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PGIO Newsletter | Winter 2018

Feature Article:
Excitement Builds for the 2018 Forum! Have You Saved the Date?

PGIO Forum logo

Save the date! The 2018 Ontario Problem Gambling Provincial Forum will take place on June 18 and 19 in Ottawa. Featured speakers include two local Ottawa treatment specialists covering the respective topics of "Attachment and Gaming" and "Trauma and Shame" as well as a Toronto-based expert presenting on "Cognitive-Behavioural Therapy for Insomnia." Read on to learn more!

Attachment and gaming

In your clinical practice, have you grappled with how best to support families experiencing problem technology use such as excessive Internet use or video gaming? Have you wondered how to make some progress with attachment patterns in these negatively impacted families? Attachment and its role in both the development and treatment of addictive behaviours have been examined in many studies (Eichenberg et al., 2017). To date, however, few studies have looked at the role of attachment in problem technology use. One recent study by Eichenberg and colleagues (2017) found that people with insecure attachments were more likely to develop an Internet addiction compared to people with secure attachments. This study also found a link between an ambivalent attachment style and Internet addiction (Eichenberg et al., 2017).

Some of the pioneering clinical work in this field has been done by Dr. Michael Cheng, a child and family psychiatrist at the Children's Hospital of Eastern Ontario and associate professor in the Department of Psychiatry at the University of Ottawa. Dr. Cheng will provide attendees with strategies to help families disconnect from things, activities and people that are harmful in their lives and provide guidelines for (re)building attachments with youth experiencing problem technology use.

Following Dr. Cheng's presentation at the forum, we will welcome Elaine and Jake Uskoski―a mother and son with lived experience―who will provide us with an important, enriching learning opportunity to hear firsthand about their challenges and triumphs and their navigation of the treatment system.

Trauma and shame

You know from your clinical experience what has been well documented in research―that a majority of people with gambling problems have experienced trauma at some point in their lives (Kausch et al., 2006; Shultz et al., 2016).

Our clients often experience complex feelings of guilt and shame as they deal with past or current traumas along with their problem gambling. Deeply entrenched feelings of guilt and shame can affect gambling behaviours, and gambling behaviours can further reinforce these feelings, resulting in a complex interaction. With Mary Ann Carmichael, we will delve into the connections between emotions, behaviours, trauma and shame. Carmichael is a registered social worker certified in Eye Movement Desensitization and Reprocessing who works in a private practice in Ottawa, Ontario. She will speak to us about trauma, shame and the implications and considerations for problem gambling treatment.

Cognitive-behavioural therapy and insomnia

Do your clients experience problems with their sleep patterns? Do you ever wonder what the best practices are for addressing insomnia in your clients with problem gambling?

Dr. Colleen Carney, associate professor and director of the Sleep and Depression Laboratory at Ryerson University, is an expert on adapting cognitive-behavioural therapy (CBT) to treat insomnia. As an invited speaker at the 2018 Ontario Provincial Forum, she will speak to us about how CBT techniques can help your clients manage sleep problems alongside their gambling concerns.

Although sleep issues were previously thought to occur only when a client is in crisis or during withdrawal, recent studies show a link between problem gambling and sleep problems (Parhami et al., 2012; 2013).

More research still needs to be done on the causes of insomnia as they relate to problem gambling. However, some speculations as to possible causes include stress, anxiety, depression, anger, guilt, shame and/or preoccupation with thoughts of gambling or plans to gamble (Parhami et al., 2013). Sleep problems can also arise when people engage in gambling activities at night.

Furthermore, Loft and Loo (2015) found a relationship between problem gambling, sleep difficulty and negative sleep habits, and self-regulatory capacity, suggesting that sleep problems may further exacerbate gambling concerns by depleting one's ability to regulate emotions, thoughts and actions.

No matter what the cause or consequence, having tools to assist clients in managing their sleep problems is invaluable, since sleep problems are often not the primary focus of treatment or not looked at to the extent needed.

Interested in learning more? Save the dates of June 18 and 19, and stay tuned for upcoming registration details for the 2018 Ontario Problem Gambling Provincial Forum!

