What similarities/differences are there in treating gambling disorders versus treating substance use disorders? Are self-help groups like Gamblers Anonymous, or GA, effective? Less effective? Are motivational interviewing techniques and relapse prevention education part of the standard of care?
kerewin1971, Washington, D.C.
A.
Dr. Fong responds:
Treatments for pathological gambling and substance abuse disorders are similar in that they both require an integrated approach that will meet the needs of the individual patients. Treatment programs will consist of individual therapy, group therapy (like GA or AA), family therapy and other structured recovery programs.
Most treatment programs for gambling addiction are successful if the patient fully commits to treatment and does the work and recovery activities that are recommended. Gamblers Anonymous is the most widely available form of support for recovery and is part of most treatment plans.
The major difference between treatment of gambling addictions versus substance abuse is that there are no objective tests, such as random urine drug testing, to identify someone who has gambled recently. Because gambling addiction and substance use disorders commonly co-occur, treatment for both oftentimes happens in substance abuse treatment settings.
Gamblers Anonymous
Q.
Gamblers Anonymous is one program for gamblers who can admit they are powerless over gambling (once they start they can’t stop) and their life is unmanageable. I suggest googling GA to find local meetings.
Anne, New York
A.
Dr. Fong responds:
Gamblers Anonymous is available in every major city in America and has been around for over 50 years. To find a local meeting, visit the GamblersAnonymous.org Web site.
Drugs for Compulsive Gambling?
Q.
Are there medical treatments (drugs) available to treat gambling addictions?
zzishate, Alexandria, Va.
A.
Dr. Fong responds:
There are no medications currently approved by the Food and Drug Administration for the treatment of gambling addiction. Over the last 15 years, several medications have been studied, with varying degrees of success in helping pathological gamblers curb their symptoms. These drugs include antidepressants, seizure medications and medications that block opioid receptors.
Medications can reduce the urges and cravings to gamble and can also lessen the symptoms of depression or anxiety that might be triggering continued gambling. When considering treatment for gambling addiction, medications are an important part of the recovery plan, but they are most effective when used in conjunction with professional counseling.
Gambling Addiction vs. Gaming Addiction
Q.
Do you believe there is a difference between compulsive gambling and compulsive video gaming, since both work on intermittent reward systems and dopamine action in the brain? And, if you believe somebody can be treated with drugs, must there be a cognitive/social/behavioral intervention as well, for treatment to be effective?
Sumer, New York, N.Y.
A.
Dr. Fong responds:
Behavioral addictions have been shown to involve the neurochemical dopamine. The exact neurocircuitry and neurochemicals involved in pathological gambling versus video game addictions have not been differentiated. Clinically, the disorders are similar in that they involve loss of control, preoccupation and continued involvement despite harmful consequences. A fascinating question is why one person drifts toward gambling while another drifts toward video gaming.
Effective treatments for pathological gambling and any other addictive disorder require an integrated approach that combines individual therapy, medications, group therapy and restoring the ability for self-care. Treatment plans that only provide one or another form of treatment but not all of them will not be as effective.
Convincing Gambling Addicts They Need Help
Q.
How can relatives of compulsive gamblers help convince them to get help? If they cannot convince them, how can they best deal with their addiction?
Carolyn, St. Louis
A.
Dr. Fong responds:
The most important action family members of pathological gamblers can do to help the situation is to learn more about pathological gambling and how to take care of themselves. Family members who are supportive and willing to participate in the treatment process instead of making threats or judgments are more likely to see positive outcomes.
There are no magic words that family members can say to those with gambling addiction that will convince them to seek treatment. Instead, stating to the gambler how concerned and how much the gambling has impacted their own lives will often be enough to motivate gamblers to seek treatment.
Finally, family members ought to seek out professional help for themselves or seek support from a Gam-Anon meeting, a 12-step support group for family members, to help stop any behaviors that are enabling the gambler. More information is available at the GamAnon.org Web site.
Helping Family Members of a Compulsive Gambler
Q.
How can I help the spouse of a recovering gambling addict handle the aftermath of the gambling addict’s behavior (I am a relative of the spouse)? A large portion of the family’s money was gambled away, but five-plus years have passed and the spouse still retains a LOT of anger towards the gambler regarding the lost money. What resources are there for those of us dealing with an addict and the problems caused by the addict’s behavior?
P, New England
A.
Dr. Fong responds:
For affected individuals of a pathological gambler, help is available through Gam-Anon, a support group for family members of gambling addiction. In these groups, one will find emotional support and ideas on how to deal with the consequences of gambling. In addition, individual therapists or counselors are available to help deal with the anger, depression, shame, guilt that the affected individual ends up feeling. This disease leaves traumatic scars, emotionally and financially, and there are times that only professional help can manage those feelings.
Medications That Cause Gambling Addiction
Q.
A person with Parkinson’s developed a gambling, risk-taking addiction while being treated with the dopamine agonist Mirapex. The behavior stopped after the drug was removed, but is he now at a higher risk for relapsing?
Ms. R., New York
A.
Dr. Fong responds:
If the person did not have a gambling problem before taking Mirapex, and if that drug is stopped, there is a good chance that the gambling addiction will not return. There is no guarantee that the gambling will not return, though, and the best course of action would be to refer the person to a gambling treatment specialist.
In Search of a Healthy Environment
Q.
I gamble as a social outlet. I’d much rather do something to reform society, which is in a mess at the moment. A. A. Berle pointed out that we have no social. index, no system of value. Kenneth Arrow pointed out that we can’t have a social welfare function. Interesting work with a real purpose is unavailable to most of the population because capitalism has failed to produce the abundance of resources that Marx predicted. Malthus and Darwin are still strangling Condorcet. You might refer to the work of Bruce Alexander who demonstrated that rats gave up their addictions when placed in an interesting environment. If a healthy environment gave addicts the release they seek in drugs, there would be no addicts.
Richard Maxwell, Winter Haven, Fla.
A.
Dr. Fong responds:
Your comment taps into the idea that recovery from addictive disorders is a voluntarily maintained lifestyle characterized by sobriety, self-care and citizenship. The reality is that our current environment is one that promotes consumption, recreation and instant rewards, all of which are very reinforcing and compelling to the brain.
Casino Education
Q.
Las Vegas is seeking ways to fill its hotel rooms. Why not teach courses on gambling addiction control there all year round? Some of the older hotels offer amazing discounts.
Sol Biderman, Brazil
A.
Dr. Fong responds:
Many of the Las Vegas casinos do train their employees on how to spot signs and symptoms of gambling addiction and there are conferences each year on the topic of gambling addiction.
For more information, see Dr. Fong’s additional responses in the Related Posts section, below.

