Top

Published in:

01-09-2008 | Original Paper

Adapted Couple Therapy (ACT) for Pathological Gamblers: A Promising Avenue

Authors: Karine Bertrand, Magali Dufour, John Wright, Benoît Lasnier

Published in: Journal of Gambling Studies | Issue 3/2008

Abstract

The study of the effectiveness of treatment for pathological gambling constitutes a field that is still largely unexplored. To date, the models assessed primarily target the individual and include little or no involvement of the family circle. Yet, the deleterious effects of gambling on loved ones and especially spouses are well recognized. Further, the addition of a couple modality to individual treatment has been shown to be effective on many levels in the treatment of substances use disorders. This article therefore proposes a critical review of (1) the literature providing a better understanding of the complex interactions between the couple relationship and pathological gambling, (2) studies on the effects of couple therapies on gamblers and their partners. We then present the therapeutic model developed by our team of clinician-researchers in collaboration with actors from Québec clinical settings: Adapted Couple Therapy (ACT) for pathological gamblers. In the Québec context, this model will serve as a complement to an individual cognitive-behavioral treatment model that has been proven effective and is employed throughout the Canadian province. The assessment of couple therapies could reveal avenues of solutions to better assist pathological gamblers who tend to drop-out of treatment and relapse.

Abbott, D. A., Cramer, S. L., & Sherrets, S. D. (1995). Pathological gambling and the family: Practice implications. Families in Society, 76(4), 213–219.

Beaudoin, C. M., & Cox, B. J. (1999). Characteristics of problem gambling in a Canadian context: A preliminary study using a DSM-IV-based questionnaire. Canadian Journal of Psychiatry, 44, 483–487.

Bergh, C., & Kühlhorn, E. (1994). Social, psychological and physical consequences of pathological gambling in Sweden. Journal of Gambling Studies, 10(3), 275–285. doi:10.1007/BF02104968.CrossRef

Blaszczynski, A., & Farrell, E. (1998). A case series of 44 completed gambling related suicides. Journal of Gambling Studies, 14, 93–109. doi:10.1023/A:1023016224147.PubMedCrossRef

Blaszczynski, A., & McConaghy, N. (1989). The medical model of pathological gambling: Current shortcomings. Journal of Gambling Behavior, 5, 42–52. doi:10.1007/BF01022136.CrossRef

Boyd, B. F., & Bolen, G. (1970). The compulsive gambler and spouse in group psychotherapy. International Journal of Group Psychotherapy, 20, 77–90.PubMed

Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H., & Simpson, L. E. (2004). Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Journal of Consulting and Clinical Psychology, 72, 176–191. doi:10.1037/0022-006X.72.2.176.PubMedCrossRef

Christensen, A., & Jacobson, N. S. (2000). Reconcilable differences. New York: Guilford Press.

Ciarrocchi, J. (2002). Counseling problem gamblers: A self-regulation manual for individual and family therapy. San Diego, CA, US: Academic Press.

Ciarrocchi, J., & Hohmann, A. A. (1989). The family environment of married male pathological gamblers, alcoholics, and dually addicted gamblers. Journal of Gambling Behavior, 5(4), 283–291. doi:10.1007/BF01672429.CrossRef

Cunningham-Williams, R. M., Cottler, L. B., Compton, W. M., Spitznagel, E. L., & Ben-Abdallah, A. (2000). Problem gambling and comorbid psychiatric and substance use disorders among drug users recruited from drug treatment and community settings. Journal of Gambling Studies, 16(4), 347–376. doi:10.1023/A:1009428122460.PubMedCrossRef

Daughters, S. B., Lejuez, C. W., Lesieur, H. R., Strong, D. R., & Zvolensky, M. J. (2003). Towards a better understanding of gambling treatment failure: Implications of translational research. Clinical Psychology Review, 23(4), 573–586. doi:10.1016/S0272-7358(03)00037-0.PubMedCrossRef

Dickson-Swift, V. A., James, E. L., & Kippen, S. (2005). The experience of living with a problem gambler: Spouses and partners speak out. Journal of Gambling Issues, 13, 1–22.

