Liar, Liar, Money’s on FireTreating Families of Problem Gamblers

Gary Lange PhD

MFT, NCGC, CAS, BACC

760-773-1014

www.GaryLangePhD.com

CodependencyCo-dependent: “A person who has let someone

else’s behavior affect him or her and is obsessed with controlling other people’s behavior” M. Beattie

Co-dependency is “when you depend on another person for your happiness, security, life satisfaction, even self worth.” Sugg and Siegel 2009

Enabler: person who intervenes in such a way as to prevent the problem gambler from facing the consequences of their actions.

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Focus on the family means....

The family needs time and resources

Their recovery is different and they need their own program beyond getting the gambler to stop

They need knowledge for protection

They deserve hope for a better life

Treatment overview:Emotional IssuesBetrayal, deceit and resentment

May have enjoyed the winning times and are reluctant to give up the spoils

May have truly not known about the problem

May have believed they were crazy

Little known about impact on children

Significant Other* Involvement

Ingle et.al. 2008

Gamblers who have a Significant Other, are older, employed and have had some undergraduate education, stay in treatment longer and are more successful

Oregon State OPG N=2575

Gamblers without SO (86%)

Gamblers with Involved SO (14%)

Length of TX 146 days (+80) = 226 days

Successful TX 34% (+21) = 55%

Characteristics of FamiliesLoyal; Defer gratification; overly responsible

Personal/Family History of Addictions

High resilience and tolerance for pain

Low self-esteem

Over emphasis on $$$$$$

Putting out the FireInvolve FamilyAssess who is supportive$$$ ProtectionDiffuse emotionsPush Gam-Anon, support

Gary Lange Ph.D. Dissertation

23 Symptoms/Patterns of Codependents studied before and after Betty Ford Center’s Family Week of Treatment

17 statistically significant reduction over 4 months

10 statistically significant reduction over 12 months

10/23 Symptoms/Patterns statistically significant reduction over 12 months (Lange, ’86)

Frequency of drinking/using

Frequency of over drinking/using*

Functional sexual problems

Nervous/apprehensive

Difficulty concentrating

Stiff neck and shoulders

Depressed

Withdrawing from supportive relationships

Sleeping problems

Weight loss* (not stats sig at 4 mos.)

Family Phases of Progression: 1. Denial: makes excuses for gambling;

becomes great financial manager/manipulator

2. Stress Phase: arguments; attempts to control gambler; enjoys gifts from gambler; provides bailouts; secrets, isolation

3. Exhaustion Phase: confusion; physical symptoms; rage; anxiety and panic; separation/divorce

4. Hopeless Phase: reactive, suicidal (Wexler)

Stages of Recovery

1. Critical Phase: desires and accepts help; recognizes true problem; self-focus and self-care; guilt diminishes; deals with resentments; stops bailouts

2. Rebuilding Phase: increased self-confidence; communication; problem solving; making decisions; realistic planning

3. Growing Phase: sharing; relaxed; closer with family; more affectionate and trusting (Wexler)

The 8 Techniques for Treating Families (Lange, 2012)

1. Crisis Intervention

2. Educatation

3. Forgiveness

4. Making Decisions

5. Assertiveness

6. Managing Stress

7. Negotiating

8. Trust and Hope

1. Crisis Intervention (Lange, 2012)

Monitor for Safety, physical, emotional or sexual abuse, neglect

Assess Co-occurring Disorders: Depression, anxiety, Axis II…

Monitor needs of all family members/kids/others

Assess severity of $$$ and legal problems

“Yes we love you, No to gambling”

2. Educate about the Recovery Process (Lange, 2012)

Path is seldom smooth, quick or easy

The Gamblers’ impaired midbrain and affects of Neurotransmitters

Each chose their path and speed

Decrease stress Decrease Craving

Treatment will improve the families’ physical and emotional health

3. Forgiveness vs. Forgetting

(Lange, 2012)

Survival based on learning and remembering Write a list of things that are difficult to

forgive him/her for doing Apologize Forgetting is a spiritual release

4. Making Decisions (Lange,

2012)

Stop Procrastinating NOW

What do you have power over?

Establishing priorities

Communicating; “When you gamble/_____I feel…”

3 things important to me…

5. Assertiveness (Lange, 2012)

– Tender (Passive) Tough (Bulldozer)

– Refusing others' requests if they are too demanding

– Being firm so that your rights are respected– Expressing positive AND negative emotions

6. Managing Stress (Lange, 2012)

• Is the crisis over with?

