by Peter Chen and Jim Milligan
Residential Programs: Rationale
Much of the literature refers to residential programs as “inpatient” treatment. This label clearly places people in the medical hierarchy as persons “receiving or registered to receive medical treatment” (Oxford English Dictionary, 1989). Nora (1989) notes one of the benefits of coming into residential treatment: “patients who choose to participate in an inpatient program learn early to accept the concept of themselves as sick patients in need of treatment” (p. 128).
Key indicators for choosing inpatient treatment
- psychiatric emergencies, such as suicidal ideation, violence, anxiety or existing comorbidities
- the need to provide a safe and stable environment for an overwhelmed client
- a client’s lack of success with previous outpatient treatments (Nora, 1989). Key Benefits of Inpatient Treatment
- Clients experience abstinence and time to see the value of a new abstinent lifestyle.
- Clients have an opportunity to receive education about gambling, other co-occurring disorders, lifestyle issues and financial management.
- Clients receive a broad introduction to Gamblers Anonymous. Regular and frequent attendance at ga meetings is often a requirement of residential programs.
In addition, most residential settings require all clients in the program to abstain from their problematic behaviours while in residence.
Day Treatment Programs: Rationale
With the onset of managed care, the US system is being forced to re-evaluate its stance on residential and day (“outpatient”) services. In Ontario, current government funding policy related to problem gambling has been to fund outpatient/day programs, rather than residential services. key benefits of day/outpatient programs
- They are cheaper, more cost effective, and less intrusive.
- Clients learn to deal with their gambling issues while remaining in their own community, rather than living in the artificial hospital-like setting of most residential programs.
- Clients can learn to access their community resources as the need arises.
- Clients have opportunities to practise their newly acquired coping skills as they experience their triggers in real-life settings.
- Clients are able to integrate more fully into their community, thus decreasing the isolation that often accompanied their problem gambling and subsequent attempts to resolve their problems.
- Clients learn to deal with problems/triggers/cravings as they arise between outpatient sessions, which subsequently decreases their dependence on program staff.
- Clients’ gambling problems are normalized because they are being dealt with in the context of their daily lives, not in an artificial setting. They are not uprooted or distanced from supportive family and friends. As a consequence, they enhance their sense of personal control and self-efficacy.
- Clients are not pathologized by having to become “the identified patient.”
We chose day programming, as this is what the Ministry decided to fund. As it turned out, the vast majority of clients that have accessed the Problem Gambling Service have requested day programming and the program seems to have been sufficient to meet their needs without the need for a residential component. A small number of clients have requested residential programming and those clients were either referred to existing resources or they realized that a day program would be sufficient to meet their needs.
Back Setting Up a Problem Gambling Program