Dumka, L. E., & Roosa, M. W. (1993). Factors mediating problem drinking and mothers’ personal adjustment. Journal of Family Psychology, 7, 333–343. doi:10.1037/0893-3200.7.3.333.CrossRef

Dumka, L. E., & Roosa, M. W. (1995). The role of stress and family relationships in mediating problem drinking and fathers’ personal adjustment. Journal of Studies on Alcohol, 56, 528–537.PubMed

el-Guebaly, N., Patten, S., Currie, S., Williams, J., Beck, C., Maxwell, C., et al. (2006). Epidemiological associations between gambling behavior, substance use mood and anxiety disorders. Journal of Gambling Studies, 22(3), 275–287.PubMedCrossRef

Epstein, N. B., & Baucom, D. H. (2002). Enhanced cognitive-behavioral therapy for couples: A contextual approach. Washington, DC: American Psychological Association.

Epstein, E. E., & McCrady, B. S. (2002). Couple therapy in the treatment of alcohol problems. In A. S. Gurman & N. S. Jacobson (Eds.), Clinical handbook of couple therapy (3rd ed., pp. 597–628). New York, USA: Guilford Press.

Evans, L., & Delfabbro, P. H. (2005). Motivators for change and barriers to help-seeking in Australian problem gamblers. Journal of Gambling Studies, 21, 133–155.PubMedCrossRef

Fals-Stewart, W., Birchler, G. R., & Kelley, M. L. (2006). Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients. Journal of Consulting and Clinical Psychology, 74, 579–591.PubMedCrossRef

Fals-Stewart, W., Birchler, G. R., & O’Farrell, T. J. (1996). Behavioral couples therapy for male substance-abusing clients: Effects on relationship adjustment and drug-using behavior. Journal of Consulting and Clinical Psychology, 64, 959–972.PubMedCrossRef

Fals-Stewart, W., Birchler, G. R., & O'Farrell, T. J. (1999). Drug-abusing patients and their intimate partners relationship stability, and substance use. Journal of Abnormal Psychology, 108, 11–23.PubMedCrossRef

Gottman, J. M., & DeClaire, J. (2001). The relationship cure: A five-step guide for building better connections with family, friends, and lovers. New York: Crown Publishers.

Grant, J. E., Kim, S. W., & Kukowski, M. (2004). Retrospective review of treatment retention in pathological gambling. Comprehensive Psychiatry, 45(2), 83–87.PubMedCrossRef

Griffiths, M., Scarfe, A., & Bellringer, P. (1999). The UK national telephone gambling helpline-results on the first year of operation. Journal of Gambling Studies, 15, 83–90.PubMedCrossRef

Halford, W. K., & Osgarby, S. M. (1993). Alcohol abuse in clients presenting with marital problems. Journal of Family Psychology, 6, 245–254.CrossRef

Hall, G. W., Carriero, N. J., Takushi, R. Y., Montoya, I. D., Preston, K. L., & Gorelick, D. A. (2000). Pathological gambling among cocaine-dependent outpatients. American Journal of Psychiatry, 157, 1127–1133.PubMedCrossRef

Harvey, P., Trudel, G., Poirier-Arbour, A., & Boyer, R. (2007). Le jeu pathologique et l’expression de la colère au sein du couple. XXIXème congrès annuel de la SQRP, Université de Sherbrooke, Sherbrooke.

Hodgins, D. C., & el-Guebaly, N. (2000). Natural and treatment-assisted recovery from gambling problems: A comparison of resolved and actives gamblers. Addiction, 95, 777–789.PubMedCrossRef

Hodgins, D. C., & el-Guebaly, N. (2004). Retrospective and prospective reports of precipitants to relapse in pathological gambling. Journal of Consulting and Clinical Psychology, 72, 72–80.PubMedCrossRef

Hodgins, D. C., Shead, N. W., & Makarchuk, K. (2007). Distress among concerned significant others of pathological gamblers. Journal of Nervous and Mental Disease, 195, 65–71.PubMedCrossRef

Jacobson, N. S., & Christensen, A. (1996). Integrative couple therapy. New York: Norton.

Johns, A. L., Newcomb, M. D., Johnson, M. D., & Bradbury, T. N. (2007). Alcohol-related problems, anger, and marital satisfaction in monoethnic Latino, biethnic Latino, and European American newlywed couples. Journal of Social and Personal Relationships, 24(2), 255–275.CrossRef

Kahler, C. W., McCrady, B. S., & Epstein, E. E. (2003). Sources of distress among women in treatment with their alcoholic partners. Journal of Substance Abuse Treatment, 24(3), 257–265.PubMedCrossRef

Kalischuk, R. G., Nowatzki, N., Cardwell, K., Klein, K., & Solowoniuk, J. (2006). Problem gambling and its impact on families: A literature review. International Gambling Studies, 6(1), 31–60.CrossRef

Ladouceur, R., Gosselin, P., Laberge, M., & Blaszczynski, A. (2001). Dropouts in clinical research: do results reported reflect clinical reality? The Behavior Therapist, 24, 44–46.

