Substance Dependence Recovery Rates: With and Without Treatment

Have you ever seen addiction up close? Percept as a screen: Maybe cancer and AIDS are too or maybe you should ask the people that are dying of it what they think it is that makes them sick. The psychoanalytic understanding of gambling problems rests on the foundation formulated by Freud , who thought that it was not for money that the gambler gambled, but for the excitement. Moreover, the majority of state affiliates to the National Council on Problem Gambling probably do not receive this level of funding Letson, and, although 47 states have some form of legalized gambling and all 50 states have gambling venues legal and illegal , only 34 have a council.

Recommendations

Point #1: Most People Cease to Be Substance Dependent

National Academies Press US ; The treatments and interventions for pathological gambling that have been developed and reported in the literature are quite similar to methods of treating other disorders or addictions.

Substantial progress has not been made in understanding the treatment of this disorder or the characteristics of those seeking help for it, nor is there research basis for matching clients to treatments. Most published investigations are case studies or studies with small samples of clients whose circumstances may not be generalizable to larger populations Knapp and Lech, ; Murray, Moreover, treatment approaches have not been subjected to rigorous and detailed empirical research Blaszczynski and Silove, Given the lack of national attention to the treatment of pathological gambling, it is difficult to estimate the scope of intervention services available in the United States.

We begin with a discussion of the definition of treatment and challenges in treating such disorders as pathological gambling. We then discuss what is known about the characteristics of those who seek treatment for pathological gambling.

We then turn to treatment models that have been applied for helping pathological gamblers, what is known about treatment effectiveness, whether treatment is warranted, and issues related to treatment availability, utilization, funding, and treatment providers in the United States. We also identify priorities for further research, including treatment effectiveness, cost-effectiveness, how patients should be matched to treatments, and prevention strategies.

In the committee's view, the definition of treatment needs to be a broad one. We define treatment as: Comprehensive treatments move through three stages: These three stages can vary according to the philosophy of the providers, the settings in which treatment takes place, and the specific approaches employed.

No systematic compilation of treatment services for pathological gambling has been made in the United States. Treatment is provided in many ways and in many settings, although outpatient treatment is probably the most common; no single treatment approach dominates the field.

In fact, it appears to be common for approaches to be combined in most clinical settings. It is important, as well, to recognize that recovery from pathological gambling can take place without formal treatment. Such individuals have been classified by various descriptors, for example, so-called spontaneous recovery and natural recovery Wynne, personal communication, Although the subject of natural recovery from psychoactive substances, such as alcohol and opiates, has received some attention in the professional literature McCartney, , no such attention has been given to gambling.

All addictions, by their nature, pose special problems to treatment providers. Like other purposive human behavior, addictive behaviors have adaptive or functional value, with the result that efforts to change these behaviors often fail. Ambivalence is at the core of addiction Shaffer, Those who are addicted and thinking about change want to free themselves from their addiction.

At the same time, they crave the satisfactions that their addiction provides. As they become aware of the harm their addiction is doing, they begin to say that they want to quit. Of course, wishing or expressing a desire to quit a behavior is not the same as doing it.

Despite the obvious harmful consequences, people in the throes of addiction cling to the part of the experience that they like: The key to change comes when those addicted begin to realize that the costs of their addiction exceed the benefits, as when pathological gamblers identify gambling as a destructive agent in their life.

It is at this point that addicted people often ask those who they trust to help them stop, and they take the first steps to seek professional help. This turning point is but the first step of a complex dynamic process, including the possibility that bouts of abstinence and relapse may occur for some time Marlatt and Gordon, A challenge in the treatment of pathological gambling is preventing relapse.

For example, few people who stop using drugs remain abstinent thereafter. Marlatt and Gordon examined how slips, that is, single episodes of drug use, can lead to a full-blown relapse Marlatt and Gordon, Many personal and environmental factors interact to influence the risk of relapse for any individual trying to recover from an addiction.

Successful recovery also involves the development of new skills and lifestyle patterns that promote positive patterns of behavior. The integration of these behaviors into day-to-day activities is the essence of relapse prevention Brownell et al. Successful quitters substitute a variety of behavior patterns for their old drug-using lifestyle.

For example, many take up some form of exercise. Spiritual conversions sustain others. In some patients, new behavior can become excessive, almost another addiction. We do not know whether the same substitute behaviors occur in pathological gamblers determined to quit. Understanding the characteristics of those who seek help for a given disorder can assist in developing effective treatments.

