PCN 481 Topic 8 Benchmark Process Addictions Treatment Paper

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1 Benchmark-Process Addictions Treatment Paper Brandi Parks College of Science, Grand Canyon University PCN-481 Professor Amy Sohler August 17, 2023

2 Benchmark-Process Addictions Treatment Paper The exploration of process addictions will be the main topic of this paper. The "Process Addictions Case Study" media piece (Addiction Counselor, n.d.) showcasing John a client with an addiction to gambling will serve as the basis for this discussion of the process of addiction to gambling. John's treatment plan will be created and discussed. The client will be given an evaluation of both the psychological and physiological consequences of the addiction. John's current stage of transformation will also be examined, along with an evaluation of the pertinent psychological concerns to consider. The client's family problems and any medical problems will be noted. The effectiveness of strategy interventions and associated treatment barriers will be evaluated. John's local resources and aftercare plans will be identified. People with process addictions typically operate despite negative impacts on their physical, emotional, or interpersonal health (Karim & Chaudhri, 2012). To provide a patient with the best chance of a full recovery, it is essential to develop effective treatment plans for them. Impact of John’s Gambling Addiction A thirty-six-year-old Caucasian man named John claims that his wife pushed him to seek counseling because of his gambling. The client claims that until John gets therapy, his wife won't come home. Since high school, John has sometimes gambled, mostly partaking in games such as blackjack, poker, and sports wagering. John thinks he can keep gambling but maybe only cut back to please his wife, as their financial condition has been unstable because of his gambling problem. The client claims that he frequently quarrels with his spouse and that four years ago, he had an affair. In addition to drinking and smoking, he also has trouble falling asleep, is overweight, and has elevated blood pressure. John frequently hides his gambling from his partner and claims he can never see himself giving up gambling entirely. When John was little, his

3 parents were divorced, and he spent a lot of time going between the two of them. His father was a heavy drinker who occasionally hurt John physically. The client also acknowledges using alcohol, marijuana, and other substances throughout his time in high school. John has two older brothers and claims that they get along well with their mother, who suffers from depression but does not communicate with their father. John has two small children himself. Physiological Impact The client's physical health has been harmed by his gambling addiction. John claims he has trouble falling asleep and frequently drinks to do so. John claims that he has high blood pressure and that he is overweight. The customer works as a salesperson, which is seen as a stressful position. One well-known negative impact of gambling is sleep deprivation. According to Womack, et al. (2013), sleep deprivation has been related to several physical and psychological issues, such as mood instability, immunological dysregulation, and motor and cognitive impairment. According to the American Psychiatric Association (2013) in the DSM-5, drug use is frequently associated with gambling disorders. Pathological gamblers have more instances of nicotine and alcohol addiction in comparison to the general population. Although it hasn't been established, the presence of free alcohol and secondhand smoke in a casino setting may be a factor in the increased rates. These traits are all risk factors for developing a drug use disorder, along with impulsivity, stressful situations, and personalities that need big rewards. Studies on the health correlates of gamblers have shown a connection between gambling and obesity, as well as hypertension. Studying and treating those with gambling and weight problems may benefit from focusing on the neurological causes of impulsivity (Grant, et al., 2015). Gambling on the side can develop into an addiction with all the associated physical and psychological effects.

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4 Psychological Impacts Psychiatric comorbidity is often associated with gambling disorder (Chou & Afifi, 2011). John's gambling has had a psychological impact that has led to substance use, impulsivity, dishonesty, denial, and despair. John claims not to be sad or nervous, but his psychological symptoms and heritage of depression suggest otherwise. According to Erbas and Buchner (2012), gambling problems are associated with higher rates of co-occurring drug use which includes smoking, anxiety, and depressive disorders. Gambling addiction can also lead to problems at work, such as absenteeism and subpar performance. Trust concerns, marital troubles, and problems with intimacy are frequent psychological impacts on friends and loved ones (Grant & Kim, 2001). The psychological problems of the client show signs of an addiction problem. Psychosocial Issues to Consider The client claims that his wife took the kids and is now residing with her parents because of the loss of family ties caused by John's gambling addiction. Due to John's gambling addiction, the client's family's financial condition is precarious. The customer claims to have had a sexual encounter with someone else before and that he secretly gambles without his wife knowing. John adds that despite being aware of the negative effects, he has no plans to stop gambling altogether. People with a gambling condition frequently have intrusive thoughts or cravings to gamble that interfere with their ability to concentrate, whether at home or at work (Grant & Kim 2001). Because the client is under stress from his job and his family, there is evidence linking gambling disorder to high rates of suicidal thoughts and attempts (Wong, et al., 2010). Despite all of these psychological problems, John claims he can never imagine not gambling.

