eacbt sabbatino mi 2010

8/8/2019 Eacbt Sabbatino Mi 2010

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Removing barriers toRemoving barriers to

accessing treatmentaccessing treatmentSonya SabbatinoSonya Sabbatino

ISTITUTO WATSONISTITUTO WATSONwww.iwatson.comwww.iwatson.comTorinoTorino

[email protected]@iwatson.com [email protected]@iwatson.com


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Classifying the EvidenceClassifying the EvidencePractice Guidelines for Treating Gambling-Related Problems

An Evidence-Based Treatment Guide for Clinicians

David A. Korn, Howard J. ShafferDeveloped by the Massachusetts Council on Compulsive Gambling January, 2004

Strength of EvidenceStrength of Evidence InterventionsInterventions

Strong evidence

Cognitive Behavioral Therapy

Behavioral Therapy

Moderate Evidence Relapse Prevention

Weak Evidence

Psychodynamic Psychotherapy

Aversion Therapy

12-step (e.g., GamblersAnonymous; self-help)

Self-Exclusion (self-help)


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Minimal Interventionsrange from

MotivationalMotivational InterviewingInterviewing::

A directive, client-centred method for enhancingintrinsic motivation to change by exploring and

resolving ambivalence (Miller & Rollnick, 2002)

SelfSelf HelpHelp ManualsManuals::

- Cognitivebehavioral/self-control strategies such

as selfmonitoring,- Functional analysis,

- Goal setting, and

- Selfreinforcement.


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Dickerson and Weeks (1979)Dickerson and Weeks (1979)

Found that the use of a SelfSelf--HelpHelp

ManualManual significantlysignificantly reducedreduced gamblinggamblingalonealone oror inin conjunctionconjunction withwith aa singlesingle in-depth motivation interview.


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Present evidence that a MotivationalMotivational

InterviewingInterviewing approach may maximizethe benefit of a BriefBrief InterventionIntervention andhelp engage people with addictivebehaviors in therapy by overcoming

ambivalence and clarifying goals, thusincreasing opportunity for positivechange.

Miller and Rollnick (1991) :


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1 month follow up: MotivationalMotivational EnhancementEnhancementTelephoneTelephone InterventionIntervention ++ SelfSelf HelpHelp WorkbookWorkbook (not theWorkbookWorkbook OnlyOnly) had better outcomes than part. inWaitWait ListListControlControl

3 & 6 month follow up: MotivationalMotivational Interview+Interview+ SelfSelfHelpHelp WorkbookWorkbook showed better outcomes thanWorkbookWorkbook OnlyOnly

12 month follow up: The advantage of theMotivationalMotivational InterviewInterview ++ SelfSelf HelpHelp WorkbookWorkbook group

was found only for part. with less severe gamblingproblems

RESULTSRESULTS:: 8484%% PARTECIPANTSPARTECIP ANTS (N=(N=102102)) REPORTEDREPORTED AASIGNIFICANTSIGNIFICANT REDUCTIONREDUCTION ININ GAMBLINGGAMBLING OVEROVER AA 1212MONTHMONTH FOLLOWFOLLOW UPUP PERIODPERIOD

Motivational Enhancement and SelfMotivational Enhancement and Self--HelpHelpTreatments for Problem GamblingTreatments for Problem Gambling

(Hodgins, Currie, el(Hodgins, Currie, el--Guelaby, 2001)Guelaby, 2001)


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Minimal treatment 24 MonthMinimal treatment 24 Monthoutcomeoutcome


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Brief Motivational Treatment forBrief Motivational Treatment forProblem Gambling: A 24 Month Follow UpProblem Gambling: A 24 Month Follow Up

(Hodgins, Currie, el(Hodgins, Currie, el--Guelaby, 2004)Guelaby, 2004)

MotivationalMotivational EnhancementEnhancement TelephoneTelephone InterventionIntervention ++ SelfSelfHelpHelp WorkbookWorkbook compared with WorkbookWorkbook OnlyOnly

NoNo differencesdifferences in the number of partecipants reporting 6

month abstinence

MotivationalMotivational InterventionIntervention ++ SelfSelf HelpHelp WorkbookWorkbook gambledfewer days, lost less money, and had lower South OaksGambling Screen scores

RESULTSRESULTS:: SUPPORTSUPPORT EFFECTIVENESSEFFECTIVENESS OFOF A A BRIEFBRIEFTELEPHONETELEPHONE ANDAND MAILMAIL BASEDBASED TREATMENTTREATMENT FORFOR PROBLEMPROBLEMGAMBLERSGAMBLERS


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Randomized trial of Internet Delivered Self HelpRandomized trial of Internet Delivered Self HelpWith Telephone Support for Pathological GamblersWith Telephone Support for Pathological Gamblers

(Carlbring, Smit2008)(Carlbring, Smit2008)

THETHE GOALGOAL: Test an OnlineOnline alternative to the effectivetherapies to lower the barriers for help seeking

N=66 partecipants pathological gamblers

Wait list Control compared with 88 WeekWeek InternetInternet basedbasedCBTCBT programprogram with minimal therapist contact via e-mail andweekly telephone calls of less than 15 min. (average timespent on each part.= 4 h)

RESULTSRESULTS:: FAVORABLEFAVORABLE CHANGESCHANGES ININ PP..GG..,, ANXIETY,ANXIETY,DEPRESSIONDEPRESSION (not(not severe),severe), QUALITYQUALITY OFOF LIFELIFE..FollowsFollows upup atat 66--1818--3636 monthsmonths indicatedindicated thatthat treatmentstreatmentseffectseffects werewere sustainedsustained..


