Organisational Health Organisational Health ConferenceConference

EA Group discussion: Addictive EA Group discussion: Addictive behaviours incl. gambling.behaviours incl. gambling.

Tracey Atkinson Tracey Atkinson

Quidquid latine dictum sit, Quidquid latine dictum sit,

altum vidituraltum viditur

ObjectivesObjectives

What do we want from this session?What do we want from this session? What experiences and resources can we share today?What experiences and resources can we share today? Theory of addiction: Stages of Change Model Theory of addiction: Stages of Change Model Treating addictive behaviours: Motivational interviewingTreating addictive behaviours: Motivational interviewing Goals, applications, principlesGoals, applications, principles Other treatmentsOther treatments Gambling addiction Gambling addiction References and resourcesReferences and resources Where to from here? Where to from here?

Stages of Change ModelStages of Change Model

(DiClemente & Prochaska, 1998)(DiClemente & Prochaska, 1998)

Health behavioursHealth behaviours Addictive behavioursAddictive behaviours

Stages of Change ModelStages of Change Model

Pre contemplation Pre contemplation Contemplation Contemplation Preparation Preparation Action Action MaintenanceMaintenance RelapseRelapse Change is circular Change is circular NOT uni-directionalNOT uni-directional

Motivational InterviewingMotivational Interviewing

Denial, resistance, poor motivation, Denial, resistance, poor motivation, ambivalence are features of many client ambivalence are features of many client presentationspresentations

Hypothesis: The way clients are spoken to Hypothesis: The way clients are spoken to can either enhance or minimize motivation can either enhance or minimize motivation to change (Miller, 1983) to change (Miller, 1983)

GoalsGoals

The goal is The goal is notnot to change the client’s to change the client’s behaviour but to allow the client to argue behaviour but to allow the client to argue for their own change.for their own change.

PreparesPrepares people for change people for change

Motivation to changeMotivation to change

Every therapist knows that motivation is a vital Every therapist knows that motivation is a vital element of change. Nowhere is this clearer than element of change. Nowhere is this clearer than in the treatment of addictive behaviours, which in the treatment of addictive behaviours, which are, if one thinks about it, fundamentally are, if one thinks about it, fundamentally motivationalmotivational problems. …When one continues to problems. …When one continues to act despite personal risk and cost, something is act despite personal risk and cost, something is overriding common sense. In the context of war, overriding common sense. In the context of war, we call it bravery or heroism. In the context of we call it bravery or heroism. In the context of pleasure, we call it pleasure, we call it addiction..addiction.. (Miller, 1998). (Miller, 1998).

Motivation to changeMotivation to change

AmbivalenceAmbivalence is normal is normal It is the inter-relationship of ambivalence It is the inter-relationship of ambivalence

about change and the client’s goals and about change and the client’s goals and core values that is the substance of core values that is the substance of motivational interviewing (Rollnick & motivational interviewing (Rollnick & Allison, 2001) Allison, 2001)

Motivation to ChangeMotivation to Change

Resistance:Resistance: observable behaviour that observable behaviour that arises when the counsellor loses arises when the counsellor loses demonstrable congruence with the client demonstrable congruence with the client (Miller & Rollnick, 1991)(Miller & Rollnick, 1991)

I know..butI know..but I can’t……………I can’t……………

Motivational Interviewing isMotivational Interviewing is

EmpathicEmpathic Non-confrontationalNon-confrontational A constructive conversation about behaviour A constructive conversation about behaviour

changechange Technique secondaryTechnique secondary Directive (vs non-directive)Directive (vs non-directive) Clear structureClear structure Coaching to explore and resolve ambivalence to Coaching to explore and resolve ambivalence to

behaviour changebehaviour change

Other applicationsOther applications

Motivational interviewing strategies may Motivational interviewing strategies may be applied in situations where insight is be applied in situations where insight is impaired, e.g.impaired, e.g.

