Your First Step to Change

People frequently assume everyone who is affected by an addictive disorder seeks treatment from a professional health care provider. However, this frequently is not the case. Studies examining the varying treatment approaches for problem gambling point to a number of reasons why many individuals with this disorder are not in formal treatment.
 
For example, one research project found that many had a strong desire to handle their problems on their own or faced several obstacles to treatment such as embarrassment, the lack of available treatment, ignorance of resources, and the stigma of the disorder (Hodgins & El-Guebaly, 2000). Furthermore, in today's world of limited mental health benefits, even the insured may confront financial obstacles to seeking professional help.
 
Self-help workbooks provide a cost-effective, accessible, and private alternative to formal treatment for addictive disorders. Workbooks such as Problem Drinkers: Guided Self-Change Treatment have been tested among individuals who abuse alcohol, with positive results. Gambling researchers believe this approach might be especially useful for level 2 gamblers (i.e., gamblers who are experiencing problems but do not meet diagnostic criteria for pathological gambling.). The most recent guide was developed by the Massachusetts Council on Compulsive Gambling (MCCG) in collaboration with the Institute for Research on Pathological Gambling and Related Disorders. Funded by the Massachusetts Department of Public Health, copies of Your First Step to Change are now available to MCCG help line callers.

Reflecting the influence of research on recovery, the guide recognizes that individuals affected by an addictive disorder are often ambivalent about experiencing personal change (Shaffer & Simoneau, 2001). As evident in the first page of the guide, Your First Step to Change provides a place for the indecision inherently associated with change.

If gambling is affecting your life and you are thinking about change, you've already taken the first step. This guide will help you understand gambling, figure out if you need to change, and decide how to deal with the actual process of change. If you're at all concerned about your gambling, this guide is for you.

Should you decide to change, this guide can help you begin your journey. You can use the guide in the way you feel most comfortable. Complete it all at once, a little at a time, or keep it as a reference that you can read whenever you want. The guide is divided into the following three sections:

Section 1: Facts about Gambling, will explain how gambling works and how it can become a problem for some people.
Section 2: Understanding Your Gambling, will help you think about how you gamble and your reasons for gambling.
Section 3: Thinking About Change, will lead you through the process of change.

The MCCG and the Institute plan to test the efficacy of the guide. The MCCG is currently inviting help line callers to participate in the study.
 
For a copy of Your First Step to Change, contact the MCCG (617-426-4554) or download the guide in PDF format from the Web site of the Division on Addictions, Harvard Medical School (Click on Library and Archives and go to Division Publications). An online, interactive version of the guide is also in the works.

REFERENCES

- Hodgins, D. C., S. R. Currie, et al. (2001). Motivational enhancement and self-help treatments for problem gambling. Journal of Consulting & Clinical Psychology 69(1), 50-57.
- Hodgins, D.C. & el-Guebaly, N. (2000). Natural and treatment-assisted recovery from gambling problems: A comparison of resolved and active gamblers. Addiction, 95(5): 777-789.
- Hodgins, D.C. & Makarchuk, K. (1998). Becoming a Winner: Defeating Problem Gambling.  Calgary, Alberta, Canada: University of Calgary Press.
- Shaffer, H. J. & Simoneau, G. (2001).  Reducing resistance and denial by exercising ambivalence during the treatment of addiction. Journal of Substance Abuse Treatment 20, 99-105.
- Sobell, L.C., Cunningham, J.A., Sobell, M.B., Agrawal, S., Gavin, D.R., Leo, G.I. & Singh, K.N. (1996).  Fostering self-change among problem drinkers: A proactive community intervention.  Addictive Behaviors, 21, 817-833.
- Sobell, M. B. and Sobell, L.C. (1993). Problem drinkers: guided self-change treatment. New York, Guilford.