• Continue to set priorities, structure

• Breathe, walk, sit, play, sleep, eat, relax…

• Explore options for assistance.– Therapy– Gam-Anon• Sponsor• Family/group support

The Gam-Anon Myths of TrustTrust is something you can give to another.

Trust should be given unconditionally to a loved one.

Trust is the foundation of a relationship.

A person is completely trustworthy or completely untrustworthy.

Love and trust always co-exist.

Adapted from "The Gam-Anon Way of Life"

7. Negotiation around $$$ (Lange, 12)

– Pull a credit report; what is in your name or held jointly?

– Take in the mail or use a P. O. Box– Work together to pay bills, although a

responsible family member should probably handle the money.

– Change passwords on all accounts.– Meet with someone about

pressure and budget relief

8. Trust and Hope (Lange, 12)

Stop name calling and negative projections

Practice small behavioral trust exercises

Utilize your support system

Acceptance

Spiritual release

Change Today and have Hope in a Better Tomorrow

Stages of Family Recovery Jo Ann Towle, MA www.familyinterv.com

Respect that family members are at different phases of grief and understanding of their pain

Accept the reality of the loss (shock, denial, bargaining)

Working through the pain (anger and depression)

Adjusting to the environment (starting to accept)

Emotional relocation of the loss (acceptance and recovery)

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Families Recovering

Against All Odds

Helping Family Members

of Problem Gamblers Rebuild

A 15-Session Workbook

Judith Sugg, Ph.D., and Renee Siegel, M.A.

Family Cases

What are the crisis/clinical issues?

What legal/ethical issues are present?

What is your diagnosis on all axes?

What would your treatment plan be?

Case I: Sarah

Sarah is a passive, codependent female client who complains that her husband is gambling and spending all of the family’s money. She claims that her extended family is tired of bailing them out. If she fears the “embarrassment” of going to Gam-Anon and doesn’t believe in a God, how can you help her? What resources, books, etc would help her?

Case II: Fan and her husband

Fan is a 34 yo Asian immigrant who comes with her husband who has a black jack addiction. They have two children and he began gambling when she was first pregnant. He works 12 hours per day earning $9/hr. and is worried that if he doesn’t stop gambling, he’ll lose his job, the only income for his family.

Fan’s English is understandable, but her husband has a strong accent and refuses help in his native language. Fan often translates for him during the session. It is difficult to strategize about treatment options, support systems or developing behavioral strategies because of the language barriers. A psychic told her husband that he would have a curse for 2 more years. Fan is busy with the children and the household but knows you can tell him what to do to stop gambling.

Case IV: Rodriguez FamilyThe Rodriguez Family of 4 come because

the divorced mother is scared and wants to leave town. She reports answering the door one night to two large guys who say if she does not give them $2000 by Friday, they are going to harm, her 17-year-old son, Manuel. Even though Manuel reports 5 symptoms of DSM IV 312.31, he minimizes his gambling and seems aloof. The daughter, Maria who knew about her brother’s gambling is willing to give her mother the money out of her savings. Their live-in grandfather says, “to hell with the threat”.

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Resources Berman, Linda and Siegel, Mary-Ellen, 2008, Behind the Eight-

Ball, "A Guide for Families of Gamblers", University.

Ingle, Prajkta et.al., 2008 Significant Others and Gambling Treatment Outcomes, J Gambling Studies 24:381-394

Gam-Anon: www.gam-anon.org

Lange, Gary, 2010, You Bet Your Life: Pathological Gambling, DVD, GaryLangePhD.com

Petry, Nancy, 2005, Pathological Gambling: Etiology, Comorbidity, and Treatment, Wash, DC., www.apa.org

Personal Financial Strategies for the Loved Ones of Problem Gamblers. National Endowment for Financial Education and the National Council on Problem Gambling

Sugg, Judith and Siegel, Renee 2009, Families Recovering Against All Odds: “Helping Family Members of Problem Gamblers Rebuild”, ABC Wellness Centre, Scottsdale, AZ

GaryLangePhD.com

DVDs:DVDs: “Pathological “Pathological Gambling”, Gambling”,

““T-ender L-oving C-T-ender L-oving C-ommunication”, “It’s About Time ommunication”, “It’s About Time Management”, “Feelings ‘R’ Us” Management”, “Feelings ‘R’ Us” and “Getting Past Tense” and “Getting Past Tense” $25.00 $25.00 each (760-773-1014)each (760-773-1014)

Gary@GaryLangePhD.comGary@GaryLangePhD.com