5 Stage of Change One of the most well-known approaches to change is the Stages of Change or Transtheoretical Model, which was created by philosophers Carlo DiClemente and James Prochaska in the late 1970s. They were searching for methods to help individuals stop smoking. It has been demonstrated that the Stages of change model is a helpful tool for figuring out how people modify their behavior (Krebs et al., 2018). With this approach, change happens gradually, and relapses are an inevitable part of the process. People are usually at first hesitant or anxious to change, but with time they develop an active and driven approach to changing their behavior. This model consists of six steps, pre-contemplation, contemplation, preparation, action, maintenance, and termination (Castillo, et al., 2019). According to John's interview, the Contemplation Stage is the one he is closest to. The client exhibits ambivalence and mixed feelings at this stage. At this time, people start to become more aware of the possible advantages of changing, but the costs usually become much more apparent. When it comes to change, this contradiction significantly increases fear. John claims that unless he receives therapy, his wife won't return home, but he also claims that he is in control of the situation and does not need treatment. Family Issues John discussed that the family is having financial instability and credit card debt due to his gambling problem. John has a family history of alcohol abuse, depression, and divorce, and says that his dad would hit him from time to time but says that he was not abused as a child. John hides his gambling problem from his family and has cheated on his wife previously. John says that he is a social person but due to him working long hours, he has friends but not very

6 close friends. He says that he must go to counseling to save his marriage and his family but denies that he has a problem with gambling. Possible Medical Issues John's addiction comes with many negative medical consequences. According to Fong (2005), people with a pathological gambling addiction are more prone to diseases such as high blood pressure, sleep issues, heart disease, and even gastrointestinal issues such as ulcers in the stomach, all related to stress. Other medical issues such as severe depressive disorders, anxiety, and drug and alcohol disorders are mental health consequences of gambling disorders. Impaired and impulsive decision making, extreme feelings of shame and guilt are some of the psychological consequences that may come with a gambling addiction (Fong, 2005). John is suffering from many of these side effects including the fact that he is overweight, all because of his problem with gambling. Components of Treatment Interventions and Strategies John is ambivalent about change although he shows all the signs and fits the criteria of having a problematic gambling addiction. According to the DSM-5 (2013), to diagnose a person with a gambling disorder, they must meet 4 out of 9 criteria symptoms such as gambling comes before anything else (pre-occupation), needs more money to continue gambling addiction, attempts to slack off or quit, anxious or restless when cannot gamble, gambles to escape life, goes back to gambling to win back money (chasing losses), keeps the extent of addiction hidden, certain relationships or opportunities lost because of addiction, relieve financial strain from the gambling disorder. There are many treatments to consider for gambling addiction including IOP

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7 (intensive outpatient treatment), residential inpatient, pharmacotherapy, and CBT (cognitive behavioral therapy) (Grant & Odlaug, 2014). According to Kushner, et al., (2007), MI (motivational interviewing has also been successful in treating gambling disorders. Because John is ambivalent to change and his only motivation is his wife and family, MI would be the best suit for him because it is client-centered and focuses on increasing and building motivation and commitment and resolving the issue of ambivalence (Kushner, et al., 2007). John can use skills such as rolling with resistance, change talk, and discrepancy at this point in his stage of change. Potential Obstacles to Treatment John has many obstacles that he must face. He is oblivious to all the problems that his gambling has caused such as the financial strain he has put on his family, his unfaithfulness to his wife, and any problems that he may have in his marriage. He is also in denial of his substance abuse problems, the possibility of losing his wife and kids, and possible abuse as a child. John is ambivalent about change and treatment and thinks all he needs to do is to slow down on gambling and that his wife will not divorce him. Because of John’s financial instability, he may not be able to afford treatment, his insurance may not cover it, if he has any. He is in denial and thinks that he can independently deal with the problems at hand. At this point, John and his family are in dire need of community support. Community Supports There are many different types of community support groups established for gambling disorders for clients and their families. John will need to be referred to a 12-step program like Gamblers Anonymous or even a more Christian-based program such as Celebrate Recovery.

