This July, I attended the 30th National Conference on Problem Gambling in Tarrytown, New York. The title of the annual conference this year was “30 Years: Proud of Our Past, Planning Our Future.” New York was selected because 30 years ago this was the site for the National Council on Problem Gambling’s first conference.

Over 500 participants participated, including researchers, educators, therapists, gamblers, and family members. There were participants from all over the world including the Netherlands, Australia, Taiwan, and the U.K.  The two days were filled with lectures, workshops, and Professional Educational Development (PED) talks. Within the conference structure, tracks were available for therapy, prevention, and research as well as for those in recovery.

I enjoyed the meals (they were even able to accommodate my gluten free needs) and the snacks during breaks.  All events were held at the Westchester Marriott, which is located in the Lower Hudson Valley right off the Hudson River.

Kathryn Elliott-Hudson with Dr. Chuck Maurer

Kathryn Elliott-Hudson with Jenny McIver (GA) and Catalina Christophe (AZ)

All the presentations I attended were stellar, but I had a few favorites:

• “Developments in Treatment” by Mark Potenza, M.D., Yale University psychiatrist and researcher, whose focus was on the challenges of getting people with gambling problems into treatment and “identifying which treatments might work best for whom.”
• Gender Differences in Treatment-Seeking British Pathological Gamblers by Henrietta Bowden-Jones, M.D., who developed the first national problem gambling clinic in the U.K.
• Richard Rosenthal, M.D., founder of the gambling treatment program in UCLA, who presented a talk on how problem gambling became accepted as a disease in the medical world back in 1980.  His topic, “The Inclusion of Problem Gambling in the DSM-III” (the Diagnostic and Statistical Manual), was based on papers from the archives of the American Psychiatric Association and NCPG as well as his own documents and interviews with several members of the committee, in addition to his experience as a member of the DSM-IV IDNEC committee.
• Longtime NCPG member and former board member Don Feeney of the Minnesota Lottery presented a fantastic PED talk, “Generations in Gambling.” His focus was on whether treatment developed for Baby Boomers is appropriate for Millennials, those born 1982 to 2004. Although the talk was brief, we were left with questions about accommodating the differences between the generations: what are the differences in their ideas and beliefs about gambling and in their gambling behavior? For instance, the Millennials grew up in an era of acceptance for gambling after lotteries opened the door; Baby Boomers had to be sold on it, literally.
• Roberta Broughton from Ontario presented a workshop with focus on women and group work, two topics that are of particular interest to me.  Her topic was titled “Treatment of Female Gamblers: A Workbook and Webinar Effectiveness Pilot.” Roberta has designed a five-unit workbook focusing on issues presented by women gamblers. The workbook is designed to increase resilience and teach skills necessary for sustained recovery.
• Dr. Heather Chapman, director of the Louis Stokes Hospital Gamblers Recovery Program (Brecksville, Ohio), discussed client reluctance and GA. As an aside, Brecksville was the first hospital to treat gamblers—ever—in 1972. For those of you who have questioned GA’s effectiveness or validity, Dr. Chapman said that GA continues to be underutilized, despite suggestions by therapists and others that GA is a helpful adjunct in the recovery process. I believe that a 12-step program is essential. Treatment is short-term, but the disease is always going to be there, and one needs as much ammunition as possible to keep the disease at bay. Where else in society besides GA can one get ongoing reinforcement and understanding about a disease that is “cunning, baffling and powerful”?

Why Attend a Gambling Conference

All of these topics allow me to be more sensitive to my clients’ needs. The field is changing as gambling has become more prevalent and the means of gambling more sophisticated.  We as therapists must continue to avail ourselves of opportunities that enhance our knowledge and allow us to share ideas so that we can best support those whose gambling has gone way beyond a social level in addition to those affected by their gambling.

I’m already looking forward to the 31st National Conference on Problem Gambling in Portland, Oregon, where the topic will be Listening, Learning, Leading, all of which I hope to do next July.  Until then, I will implement new information in individual and group sessions.

Kathryn Elliott-Hudson with National Council on Problem Gambling Executive Director Keith Whyte and Barbara Rollins

Kathryn Elliott-Hudson with co-presenters Dr. Phillip Townshend and Matthew McMillan at the 5th International Gambling Conference

I was invited to present at the 5th International Gambling Conference in Auckland, New Zealand, February 19-21, 2014. I’ll share some of the highlights of this conference, whose goal was to examine “how positive change can be brought about through research, policy, and practice.”

