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Organisational Health Conference EA Group discussion: Addictive behaviours incl. gambling. Tracey Atkinson.

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Presentation on theme: "Organisational Health Conference EA Group discussion: Addictive behaviours incl. gambling. Tracey Atkinson."— Presentation transcript:

1 Organisational Health Conference EA Group discussion: Addictive behaviours incl. gambling. Tracey Atkinson

2 Quidquid latine dictum sit, altum viditur

3 Objectives  What do we want from this session?  What experiences and resources can we share today?  Theory of addiction: Stages of Change Model  Treating addictive behaviours: Motivational interviewing  Goals, applications, principles  Other treatments  Gambling addiction  References and resources  Where to from here?

4 Stages of Change Model (DiClemente & Prochaska, 1998)  Health behaviours  Addictive behaviours

5 Stages of Change Model  Pre contemplation  Contemplation  Preparation  Action  Maintenance  Relapse  Change is circular  NOT uni-directional

6 Motivational Interviewing  Denial, resistance, poor motivation, ambivalence are features of many client presentations  Hypothesis: The way clients are spoken to can either enhance or minimize motivation to change (Miller, 1983)

7 Goals  The goal is not to change the client’s behaviour but to allow the client to argue for their own change.  Prepares people for change

8 Motivation to change  Every therapist knows that motivation is a vital element of change. Nowhere is this clearer than in the treatment of addictive behaviours, which are, if one thinks about it, fundamentally motivational problems. …When one continues to act despite personal risk and cost, something is overriding common sense. In the context of war, we call it bravery or heroism. In the context of pleasure, we call it addiction.. (Miller, 1998).

9 Motivation to change  Ambivalence is normal  It is the inter-relationship of ambivalence about change and the client’s goals and core values that is the substance of motivational interviewing (Rollnick & Allison, 2001)

10 Motivation to Change  Resistance: observable behaviour that arises when the counsellor loses demonstrable congruence with the client (Miller & Rollnick, 1991)  I know..but  I can’t……………

11 Motivational Interviewing is  Empathic  Non-confrontational  A constructive conversation about behaviour change  Technique secondary  Directive (vs non-directive)  Clear structure  Coaching to explore and resolve ambivalence to behaviour change

12 Other applications  Motivational interviewing strategies may be applied in situations where insight is impaired, e.g.  Eating disorders  Other mental illness e.g.schizophrenia, bipolar disorder, depression  Enhance medication compliance  Enhance treatment commitment

13 Principles of MI  Express empathy  Avoid arguments  Roll with resistance  Support self-efficacy  Deploy discrepancy

14 Present, past, and future oriented questions  If you continue to drink at this level, what will be the benefits in a year’s time?  Could there be any disadvantages?  So, on one hand, you love the feeling and the taste, but you are less pleased with the way you act and the things you say?  What was it like when you stopped drinking last time?

15 More questions………  What are some of the good things about your cannabis use?  What are some of the less good things?  What do you enjoy most about poker machines?  What are some of the side effects of the medication? What are the benefits of it?

16 More questions……….  On a scale of 0 to 5 how important is it for you to give up alcohol?  On a scale of 0 to 5 how confident are you about giving up?  What will keep you at this level?  How high does it have to be before you make an attempt to change?

17 Present  Positive/Advantages  Future  Advantages Present  Negatives/Disadvanta ges Future  Disadvantages

18 Other treatments  Cognitive behaviour therapy: e.g. psychoeducation, behaviour monitoring, contingencies, managing cravings, social situations (saying no), controlled drinking, relapse prevention, needle exposure, lapses vs. relapse  Abstinence vs controlled use  12 Step Programs  Medication

19 References: Motivational Interviewing  Rollnick, S. & Allison, J. (2001). Motivational interviewing. In Heather, N., Peters, T.J. & Stockwell, T. (Eds.).The International handbook of alcohol dependence and problems. Wiley & Sons.  Institute of Psychiatry Kings College London (2004). A General practitioner’s guide to eating disorders.  Dept Veteran Affairs. Key ideas underlying motivational interviewing. m

20 Gambling facts  2.1% of Australian adults have a problem, i.e. 293,000.  On average 7 other people are affected by the gambler’s behaviour, i.e. 2 million people (Source: Relationships Australia).

21 Qld gambling facts Per capita expenditure:  Total $ p.a.  Gaming machines $ p.a.

22 Qld gambling facts Growth rates  Gaming machines 7% per annum  Most others declining Total expenditure $2.79 billion  Gaming machines 53.66%  Casino 21.2%  Lottery 12.18%  Racing 10.28%

23 Qld gambling facts Total government revenue $ million  Gaming $ million  TAB $30.58 million Increased household disposable income spent on gambling  %  % (Source: ANU Centre for gambling research-Fact sheets 2005)

24 Gambling treatment  In general: Individual, group, relationship, financial counselling, self help kits. Includes…  Understanding factors such as false beliefs, motivations for gambling, triggers  Relapse prevention strategies  Underlying issues: anxiety, depression, relationship problems  Financial: budgeting, legal issues, coping with creditors, reorganising finances.

25 Gambling treatment  Relationships Australia  Psychologists  Gamblers Anonymous

26 Resources: Gambling  No more bets please! Overcoming problem gambling. Presented by HG Nelson (DVD).  Gambler’s Help Ph  Problem Gambling Service (incl. Chinese, Greek, Italian, Tagalog, Spanish language)  ANU Centre for Gambling Research. Research, fact sheets, journals  Gamblers Anonymous. Ph (Brisbane)

27 Resources: Gambling  Relationships Australia Gambling Counselling Service and Gambling Help Line  FREE  Redlands, Mt Gravatt, Gympie, Caloundra, Noosaville, Gold Coast, Ipswich, Rockhampton, Gladstone, Logan, Mackay and Whitsunday, Spring Hill.

28 Summary  What we did in this session  Theory of addiction: Stages of Change Model  Treating addictive behaviours: Motivational interviewing  Goals, applications, principles  Other treatments  Gambling addiction  References and resources  Where to from here?


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