As already noted, most clinical investigations in this field are case studies or studies with small samples of clients whose data may not be generalizable to larger populations. Thus, establishing an accurate profile of those seeking treatment is difficult. We can say a few things, however. Treatment seekers tend to be white middle-aged men Blackman et al.

The majority tend to be in their 30s and 40s and have graduated from high school and attended some college Blackman et al. Most clinical studies indicate that, before pathological gamblers come in for treatment, they gamble either every day or every week Moore, ; Stinchfield and Winters, Little is known at this time about their preferences for types of gambling. One factor that may influence preference is proximity of certain games to gamblers; for example, one study showed that the preferred game of gamblers in Maryland was horse racing at Maryland tracks Yaffee et al.

Game availability does not simply translate to preference. Minnesota gamblers have been shown to prefer to gamble in casinos, which may be far from their homes, over purchasing lottery tickets, which can be bought almost everywhere in the state Stinchfield and Winters, Although clients may be reluctant to fully disclose their legal entanglements, most clinical studies indicate that a sizable percentage reports having criminal charges pending as a result of engaging in illegal activity to fund their gambling or pay off their debts Yaffee et al.

Some reports indicate that from half to two-thirds of pathological gamblers have committed an illegal act to get money to gamble Dickerson, ; Dickerson et al. Large debts, most often in the tens of thousands of dollars, are also part of the picture Blackman et al. Additional personal and social consequences reported by those seeking treatment include work absenteeism and lost productivity on the job, presumably because they either skip work in order to gamble or are involved in gambling-related activities while at work; and marital discord and family estrangement, due to the deception, lying, and stealing associated with their gambling Ciarrocchi and Richardson, ; Ladouceur et al.

As discussed in Chapter 4 , a number of studies have found significant rates of cooccurring mental disorders and psychiatric symptoms among pathological gamblers. Studies have indicated evidence of pathological gambling cooccurring with substance use disorders, depression, suicidal thoughts and attempts, and various personality disorders.

Methods for treating pathological gambling include approaches that are psychoanalytic, psychodynamic, behavioral, cognitive, pharmacological, addiction-based and multimodal, and self-help. Often these approaches are combined to varying degrees in most treatment programs or counseling settings.

The discussion below briefly describes each method and summarizes what is known from the empirical research about its effectiveness. In doing so, the discussion expands on the other literature reviews of treatment outcome e. Wildman, personal communication to the committee, A table summarizing the literature on treatment outcome studies reviewed by the committee appears in Appendix D.

Psychoanalysts seek to understand the basis of all human behaviors by considering the motivational forces that derive from unconscious mental processes Wong, Psychodynamics refers to the ''science of the mind, its mental processes, and affective components that influence human behavior and motivations Freedman et al. During the first half of the twentieth century, psychoanalysts provided the first systematic attempts to understand and treat gamblers Rabow et al. Psychoanalytic and psychodynamic treatment approaches have not been proven effective through evaluation research.

They are briefly described here because they are the most common forms of treatment for pathological gambling at this time. These approaches are based on the principle that all human behavior has meaning and is functional. Even the most self-destructive behaviors can serve a defensive or adaptive purpose. This perspective suggests that pathological gambling is a symptom or expression of an underlying psychological condition. This approach takes the view that, although some individuals don't need to understand why they gamble in order to stop, there are many others whose lives do not improve with abstinence, which is experienced as futile and hopeless Rosenthal and Rugle, They then develop a major depression, turn back to gambling, or seek out some other addictive or self-destructive behavior with which to distract themselves.

Psychoanalytic and psychodynamic therapy attempts to help pathological gamblers to understand the underlying source of their distress and confront it. Clinicians have considered psychodynamically oriented psychotherapy useful in treating some of the comorbid disorders and character pathology observed among pathological gamblers, perhaps especially the narcissistic and masochistic subtypes.

Although several others have noted the value of psychodynamic treatment for addictive behaviors Boyd and Bolen, ; Kaufman, ; Khantzian, ; Shaffer, ; Wurmser, , there have been no controlled or randomized studies exploring the effectiveness of this approach for treating pathological gamblers.

The psychoanalytic understanding of gambling problems rests on the foundation formulated by Freud , who thought that it was not for money that the gambler gambled, but for the excitement.