AGENCY SPOTLIGHT:
Q & A with Chantal Surgeson, Lifestyle Enrichment for Senior Adults (LESA) Counsellor at the Centretown Community Health Centre

CCHC logo

Tell us more about Lifestyle Enrichment for Senior Adults (LESA) and the problem gambling services provided for older adults aged 55 and older.

The LESA program is a community-based treatment program for adults aged 55 and older that offers age-specific services in English and French. The program supports older adults in their efforts to stop or reduce the misuse or abuse of alcohol, drugs, medications and gambling that negatively affect their physical or mental health. The LESA program works from a harm reduction perspective and recognizes that recovery is a personal journey. A primary goal of the program is to reduce the health and social harms associated with substance use and/or gambling. Our counsellors support clients in making healthy lifestyle changes without requiring that individuals abstain.

The program serves Ottawa and its surrounding areas and has satellite offices throughout the city.

Clients of the LESA program have access to individual counselling as well as weekly support groups and are provided the option to participate in monthly recreational outings.

The LESA program is a long-term treatment program that incorporates knowledge of the normal aging process, drug and behaviour dependency, and holistic health.

What are some of the challenges faced by older adults with gambling problems?

A number of challenges face older adults with gambling problems, including shame and guilt associated with addiction, financial hardships, lack of social awareness about gambling as an addiction, lack of community support, isolation, boredom, lack of age-specific services, a decrease in family and social support, declining health, grief, accessibility issues, stigma, legal issues, undiagnosed or untreated mental health issues, and trauma.

Are there any resources you would recommend for clinicians who may be new to working with older adults with gambling problems?

CAMH provides a number of very useful training resources for those who are new to the world of gambling. The PGIO website is an excellent source of support for both clients and clinicians and offers a number of self-help tools that clients can use at home on their own.

The Responsible Gambling Council's website is another useful site that provides clinicians with up-to-date news and research specific to gambling. It also provides information specific to working with older adults.

The Ontario Problem Gambling Helpline is an ideal resource for clients seeking phone or online support and referral to local community supports.

Many clients can also benefit from the support of Gamblers Anonymous (GA) meetings in their local communities.

On a personal note, I found that Alex Blaszczynski's book Overcoming Compulsive Gambling provides an in-depth, firsthand account of gambling addiction and offers clinicians helpful tools for use with clients.

What are some important tips for clinicians who may see older adults with gambling problems in their practice?

Important tips when working with older adults include:

  • remaining flexible and unhurried in our approach
  • providing an environment that is safe and non-judgmental
  • refraining from making assumptions
  • using creativity in our approach and meeting clients where they feel most comfortable (both in their stage of
    • recovery and in the location chosen for sessions)
  • providing sufficient time and options for completing assessments
  • co-creating treatment goals that are client centred and client driven
  • collaborating with other service providers
  • providing holistic care by exploring all aspects of the client's life with a focus on improving the client's overall quality of life.

Relevant to this topic, PGIO put out a press release regarding the link between casino tour buses and problem gambling in older adults within Central and Southwestern Ontario. Do you see the same trends in your region?

I can agree that the same trends exist here in Ottawa. A strike at the Rideau Carleton Raceway that took place over a number of months in 2016 meant that many clients couldn't access the casino, as their shuttle service wasn't available. For many clients, especially those without access to a vehicle, this meant a period of abstinence from gambling, which speaks to the impact of accessibility and proximity to casinos.

AnnouncementsAnnouncements

Reminder: New Registration Process for Our New Learn.ProblemGambling.ca

Since we have now launched our website, you will need to create a new account on Learn.ProblemGambling.ca. If you are part of the designated Ontario Problem Gambling Treatment System (PGTS), registering on Learn.ProblemGambling.ca allows you to access our courses, webinars and content archive.

