Understanding and treating the pathological gambler: Book review.

Abstract

ROBERT LADOUCEUR, CAROLINE SYLVAIN, CLAUDE BOUTIN, and CELINE DOUCET. Understanding and Treating the Pathological Gambler. San Francisco, CA: Jossey-Bass, 2002, 192 pages. (ISBN 0-470-84377-2, US$85.00). In recent years, with the increasing availability of games of chance throughout North America and a corresponding increase in problem gambling, there has been a growing interest in developing validated treatments for this disorder. Dr. Ladouceur and his colleagues are one of very few research teams devoted to developing and evaluating cognitive-behavioural treatments for problem or pathological gambling. As a result, this new book represents an excellent introduction to basic cognitive and behavioural treatment principles and strategies that guide this group's clinical research. The first chapter provides a brief historical overview of gambling with a focus on the psychology of gambling to help explain this sometimes puzzling human activity. Chapter 2 surveys the major etiological theories of problem gambling, with greater focus on the cognitive/behavioural models. The authors suggest that the cognitive-behavioural approach to treatment may yield the best clinical results, and allude to their own treatment research program, the components of which are elaborated in the ensuing chapters. A detailed description of the symptoms comprising the 10 diagnostic criteria for pathological gambling according to DSM-IV is presented in Chapter 3 followed by an assessment protocol used by the authors to evaluate the nature of the gambling problem. Several pages are devoted to the assessment of erroneous gambling cognitions, considered by the authors to be the key variable maintaining excessive gambling, with illustrative case vignettes. Chapter 4 elaborates further on what is considered to be the primary cognitive distortions: believing that gambling events are contingent or nonindependent, illusions of control, and superstitious behaviour. The details of conducting cognitive treatment are presented in Chapter 5. The key components include: the identification of cognitive distortions that may be mediating the gambling behaviour, an analysis of the pros and cons of gambling and not gambling, education about the nature of chance, and an informative illustration of how to identify the chain of cognitions that lead to gambling behaviour. Throughout the chapter numerous clinical case vignettes and examples are utilized demonstrating alternative cognitions and reappraisals to help the client cope with gambling-related cognitive distortions. A behavioural approach to treatment is outlined in Chapter 6, including effective responses to high-risk gambling situations, modifying the client's availability of money, improving social, recreational, and leisure functioning, and coping with daily stress and frustration. This chapter is considerably less detailed with fewer illustrative clinical examples but with plenty of helpful strategies. Chapter 7 is devoted to relapse prevention. The case is made for integrating relapse prevention into treatment by raising the possibility of relapse and appropriate responses early in treatment. In addition, the authors have adapted relapse prevention strategies common in the wider addiction treatment literature. …