In fact, Freud speculated that some people gamble to lose. He thought this tendency was rooted in a need for self-punishment, to expiate guilt, and, for the male gambler, because of ambivalence toward the father.

Bergler , , expanded on this concept of masochism, emphasizing the pathological gambler's rebellion against the authority of the parents and specifically the reality principle they represent.

A number of early psychoanalysts, dating back to Simmel in , emphasized narcissistic fantasies and a sense of entitlement, pseudo-independence, and the need to deny feelings of smallness and helplessness. Other analysts Greenson, ; Galdston, described early parental deprivation, with the gambler then turning to Fate or to Lady Luck for the love, acceptance, and approval he or she had been denied. Several analysts Greenson, ; Comess, ; Niederland, saw compulsive gambling as an attempt to ward off an impending depression.

Boyd and Bolen viewed it as a manic defense against helplessness and depression secondary to loss. Still others have emphasized the eroticization of tension and fear Von Hattingberg, , the central role of omnipotence Simmel, ; Bergler, ; Greenson, ; Lindner, , and problems identifying with parents Weissman, More recently, analysts have been investigating deficiencies in self-regulation as they pertain to gambling and other addictive disorders Krystal and Raskin, ; Wurmser, ; Khantzian, ; Schore, ; Ulman and Paul, The psychoanalytic literature provides individual case histories of gamblers treated successfully Lindner, ; Harkavy, ; Reider, ; Comess, ; Harris, ; Laufer, The only analyst to present information about a series of treated gamblers was Bergler In his account of referrals, 80 appeared to be severe cases and, of those, 60 remained in treatment.

A critique of his treatment appears in Rosenthal According to Bergler, 45 were cured and 15 experienced symptom removal. By a cure, he meant not only that they stopped gambling, but also that they addressed core conflicts and gave up their pattern of self-destructiveness.

There is no information on whether "cured" patients were followed-up after treatment. There is a significant need, not only for randomized treatment outcome studies, but also for clinical vignettes and case histories that discuss what it is that clinicians who use these treatments actually do. It is necessary to deconstruct psychoanalytically and psychodynamically oriented interventions and techniques to see what specific components contribute to favorable treatment outcomes.

And of course there are differences between one therapist and another with regard to their capacities for empathy, timing, tact, role-modeling, and support—which can complicate research on treatment effectiveness in general and psychodynamic treatment in particular.

Behavioral treatment methods actively seek to modify pathological gambling behavior on the basis of principles of classical conditioning or operant theory. Several variations of behavioral treatment methods are used today, often in combination. Aversion treatment consists of applying an unpleasant stimulus, such as a small electric shock, while the patient reads phrases that describe gambling behavior.

During the procedure's final phrase, the patient reads about an alternative activity to gambling, such as returning home, but receives no shock McConaghy et al. Imaginal desensitization consists of two steps. Patients first engage in a procedure to relax. Then they are asked to imagine a series of scenes related to gambling that they find arousing.

They learn from this procedure to relax when they encounter opportunities to gamble, rather than to submit to their cravings. An extension of imaginal desensitization is in vivo exposure, in which relaxation techniques are applied while the patient is actually experiencing a gambling situation.

Behavioral counseling has been used in both individual and group treatment settings. Subjects receive reinforcement for desired gambling behaviors, such as gambling at a reduced level, betting less money, and so on.

Specific treatment goals can be more formalized in the form of contingency contracting, in which specific aspects of behavior are rewarded or punished.

Other behavioral techniques have been reported in the gambling treatment literature. Two of them, behavioral counseling, in which the gambler is given verbal reinforcement for desired outcome behaviors, and in vivo exposure, in which the gambler is exposed to gambling behaviors but is not allowed to gamble, are mentioned in the literature but have not been empirically tested.

Although behavioral treatment methods have been used and evaluated, such studies typically have had small sample sizes and no control groups. Case studies using various combinations of behavior treatments are common e. However, findings from these limited studies are not consistent enough to reach conclusions about treatment effectiveness.

Early studies of effectiveness on behavioral forms of treatment for pathological gamblers focused on aversion treatment. The studies involved single patients and provided minimal evidence of treatment success e.

Subsequent research on aversion treatment using electric shock for pathological gamblers had only slightly larger samples e. Larger outcome studies have been undertaken and provide more evidence for treatment effectiveness.

