Another issue related to gambling is whether the gambler should abstain, not only from gambling activities, but from anything to do with money. Some models suggest gamblers turn over control of their money to a trusted other, who would act as a trustee or guardian, doling out money to the gambler in manageable amounts as needed. This belief system helps gamblers limit the trigger experiences they have handling money. (See Section “ Teaching Clients Skills for Change and Relapse Prevention ”).

These strategies could be seen either as a lifetime requirement or as a short-term strategy that might allow the gambler to experience his or her life without having to deal with the problems of managing money, giving the gambler some time to grow and become stronger, so that eventually he or she is able to deal with money again. However, some clinicians question this practice, and say that you only learn how to handle money issues by dealing with them, not avoiding them by having someone else deal with them. There is no agreement about this practice in the field.

Abstinence Seems to Be Appropriate in the Following Circumstances

• when the gambling has reached the extreme end of the continuum, i.e., when the client has received the diagnosis of “pathological” gambler, using the DSM-IV criteria
• when the client has already made attempts to moderate without success
• when the client names his or her goal as abstinence
• when a client wants to enter an abstinence-based treatment program
• when a client is mandated by an employer or the criminal justice system
• when relationships are at risk, especially for the peace of mind of the partner, or to match the non-gambling partner’s belief system about what needs to happen in order for the relationship to be saved.

Disadvantages of the Abstinence-Only Approach

• Abstinence doesn’t recognize improvements or successful attempts to cut down.
• Abstinence criteria may be excessively stringent and therefore a barrier for some potential clients entering a treatment program where abstinence is a requirement — they might not be ready, it does not match their belief system, or it is too difficult to achieve now.
• An abstinence-only approach contradicts some current research that suggests moderation is appropriate for some clients.

These terms are often incorrectly used interchangeably. For the purposes of this chapter, we are using these terms to mean very different things. The results of each approach are often similar, as are the strategies that are used, but the context and the intent of each concept are vastly different. harm reduction Harm reduction means “reducing the harm associated with gambling,” or, conversely, “increasing the safety related to continued gambling.” This term applies when a client has decided that he or she will continue gambling without necessarily modifying either the amount of money or time spent, although this approach often results in modifying the amount of money and/or time spent.

Harm Reduction Strategies Could Include:

• setting limits on the amount of money spent by not bringing money access cards to the gambling venue (e.g., credit cards, atm cards)
• paying attention to physical needs while gambling (e.g., taking a break from the gambling activity, using the washroom facilities, eating, stretching)
• only gambling with designated money, and not dipping into money allocated for other specified expenses (e.g., rent, mortgage, food, clothing, tuition, car payments, utilities, etc.)
• negotiating with a partner (or other family member) to designate specific agreed-upon times for gambling

Criteria for choosing a harm reduction approach

A harm reduction approach might be adopted by anyone at any point on the continuum who is experiencing negative consequences in any one or more of their life domains: self (physical, emotional, psychological), family, community, employment, leisure, financial, legal or spiritual. moderation Moderation means “reducing the amount of time and/or money spent gambling.” This term applies when a client has decided that he or she wants to cut down on his or her gambling. The intent of this approach is always to decrease the amount of money and/or time spent. As a result of this reduction, the negative consequences of the gambling are often affected positively.

Moderation Strategies Could Include:

• examining how much money and/or time the client is currently spending on gambling, and contracting with the client to reduce the amount spent by an agreed-upon percentage
• examining the client’s budget to determine how much he or she can afford to gamble and agreeing to stay within this limit

Criteria for and a moderation approach

• a client who is not currently experiencing negative consequences from his or her gambling behaviour, but who has concerns about negative consequences in the future if he or she continues gambling in the current pattern.
• a client who is currently experiencing negative consequences from his or her gambling behaviour, but who is not willing to accept abstinence as a goal at this time

Some people incorrectly believe that moderation is only a stepping stone on the road to abstinence. This could be true for some clients, but it is also a legitimate goal in itself.

Controlled gambling

Controlled gambling means “gambling with certain controls put in place to ensure that the gambler does not exceed an agreed-upon upper limit of time and money spent gambling while not incurring any negative consequences as a result of his or her gambling behaviour.” This term applies when a client has already abstained for a period of time, and has decided that he or she wants to return to gambling without incurring the previous negative consequences. This approach limits the amount of money and time spent and also includes establishing reasonable safeguards to prevent negative consequences from occurring in any of the client’s life domains.

Criteria for choosing a controlled gambling approach
Before implementing a controlled gambling strategy, the client needs to have lived an abstinent, problem-free existence for a long enough period of time that he or she feels confident prior gambling-related issues or problems have been satisfactorily resolved.

→CAVEAT: Although we know that harm reduction/moderation is appropriate for some clients, there are currently no predictors about who these clients might be.

We chose a harm reduction approach. We wanted to offer a program that was different from traditional abstinence-based problem gambling treatment programs and would also serve clients with a wide range of goals from abstinence to moderation and harm reduction. This approach seemed to make more sense because of the growing social acceptability and accessibility of gambling. At the same time it empowers clients to make informed choices. The harm reduction approach allows clients the flexibility to explore the goals that best match their needs. Clients have said to us that had we insisted on abstinence, they would not have come to our program. Outcome studies on the program also indicate remarkable success with this approach, with the majority of clients choosing to abstain and a smaller percentage moderating their gambling behaviour.

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