brief communications: treating problem gamblers: a residential therapy approach

Journal of Gambling Studies, Vol. 17, No. 2, 2001

161

1050-5350/01/0600-0161$19.50/0 � 2001 Human Sciences Press, Inc.

Treating Problem Gamblers:A Residential Therapy Approach

Mark GriffithsNottingham Trent University

Paul BellringerGamCare, London

Kevin Farrell-RobertsFaith Freestone

Gordon House Association, Dudley

The Gordon House Association (GHA) is the UK’s only specialist and dedicated resi-dential facility for problem gamblers. This paper describes the GHA therapeutic pro-gramme which is centred round a nine-month period of residency. Progressionthrough the programme is described by overviewing each of the phases. These areinitial assessment and five distinct phases comprising ‘coping with today’ (Phase One),‘coping with yesterday’ (Phase Two), coping with change (Phase Three), coping withtomorrow (Phase Four), and ‘coping on my own’ (Phase Five). These phases are them-selves underpinned within the GHA core therapeutic approach which is also described.

KEY WORDS: residential treatment; problem gambling; coping.

The Gordon House Association (GHA) was founded in 1971 andis the UK’s only specialist and dedicated residential facility for prob-

Address correspondence to Dr. Mark Griffiths, Psychology Division, Nottingham Trent Univer-sity, Burton Street, Nottingham NG1 4BU, United Kingdom.

162 JOURNAL OF GAMBLING STUDIES

lem gamblers. Although there are a handful of UK treatment centresthat provide treatment facilities to help problem gamblers (such as thePromis Recovery Centre in Kent), they tend to treat addicts of all typesrather than gamblers specifically. Furthermore, the approach of theseorganizations in treating problem gamblers tends to be based aroundthe twelve-step model favoured by such organizations as GamblersAnonymous (GA). This paper describes the GHA therapeutic pro-gramme—one which provides a strong framework on which problemgamblers can begin to rebuild their shattered lives.

BACKGROUND

The first Gordon House was named after its founder, the Rever-end Gordon Moody. (In the 1960s, Moody also helped to establish GAin the UK.) The GHA was established as a charity and from its incep-tion it has had strong links with the judiciary. It very quickly became arefuge for problem gamblers who were released, or diverted, fromprison. The GHA’s intention was to break the cycle of gambling,crime, and imprisonment. It has successfully treated hundreds ofchronic problem gamblers. The GHA ethos has not changed since itsestablishment. The GHA programme is available to any male problemgambler who is assessed as being suitable to take up residency. (Entryfor female problem gamblers is currently under review). The aim ofthe GHA is to provide an accountable service that reduces problemgambling and the harm done by such gambling.

The objects of the GHA (Bellringer, 1999) are to:

• Provide support and effective residential therapies to thosemost affected by problem gambling

• Provide, where possible and practicable, effective outreach forthose waiting to join, or who have recently left, the residentialprogramme

• Undertake and facilitate reviews, studies and research that maylead to a better understanding of the nature and effects ofproblem gambling and its treatment

MARK GRIFFITHS ET AL. 163

• Provide, where possible and practicable, effective outreach andtherapeutic interventions to those for whom the residentialprogramme is not appropriate

• Undertake tasks (alone or in conjunction with others) that willreduce the harmful social impact of gambling.

WHO COMES TO THE GORDON HOUSE ASSOCIATION?

In depth analyses of the gamblers being treated at the GHA willappear in due course. However, between October 1998 and March2000, 53 males (aged between 23 and 51) entered the programme. Ofthese, 32% gambled on slot machines only, 38% gambled with book-makers only, 18% gambled with bookmakers and at casinos, 9% gam-bled on slot machines and with bookmakers, and 3% gambled on ca-sino games only.

THE GORDON HOUSE ASSOCIATION THERAPY PROGRAMME

The GHA programme is centred round a nine-month period ofresidency followed by support when the gambler moves back into thewider community. Progression through the programme has been splitinto initial assessment (1–2 weeks) and five distinct phases. These are‘coping with today’ (12 weeks), ‘coping with yesterday’ (12 weeks),coping with change (12 weeks), coping with tomorrow (12 weeks), and‘coping on my own’ (ongoing). These phases are themselves under-pinned within the core therapeutic approach (see below). Further tothis, on a basic level, the GHA provides:

• A safe haven (“a place to hide”) at a time when events havereached “rock bottom”

• A structured programme that enables the re-establishment of aroutine

• A framework to understand their problem gambling and whythey did it

• Help (practical, legal, emotional, etc.) in facing problems thathave been created by problem gambling


• Practical help in taking responsibility for themselves and pre-vious actions created by problem gambling

Initial Assessment

Before entering the GHA programme, problem gamblers are as-sessed by GHA staff. Individual needs are assessed via an initial appli-cation form, a face-to-face interview and visit to the GHA. The assess-ment process establishes the context of the individual’s gamblingproblem. From this, a report is written which outlines the nature ofthe gambling problem, the likely causes and major consequences oftheir gambling. Further to this, the GHA staff also assess appropriate-ness, type of intervention and whether the problem gambler will bene-fit from residential provision (i.e., their motivation and suitability forthe programme). If they are given a place on the programme and wishto continue, a chart is drawn up outlining what they hope to achieveduring their stay. This plan, which is agreed as a contract, is compiledin conjunction with a key worker and a consultant psychotherapist.Other measures taken at this stage include the SOGS, DSM-IV and theGeneral Health Questionnaire.

