Research is finding that people come to treatment on average for six sessions. Any treatment program that lasts fewer than six sessions, then, can be considered short-term. Long-term programs — including aftercare — can last up to five years.
Long-term programs: Rationale
Traditional problem gambling treatment programs in the United States are 28-day residential programs based on a Gamblers Anonymous (GA) approach. There is no “cure” — problem gamblers are seen to need an ongoing commitment to a recovery program for the rest of their lives. GA’s core belief is “once a gambler, always a gambler...” They believe that people gamble for reasons that are within their psyches. To “cure” that they need to make changes to themselves, not just their behaviour. This is seen to take a long time and to be hard work. This is appropriate, if you believe that there is no “cure.” People who are diabetic, for example, must watch their diet and exercise program, and pay attention to their insulin needs for the rest of their life. If you hold the same belief about gambling, then long-term treatment and a lifetime commitment to abstinence is the only way to deal with it.
Long-term programs: Characteristics
Long-term programs are often based on clients understanding why they gambled in the first place. They believe that in order to change, people need the “support” of another, whether that is a professional, a friend or a family member.
Gamblers Anonymous (GA) is long-term. It is also free, and therefore cost-effective. Traditionally, support has involved one recovering person helping another, a “buddy” system, sponsorship or the “twelve-stepping” process (that is, one member of a 12-step program reaching out to another when the other is in trouble). Some current models of change have begun to look at self-changers, and to question whether they need any support, or even find it helpful. We know from the literature that the bulk of people who make changes in their lives do so on their own with no support whatsoever from anyone.
Short-term programs: Rationale
Some places have adopted short- or shorter-term treatment, which could be as short as a single session, either face-to-face or on the telephone. As noted earlier, most clients only come on average for six sessions anyway. The change literature also suggests that the bulk of the change occurs within the first eight contacts with a professional (counsellor, therapist, mental health practitioner, etc.)
Short-term programs: Characteristics
Shorter term tends to focus on learning skills and changing behaviours, finding solutions in the moment and alternatives that the client can implement to help him or her deal with the problem now. It focuses on achieving immediate results, rather than understanding the predisposing factors or root causes of the gambling.
We chose short-term treatment as this, we thought, would be the most cost-effective with the funding we received. As it turned out, the outcome studies of the Problem Gambling Service have indicated that most clients have been attending from one to six sessions and that the vast majority of our clients have been reporting maintaining positive changes even after having disengaged from the program for one, two and three years.
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