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Studies conclusionsStudies conclusions

Significant reduction in gambling.

Support for Stepped Care Model.

Motivational enhancement helpful.

No gender differences.

Media recruitment is an effective way to attractproblem gamblers not seeking treatmentparticularly women.

Results promising. More evidence needed fordistance treatment trough help online, telephone,video conferencing and workbooks


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FavorableFavorable outcomesoutcomes in changing gambling behavior,although research is needed to replicate the findings

CostCost effectiveeffective to the consumer and for those who areproviding the service.

Considering the cost of health care and the possibility theindividual might lack insurance coverage, this approachcould be a valuablevaluable firstfirst stepstep in treatment of pathologicalgambling.

If the gambler does not respond favorably to thistreatment approach, the treatment professional shouldoffer the client a more intensive intervention.

Whatsinteresting?Whatsinteresting?

The MinimalistApproach


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An overwiew on WorkbooksAn overwiew on Workbooks


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Freedom from Problem GamblingFreedom from Problem Gambling

http://www.uclagamblingprogram.org/clinical_drug_trials.html

This self-help workbook for problem gamblers,developed by the UCLA Gambling StudiesProgram, is a tool for assisting people who aremotivated to stop gambling or reduce theirproblems associated with gambling.

The workbook is under evaluation forEffectiveness and is NOT a substitute forprofessional help.

5 chapters, each of which focuses on adifferent aspect of gambling. The chaptersare further divided into sections or topics that

contain several paper exercises.

Timothy W. Fong M.D., Richard J. Rosenthal M.D.

Office of problem Gambling

California Departement of Alcohol & Drug Abuse

Version 1.1, March 2008Version 1.1, March 2008


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How to Quit or Reduce Your Gambling:How to Quit or Reduce Your Gambling:SelfSelf--Help WorkbookHelp Workbook

http://www.problemgambling.ca

Studies have shown that most clients attendtreatment an average of 6 times, which is whythis Program has been structured so that thebulk of the treatment can be completed in about

6 weeks.

This Workbook summarizes the most effectiveways to help someone trying to overcome agambling habit. Each of the Treatment Topicsincludes a short description, some information to

think about, and an exercise to work on.

Tony Toneatto, Ph.D., Barbara Kosky, M.A.Sc., Gloria I. Leo, M.A.Copyright 2003 Centre for Addiction and Mental Health


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Gambling Behaviour SelfGambling Behaviour Self--Study WorkbookStudy Workbookhttp://www.responsiblegambling.org/

5 chapters containing:

An overview, information on the topics, and exercises

to complete An invitation to record daily activities as a way of

tracking progress A checklist to help review work and help decide if

ready to move on.

RESPONSIBLE GAMBLING COUNCILADDICTIONS FOUNDATION OF MANITOBA


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Workbooks utilityWorkbooks utilityin my experiencein my experience

PatientsPatients Type ofType ofgamblinggambling

SpentSpent

MonthlyMonthly

SOGSSOGS TreatmentTreatment

Men, 28

years

Totogol 600,00 9/20 1 hour Weekly

sessions:Motivationalenhancement + UCLAWorkbook

Men, 50years

SlotMachines

2.000,00 9/20 1 hour Weeklysessions:

CBT + UCLAworkbook

Men, 30years

SlotMachines

2.000,00 10/20 1 hour Weeklysessions:

CBT + UCLA

workbook


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ResultsResults

PatientsPatients TotalTotalhours ofhours of

treatmenttreatment

1 Year1 YearFollow UpFollow Up

TimeTimeSpentSpent

GamblingGambling

ConclusionsConclusions

Men, 28

years

8 Controlled

gam

bling

Once in a

Week

Motivational

enhancement helpfulGamblers reported theutility of reading themanual and followingthe strategies.

WB useful in relapseprevention

Men, 50years

12 Abstinence 0

Men, 30years

20 Abstinence 0


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Thanks for AttentionThanks for AttentionContacts:Contacts:

[email protected]@iwatson.com

[email protected]@iwatson.com

Istituto WatsonIstituto Watson www.iwatson.comwww.iwatson.com +390115611102+390115611102

Sonya SabbatinoSonya Sabbatino

eacbt sabbatino mi 2010

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