Ladouceur, R., Sylvain, C., & Boutin, C. (2000). Pathological gambling. In M. Hersen & M. Biaggio (Eds.), Effective brief treatment for adults: A clinician’s guide (pp. 308–318). New York: Academic Press.

Ladouceur, R., Sylvain, C., Sévigny, S., Poirier, L., Brisson, L., Dias, C., et al. (2004). Caractéristiques des joueurs excessifs selon le mode de traitement. Québec: Université Laval.

Ledgerwood, D. M., & Petry, N. M. (2006). What do we know about relapse in pathological gambling? Clinical Psychology Review, 26, 216–228.PubMedCrossRef

Lee, B. (2002). Well-being by choice not by chance: An integrative system-based couple treatment model for problem gambling. Research report submitted to Ontario Problem Gambling Research Center, April 2002.

Leonard, K. E., & Roberts, L. J. (1998). The effects of alcohol on the marital interactions of aggressive and nonaggressive husbands and their wives. Journal of Abnormal Psychology, 107, 602–615.PubMedCrossRef

Leonard, K. E., & Senchak, M. (1993). Alcohol and premarital aggression among newlywed couples. Journal of Studies on Alcohol, 11, 96–108.

Lobsinger, C., & Beckett, L. (1996). Odds to break even: A practical approach to gambling awareness. Sydney: Relationships Australia Inc.

Locke, T., & Newcomb, M. (2003). Childhood maltreatment, parental alcohol/drug-related problems, and global parental dysfunction. Professional Psychology-Research and Practice, 34, 73–79.CrossRef

Lorenz, V. C. (1987). Family dynamics of pathological gamblers. In T. Galski (Ed.), The handbook of pathological gambling (pp. 71–88). Springfield, IL: Charles C. Thomas.

Lorenz, V. C. (1989). An overview of pathological gambling. Baltimore: National Center for Pathological Gambling.

Lorenz, V. C., & Shuttlesworth, D. (1983). The impact of pathological gambling on the spouse of the gambler. Journal of Community Psychology, 11, 67–76.CrossRef

Lorenz, V. C., & Yaffee, R. A. (1988). Pathological gambling: Psychosomatic, emotional, and marital difficulties as reported by the spouse. Journal of Gambling Behavior, 4(1), 13–26.CrossRef

Lorenz, V. C., & Yaffee, R. A. (1989). Pathological gamblers and their spouses: Problems in interaction. Journal of Gambling Behavior, 5(2), 113–126.CrossRef

Maisto, S. A., McKay, J. R., & O’Farrell, T. J. (1998). Twelve-month abstinence from alcohol and long-term drinking and marital outcomes in men with severe alcohol problems. Journal of Studies on Alcohol, 59, 591–598.PubMed

Marshal, M. P. (2003). For better or for worse? The effects of alcohol use on marital functioning. Clinical Psychology Review, 23(7), 959–997.PubMedCrossRef

McCrady, B. S., & Epstein, E. E. (1995). Marital therapy in the treatment of alcohol problems. In N. S. Jacobson & A. S. Gurman (Eds.), Clinical handbook of clinical therapy (pp. 369–393). New York, NY: Guilford Press.

McCrady, B. S., Hayaki, J., Epstein, E. E., & Hirsch, L. S. (2002). Testing hypothesized predictors of change in conjoint behavioral alcohol treatment for men. Alcoholism: Clinical and Experimental Research, 26, 463–470.CrossRef

McGurrin, M. C. (1992). Pathological gambling: Conceptual, diagnostic and treatment issues. Sarasota, FL: Professional Resource Press.

Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2007). Psychological treatment dropout among pathological gamblers. Clinical Psychology Review, 27(8), 944–958.PubMedCrossRef

Miller, W. R., Rollnick, S., & Conforti, K. (2002). Motivational Interviewing, 2nd edn: Preparing people for change. New York (NY): Guilford Publications.

Minuchin, S. (1974). Families and family therapy. Cambridge, MA, Harvard University Press.

Moos, R. H. (2007). Theory-based processes that promote the remission of substance use disorders. Clinical Psychology Review, 27, 537–551.PubMedCrossRef

Moos, R. H., & Moos, B. S. (1981). Family environment scale manual. Palo Alto, California: Consulting Psychologists Press.