In a study of German pathological gamblers, Iver Hand described a behavioral treatment that begins with an extensive assessment of the client's motivation for treatment, symptoms, the consequences of his or her gambling, and social competence.

This assessment is followed by client training in emotional awareness, coping with negative emotions, and social and problem-solving skills. An uncontrolled evaluation of this approach revealed favorable treatment results Hand, The most rigorous work on behavior treatments with pathological gamblers has been published in a series of study reports by McConaghy, Blaszczynski, and colleagues McConaghy et al.

The earlier studies by this group compared imaginal desensitization with either aversion treatment or behavioral approaches. In a study McConaghy et al. Although the early studies by this group had relatively small sample sizes, otherwise strong methodologies revealed that treatment techniques were successful at one month and also at one year following treatment. Using a large sample and expanding the comparisons of behavioral approaches, McConaghy et al. A total of 63 clients were recontacted two to nine years later a 53 percent follow-up response rate.

The group that received imaginal desensitization benefited more than those receiving the other three behavioral approaches when abstinence and controlled gambling were combined as the outcome variable. The authors defined controlled gambling as gambling in the absence of the subjective sense of impaired control and adverse financial consequences, based on self-rating and confirmation from a spouse or significant other.

If just abstinence was considered, imaginal desensitization was equivalent to the other treatments' combined rate of abstinence 30 percent and 27 percent, respectively. In a further investigation of this sample, Blaszczynski and colleagues found that the abstainers and controlled gamblers showed a significant reduction in arousal levels, anxiety, and depression during the follow-up period compared with those who could not control their gambling.

Also of significance are the study's findings pertaining to the controlled gamblers. The pattern of gambling suggested that controlled gambling is not necessary a temporary response followed by a relapse to heavier gambling Blaszczynski et al. Because the sample sizes of the McConaghy and Blaszczynski studies are relatively small and because only about half of the original sample was contacted for follow-up although the long follow-up periods used were laudable , these results should be interpreted with caution.

Several clinicians and researchers have convincingly argued see Blaszczynski and Silove, ; Walker, ; Gaboury and Ladouceur, that pathological and problem gamblers share irrational core beliefs about gambling risks, an illusion of control, biased evaluations of gambling outcomes, and a belief that gambling is a solution to their financial problems Ladouceur et al. Cognitive treatment aims to counteract underlying irrational beliefs and attitudes about gambling that are believed to initiate and maintain the undesirable behavior Gaboury and Ladouceur, Treatment typically involves teaching clients strategies to correct their erroneous thinking.

Many, for example, do not understand the concepts of probability and randomness, believing that they can exert some control over whether they win or lose. The effectiveness of cognitive treatments has received limited attention by researchers and, as for other studies of treatment success, most have small sample sizes and no control groups e. However, a push for more comprehensive models to explain the origins of problem gambling Sharpe and Tarrier, has elicited investigations of the efficacy of combining cognitive and behavioral approaches.

Investigations combining these treatments include case studies Bannister, ; Sharpe and Tarrier, , small and uncontrolled studies Arribas and Martinez, , and controlled studies with larger samples Echeburura et al. Combined cognitive-behavioral approaches have been successful for both adolescent problem gamblers Ladouceur et al. The Sylvain study is noteworthy in that it expanded the cognitive-behavior treatment to include a waiting-list control group.

The study found that the cognitive-behavioral group improved vastly more than the control group. However, 11 of the original 40 individuals dropped out of the study and the follow-up data suffered from appreciable attrition. Another cognitive-behavioral controlled investigation with a waiting-list control group was done by Echeburura and his colleagues They compared the effectiveness of cognitive and behavioral techniques in a Spanish sample of 64 men and women who met DSM-III-R criteria for pathological gambling.

Participants were randomly assigned to one of four treatments: At six-month follow-up, the outcome data indicated that the most favorable outcome was associated with the first two groups; these groups significantly outperformed the control group and reported therapeutic success rates abstinence or 1 or 2 gambling episodes in which the amount gambled did not exceed the amount gambled in the week prior to treatment of 75 percent and 63 percent, respectively.

However, the combined individual and group treatment condition showed significantly poorer results compared with the other treatment groups. Pharmacotherapy is a relatively new approach to the treatment of pathological gambling. There are only a few studies and reports in the literature. In , just prior to the introduction of DSM-III, Moskowitz described the treatment of three compulsive gamblers with lithium carbonate.

