Dr Daniel A Kaufmann PhD LPC ICGCII amp BACC Presentation Year 2020 Session 7 Topics Levels of Care American Society of Addiction Medicine Levels of Care in Gambling Treatment From the work of L Rugle PhD ID: 1044459
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1. Module 7: Application of Treatment ConceptsDr. Daniel A KaufmannPh.D., LPC, ICGC-II & BACCPresentation Year 2020
2. Session 7 Topics
3. Levels of Care
4. American Society of Addiction Medicine
5. Levels of Care in Gambling TreatmentFrom the work of L. Rugle PhD.
6. Levels of Care in Gambling TreatmentFrom the work of L. Rugle PhD.
7. Video Lecture 17: Patient Placement Criteria
8. Therapeutic DecisionsLevels of care are intensities along a treatment continuumCounselors need to consider the least restrictive and most appropriate level of care for each client. Therapeutic options along the continuum are summarized on the next slides…American Society of Addiction Medicine
9. Levels and InterventionsLevelsOutpatientIntensive OutpatientResidentialInpatientModalitiesIndividual Family/couplesGroup psychotherapyGender specific groupsPeer counselingInterventionsBrief Feedback & EducationPsychoeducationCognitive Behavioral Therapies12 Step FacilitationAddressing Financial IssuesMotivational EnhancementFamily Education & CounselingWorkbooks/JournalingPsychodynamic Therapy
10. Key Elements to Treatment DecisionsASSESS FOR PSYCHIATRIC COMORBIDITY AS WELL AS CLIENT STRENGTHS AND LIMITATIONS
11. Key Elements to Treatment DecisionsEDUCATE THE GAMBLER ABOUT THE DISORDER
12. Key Elements to Treatment DecisionsINCLUDE FINANCIAL RESTRUCTURING AND DEBT REPAYMENT
13. CONSIDER MOST HELPFUL APPROACHES ABSTINENCE VS HARM REDUCTION(Subramaniam et al. 2017)
14. Key Elements to Treatment DecisionsIF APPROPRIATE…EMPHASIZE SOCIALIZATION TO GAMBLERS ANONYMOUS OR OTHER SUPPORT GROUPS
15. Key Elements to Treatment DecisionsELICIT GAMBLER’S MOTIVATION TO CHANGEANTICIPATE BARRIERS TO RECOVERY
16. Key Elements to Treatment DecisionsANTICIPATE AND RESPOND APPROPRIATELY TO GAMBLER’S IRRATIONAL THINKING AND COGNITIVE DISTORTIONS
17. Key Elements to Treatment DecisionsEXAMINE AFFECT DISORDERS AND CONSIDER USE OF APPROPRIATE MEDICATION
18. Key Elements to Treatment DecisionsINVOLVE THE FAMILY/SIGNIFICANT OTHER IN ASSESSMENT, TREATMENT, AND THE RECOVERY PROCESS WHEN POSSIBLE
19. Key Elements to Treatment DecisionsUNDERSTANDING THE REWARD THE GAMBLER RECEIVES FROM GAMBLING WILL HELP IN IDENTIFYING AND RECOMMENDING ALTERNATIVE MEANS OF GOAL ATTAINMENTHelén and Toivio (2015)
20. ENCOURAGE THE DEVELOPMENT OF ALTERNATIVE LEISURE ACTIVITIES
21. Key Elements to Treatment DecisionsDevelop Coping Skills and Self-Regulation in Anticipation of Relapse
22. Video Lecture 18: Mood Cycle
23. IDesigning a Treatment Program: Admission CriteriaWHAT ARE YOUR ADMISSION CRITERIA?Will you admit a person with a Primary Gambling Disorder?Will you admit family members/concerned others whether the person with the gambling disorder is in treatment?Will you admit those with co-occurring disorders? If so which ones?
24. IIDesigning a Treatment Program: Screening ToolsWHICH GAMBLING SCREENS WILL YOU USE?DSM-5 CriteriaSOGSNODSSOGS-RA NODS PERCBrief Biosocial Gambling Screen
25. IIIDesigning a Treatment Program: Client PlacementWHAT IS YOUR PROTOCOL FOR DETERMINING APPROPRIATE LEVELS OF CARE?Review the Gambling Disorder explanation of the ASAM criteria from earlier in this session
26. IVDesigning a Treatment Program: Client MotivationHOW WILL YOU ENHANCE YOUR CLIENT’S MOTIVATION FOR RECOVERY?
27. VDesigning a Treatment Program: Treatment GapsHOW WILL YOU MANAGE ANY GAPS BETWEEN A CLIENT'S FIRST CONTACT FOR HELP AND THE INITIATION OF TREATMENT?
28. VIDesigning a Treatment Program: Payment for ServicesHOW WILL YOU HANDLE PAYMENT FOR TREATMENT SERVICES?
29. VIIDesigning a Treatment Program: Treatment ActivitiesWHAT ARE THE COMPONENTS OF YOUR TREATMENT ACTIVITIES?
30. VIIIDesigning a Treatment Program: Assessing Client ProgressWHAT ARE YOUR CRITERIA FOR ASSESSING CLIENT PROGRESS?
31. IXDesigning a Treatment Program: Stages of TreatmentWHAT ARE YOUR PROGRAM’S CRITERIA FOR STAGES OF TREATMENT?
32. XDesigning a Treatment Program: Coordinated ServicesWhat are your plans for coordinated services and referrals:Overall medical services?Pharmacology?Financial services? Social services?
33. XIDesigning a Treatment Program: Family ProgramWHAT ARE YOUR PLANS FOR A FAMILY PROGRAM?
34. XIIDesigning a Treatment Program: Co-Occurring DisordersHOW WILL YOU INCORPORATE TREATMENT FOR CO-OCCURRING AND COMORBID DISORDERS?
