By Denise F. Quirk, M.A.
Notes from a Therapist in Reno
For ten years I’ve served with great satisfaction and co-occurring frustration at the Reno Problem Gambling Center (RPGC). I’m the Clinical Director and CEO, which offers me a number of opportunities for growth.
I learn each day from families of addicted gamblers what it means to have hope and help for gambling disorder. The family members are all traumatized, every single one. How they choose to stay in the family and deal with Gambling Disorder, the only DSM-5 entry in the “Substance-Related and Addictive Disorders” chapter dealing with behavioral or process disorders, is a wonder to me.
What works for families of problem gamblers?
Here’s my bullet list of what I see in my work with clients, and what I believe works for families:
1. End the lying and betrayal
Everyday, with all families. Stop lying.
2. Address shame
Everyone… the hole that gambling families find themselves in is a really dark and awful place and they have a hard time getting out. See Brené Brown’s excellent cartoon video on what empathy is.
3 Address financial despair
I love Financial Peace University and Dave Ramsey is my hero, and becoming one to millions more because of his no-nonsense approach to financial despair, which all my clients have.
4. Resolve money issues
It’s all about money, it’s not about money. But if you have none, it’s really emotional and full of failure messages…back to shame, and more Brené Brown You Tube videos.
5. Get out of crazy town
Students, lawyers, public defenders and judges, all seem to need navigation help to grasp why the gambler is in “crazy town.”
6. Get back to hope
Family members need so much, especially validation and assurance that there is help and sunshine available for them, somehow, someday. Back to hope.
7. Practice honesty
Lying doesn’t go away easily. This takes a lot of work, patience, and frustration tolerance. Thus RPGC’s methods are long-term, group therapy and couples’ therapy, for at least a year.
8. Express anger
It doesn’t melt away easily. It needs a place to be heard.
9. Work a program of recovery
Because it’s worth it. There are many paths to recovery, including 12-Steps and spirituality.
10. Learn boundaries
This is a life-long process. Keep coming back and using your safety check list (see Dr. Kevin McCauley’s “Memo to Self” 90-minute film).
11. Learn about emotions
Learning the who/what/why/where/when/how about emotions is also life-long and one of my keys to happiness and serenity. We focus on emotions work for everyone at RPGC.
12. Brainwashing can be healthy
Out with the old messages and in with the new. It’s how we do cognitive-behavioral therapy at the RPGC. Irrational core beliefs need to be discovered and rewritten.
How to avoid old trauma in families?
Given this environment of pre-existing, comprehensive family trauma, it is important not to revive old trauma, and inadvertently or vicariously re-traumatize the client or family member. At RPGC, we have introduced Adverse Childhood Experiences (ACEs) screening in our intake packets for clients and families. Having some indication of the lifetime trauma level of our clients can help us be more responsive and respectful in treatment.
Recent improvements to addictions care include the Substance Abuse and Mental Health Services Administration (SAMHSA) emphasis on Trauma-Informed Care. Moreover, trauma-informed care is not just good policy; it’s good practice.
What needs to be done? Looking beyond the acute diagnosis
Unless we as professionals proactively seek out, identify, and address the trauma history of our clients, and share that knowledge with the client, the family, and the rest of the treatment team, we fail to address the “whole client.” How can we achieve this?
Our clients may present for one particular, acute issue. We need to explore for underlying, undetected, or unreported injuries that shape the presentation of the addictive behavior, the response to treatment, and the likelihood of long-term recovery for the client and the family.
Have more questions about treating gambling?
For any further questions or comments on this topic, feel free to post in the designated section below. We try to answer personally and promptly to all legitimate inquiries, or we can refer you to someone who can help.