Significant abstinence was achieved in all three cases, with improvement documented by long-term follow-up. However, two of the three were clearly manic depressive, and the third had a bipolar spectrum disorder. Twelve years later, Hollander et al. When the patient entered the study, she had been gambling consistently 2 to 3 times per week for the previous 6.

The study's design was double-blind, placebo controlled, 10 weeks to each phase. She was minimally improved on the placebo, then became abstinent on the medication and didn't gamble for the duration of the trial.

Except for a relapse at week 17, she remained abstinent on open maintenance for an additional seven months. Significant in her personality were compulsive features, including perfectionism and hoarding, and a history of social phobia, all of which respond well to such drugs as clomipramine.

Haller and Hinterhuber published a double-blind, controlled study 12 weeks each phase of one gambler treated with carbamazepine.

The patient's gambling continued on placebo, with no improvement, but he became abstinent on carbamazepine by week 2 and did not gamble for the duration of the trial. The results are particularly impressive given his prior history of treatment failures. Despite years of behavior therapy, psychoanalysis, and Gamblers Anonymous, his longest previous period of abstinence was three months.

Carbamazepine is an anticonvulsant that has been used as a mood stabilizer, particularly in patients with bipolar disorders. There is no mention in the report of emotional instability. We are told only that the patient played roulette to relieve stress and depression. The authors postulated that the efficacy of the medication may have been due to its limbic antikindling effect or its effect on the noradrenergic system. More recently, Hollander et al. Of 19 pathological gamblers, 9 dropped out during the placebo phase.

Of the 10 who remained, 7 responded with significant improvement, as measured by a marked decrease in cravings and the achievement of abstinence.

Two of the three nonresponders also had emotional instability. The authors recommended that, in future studies in which pathological gamblers are to be given SSRIs, subjects with bipolar disorder should be excluded. Overall, these results suggest that medication may be of some benefit, but more systematic randomized studies are clearly needed.

Long-term follow-up one to two years is also recommended. Neurobiological studies also discussed in Chapter 4 suggest the involvement of serotonin, norepinephrine, and dopamine in pathological gambling. The medications used in the above studies target one or more of these neurotransmitter systems. The norepinephrine system has been associated with arousal and novelty-seeking, dopamine with reward and motivation, and serotonin with impulsivity and compulsivity Hollander et al.

Another avenue of approach suggested by these studies is the use of medication to treat comorbid conditions. In practice, this is probably the most frequently cited reason for putting gamblers on medication. Comorbid disorders for which medications are commonly prescribed include depression, bipolar disorder, and attention-deficit hyperactivity disorder. Rosenthal discussed indications for using medication in the treatment of pathological gamblers.

Although some patients experience withdrawal symptoms, including prominent physical symptoms, Wray and Dickerson, ; Meyer, ; Rosenthal and Lesieur, , they do not need to be medicated. Also, some gamblers report frequent and intense cravings. Rosenthal reviewed several approaches to a pharmacotherapy of cravings. One of the most promising involves agents that block the excitement or pleasure of the addictive drug. The best known of these blocking agents is naltrexone, an opioid antagonist used in the treatment of alcoholism.

It has also been used in treating those addicted to cocaine and heroin. The effectiveness of the drug in treating pathological gamblers is currently being investigated under controlled conditions by Suck-Won Kim at the University of Minnesota Kim, However, medication is useful only if the patient takes it.

It is estimated that, 50 percent of all patients don't take the medications their doctors give them. For pathological gamblers, compliance is an issue because they are often ambivalent about giving up their gambling or altering long-standing patterns of coping, no matter how ineffective.

When they stop gambling, they often feel something has being taken away from them Taber, This category of treatments, which has a relatively long tradition, includes a broad range of techniques used by inpatient and outpatient programs.

The first gambling inpatient program, which started in at the Brecksville, Ohio, Veterans Administration hospital, was based on a preexisting program for alcoholics. Similarities with substance abuse programs continue and include the use of recovering gamblers as peer counselors, an emphasis on Gamblers Anonymous and other step meetings, and an educational component about addiction, including relapse prevention Kruedelbach, personal communication to the committee, This latter component focuses on how to avoid high-risk situations, being able to identify specific gambling triggers, and developing problem-solving skills for dealing with urges or cravings.

