Academic journal article Journal of Marital and Family Therapy

Conceptualizing and Treating Problem Gambling as a Family Issue

Academic journal article Journal of Marital and Family Therapy

Conceptualizing and Treating Problem Gambling as a Family Issue

Article excerpt

Few family therapists have training in the identification, assessment, and treatment of problem gambling and its impact on couple and family relationships. The authors conceptualize problem gambling (PG) as a family issue and encourage clinicians and researchers to pay attention to the systemic antecedents and consequences of PG on family relationships. A review of the literature and clinicians' experiences regarding the impact of PG on couple and family relationships are presented and discussed. In light of the limited systemic-based treatments for PG, marriage and family therapists are urged to begin paying attention to this emerging issue that has significant couple and family ramifications.

Although gambling is not a new phenomenon in society, its presence has expanded considerably since gambling has become a socially acceptable, widely accessible and legal recreational activity in many jurisdictions around the world. Prevalence research estimates that 0.2-1.2% of the world population meets the criteria for past-year pathological gambling (Shaffer, LaBrie, LaPlante, Nelson, and Stanton, 2004). Although most Americans gamble responsibly, the National Council on Problem Gambling (2009) estimates that nearly 2 million people (approximately 1% of the population) in the United States meet the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR; American Psychiatric Association, 2000) criteria for pathological gambling, and another 4-6 million people (2-3% of the population) have a less serious but still significant gambling problem. It is important to note that these statistics do not capture the millions of people, primarily family members, whose lives are profoundly impacted by someone else's gambling. Due to the increasing prevalence of problem gambling (PG) and the devastating effects that it can have on families, it behooves marriage and family therapists to acquire knowledge and expertise in the assessment and treatment of problem gambling.

The purpose of this article is to provide marriage and family therapists with current knowledge about the signs of problem gambling, to describe its impact on couple and family relationships, to note its systemic connections and ramifications to the family, and to propose how marriage and family therapists, both clinicians and researchers, can expand the conceptualization and treatment of PG as a family issue with a systems framework.

Problem gambling is a term frequently used to describe a range of problems and negative consequences related to gambling that exist along a continuum, in which pathological gambling represents the severe end (Ontario Problem Gambling Research Centre, n.d.). According to the DSM-IV-TR (American Psychiatric Association, 2000), pathological gambling is classified as an impulse control disorder that involves persistent and recurrent maladaptive gambling behavior as indicated by five or more of the diagnostic criteria (see Table 1). Less severe problem gambling involves fewer of these behaviors and typically does not involve criminal and/or legal consequences, although it can result in extensive personal, relational, and financial consequences.

Problem gambling shares a number of the characteristics that are typical of other impulse control disorders and is often comorbid with these other disorders, including alcohol and drug abuse (Crockford & el-Guebley, 1998; Cunningham- Williams, Cottier, Compton, & Spitzsnagel, 1998; Hall et al., 2000; Ibanez et al., 2001; Stinchfield, Kushner, & Winters, 2005). Furthermore, problem gambling is commonly observed with a variety of other comorbid psychiatric disorders, including major depression (Boughton & Brewster, 2003; Cunningham-Williams et al., 1998; Petry, Stinson, & Grant, 2005), antisocial personality disorder (Hall et al., 2000), and elevated rates of suicide attempts and ideation (Boughton & Brewster, 2003; Newman & Thompson, 2003; Petry & Kiluk, 2002). …

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