8 Studies have shown that these two programs rebuild their commitment and help them to remain abstinent from the addiction, and find their true purpose (McGrath, et al., 2018). Because relapse rates are so prevalent, it is especially important to combine community support with some type of aftercare therapy. Aftercare Strategies It is crucial on the road to recovery to have an aftercare plan. A client should have a list of references and resources that are available to them before they leave treatment so that they can get a plan into action. Group or individual counseling should be required for the client to continue their recovery. Spiritual and family organizations are good to get involved in and can help the individual as well as the family to grow and rebuild their bond. Summary John’s gambling addiction has caused problems in his family life as well as financially. The counselor must assess John’s mental, physical, and social issues along with the current stage of change that he is in when attempting to develop treatment strategies. The counselor must also be aware and alert of any family history or medical issues the client is facing when deciding on a treatment plan, checking for co-occurring disorders as well. It is also important to consider any obstacles the client may have when beginning treatment and the community sources and aftercare strategies for after treatment.

9 References American Psychiatric Association. (2013). DSM-5 behavior: A review of the literature. Behavioral Sleep Medicine, 11(5), 343–359. Castillo, G. J. A., Montes, V. A., Perales, E. A., Sánchez, V. A., & Medina, C. S. (2019). Stages of change and engagement in a family intervention. Child & Family Social Work. https://doi.org/10.1111/cfs.12651 Chou, K. L., & Afifi, T. O. (2011). Disordered (pathologic or problem) gambling and axis I psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. American journal of epidemiology, 173(11), 1289–1297. https://doi.org/10.1093/aje/kwr017 Erbas, B., & Buchner, U. G. (2012). Pathological gambling: prevalence, diagnosis, comorbidity, and intervention in Germany. Deutsches Arzteblatt international, 109(10), 173–179. https://doi.org/10.3238/arztebl.2012.0173 Fong T. W. (2005). The biopsychosocial consequences of pathological gambling. Psychiatry (Edgmont (Pa.: Township)), 2(3), 22–30. Grant, J. E., & Kim, S. W. (2001). Demographic and clinical features of 131 adult pathological gamblers. The Journal of clinical psychiatry, 62(12), 957–962. https://doi.org/10.4088/jcp.v62n1207

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10 Grant, J. E., & Odlaug, B. L. (2014). Diagnosis and Treatment of Gambling Disorder. In K.P. Rosenberg & L.C. Feder (Eds.), Behavioral addictions: Criteria, evidence, and treatment (pp. 72-104). Academic Press. https://doi.org/10.1016/B978-0-12-407724- 9.00003-3 Karim, R., & Chaudhri, P. (2012). Behavioral addictions: an overview. Journal of psychoactive drugs, 44(1), 5–17. https://doi.org/10.1080/02791072.2012.662859 Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta-analysis. Journal of clinical psychology, 74(11), 1964–1979. https://doi.org/10.1002/jclp.22683 Kushner, M. G., Abrams, K., Donahue, C., Thuras, P., Frost, R., & Kim, S. W. (2007). Urge to gamble in problem gamblers exposed to a casino environment. Journal of Gambling Studies, 23(2), 121–132. https://doi.org/10.1007/s10899-006-9050-4 McGrath, D. S., Kim, H. S., Hodgins, D. C., Novitsky, C., & Tavares, H. (2018). Who are the anonymous? Involvement and predictors of Gamblers Anonymous attendance among disordered gamblers presenting for treatment. Journal of Gambling Studies, 34(4), 1423– 1434. https://doi.org/10.1007/s10899-018-9774-y Womack, S. D., Hook, J. N., Reyna, S. H., & Ramos, M. (2013). Sleep loss and risk-taking Wong, P. W., Chan, W. S., Conwell, Y., Conner, K. R., & Yip, P. S. (2010). A psychological autopsy study of pathological gamblers who died by suicide. Journal of affective disorders, 120(1-3), 213–216. https://doi.org/10.1016/j.jad.2009.04.001

PCN 481 Topic 8 Benchmark Process Addictions Treatment Paper

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