McCormick believes that pathological gamblers are deficient in the number of coping skills they have available and in their ability to flexibly choose the skill most appropriate to the stressful, or potentially relapse-triggering, situations they face. In a comparison with nongambling substance abusers, he found that substance abusers with a gambling problem utilize significantly more avoidance and impulsive coping styles.

There are other therapeutic components commonly employed by addiction-based programs. One is autobiography Adkins et al. Patients write a history of their gambling problem incorporated into a narrative of the significant events in their life, and then read it to the therapy group. Feedback focuses on the role gambling has played in the person's life, as well as how his or her behavior and perceptions contributed to the development of the problem.

The reading of one's autobiography is often a very emotional experience, and many view it both as a rite of passage in the treatment program and as a turning point in their recovery Adkins et al. Joint or family therapy is another therapeutic component of addiction-based treatment. This element is important when dealing with pathological gamblers, because families are often loath to forgive the gambler. Clinical wisdom suggests that it is not until after the individual has stopped gambling that the anger of family members begins to surface.

This may be so because gambling can be easy to hide and the financial and interpersonal damage can be swift; those close to the gambler remain distrustful and hold on to their anger to protect themselves. Franklin and Thomas note that the return of the gambler into the family is often met with resentment and resistance. The spouse and children often are depressed and have problems of their own that are in need of therapy.

Alternatively, because the gambling offers intermittent rewards Heineman, , family members may be angry that the patient has stopped gambling. Another key aspect of the addiction-based approach is after-care planning. This may include identification of a support system, continuing involvement in Gamblers Anonymous, relapse prevention strategies, a budget and plan for financial restitution, a plan for addressing legal issues, ongoing individual or group therapy, family therapy, and medication.

The literature contains several outcome studies of addiction-based treatments. For studies that reported six-month and one-year outcome data, abstinence rates for those contacted were roughly 50 percent Russo et al.

All studies found that those who abstained from gambling reported greater improvement in interpersonal and intrapersonal functioning than those who returned to some level of gambling; some studies found decreased substance use as well at follow-up Lesieur and Bloom, ; Taber et al. Whereas most of the studies involved small samples, a Minnesota study of six state-funded multimodal programs described the outcomes of several hundred clients Stinchfield and Winters, This investigation found abstinence rates of 43 percent at 6 months and 42 percent at 12 months , and rates of gambling at less than once a month for 29 percent at 6 months and 24 percent at 12 months of the contacted subjects.

Interestingly, gamblers who started treatment but did not complete it, or who received only an intake evaluation, also reported improvement in virtually all variables related to gambling and psychosocial functioning, even though the extent of change was less dramatic than for those who completed treatment Rhodes et al. Some of the multimodal approaches have been evaluated for long-term effectiveness. Hudac and colleagues assessed 26 male gamblers four years after they were treated.

Of the 26, 8 were abstinent and the others showed less gambling compared with the period prior to treatment. However, the gamblers contacted at the four-year follow-up represented only about one-third of the original treatment sample of 99 pathological gamblers. Schwartz and Linder found that, after two years following inpatient treatment with a client-centered approach, 13 of 25 assessed clients remained abstinent 33 original subjects were not contacted.

Gamblers Anonymous GA is believed to be the most commonly used of all approaches to deal with pathological gambling, and it is routinely included in multimodal strategies Lesieur, The data suggest that relapse rates tend to be quite high for participants.

Stewart and Brown found that total abstinence was reported by only 8 percent of members surveyed one year after their first attendance and by 7 percent at two years. When those who continued to gamble were compared with those who dropped out of Gamblers Anonymous, Brown found that dropouts were more likely to perceive that they had less of a gambling problem, found themselves in personality clashes with the members who did attend, and reported that Gamblers Anonymous was too rigid in its abstinence-only policy.

Other researchers have examined the role of Gamblers Anonymous in maintaining abstinence. Taber and colleagues found that 74 percent of abstinent gamblers in their sample attended at least three meetings in the prior month, compared with only 42 percent of those who continued to gamble. The therapeutic effectiveness of Gamblers Anonymous has also been explored with respect to participation by the gambler's spouse. Johnson and Nora found that there was a trend for higher abstinence rates for gamblers whose spouses were present at meetings compared with gamblers whose spouses did not attend.

