book review

Overcoming Pathological Gambling:  Therapist Guide

and

Overcoming Your Pathological Gambling:  Workbook

By Robert Ladouceur and Stella Lachance

Therapist Guide: (November 2006). Oxford University Press USA. 144 pp. ISBN #9780195317039. $37.95 USD (paperback).

Workbook: (December 2006). Oxford University Press USA. 96 pp. ISBN #9780195317015. $27.95 USD.

Reviewed by: Timothy Fong MD, Assistant Professor of Psychiatry, UCLA Gambling Studies Program

A quick Internet search on Amazon.com reveals that there are hundreds of books available on the topic of pathological gambling.  Some are meant for researchers, some for clinicians, and others for the patients and families themselves.  The majority of the self-help workbooks for sale, though, are not evidenced-based and have not been tested in a rigorous scientific manner.

These two companion books—first-authored by one of the leading clinicians and researchers in the world on pathological gambling—are quite different.  Both books are created under the Treatments That Work series, which was designed to provide updated, effective, and objective treatment information to the public in a user-friendly presentation.¹  The material presented in these works is the latest version of an empirically supported cognitive behavioral treatment (CBT) program for pathological gambling.

Both guides contain all the information and materials needed to initiate and conduct CBT for pathological gambling.  The patient workbook is divided into 10 chapters which detail 12 individual sessions.  Each session focuses on identifying and then correcting misconceptions or erroneous beliefs about the nature of gambling.  For example, some pathological gamblers believe that they can “beat the system” or that they can control the outcome of the cards, dice, machine, etc.  Others may believe that gambling is the solution to life’s problems and that the longer they play, the more likely they will win.  Once these cognitive distortions are identified, they can be modified through various exercises and homework assignments.  One example of this is the ABCD model, which is a table that the patient completes.  It starts with the patient identifying a high-risk situation (e.g., getting a paycheck) and then identifying the automatic thought that leads to gambling more than planned (e.g., “Now that I have money, I deserve to gamble it”).  Next, behaviors resulting from the automatic thought are identified (“I end up gambling more than I intended and losing more than I can afford”).  Finally, the consequence of the high-risk situation leading to gambling is identified (“I feel upset, guilty, and ashamed, and I don’t have enough money until my next paycheck”).  In addition to correcting erroneous beliefs about gambling, this program teaches problem-solving skills, self-assessment techniques, and trigger-recognition and avoidance.

The therapist guide provides step-by-step instructions for clinicians to help clients understand all of the facets of their problem.  This guide is written to parallel the patient workbook and also to address common barriers, problems, and difficulties seen in gambling treatment.  The therapist guide is an essential component to providing CBT treatment, especially for therapists who are not trained in CBT or who do not have extensive problem gambling treatment experience.

The books conclude with post-treatment assessments that are designed to be completed after the 12 weeks of treatment.  Treatment and recovery for pathological gambling should continue beyond that, and one area of research not yet explored is how long the treatment effects from CBT last once treatment is completed.  

Overall, the materials presented in both books are accurate, easy-to-read, and applicable to every subtype of problem and pathological gambler.  The homework assignments are clearly presented and represent the type of assignments that therapists and clients will actually complete.  CBT is easy to conceptualize, but the actual delivery of it is not always easy or obvious.  Having a manual on hand gives therapists and patients the security of knowing that the product they are delivering is as close as possible to the one that was tested during clinical trials. 

By definition, these manuals are very explicitly focused on presenting a cognitive behavioral approach.  Other evidenced-based therapies and biological approaches are not covered here, nor are they meant to be.  These two books would be excellent starter materials to any gambling treatment program or counselor who is beginning to gain experience in the management of pathological gambling.