The term “harm reduction” is used by different people to mean different things. What follows is a listing of some of the ways in which the concept of harm reduction for high risk behaviors can be implemented:
1. Attempts to reduce legal access to high risk behaviors, e.g. increased tax on alcohol, limits to the availability of certain types of gambling machines
2. Attempts to prevent people from becoming engaged in high risk behaviors through the use of educational programs aimed primarily at youth
3. Interventions aimed at a specifically risky aspect of a certain behavior, e.g. needle exchange for HIV prevention, condom distribution for sex workers for HIV prevention, free rides for intoxicated drivers (Operation Red Nose in Canada) for prevention of drunk driving fatalities, wet housing (Seaton House of Toronto) for getting homeless drinkers off the street, safe injection facilities (Insite, Vancouver Canada) for overdose prevention, “drunk vans” in Finland to prevent death from exposure of the intoxicated
As of the time of this writing there are no support groups in the world for controlled gambling nor are there any formal programs which offer controlled gambling training.
There are, however, several papers in the literature which discuss outcomes of abstinence oriented treatment which resulted in controlled gambling as well as some case studies of individuals counseled in controlled gambling strategies.
Weinstock, et al (2007) conducted a 12 month follow-up assessment of pathological gamblers who had received abstinence based treatment (three treatment variants were used–but these are not relevant to this paper by Weinstock et al). Of the 231 individuals entering gambling treatment, 178 were still available for 12 month follow up. SOGS (South Oaks Gambling Screen) testing revealed the following data:
· Abstinent n = 32
· Problem free (SOGS = 0) n = 15
· Symptomatic (SOGS = 1) n = 13
· Disordered (SOGS = 3 or 4) n = 23
· Probable pathological (SOGS >= 5) n = 95
(Note that two of the thirty two abstinent gamblers scored as Symptomatic on SOGS.)
The 45 people scoring 0 on the SOGS (30 abstinent and 15 gambling problem free) showed the following behaviors:
· Gambling days per month: mean = 1.7, SD = 5.6
· Gambling hours per month: mean = 3.5, SD = 10.6
· Percent of income spent on gambling: mean = 3.9%, SD = 10.8%
Weinstock, et al (2007) conclude that gambling no more than 1.5 hours per week and spending no more than 1.9% of monthly income on gambling are behavioral indicators of a return to problem free gambling among pathological gamblers.
Ladouceur (2005) gave cognitive behavioral therapy with a goal of controlled gambling to six pathological gamblers with the following results: three of the gamblers decided to change their treatment goal to one of abstinence from gambling and of these three choosing abstinence one dropped out of the study and was not available for follow up. The remaining three subjects all achieved a successful controlled gambling and were found at three month follow up to no longer meet the DSM – IV criteria for pathological gambling.
Blaszczynski, et al (1991) conducted a follow up study of 63 individuals who had been treated for pathological gambling with a week-long behavioral treatment between 2 and 9 years previously (120 gamblers had undergone the treatment and these 63 were still available for follow up). The results were as follows:
Abstinent gamblers: n = 18
Controlled gamblers: n = 25
Uncontrolled gamblers: n = 20
Rating was done based both on self-report and independent corroboration by one other person.
Dickerson and Weeks (1979) report the first case history of successful treatment of pathological gambling with a controlled gambling outcome. The gambler was allowed a single 50 pence wager once per week on Saturdays. Cash flow was strictly controlled by the gambler’s wife.
Rankin (1982) also reports a successful case history of controlled gambling as an outcome for the treatment of pathological gambling. In this case the limit was 5 pounds per week, there was to be no chasing of losses and no carry-over of winnings to be gambled the following week, and once again cash flow was otherwise managed by the wife.
The data from these studies suggests that controlled gambling is a viable outcome for at least some pathological gamblers. Both further research and the creation of controlled gambling programs for pathological gamblers are indicated.
Blaszczynski, A. (1988). Clinical studies in pathological gambling: Is controlled gambling an acceptable treatment outcome? Dissertation Abstracts International, 51, 2609–2610.
Blaszczynski, A., McConaghy, N., & Frankova, A. (1991). Control versus abstinence in the treatment of pathological gambling: A two to nine year follow-up. British Journal of Addiction, 86, 299–306.
Dickerson, M. G., & Weeks, D. (1979). Controlled Gambling as a Therapeutic Technique for Compulsive Gamblers. Journal of Behavioral Therapy and Experimental Psychiatry, 10, 139–141.
Gaboury, A., & Ladouceur, R. (1989). Erroneous perceptions and gambling. Journal of Social Behavior and Personality, 4, 411–420.
Heather, N., & Robertson, I. (1981). Controlled drinking. New York: Methuen.
Ladouceur, R. (2004). Perceptions among pathological and non-pathological gamblers. Addicitive Behaviors, 29, 555–565.
Ladouceur, R. (2005). Controlled gambling for pathological gamblers. Journal of Gambling Studies, 21, 51–59.
Ladouceur, R., Gosselin, P., Laberge, M., & Blaszczynski, A. (2001). Dropouts in clinical research: Do results reported in the field of addiction reflect clinical reality? The Behavior Therapist, 24, 44–46.
Ladouceur, R., Sylvain, C., Letarte, H., Giroux, I., & Jacques, C. (1998). Cognitive treatment of pathological gamblers. Behavior Research and Therapy, 36, 1111–1120.
Ladouceur, R., & Walker, M. (1996). A cognitive perspective on gambling. In P. M. Salkovskis, (Ed.), Trends in cognitive and behavioral therapies, (pp. 89–120). New York: John Wiley and Sons.
Petry, N. M., & Armentano, C. (1999). Prevalence, assessment, and treatment of pathological gambling: A review. Psychiatric Services, 50, 1021–1027.
Rankin, H. (1982). Control rather than abstinence as a goal in the treatment of excessive gambling. Addictive Behaviors, 8, 425–428.
Rosecrance, J. (1988). Active gamblers as peer counselors. International-Journal-of-the-Addictions, 23, 751–766.
Scodel, A. (1964). Inspirational group therapy: A study of Gamblers Anonymous. American Journal of Psychotherapy, 18, 1115–1125.
Sobell, L. C., & Sobell, M. B. (1992). Timeline followback user’s guide: A calendar method for assessing alcohol and drug use. Toronto, Ontario, Canada: Addiction Research Foundation.
Sylvain, C., Ladouceur, R., Boisvert, J.-M. (1997). Cognitive and behavioral treatment of pathological gambling: A controlled study. Journal of Consulting and Clinical Psychology, 65, 727–732.
Toneatto, T., & Ladouceur, R. (2003). The treatment of pathological gambling: A critical review of the literature. Journal of Addictive Behaviors, 17, 284–292.
Walker, M. (1992). The psychology of gambling. Oxford: Pergamon Press.
Weinstock J, Ledgerwood DM, Petry NM (2007). Association between posttreatment gambling behavior and harm in pathological gamblers. Psychology of Addictive Behaviors, 21(2):185-93.
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