Although not statistically significant, the results revealed that 20 out of 44 gamblers whose spouses were present at meetings stopped gambling for at least four years, compared with 13 out of 46 gamblers whose spouses did not participate. In sum, Gamblers Anonymous may be increasing in popularity Lopez Viets and Miller, , but whether participating in meetings makes a significant and lasting impact is still not known Brown, ; Rosecrance, Related to the Gamblers Anonymous approach is the use of self-help and psychoeducational literature for pathological gamblers.

The manual focused on the definition and underlying causes of problem gambling and how the individual could monitor the problem behaviors and replace them with incompatible but healthier behaviors. Problem gambling is associated with financial difficulties, and comorbid alcohol and substance use problems, and psychological disorders that require interventions Petry, ; Hodgins et al.

Self-help programs are generally intended for those with less severe gambling or co-morbid problems Toneatto et al. Consequently, it is important that online interventions incorporate assessment procedures that allow individuals to determine which treatment components are appropriate to their needs Raylu et al. Not all gamblers need to seek formal help to overcome or at least moderate their gambling difficulties Hodgins et al. However, others have difficulty making the change without external help and support.

The processes by which pathological gamblers manage their own recovery, and social gamblers self-manage, have received minimal research attention. One very small process-oriented study of six recovered problem gamblers Hodgins et al. The Self-Regulation of Gambling. Self-change research has contributed to a reformulation of basic questions in mainstream treatment research and a reframing of policies.

The concept has also been applied to other problem areas such as gambling [3, 4], smoking also cannabis [5,6], mental illness [7], eating disorders [8][9][10] and criminality [11]. At the present time, a central research question in this area is 'why do people change? Discover more publications, questions and projects in Gambling. A qualitative examination of factors underlying transitions in problem gambling severity: Eating disorders and addiction.

Natural history of gambling problems: Results from a general population survey. And research by NIDA shows that about 1 in 9 has a substance use disorder. This article is just fuel for people to continue to try to stop and many times the results are horrific for them and their families. I sought help several times, stayed abstinence for a time, sometimes longer sometimes not.

I used substances to hide from inner turmoil that was eating me alive. I at least met one counselor that let me write a brief synopsis of my story to share in group. I also learned, unfortunately, that while I was in the number zone I was a target for abusers and partook in activities that made me want to just remain numb. After 10 years of sobriety, I sought treatment for depression because I still remain my own worst critic and I felt I should be over my pain.

When I went to a counselor I was honest in my pre-evaluation survey and admitted to my extensive history of substance abuse.

I had to pull out all the strength I had and overcome my depression alone because there was no help. I have been told by many that I am a smart, competent, strong individual but I still do not see it, I just do what I have to to make my life functional and give love to the ones who love me instead of disappointment there are so many studies about what trauma and abuse do to the brain but it seems that no one is willing to put the work into actually helping.

Where are the trained ears that provide guidance? I have yet to find a single pair. I am a survivor and a warrior. I am currently working on my masters degree in professional counseling so I can be the ears for someone who needs to dump their destructive garbage. It is my goal someday to open up my own center of intensive treatment that teaches people to believe in themselves and take back the power to face their problems, suffer through their pain and move on.

If you let the trauma live on inside you and surrender to its destructiveness, you essentially just throw a blanket on a fire…it may go out, but it may set the blanket ablaze and consume you.

The real goal of treatment should be to seek out why you use in the first place and then fix those issues. I believe that most people would discontinue their self destructive behaviors if the root of those behaviors were dealt with. I can understand a lot of the angles on how people feel about a 12 step based recovery. I have tried therapy, cbt, moderate using, etc.

However for myself it seems to be the only thing that works. I do still feel like treatment programs are money grubbing bastards, I think it is a straight up business and the sick things they said to my family to keep me in when i had received all the information they had to offer were just disturbing.

But at the end of the day for myself, I needed AA. Anyways, nothing else worked and believe me I tried every other way because I definitely was not a fan of AA lol now im doing well in there, have a good group of friends who are not insane AA thumpers, and just lead a more thoughtful principled life, which I could not do when I tried to moderate my usage.

A lot of healing has occurred and I have grown up a lot through the program and help from family, just basically growing up, and sometimes wonder if I could handle using recreationally again, but the risk of ending up back where I was, for myself, outweighs the benefits of having a beer or smoking a joint with some friends. It just is not that big of a deal to me to have a glass of wine with dinner, or whatever else anymore.

