3. Dr. Sally Gainsbury, Dr. Ken Winters and
Mr. Alfonso Fernandez
Senior Lecturer, Centre for Gambling Education & Research
Department of Psychiatry, University of Minnesota
CEO, AMS Media

4. Alternative treatments for
problem gambling
Sally Gainsbury
Centre for Gambling Education and Research, Southern Cross
University
Presentation at New Horizons in Responsible Gambling
Vancouver, February 4, 2015

5. Achieving treatment & responsible gambling objectives
Internet & mobile technology:
1. Assist people with gambling-related problems
2. Facilitate responsible gambling
• A comprehensive system
• Customisable for specific needs and populations
• Country/Province-wide access
• Evaluation & updates
 Evidence-based
 Value for money

6. Constant connectivity

7. Internet & mobile technology
• Online screening with automated feedback
• Self-directed online CBT
• With therapist support (email, chat, phone, face-to-face)
• Brief interventions & prevention resources
• Online
• SMS

8. Online treatment options
Face-to-face
counselling
e.g., video conferencing
Online counselling:
Email, video conferencing, chat
Treatment with
therapist support
Self-directed interventions
Structured online CBT
Customized SMS
Brief interventions
Online peer-support
forum
Peer support
Support:
GP, counsellors, telephone or online chat

9. Treatment and responsible gambling principles
Build capacity & sustained solutions tailored to community needs
• Integrated treatment and prevention options
• Allow individuals to seek help in the way they wish
• Help-seeking is cyclical
Promote innovation through technology & leveraging existing
programs
• New online interventions
• Working with existing support services

10. Promote simple pathway to support
• One entry point, many options
• Customised support recommendations
• Province-wide access
• Value for money
• Time efficient
• Greater uptake
• Builds on existing programs

11. Early intervention
Prevention isn’t about ‘help’
• Evidence gap – encouraging uptake of
responsible gambling resources and
tools
• Brief online tools
• Stay in control
• Integrated into wider support services

12. Options to suit users
Layer low, medium, and high
intensity interventions
Communication is key
Integrate with professionals,
community and local
organisations

13. Best practice
• Preliminary research support
• Efficacy of funding
• Program evaluation
• Demonstrate performance & value for money
• Incorporate best practice
• Build research capacity

14. Conclusions
• Face-to-face treatment is still important
• But support can be more inclusive
• Full range of options to suit diverse needs
• Ongoing funding needed for development, evaluation & updates
• Continue to build capacity to improve ongoing support services

15. Thank you, questions?
Dr Sally Gainsbury
Senior Lecturer, Centre for Gambling Education & Research
Southern Cross University
Email: sally.gainsbury@scu.edu.au
Website: http://works.bepress.com/sally_gainsbury/
@DrSalGainsbury

16. Screening, Brief Intervention
and Referral to Treatment
(SBIRT)
To Address Problem Gamblers
Ken Winters, Ph.D.
Department of Psychiatry
University of Minnesota
winte001@umn.edu
New Horizons in Responsible Gambling
Conference
Vancouver, BC
February 4, 2015
Source: Linda Sobell

17. Who Am I?
• Problem gambling researcher since early
1990’s
– Applied research projects include treatment outcome
studies and development of GAMTOMS
• SBIRT researcher in the last decade

18. • At the risk of being over-simplistic, the keys
to treating a problem gambler:
• Develop a therapeutic alliance with the person.
• Help him/her to break the functional value of their
gambling.
General Views of Any Counselling
Program to Address Problem Gambling

19. General View of SBIRT

20. Gambling Involvement and Response
Intensive
Treatment
Adapted from Broadening the Base of Alcohol Treatment (IOM)
Prevention
Brief
Intervention
~85-90% ~1%~5-10%

21. SBIRT
Screening, Brief Intervention, Referral to Treatment
Prob Identif. Next step Referral
Screening Probable? BI or More Assess Treatment?
Assessment Definitive? Treatment Continuing Care?

22. SBIRT
Screening, Brief Intervention, Referral to Treatment
Prob Identif. Next step Referral
Screening Probable? BI or More Assess Treatment?
Assessment Definitive? Treatment Continuing Care?

23. SBIRT
Screening, Brief Intervention, Referral to Treatment
• Many favorable screening tools available (good resource: www.ncrg.org)
• Lie/Bet
• BBGS
• MAGS
• NORC Diagnostic Screens (4- and 17-item versions)
• PGSI (screen of the CPGI)
• SOGS

24. SBIRT
Screening, Brief Intervention, Referral to Treatment

25. BI “Sweet Spot”
Intensive
Treatment
Adapted from Broadening the Base of Alcohol Treatment (IOM)
Prevention
Brief
Intervention
~85-90% ~1%~5-10%

26. SBIRT-T
Common Elements of Brief Interventions
• Motivational interviewing
• Normative feedback
• Decisional balance
• Negotiated goals

27. DECISIONAL BALANCE EXERCISE
Pros
“What do you like about gambling?
What are the good things about ugambling?
What else?” (Ask again until nothing else.)
Cons
“What don’t you like as much about gambling?
What are the not-so-good things ?
What else?” (Ask again until nothing else.)

28. DECISIONAL BALANCE EXERCISE
More probing
“If you were to stop gambling, what would be the good things that might
happen?
What would be the bad things? “
“If you were to continue to gamble, what would be the good things that might
happen?
What would be the bad things? “

29. SBIRT
Screening, Brief Intervention, Referral to Treatment
• Efficacy: Small body of research
• Effect sizes in the “moderate range” (singles and
doubles, not home runs)
• Not clear if harm reduction effective over the long
term

30. SBIRT
Favorable outcome
Minimal/no change
Problem worsens
Support
recovery
Refer more
services
Conduct booster or
refer more services
Multi-screen red flags Refer more
assessment

31. Summary
• The SBIRT approach is an
emerging and promising set of
tools to address those with a
gambling problem.
• Evidence-based and evidenced-
informed models from the drug
abuse literature can be
harnessed for the PG field.
• Apply a PG-focused SBIRT to
clients in drug treatment and
mental health clinics.
Screening
Brief Intervention
Referral to Treatment

32. THANK YOU!
winte001@umn.edu

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