Treating Gambling Problems and Best Possible Odds: Contemporary Treatment Strategies for Gambling Disorders

Treating Gambling Problems

by William G. McCown

and William A. Howatt

2007 – Wiley Series on Treating Addictions

Best Possible Odds: Contemporary Treatment Strategies for Gambling Disorders

by William G. McCown

and Linda L. Chamberlain

2000 – John Wiley & Sons

“The life of a compulsive gambler is a life out of control––a precipitous downward spiral into despair, abuse, and criminality. Like a tornado ripping through a Midwestern town, a pathological gambler on the “chase” can leave a trail of broken families, ruined businesses, and incalculable emotional suffering in his or her wake.” — Best Possible Odds

In the steadily growing industry of recreational gambling, four to six percent of all gamblers will become compulsive, leading to a devastating impact on their lives.

Dr. William G. McCown, clinical psychologist and professor of psychology at the University of Louisiana Monroe, the coauthor/editor of eight books and international consultant, brings his scholarly and creative talents to this relatively new and still evolving area of gambling addictions.

In these two texts, Bill and his coauthors wrestle with and illuminate the complex issues in this field, including definitions, differential diagnosis, theoretical underpinnings, and practical clinical tools needed for helping this group of individuals.

They point out that 27 percent of all people will deal with a substance or other addiction problem at some time in their lives. However, the authors note that only ten percent of therapists are trained to treat individuals with addictions. This leaves 90 percent with often limited resources.

In Treating Gambling Problems, Dr. Bill McCown and coauthor Dr. William Howatt lay out a comprehensive picture of the thinking process, skills, ideas, and tools that are essential for assisting a client with these issues.

“…It started as a theory book.” Bill explained to the Times. “However, the series editor asked me to rewrite it, given the increasing need for front line clinicians without specific training to treat people with gambling problems.”

This hands-on and readily usable text accomplishes that goal easily, with it’s engaging style and extremely thorough coverage of the topic. More appealing in presentation than most textbooks, Gambling Problems is loaded with practical ideas that are fresh, informative and immensely useful. All this is backed by the authoritative voice of experience.

This voice is likely due to Bill’s background in the area. His 2000 theoretical text, Best Possible Odds, coauthored with colleague Dr. Linda Chamberlain, has been credited as one of the first comprehensive books on the topic, fueling research and clinical interest in empirically based treatment of gambling problems.

“I certainly would not go that far…’ Bill noted, “but the literature has increased by 1100 percent since that time and people are paying more attention to gambling problems.”

Bill has been a member of the Louisiana Association of Compulsive Gambling since 2002 and has made fifteen professional presentations on the topic. He has supervised twelve theses on gambling disorders by his graduate students, and he has authored an internet-based program for helping gamblers.

Gambling Problems leaves no stone unturned in its credible, understandable, and detailed presentation. In a handy 280 pages, the author’s walk the reader through conceptual, theoretical and scientific issues.

Perhaps the most notable aspect of this user-friendly text is the surprising (for a clinical book) wealth of hands-on, practical suggestions and conceptual tools for the practitioner. The richness, creativity and completeness of this information are impressive.

The authors engage the reader with charming “Truth or Fiction” quizzes, short knowledge tests, and crisp “Points to Remember.” The text is full of checklists, assessment forms, and lists of concepts the reader can immediately put to use. A family questionnaire from Louisiana Association on Compulsive Gambling and one from Gamblers Anonymous, a list of signs of problems noticed by employers, a list of tests and their usefulness in assessment of gambling problems, and the Addictive Disorders Screen–7, are included, just to name a few.

“Recommended Readings” at the end of chapters guide the reader to in depth resources and areas of controversy or scientific debate. And along with all sorts of interesting boxes, there is a call-out titled “Imagine That!” with tidbits of fascinating and fun information.

In Chapter 1, “Conceptual Foundations of Gambling Disorders,” authors include a discussion of definitions, differential diagnosis, spontaneous remission, risk factors and prognosis. Chapter 2 continues with “Recognizing Gambling Disorders: Signs and Symptoms.”

“Utilizing Optimal Professional Resources,” Chapter 3, includes information on a professional referral network and specific resources, matching clients to the best resources, motivation, and risk management.

In Chapter 4 authors outline “Developing an Effective Treatment Plan,” giving a step-by-step approach with therapeutic issues and problems to watch for in both the clinical and legal settings.

In “Recovery Theories, Programs, and Tools,” Chapter 5 provides a broad review from the larger perspective of human change.

“Continuing Care: When and How Should Clients Be Discharged,” Chapter 6, includes statistics on positive and negative outcomes and criteria for discharge.

“Posttreatment Recovery Management: Models and Protocols of Relapse Prevention,” Chapter 7, includes triggers for relapse and emerging problems at this stage of treatment, including physical, family, and mental disorders.