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Russia to develop new methods of drug addiction treatment - RIA Novosti

Russia's state anti-narcotics committee (GAK) is developing new forms of treatment for drug addiction, following exposure of a number of cases where addicts were subjected to coercive treatment, the country's drug chief said on Monday.
"We will develop methods of coercing [drug addicts] to receiving treatment, but not physically... shackles are not the way forward," Head of Russia's Federal Drug Control Service Viktor Ivanov said.
The issue came to the fore last year when Yegor Bychkov, the director of an anti-narcotics clinic in the Urals, was jailed for over three years for using "forceful methods" when treating his patients, including restraining them to their beds.

Treatment Approaches for Alcohol and Drug Dependence: An Introductory Guide


Ivanov said that drug addicts would be allowed to undergo treatment anonymously.
"Our goal is to understand the scope of drug abuse... Personal data does not interest us, the drug dealers themselves do," Ivanov said.
Most drug addicts slip back into dependency after undergoing treatment in Russia's clinics, according to statistics.
Around 30,000 Russians die from drug abuse every year.

MOSCOW, November 1 (RIA Novosti)

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Treatment for prescription drug addiction is available, but rarely used - Tampabay.com

By Leonora LaPeter Anton, Times Staff Writer
In Print: Monday, November 1, 2010

---

At Footprints Beachside Recovery Center in Treasure Island, Joe Faupel, left, Shane Templeton, and John Templeton Sr. have extra space. Treatment costs are negotiable, John Templeton said.
	[SCOTT KEELER | Times]

At Footprints Beachside Recovery Center on Treasure Island, an employee of the drug and alcohol treatment center arrived for work one day last week to treat one patient — the only one in the place.
That's the irony of private drug rehab in Florida: Prescription drug addiction is rampant and treatment is widely available — but people don't take advantage of it because they can't pay for it.
In Tampa, the HealthCare Connection, which treats lawyers, doctors and other professionals, has lost clients because of the tough economy.

Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding (Addicus Nonfiction Books)


In Clearwater, Windmoor Healthcare, a private substance abuse and mental health hospital, has opened an outpatient unit to help narcotic addicts whose insurance won't cover hospital treatment.
Seven Floridians die of prescription drug overdoses each day. And more than 1.2 million abuse drugs and alcohol, according to the National Survey on Drug Use and Health.
"There's so much more need," said Timothy Sweeney, director of the recovering attorneys program at the privately owned HealthCare Connection. "But the downturn in the economy means that fewer people are able to access recovery."
• • •
Addiction to opiates like oxycodone is considered the toughest to kick. Prescription drugs take over fast, wreak havoc faster.
"Warp drive" is the way John Templeton Sr., one of the owners of Footprints Beachside Recovery, describes the addiction.
Yet few who succumb to prescription drugs get the treatment they need. A national drug study estimated that just 10 percent of those who need treatment ever get it.
The problem is cost. Those with insurance quickly exhaust meager benefits and most don't have $5,000 to $20,000 a month for round-the-clock rehab.
"For people with private insurance, it's really difficult to get 30 days anymore (in a treatment facility)," said Brian Talley, director of business development and outpatient services at Windmoor, the private hospital. "Any private facility you talk to will tell you the same thing."
A federal law went into effect this year that can make a difference. Before the Mental Health Parity and Addiction Treatment Act was implemented, insurance plans typically limited the number of therapy visits and sought higher out-of-pocket contributions from patients.
The typical plan at Blue Cross and Blue Shield of Florida, for example, offered $2,500 a year in substance abuse benefits. Anything over that was not covered.
Now, substance abuse benefits must be as generous as coverage for medical problems like cancer and diabetes.
Still, the new regulations apply only to companies with 51 or more employees. Though the law will likely improve care and make it more affordable, it won't change the way insurers decide what is medically necessary. So with the push away from inpatient treatment, many addicts will try outpatient programs, which cost less, experts say.
Perhaps that is why 120 outpatient programs opened across Florida in the past two years. Florida licensed almost 400 new substance abuse treatment programs across the state, including 62 in the Tampa Bay area. Many focus on intervention, detox and the use of weaning medications such as Suboxone and methadone.
• • •
Inpatient treatment centers keep opening despite the tough economy. Many are in beachfront communities like Miami, which has 85 new residential centers.
"We've hit a whole new era here," said Michael Sunich, a psychologist and addictions expert in Tampa. "There's a whole new trend here in Florida especially that's driven by the prescription drug abuse that's just skyrocketed."
At Footprints Beachside Recovery, abstract and floral art in earth tones lined the walls of the group therapy room, along with a poster of the 12 steps to recovery. A long faux-cherry wood table stretched down the center. Empty for now.
The center had just one client, who was expected later that night after work. Owner John Templeton Sr. explained that the economy had hit the center hard. Back in May, they had six of 12 spots filled. But the phone stopped ringing over the summer.
The center hired a marketing specialist to help draw more customers to its website, which offered pictures of white sandy beaches and turquoise pools.
Footprints sits in a strip of shops between a spa and a restaurant near the beach in Treasure Island. For under $10,000 a month, you can get one-on-one counseling, drug education, group therapy, food, transportation, a couple of massages at the spa next door and access to yoga at the gym across the street.
Executive director Joe Faupel runs a sober living apartment complex for 16 on the beach, four miles from the treatment center. The half-dozen residents have already completed Footprints' treatment and are attending 12-step meetings.
Templeton Sr. and his two sons, John Jr. and Shane, opened Footprints a little more than a year ago. In 2002, John Jr. drank too much in Ybor City, drove the wrong way on Interstate 275, and got into a crash that killed 18-year-old Julie Buckner. John spent nine months in jail and has crusaded against drunken driving ever since by telling his story at high schools, drug treatment centers and prisons.
"We felt like we wanted to give back so that nobody else would experience the pain of this," said John Templeton Sr. "We're doing this for a higher purpose here."
As a result, he said, treatment costs are negotiable.
"Some people can't afford to get help," he said. "We realized that setting this place up."
Leonora LaPeter Anton can be reached at lapeter@sptimes.com or 727-893-8640. Researchers Shirl Kennedy and Connie Humburg contributed to this report.

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