CORE THERAPEUTIC APPROACH

Central to the GHA programme is the communal living experi-ence where all the resident problem gamblers share the same resolve.Each resident is allocated a key worker from within the staff team.Together with this key worker, the gambler will discuss and plan allaspects of the stay at the GHA. The key worker is responsible for en-suring that the gambler’s plan is kept to and that appropriate facilitiesand opportunities are provided. They will also keep a comprehensiverecord of the gambler’s progress through the programme and will pro-vide them with as much help, advice and support that is needed.

Regular reviews take place to determine if a gambler is ready tomove on to the next phase of their stay. Reviews can be requested atany time by those undergoing the programme. No-one moves onto thenext phase or is forced to complete a phase if they are not ready. Peergroup advice and support is the key to the whole GHA programme.GHA residents will support each other through the changes that each


of them has to make. By understanding their own experiences theycan recognise and provide for each other’s needs. Any ‘slip’ or ‘lapse’back into gambling will come under close scrutiny by the others in thehouse. Unless the gambler does not want to address the problem, anexamination of the lapse will be done in a supportive fashion by peo-ple who understand and to whom the gambler can talk to. Being ableto share and having support from others in the same situation asthemselves is one of the aspects of the programme that residents iden-tify as most helpful.

Phase One: Coping with Today

In this phase, the resident is encouraged to focus on new (orrenew old) leisure pursuits. The GHA provides an organized pro-gramme of activities, talks and discussions, not gambling focused butaimed at the time left vacant by lack of gambling. This is seen as par-ticularly important as prior to coming to the GHA the gambler maywell have spent the vast majority of their waking day either gamblingor planning their next session. During the withdrawal process, gam-blers express the boring and depressing void created when they stopgambling. This first stage is essentially about time management skilltraining as a way of combatting and filling this void. Skill training isintroduced—either in conjunction with an outside agency or throughan in-house course. This gives gamblers the confidence to respondconfidently to pressure from benefit agencies, family or creditors totake paid employment, and for any return to a job to be planned inadvance.

Another objective of the first phase of the programme is to re-establish a sense of stability in the life of the gambler. Before enteringthe programme, gamblers will have typically led a chaotic lifestyle leav-ing a destructive trail of mess behind them. This needs to be ad-dressed. Residency at the GHA provides the opportunity to step awayfrom problem gambling and to bring it under control. The new resi-dent may also begin to feel a sense of security simply by re-establishinga routine into their life. All residents are required to play a part in therunning of the house (cleaning, cooking etc.) and in looking afterthemselves (sorting out financial affairs and family matters; addressingany involvement in the legal or judicial system; registering with a localGP; employment issues etc.). Residents are encouraged to tackle per-


sonal issues themselves, but have a key worker on hand to help. Thishelps remove the fear and uncertainty of facing up to their difficulties,and may help in the restoration of self-esteem and personal worth.

It is also during the first phase that support networks involvingfellow residents develop. Supportive residents help each individual toget through one day at a time. Being among other gamblers who havealready moved through the stabilization process is a tremendous helpto newcomers struggling to come to terms with their situation. Duringthe first few weeks new residents often feel a strong urge to return togambling but others in the programme can help. For instance, thecompanionship of other residents when going to collect a social secu-rity cheque, is a strong factor in preventing an early relapse.

Phase Two: Coping with Yesterday

After the initial “settling in” period, the resident is ready to moveon in the programme. The second phase is when the “real work” takesplace. Through intensive psychodynamic group work and individualcognitive-behavioural counselling sessions, gamblers are given thera-peutic opportunities to explore underlying problems and reasons fortheir gambling dependency. These sessions also provide insight intowhy gambling became so important in their lives. At the end of thesecond phase, progress is reviewed and, in certain circumstances, anextension to individual sessions may be offered. However, to avoidtransferring dependency and to use limited resources appropriately,the GHA has evolved a clear policy to limit the time spent in individ-ual counselling. Should a need to explore other issues emerge or long-term counselling appear appropriate, the resident will be referred toanother appropriate counselling facility.