On February 20, I had the privilege of presenting, along with Matthew McMillan and Dr. Phillip Townshend. Our topic was “Working Toward Best Practice: Reflections from the Northern and Southern Hemispheres.” My portion of the presentation was focused on gambling in Arizona, which included information about the Office of Problem Gambling, the Treatment Assistance Program, and an historical perspective of gambling in this state. The presentation was well received, and I fielded quite a few questions during the Q&A and later at lunch.

The conference, an educational and cultural experience, was held at Auckland University of Technology (AUT), City Campus Conference Center, which was completed just in time for the conference.  It was hosted by Hapai Te Hauora Tapui Maori Public Health, the Gambling and Addictions Research Centre at AUT, and the Problem Gambling Foundation of New Zealand (PGF).

Approximately 300 people representing fifteen countries attended. I was one of three U.S. presenters. Newly retired Judge Mark Farrell, a friend of mine, delivered the keynote “Therapeutic Justice: The World’s First Gambling Treatment Court” about the criminal and civil treatment court he founded in Amherst, NY in 1996.

Another keynote of particular interest was delivered by Professor Gerda Reith of the University of Glasgow on “Mobile and Social Gambling: Key Trends and Challenges for Research.” I also enjoyed the workshop “Web-Based Counseling for Problem Gambling” presented by Simone Rodda from Turning Point Alcohol and Drug Centre in Victoria, Australia.

Because the focus of the conference was on technology, each attendee received an Android tablet with a preloaded conference app so that we could view the program, information about the keynote speakers, presenter abstracts and bios, and maps of the venue. Despite a wonderful how-to video, there were many laughs as we struggled to learn to use our devices, and a call was sent out to any nearby five-year-olds who could possibly help us.

On the cultural side, the welcome powhiri was a one-time experience for a manuhiri (visitor). It was their way of officially welcoming us to Aotearoa/New Zealand and to the conference. This event took place at the sacred place or Marae, and each morning there was some sort of ritual except for one morning when we had the Pacific Welcome, songs and dance of other Pacific islands such as Tonga, Fiji, and Samoa.

A Maori expression appeared with the conference logo: Ma te korero ka mohio, Ma te mohio ka marama, Ma te marama ka matau, Ma te matau ka ora. It means: Through discussion comes understanding, through understanding comes light, through light comes wisdom, through wisdom comes wellbeing. I left the conference with a new appreciation for the potential application of technology in the counseling setting.

It is possible that the presentations will become available online in the near future, and if so, I will publish an update to this post.

Making the call for help is not a decision that is made lightly. It is a rare individual who is not anxious about picking up the phone and making that all-important call. Without a doubt, showing up for the first appointment may be equally anxiety provoking. However, if a client knows what to expect at the first session, this may help alleviate fear and anxiety.

During that initial call a question I’m often asked is, “What’s the cost of treatment?”  As a TAP provider, I can access monies allocated to the Office of Problem Gambling to support our treatment efforts. No one is ever turned away, and co-pays are based on one’s ability to pay, indebtedness, and need.  During the first appointment, I evaluate a client’s financial status and suggest an affordable co-pay.

The assessment or intake process normally takes 90 minutes. The goals of the assessment are for connection, disclosure, paperwork, and interpretation/planning. I encourage clients to come to their session at least 15 to 30 minutes beforehand to complete their paperwork so that they can spend the bulk of their first session sharing their gambling history and what they would like to accomplish in recovery.

In the connection stage of the first appointment, the goal is for the client to get to know the therapist and vice versa. During the disclosure phase, the focus is on the client telling his/her story. The information gathered is designed to formulate a plan of action.

During disclosure, I’m looking for what the client is seeking, his/her gambling history, and consequences.  This is the time during the assessment that I introduce the concept of gambling as a disease.

Paperwork consists of documents required by the state of Arizona’s Board of Behavioral Health, the Office of Problem Gambling, and HIPPAA as well as those documents required by the therapist. The issue of confidentiality is addressed.

The interpretation stage focuses on assessing what it is the client wants to achieve in therapy and prioritizes the client’s needs and assesses their support system. If there are medical concerns, I stress the need for an appointment with the primary care physician.

By the end of the session, we have an initial treatment plan, which will be our roadmap for next four to five weeks. The client receives an Informed Consent document to take home. We set a standing appointment. Standing appointments are very important for the client to begin the process of putting structure and accountability in his/her life.

Sometimes the client is accompanied to the first session by a friend or a loved one. Occasionally that individual is eager to share the impact of the addiction on their life or on the family system. When this occurs, I allow a small amount of disclosure and encourage that individual to seek his/her own appointment, or I refer them to Gam-Anon.

After this first appointment, clients are normally seen on a weekly basis. That’s when the real work begins, but it all starts with that phone call and first appointment.