“New Beginnings: Moving Beyond Addiction” concludes the work. Authors cover topics of personality change, humanistic therapies, positive emotions and happiness, moral development, and going beyond selfhood,” in another broad based review with strong philosophical underpinnings.

Best Possible Odds is the precursor to Treating Gambling Problems and provided one of the first and most comprehensive overviews of the emerging science and therapeutic issues available in 2000.

In Odds, Bill McCown and coauthor Linda Chamberlain work to bring a cogent review of why compulsive gambling is on the rise and why it is an addiction disorder. Odds fills a gap created by the fact that the therapeutic community is only just beginning to fully acknowledge compulsive gambling problems.

Odds is scholarly and theoretical, with authors reviewing and analyzing competing models including physiology, social-economic, and psychodynamics, in an expert, eclectic approach.

The “central thesis of this book is that recovery from addiction is a nonlinear process,” state the authors and back it up in a review of Chaos Theory as a key for understanding change.

Odds begins with “An Introduction to Gambling and Gambling Disorders,” and then fits this into a larger context in Chapter 2, “Paradigms of Problem Gambling Behavior.” In Chapter 3, “The Phenomenology of Gambling,” authors explore the “gateway concept” and review Custers’ subtypes (professional, antisocial, casual social, serious social, neurotic, and compulsive).

“Etiologies and Maintenance of Gambling Disorders: A Brief Review,” outlines evidence for reinforcement, motivational, and biological influences, among others.

In the next three chapters the authors provide what is known about current treatment methods, “Treatment for Pathological Gambling: Inpatient Programs and Gamblers Anonymous,” “A Multiphasic Model of Outpatient Treatment,” and “Working Strategies for Treatment Success: The Pragmatics of Therapy for Abusive and Addictive Gamblers.” Drawing on what has worked for them, they explain their “multifaceted treatment integration.”

“Assessment of Gambling and Gambling-Related Psychological Disturbances,” Chapter 8, outlines an assessment approach that is broad and comprehensive, a review of the critical-thinking required in assessment efforts necessary for all complex issues.

“Chaos Theory, Gambling, and Addictions: Speculations on New Methods of Nonlinear Treatment,” is a fascinating chapter that requires the reader to put on the thinking cap and is likely based on Bill’s previous work on Chaos Theory and family therapy (Strange Attractions: Chaos, Complexity, and the Art of Family Therapy, 1998 Wiley).

“Family Systems Therapy: Treating the Patient and the System,” Chapter 10, continues this integrative theme and Chapter 11, “Epilogue: Consideration for Future Research and Interventions,” closes the work.

Bill explained to the Times, “My research-clinician chronology in Louisiana begins in the 1980s, when I did an internship under Dr. Phil Griffin, at Tulane Medical Center. Those psychologists- Jim Gay, Jorge Daruna, Phil Griffin, Collin McCormick, were an incredible group!”

His first clinical/research job was at the New Orleans VA Medical Center, “…where so many present LPA psychologists got their start…it was a great place to learn and do research,” he said.

Bill later moved to Philadelphia, to become Associate Professor of Clinical Psychology at what was then Hahnemann University, now Drexel University. “I was fortunate enough to meet Myrna Shure, a developmental psychologist and the ‘godmother’ of impulsivity prevention research,” he said. “Together, we were able to edit a volume, published by the APA, which included contributions from some of the most important names in the field.”

In the mid 1990s Bill returned to Louisiana to what was then Northeast Louisiana University, now University of Louisiana at Monroe. “My research was split between nonpharmacological addictions, including gambling and chronic procrastination, and explorations of what we call nonlinear behavior, or chaos theory.” Presently, these interests have expanded to include Bipolar II Disorder and adult attention deficit spectrum problems.

“ULM has been an incredible place to have a career,” Bill said. “While we do not have the resources that larger institutions have, we are able to closely mentor our undergraduates and graduate students. Their enthusiasm and creativity usually overcome our fiscal problems,” Bill explained. “Our longtime department head, Dr. David Williamson, has kept our ship afloat during some very rough seas.”

Bill noted that his colleagues and supervisors have also made ULM a special place. “Our present dean, Dr. Sandy Lemoine, is the most effective and compassionate motivator I’ve ever met,” he said. “I keep thinking that she must be a closet psychologist!”

“Our Provost, Dr. Stephen Richters,” Bill explained, “has the vision to realize that psychology is vibrant and must be a key part of 21st century curricula. And, our new President, Dr. Nick Bruno, has an extraordinarily strong commitment to the campus and community’s mental health. He also understands the importance of psychology. This is simply a great team to work under,” Bill concluded.

Dr. William G. McCown has held various positions in the university including Director of Training and interim Associate Provost. He is presently interim Director of the Graduate School at ULM.

“However,” he noted, “teaching and research are my first loves…. well, not quite,” he said. “I became a first time dad at 50 and that is my highest priority!”

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