Eating disordersEating disorders Other mental illness e.g.schizophrenia, Other mental illness e.g.schizophrenia,

bipolar disorder, depressionbipolar disorder, depression Enhance medication complianceEnhance medication compliance Enhance treatment commitmentEnhance treatment commitment

Principles of MIPrinciples of MI

Express empathyExpress empathy Avoid argumentsAvoid arguments Roll with resistanceRoll with resistance Support self-efficacySupport self-efficacy Deploy discrepancyDeploy discrepancy

Present, past, and future oriented Present, past, and future oriented questionsquestions

If you continue to drink at this level, what If you continue to drink at this level, what will be the benefits in a year’s time?will be the benefits in a year’s time?

Could there be any disadvantages?Could there be any disadvantages? So, on one hand, you love the feeling and So, on one hand, you love the feeling and

the taste, but you are less pleased with the the taste, but you are less pleased with the way you act and the things you say?way you act and the things you say?

What was it like when you stopped What was it like when you stopped drinking last time?drinking last time?

More questions………More questions………

What are some of the good things about What are some of the good things about your cannabis use?your cannabis use?

What are some of the less good things?What are some of the less good things? What do you enjoy most about poker What do you enjoy most about poker

machines?machines? What are some of the side effects of the What are some of the side effects of the

medication? What are the benefits of it? medication? What are the benefits of it?

More questions……….More questions……….

On a scale of 0 to 5 how important is it for On a scale of 0 to 5 how important is it for you to give up alcohol?you to give up alcohol?

On a scale of 0 to 5 how confident are you On a scale of 0 to 5 how confident are you about giving up?about giving up?

What will keep you at this level?What will keep you at this level? How high does it have to be before you How high does it have to be before you

make an attempt to change? make an attempt to change?

PresentPresent Positive/Advantages Positive/Advantages

FutureFuture AdvantagesAdvantages

PresentPresent Negatives/Negatives/

DisadvantagesDisadvantages

FutureFuture DisadvantagesDisadvantages

Other treatmentsOther treatments

Cognitive behaviour therapy: e.g. Cognitive behaviour therapy: e.g. psychoeducation, behaviour monitoring, psychoeducation, behaviour monitoring, contingencies, managing cravings, social contingencies, managing cravings, social situations (saying no), controlled drinking, situations (saying no), controlled drinking, relapse prevention, needle exposure, relapse prevention, needle exposure, lapses vs. relapselapses vs. relapse

Abstinence vs controlled useAbstinence vs controlled use 12 Step Programs12 Step Programs MedicationMedication

References: Motivational References: Motivational InterviewingInterviewing

Rollnick, S. & Allison, J. (2001). Rollnick, S. & Allison, J. (2001). Motivational interviewingMotivational interviewing. In . In Heather, N., Peters, T.J. & Stockwell, T. (Eds.).The International Heather, N., Peters, T.J. & Stockwell, T. (Eds.).The International handbook of alcohol dependence and problems. Wiley & Sons.handbook of alcohol dependence and problems. Wiley & Sons.

Institute of Psychiatry Kings College London (2004). Institute of Psychiatry Kings College London (2004). A General A General practitioner’s guide to eating disorders.practitioner’s guide to eating disorders. www.iop.kcl.ac.uk/IoP/Departments/psychMed/EDU/GPguide.shtmlwww.iop.kcl.ac.uk/IoP/Departments/psychMed/EDU/GPguide.shtml

Dept Veteran Affairs. Dept Veteran Affairs. Key ideas underlying motivational Key ideas underlying motivational interviewinginterviewing. . www.dva.gov.au/health/younger/mhealth/alcohol/training/appendk.hwww.dva.gov.au/health/younger/mhealth/alcohol/training/appendk.h

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Gambling factsGambling facts

2.1% of Australian adults have a 2.1% of Australian adults have a problem, i.e. 293,000. problem, i.e. 293,000.

On average 7 other people are affected On average 7 other people are affected by the gambler’s behaviour, i.e. 2 million by the gambler’s behaviour, i.e. 2 million people people

(Source: Relationships Australia).(Source: Relationships Australia).