Mudar, P., Leonard, K. E., & Soltysinski, K. (2001). Discrepant substance use and marital functioning in newlywed couples. Journal of Consulting and Clinical Psychology, 69(1), 130–134.PubMedCrossRef

O’Farrell, T. J. (1993). Treating alcohol problems: Marital and family interventions. New York: Guilford Press.

O’Farrell, T. J., & Birchler, G. R. (1987). Marital relationships of alcoholic, conflicted, and nonconflicted couples. Journal of Marital and Family Therapy, 13, 259–274.CrossRef

O’Farrell, T. J., Cutter, H. S. G., Choquette, K. A., Floyd, F. J., & Bayog, R. (1992). Behavioral marital therapy for male alcoholics: Marital and drinking adjustment during the two years after treatment. Behavior Therapy, 23, 529–549.CrossRef

O’Farrell, T. J., & Fals-Stewart, W. (2003). Alcohol Abuse. Journal of Marital and Family Therapy, 29, 121–146.PubMedCrossRef

O’Farrell, T. J., & Fals-Stewart, W. (2006). Behavioral couples therapy for alcoholism and drug abuse. New York (NY): Guilford Press.

O’Farrell, T. J., Hooley, J., Fals-Stewart, W., & Cutter, H. S. G. (1998). Expressed emotion and relapse in alcoholic patients. Journal of Consulting and Clinical Psychology, 66, 744–752.PubMedCrossRef

Oei, T. P. S., & Gordon, L. M. (2008). Psychosocial factors related to gambling abstinence and relapse in members of gamblers anonymous. Journal of Gambling Studies, 24(1), 91–105.PubMedCrossRef

Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B. H., & Molde, H. (2005). Outcome of psychological treatments of pathologicalgambling: A review and meta-analysis. Addiction, 100, 1412–1422.PubMedCrossRef

Petry, N. M. (2005). Pathological gambling: Etiology, comorbidity and treatments. American Psychological Association Press: Washington DC.

Petry, N. M. (2007). Gambling and substance use disorders: Current status and future directions. American Journal on Addictions, 16(1), 1–9.PubMedCrossRef

Poirier-Arbour, A., Trudel, G., Harvey, P., and Boyer, R. (2007). Dépression et anxiété chez les joueurs et leur partenaire. Université du Québec à Montréal et Centre de recherche Fernand Séguin, présenté lors du Colloque « Les multiples facettes du jeu », Université Laval.

Potenza, M. N., Steinberg, M. A., McLaughlin, S. D., Wu, R., Rounsaville, B. J., & O’Malley, S. S. (2001). Gender-related differences in the characteristics of problem gamblers using a gambling helpline. American Journal of Psychiatry, 158, 1500–1505.PubMedCrossRef

Satir, V. (1983). Conjoint family therapy (3rd edn). Palo Alto, California: Science and Behavior Books.

Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). The Satir model: Family therapy and beyond. California: Science and Behavior Books.

Satir, V., Stachowiak, J., & Taschman, H. A. (1994). Helping families change. US: Jason Aronson.

Shaffer, H. J., & Korn, D. A. (2002). Epidemiology and biostatistics—gambling and related mental disorders: A public health analysis. Annual Review of Public Health, 23, 171–212.PubMedCrossRef

Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2006). Current status and future directions in couple therapy. Annual Review of Psychology, 57, 317–344.PubMedCrossRef

Snyder, D. K., & Whisman, M. A. (Eds.). (2003). Treating difficult couples: Helping clients with coexisting mental and relationship disorders. New York: Guilford Press.

Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38(1), 15–28.CrossRef

Steinberg, M. A. (1993). Couples treatment issues for recovering male compulsive gamblers and their partners. Journal of Gambling Studies, 9(2), 153–167.CrossRef

Stinchfield, R., & Winters, K. (2001). Outcome of Minnesota’s gambling treatment programs. Journal of Gambling Studies, 17, 217–245.PubMedCrossRef

St-Jacques, M., & Nadeau, L. (2008). Intervention auprès des couples alcooliques et toxicomanes. In J. Wright, Y. Lussier & S. Sabourin (Eds.), Manuel clinique des psychothérapies de couple (pp. 581–622). Québec: Presses de l’Université du Québec.