If you have already used your email address to create a profile on our Self-Help Tools website (MYGU, online worksheets, etc.), you will need to email Problem.Gambling@camh.ca with the following information:

  1. First Name
  2. Last Name
  3. Nickname / Display name (Will appear on community forum and blog comments)
  4. Company
  5. Job Title
  6. Phone
  7. Email
  8. Are you part of the designated Ontario problem gambling treatment system? Yes or No

If you haven’t already used your email address to create a profile on our Self-Help Tools website (MYGU, online worksheets, etc.), please proceed with creating your new account.

Click here to register.

Happy registering!

Register today for the 2018 Ontario Problem Gambling Provincial Forum!

Join us for this year's provincial forum as we welcome clinical experts Dr. Michael Cheng as he discusses attachment and gaming; Mary Ann Carmichael as she speaks about trauma and shame; and Dr. Colleen Carney as she speaks about cognitive-behavioural therapy and insomnia. We also have the honour of hearing from Jake Uskoski, alongside his mother Elaine, as they discuss their lived experience with problem technology use. This year's provincial forum will take place on June 18 and 19 in Ottawa. Be sure to save the date!

NEW Adolescent Problem Gambling: A Prevention Guide for Parents

This handbook is intended for parents, guardians and caregivers who have concerns about the gambling behaviour of an adolescent or young adult between the ages of 12 and 24. The purpose of this guide is to help parents: (1) understand adolescent problem gambling and how it affects families, (2) understand how problem gambling heightens the risk for mental health and substance use issues, (3) find ways to reduce the risks for the youth and their family and (4) find mental health and addiction supports. This resource will also be available in French soon.

NEW Mindfulness Animated Video

Not sure how mindfulness will benefit your clients with gambling problems? We have you covered! Our new professionals website Learn.ProblemGambling.ca now has a new animated video that provides you with an overview of mindfulness and how it can be used in practice. Watch it here.

NEW Behavioural Addictions Videos featuring Dr. Bruce Ballon

Interested in learning more about behavioural addictions? We are excited to have Dr. Bruce Ballon's three-part video series on behavioural addictions now available on our new professionals website in the Problem Technology Use evidence-informed practice section. Watch them here.

Brain Connections: New Handouts by Gambling Research Exchange Ontario

A new website Brain Connections: Understanding Problem Gambling has launched at brainconnections.ca and provides people with problem gambling and their families plain language clinical handouts that explain frequently asked questions about problem gambling and the brain. This work was funded by a BET15K grant from Gambling Research Exchange Ontario and Ministry of Health and Long-Term Care. To learn more, PGIO will also be hosting webinars on May 16 and May 28.

​Research U​​​pdates​​Research

CAMH Research Updates

*denotes researchers from the Centre for Addiction and Mental Health

Journal of Gambling Issues - No. 37 (January 2018)

Courses & TrainingUpcoming Courses and Training

Visit the Training page to register or find out more information about any of the events below.

In-Person Training

  • Cognitive-Behavioural Therapy and Problem Gambling | April 26 to 27, 2018 in Toronto
  • Hypersexuality | SAVE THE DATES November 8 to 9, 2018 in Toronto
  • Hypersexuality | SAVE THE DATES December 6 to 7, 2018 in Toronto
  • Hypersexuality | Date TBD in Thunder Bay

Online Courses

  • Introduction to Problem Gambling: Phase One | April 9 to May 21, 2018 (PG Treatment System - Login required)​
  • Early Intervention Makes a Difference: A Course for Helping Professionals
  • Pharmacological Treatments in Psychiatry: Understanding Uses, Benefits and Side Effects​​ (PG Treatment System - Login required)​

Webinars

  • I Love A Good Clinical Handout: Answering Five Key Questions About The Neurobiology Of Problem Gambling Using Person-Centered, High Quality Clinical Handouts | May 16, 2018 from 10:00 am to 11:30 am (PG Treatment System – Login Required)
  • I Love A Good Clinical Handout: Answering Five Key Questions About The Neurobiology Of Problem Gambling Using Person-Centered, High Quality Clinical Handouts | May 28, 2018 from 2:00 pm to 3:30 pm (PG Treatment System – Login Required)
  • A Free Ride: Implications for Casino and Racino Promotional Activities Aimed at Older Adults | SAVE THE DATE March 20 from 10:00 am - 11:30 am

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