Further to this, the GHA retains positive links with local GAgroups and residents are encouraged to attend. The value of concur-rent treatment approaches is often appreciated by gamblers. Gamblersare often able to make the connection between the support and re-solve gained through the fellowship of GA and the GHA with the un-derstanding that comes from both psychodynamic groupwork and cog-nitive behavioural counselling. It is also during this phase that manygamblers feel strong enough to begin to “give back” after years of “tak-ing from.” For instance, they may seek family reconciliation, sharetheir story with the media, seek voluntary work, and/or become in-


volved in awareness raising. Such activities provide a positive and pro-ductive means of occupying their time.

Phase Three: Coping with Change

Residents who embrace and take advantage of the programme’sfirst six months are usually ready to begin to look outward. They maystill undergo individual counselling, but the emphasis reverts back tothe role of their key worker and of self-help. Essentially, the thirdphase involves coping with change and seeks to develop the necessarystrategies and skills to move on to a life without a gambling depen-dency. For most gamblers, this means thinking about a new careerand/or lifestyle, based on previous life experiences or (in a small num-ber of cases) something completely different. Plans will be made toeither (i) return to their family area, (ii) to look for a fresh start some-where else or (iii) to seek accommodation locally. The GHA pro-gramme has been designed to facilitate whichever route is chosen. Forexample, links have been established with local Housing Associationsso that if the resident wishes to remain in the proximity of the GHA,good quality accommodation can be secured.

It is at this stage that residents actively seek employment. To someextent, this dictates when the resident leaves the programme. Someresidents become impatient to move on and will chose to leave beforethe nine-month period of residence is over. Others may not be readyto look outside the supportive security of the community to which theyhave become accustomed. Their stay at the GHA may therefore be-come extended.

Phase Four: Coping with Tomorrow

The fourth phase provides a natural follow-on from the previousone as the main focus is on taking practical steps towards a return toindependent living and of returning to the wider community. TheGHA provides sessions on resettlement, survival, employment and so-cial skills. Residents are helped to find and furnish accommodation orto return to live with their family. As the agreed leave date approaches,the gambler will participate in a relapse prevention programme thatcomprises both individual and group sessions. This covers (i) strate-gies to minimize a return to gambling, and (ii) psychological and prac-


tical steps that the gambler can take if relapse occurs. For the firstthree months after leaving, the GHA provides intensive outreach sup-port, further group work and, in some instances, individual counsell-ing. For those who move out of the locality, the level of “after care” isnot as high as those that live near to the GHA. However, they areencouraged to keep in touch and, when practical, support is offered.

Phase Five: Coping on My Own

The fifth and final phase provides a decreased level of supportwhile former GHA residents establish themselves back into society. Ahigh proportion of ex-residents settle locally when they leave to takeadvantage of the ongoing support provided by the GHA and fromeach other. The intensive outreach support is phased out over a fur-ther 12-week period but continued contact with the GHA is encour-aged. Ex-residents have formed their own support group and a num-ber of them continue their link with the local branch of GA. The GHAprovide reunion meetings and a newsletter to maintain some level ofcontact for support and monitoring purposes. Should an ex-residentbe unable to cope in the wider community and return to problemgambling, they can apply for re-entry to the GHA. However, for thesmall number of places, demand is high and any such requests areassessed in the light of their application and on their response whenpreviously at the GHA.

MONITORING AND EVALUATION

Systematic monitoring and evaluation of the service has only re-cently been instigated therefore there are no outcome data at thepresent time. However, informal monitoring has revealed that theproblem gamblers who participate in the therapeutic programme de-rive many benefits. They value staying in a safe and supportive environ-ment among others who understand gambling dependency. Farrell-Roberts (1997) reported that the most highly rated aspects of living atthe GHA are perceived as being:

• Socialising with, and receiving day-to-day support from, otherresidents


• Individual sessions with keyworkers and provision by them ofday-to-day support

• Group meetings to share information, views and to exploreissues

• Individual counselling sessions

As with all therapeutic communities, the potential benefit and help toresidents is affected by whichever individuals are going through theprogramme at that particular time. In this respect the GHA is no ex-ception. Negative behaviour and attitudes by just one or two residentscan seriously disrupt the progress of others in their attempt to breaktheir gambling dependency. However, the GHA is a unique residentialfacility providing specialised and dedicated help to problem gamblersand has an important place in the UK’s network of national supportservices for problem gambling.

REFERENCES

Bellringer, P. (1999). Understanding Problem Gamblers. London: Free Association Books.Farrell-Roberts, K. (1997). Evaluating effectiveness: Residents’ satisfaction survey. Paper prepared

for the Gordon House Association, London.

Received April 20, 2000; final revision September 12, 2000; accepted October 2, 2000.

brief communications: treating problem gamblers: a residential therapy approach

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