Sylvain, C., Ladouceur, R., & Boisvert, J. M. (1997). Cognitive and behavioral treatment of pathological gambling: A controlled study. Journal of Consulting and Clinical Psychology, 65, 727–732.PubMedCrossRef

Toneatto, T., & Ladouceur, R. (2003). The treatment of pathological gambling: A critical review of the literature. Psychology of Addictive Behavior, 17, 284–292.CrossRef

Toneatto, T., & Millar, G. (2004). The assessment and treatment of problem gambling: Empirical status and promising trends. Canadian Journal of Psychiatry, 49, 173–181.

Tremblay, J., Bertrand, K., & Ménard, J.-M. (2005). Implication des membres de l’entourage dans le processus de réadaptation des personnes alcooliques et toxicomanes. Publié par le Comité permanent de lutte à la toxicomanie.

Tremblay, J. & Brisson, L. (2007). Intervention conjugale en jeu pathologique. Colloque « Les multiples facettes du jeu », Université Laval.

Welte, J., Barnes, G., Wieczorek, W., Tidwell, M.-C., & Parker, J. (2001). Alcohol and gambling pathology among U.S. adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol and Drugs, 62 (5), 706–712.

Whisman, M. A., Uebelacker, L. A., & Bruce, M. L. (2006). Longitudinal association between marital dissatisfaction and alcohol use disorders in a community sample. Journal of Family Psychology, 20(1), 164–167.PubMedCrossRef

Wildman, R. (1989). Pathological gambling: Marital-familial factors, implications, and treatments. Journal of Gambling Behavior, 5, 293–301.CrossRef

Wilsnack, S. C., Klassen, A. D., Schur, B. E., & Wilsnack, R. W. (1991). Predicting onset and chronicity of women’s problem drinking: A 5-year longitudinal analysis. American Journal of Public Health, 81, 305–318.PubMedCrossRef

Winters, J., Fals-Stewart, W., O’Farrell, T. J., Birchler, G. R., & Kelley, M. L. (2002). Behavioral couples therapy for female substance-abusing patients: Effects on substance use and relationship adjustment. Journal of Consulting and Clinical Psychology, 70, 344–355.PubMedCrossRef

Wright, J., Lussier, Y., & Sabourin, S. (2008a). Manuel clinique des psychothérapies de couple. Québec: Presses de l’Université du Québec.

Wright, J., Mondor, J., Sabourin, S., & Pinsof, W. (2008b). Le statut empirique de la thérapie conjugale. In J. Wright, Y. Lussier & S. Sabourin (Eds.), Manuel clinique des psychothérapies de couple. (chapitre 17). Sainte-Foy (QC): Presses de l’Université du Québec.

Wright, J., Sabourin, S., Lussier, Y., & Poitras-Wright, H. (2008c). La psychothérapie de couple d’orientation cognitivo-comportementale. In J. Wright, S. Sabourin & Y. Lussier (Eds.), Manuel clinique des psychothérapies de couple (chapitre 4). Sainte-Foy (Québec): Presses de l’Université du Québec.

Wright, J., Sabourin, S., Mondor, J., Mcduff, P., & Mamodhousen, S. (2007). The clinical representativeness of couple therapy outcome research. Family Process, 46(3), 301–316.PubMedCrossRef

Zweben, A. (1986). Problem drinking and marital adjustment. Journal of Studies on Alcohol, 47(2), 167–172.PubMed

Title: Adapted Couple Therapy (ACT) for Pathological Gamblers: A Promising Avenue
Authors: Karine Bertrand
Magali Dufour
John Wright
Benoît Lasnier
Publication date: 01-09-2008
Publisher: Springer US
Published in: Journal of Gambling Studies / Issue 3/2008
Electronic ISSN: 1573-3602
DOI: https://doi.org/10.1007/s10899-008-9100-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Adapted Couple Therapy (ACT) for Pathological Gamblers: A Promising Avenue

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2008

Near Miss, Gambler’s Fallacy and Entrapment: Their Influence on Lottery Gamblers in Thailand

Significant Others and Gambling Treatment Outcomes

A Canadian Population Level Analysis of the Roles of Irrational Gambling Cognitions and Risky Gambling Practices as Correlates of Gambling Intensity and Pathological Gambling

The Desire to Gamble: The Influence of Outcomes on the Priming Effects of a Gambling Episode

The Impact of Social Desirability Biases on Self-Report Among College Student and Problem Gamblers

SOGS and CGPI: Parallel Comparison on a Diverse Population