Why risk all I have gained for something so insignificant, the desire to do that just is not there anymore I guess. Dude your killing people with these posts. Some suffering addict might read this and think they can stop on their on. You say addiction is not a diease, but the United States medical society says it is.

Jails, institutions and death. Maybe cancer and AIDS are too or maybe you should ask the people that are dying of it what they think it is that makes them sick. I decided I had power. I decided my mind would be the boss of my body from now on.

Nothing would cross my mouth or body without my MIND deciding over it. I made my mind stop taking orders from my body. AA sets most people up for failure, as it emphasizes the amount of days so much that the second they have a couple beers, they feel that theyve failed, and will tell themselves that they might as well go all out. AA is full of drug addicts who look down on those who dont need the program, and treat others like kids if they dont agree with everything in the program.

And unless those issues are dealt with the addict continues to be vulnerable. I agree with you Until I found a way to deal with and accept the lack of a loving and caring childhood, I was unable to deal with my use of outside sources to placate this loss. Many well meaning people hampered my progress.

Until I began to use what I could from the well meaning people I was unable to progress. I used their labels without internalizing them. I called my self an alcoholic, but never to my self. I accepted I would lie to them about this label and told myself the truth about it. I got a sponsor. A sponsor is a label lie A.

The sponsor does not sponsor. I moved on keeping the sponsor and few support people willing to help ME. I then began the process in ACA using a similar method to get what I wanted. I now have 4 members of my support group from three different programs.

I also use a few people from a church also. I am happier, healthier and freer than I ever have been. Some people in AA use the word disease erroneously. Our literature refers to it as an illness. Alcoholism is not an addiction. Good morning, my name is Lisa Hays.

I was a Crack Cocaine addict from to , the last time I used, I became very sick. I did it through the support of family, friends, Facebook. I have almost 1 year of sobriety as of , thank God. I have turned my life over to God as well. I became drug free for me. My way may not work for some, but for me it works.

I surrounded myself with positive people, NO N. Lisa, there are a lot of pathways to recovery. Some just stop as you did which is awesome.

Some go to church. Some find Step Programs. When I was in counseling school, I came across William Glasser, who developed a therapy in the s. He reworked a Freudian idea. Everyone has two needs: To love and to be loved; to have a meaningful life. Some organizations can provide that in abundance. Addiction is usually defined someone who can not by themselves quit using a substance including alcohol. They are not what the medical community, and certainly not what the recovery community would consider addicts.

Withdrawal is a short term physical problem people who use a substance experience. It may be very uncomfortable, dangerous even, but it is physical in nature and lasts days to a week or two.

Then it is over, forever. Addiction is a psychological problem that can plague a person for years, decades, sometimes for life. A person who is clean and sober for decades might experience a craving at emotional times, the loss of a loved one, at an emotionally heightened event near death, medical diagnosis, winning the lottery, etc.

These are two separate and distinctly different problems which require different kids of treatment. They fit the diagnostic criteria for addiction as defined by the medical community. There is no evidence that people called addicts cannot stop on their own. There is no evidence that stopping substance use is any different than stopping any other habitual behavior.

The idea of addiction is made up whole cloth, and no scientific evidence has ever supported it. Just about the only thing that is proven is in the issue of withdrawal syndrome. It is a result of pharmacological forces, and it causes real physical symptoms, and it can be successfully treated with medication. SomebodY offering aN opinion like This doesnt actually kill people ben. All it does is bring a little discussion Into the debate. Anyone who prefers aa or finds it works for them can give it a whirl, but i would suggest that sometimes if people are attempting to fit themselves into the aa box when it isnt right for them, that for these people aa is more likely to lead them Back into life threatening drinking than allowing them to seek and use other recovery principles that they find more helpful.

This is my opinion, after ten years of relapse in aa, now finding growth! Change, and sobriety outSide aa. The difference between whAt i say and what some aa members say however, is that i only tell you what works for me, not what you should do. For me that attempt by others to scare me or use fear Based beliefs to Force me to comply with some of the aa dogma was unhelpful.

I am trying to help a family member choose detox and residential rehabilitation at the St Jude retreat center. I asked him to review this blog as a way to think about it as a possible choice. How does a blog article and a discussion thread like this one lead someone with years of debilitating use of alcohol choose intensive support?

Defining Treatment and Challenges to Treatment