35. XIIIDesigning a Treatment Program: Client ConfidentialityWHAT IS YOUR POLICY FOR PROTECTING CLIENT CONFIDENTIALITY?
36. XIVDesigning a Treatment Program: Media DecisionsWILL CLIENTS BE ALLOWED TO PARTICIPATE IN INTERVIEWS TO SHARE THEIR EXPERIENCES IN ORDER TO HELP OTHERS?
37. XVDesigning a Treatment Program: OutreachOUTREACH STRATEGIES?HOW WILL YOU BUILD AWARENESS IN THE COMMUNITY ABOUT YOUR PROGRAM AND SERVICES?
38. XVIDesigning a Treatment Program: Relapse PreventionWHAT ARE THE COMPONENTS OF YOUR RELAPSE PREVENTION PROGRAM?
39. XVIIDesigning a Treatment Program: Program EvaluationHOW WILL YOU EVALUATE THE EFFECTIVENESS OF YOUR SERVICES?WHAT OUTCOMES MEASURES ARE IMPORTANT TO MONITOR AND HOW WILL YOU MONITOR THEM?WILL YOU HAVE A CLIENT SATISFACTION SURVEY?
40. XVIIIDesigning a Treatment Program: ResourcesDO YOU HAVE RESOURCES ON HAND?WEBSITE ADDRESSPAMPHLETSBOOKSVIDEOS
41. Beliefs AboutGambling
42. Understanding the Gambler’s BeliefsGambler’s maintain strong beliefs about their choices in their betting lifestyle Requires close examination in order to increase awareness of how the process of gambling is causing real ramifications in the different areas of their life. Often lacks insightPreserved through a series of cognitive distortions that allow gambling to be separate from the negative circumstances Gambling is only noticed as a positive contributor to their experience regardless of mounting problems.
43. Julian Taber: 51 Beliefs About Gambling
44. Julian Taber: 51 Beliefs About Gambling
45. Julian Taber: 51 Beliefs About Gambling
46. Julian Taber: 51 Beliefs About Gambling
47. Julian Taber: 51 Beliefs About Gambling
48. The Gambler Mood Cycle
49. CognitiveAffectivePhysicalANTICIPATION:Money RaisingGambling System DevelopmentPreoccupation With PlanningDeveloping Hidden AgendasAFFECTIVE ANTICIPATION:ExcitementImpatienceIRRITABILITY ACTION:ExpansivenessGrandiosityIntoxicationDepersonalizationDissociationAFTERMATH:Narcissistic Wound Self-hatred Anger Shame/GuiltANTICIPATORY MOOD: May Involve…Increased AlertnessHyperactivityIncreased Muscle ToneMobilization Of Resources
50. Education Through InterventionINTERVENTIONS FOR USE WITH THE GAMBLERBeliefs About Gambling (Taber)Cost/Benefit AnalysisElements of Gambler’s Mood CycleDefense Mechanisms
51. Workplace Gambling Issues
52. Henry Lesieur: Signs of Gambling in the Workplace
53. Henry Lesieur: Case Study Results
54. Proactive Strategy EAPs are implementing proactive strategies to improve identification of problem gambling
55. Workplace Assistance Strategies
56. Relapse Prevention
57. Overview of Relapse Prevention
58. Gambling Relapse Symptoms(From the Michigan Council on Problem and Compulsive Gambling)
59. Gambling Relapse Symptoms(From the Michigan Council on Problem and Compulsive Gambling)
60. Gambling Relapse Symptoms(From the Michigan Council on Problem and Compulsive Gambling)
61. Gambling Relapse Symptoms(From the Michigan Council on Problem and Compulsive Gambling)
62. Gambling Relapse Symptoms(From the Michigan Council on Problem and Compulsive Gambling)
63. What Symptoms Of Relapse Have You Experienced In The Past?What Symptoms Of Relapse Do You Think You’d Experience If You Did Relapse?What Actions Can You Take To Intervene In Your Relapse Process?How Can Your Recovery Plan And Meetings Assist You In Preventing The Relapse Process From Beginning?How Can GA Involvement Reduce The Probability Of Relapse?If Relapse Does Occur, What Action Do You Need To Take?How Do You Feel About People Who Relapse?Florida Council on Compulsive Gambling
64. Listing the Relapse TriggersEventsAdvertisingFinancial pressureAvailabilityFriends gamblingLarge jackpotHearing of a winNear missGambling and winningHaving moneyToo much debtAccused of gamblingThoughtsPicturing winning“My only chance”“This time I’ll do it right.”“If I win, I’ll be happy.”Magical thinking“It’s my destiny.”“I’ll only bet a little.”“I deserve some fun.”“There’s no other way I can pay what I owe.”“I’ll put the money back when I win.”FeelingsAngerIrritationBoredomDesperationHopelessnessHappinessEnvyDisappointmentFatigueDepressionIntoxicationLonelinessSpitefulnessFeeling “on top of the world”
65. EventOutcomeThinkingCatch Gambling Thoughts As They OccurPlanning Ahead (E.G. Activities, Meetings, Counseling, Etc.)Recognize Alcohol Or Drug Use ThoughtsConsider Consequences Of GamblingFeelingRecognize Feelings When They OccurMaintain And Express Feelings In A JournalAcknowledge When Feeling OkayTalk About FeelingsActionJoin A Gym Or Practice A Physical/Exercise RegimenEstablish And Adhere To A BudgetDevelop Relationships With Non-gambling FriendsIdentify And Engage In Relaxing Activities or Hobbies
66. Session 7 Topics