Qld gambling facts 2003-4Qld gambling facts 2003-4

Per capita expenditure:Per capita expenditure:

Total $967.96 p.a.Total $967.96 p.a. Gaming machines $866.25 p.a.Gaming machines $866.25 p.a.

Qld gambling facts 2003-4Qld gambling facts 2003-4

Growth ratesGrowth rates Gaming machines 7% per annumGaming machines 7% per annum Most others declining Most others declining Total expenditure $2.79 billionTotal expenditure $2.79 billion Gaming machines 53.66%Gaming machines 53.66% Casino 21.2%Casino 21.2% Lottery 12.18%Lottery 12.18% Racing 10.28%Racing 10.28%

Qld gambling facts 2003-4Qld gambling facts 2003-4

Total government revenue $719.92 millionTotal government revenue $719.92 million Gaming $688.63 millionGaming $688.63 million TAB $30.58 millionTAB $30.58 million

Increased household disposable income Increased household disposable income spent on gamblingspent on gambling

1993-4 1993-4 2.34%2.34% 2003-4 2003-4 3.17%3.17%(Source: ANU Centre for gambling research-Fact sheets 2005)(Source: ANU Centre for gambling research-Fact sheets 2005)

Gambling treatmentGambling treatment

In general:In general: Individual, group, relationship, Individual, group, relationship, financial counselling, self help kits. Includes…financial counselling, self help kits. Includes…

Understanding factors such as false beliefs, Understanding factors such as false beliefs, motivations for gambling, triggersmotivations for gambling, triggers

Relapse prevention strategiesRelapse prevention strategies Underlying issues: anxiety, depression, Underlying issues: anxiety, depression,

relationship problemsrelationship problems Financial: budgeting, legal issues, coping with Financial: budgeting, legal issues, coping with

creditors, reorganising finances. creditors, reorganising finances.

Gambling treatmentGambling treatment

Relationships AustraliaRelationships Australia PsychologistsPsychologists Gamblers AnonymousGamblers Anonymous

Resources: GamblingResources: Gambling

www.monkeysee.com.au.www.monkeysee.com.au. No more bets please! No more bets please! Overcoming problem gambling.Overcoming problem gambling. Presented by HG Nelson Presented by HG Nelson (DVD).(DVD).

www.gspot.org.auwww.gspot.org.au. Gambler’s Help Ph 1800 156 789. Gambler’s Help Ph 1800 156 789 www.problemgambling.net.auwww.problemgambling.net.au. Problem Gambling . Problem Gambling

Service (incl. Chinese, Greek, Italian, Tagalog, Spanish Service (incl. Chinese, Greek, Italian, Tagalog, Spanish language)language)

www.gambling.anu.edu.auwww.gambling.anu.edu.au. ANU Centre for Gambling . ANU Centre for Gambling Research. Research, fact sheets, journalsResearch. Research, fact sheets, journals

Gamblers Anonymous. Ph 33560117 (Brisbane)Gamblers Anonymous. Ph 33560117 (Brisbane)

Resources: GamblingResources: Gambling

www.relationships.com.auwww.relationships.com.au. Relationships . Relationships Australia Gambling Counselling Service Australia Gambling Counselling Service and Gambling Help Lineand Gambling Help Line

FREEFREE Redlands, Mt Gravatt, Gympie, Caloundra, Redlands, Mt Gravatt, Gympie, Caloundra,

Noosaville, Gold Coast, Ipswich, Noosaville, Gold Coast, Ipswich, Rockhampton, Gladstone, Logan, Mackay Rockhampton, Gladstone, Logan, Mackay and Whitsunday, Spring Hill.and Whitsunday, Spring Hill.

SummarySummary

What we did in this sessionWhat we did in this session Theory of addiction: Stages of Change Model Theory of addiction: Stages of Change Model Treating addictive behaviours: Motivational Treating addictive behaviours: Motivational

interviewinginterviewing Goals, applications, principlesGoals, applications, principles Other treatmentsOther treatments Gambling addiction Gambling addiction References and resourcesReferences and resources Where to from here? Where to from here?