Stigma and history of unsuccessful attempts to change can make it hard for clients to ask about gambling – and this makes it important for you to bring gambling up with clients.
The Motivational Interviewing approach is useful here.
Motivational interviewing is an evidence-based approach in all addiction that avoids confrontation while helping clients think about their behaviour in an accepting and constructive manner.
Asking the question
Questions relating to gambling should be included in your routine client assessment. Clients are likely to be reassured and may be relieved when you bring up gambling in a professional and non-judgemental manner.
The aim at this stage is to discover whether the client is concerned about their gambling and reassure them that this is a legitimate health issue.
In primary care practice, the use of diagnostic screening tools to identify problem gambling can be problematic because of the length of the measurement tools.
It may be more useful to include a direct, concise screening question about gambling as part of your intake interview.
Direct questioning aims to:
- normalise problem gambling as a health issue
- introduce the topic of problem gambling in a non-confronting, non-personalised manner
- offer screening for problem gambling if required
People affected by someone else's gambling are a much larger group than those affected directly. The Productivity Commission's report suggests there are seven to 10 times as many affected others than there are people with gambling problems.
Affected others can be as desperate and discouraged as gamblers themselves and may be seeking help for problems as diverse as depression and anxiety, through to domestic violence.
They also may feel the stigma of gambling problems and be relieved if you show a willingness to discuss gambling with them.
All problem gambling services in Victoria offer free and confidential help to affected others.
Talking with a client about an addictive behaviour - that is, a behaviour they persevere with, despite the negative impacts on their lives - carries the risk they will justify or minimise their behaviour, making them entrenched.
Motivational interviewing is a technique designed to:
- Enable you to talk with a client about gambling without confronting them and making them defensive
- Discuss gambling issues with your client in an accepting, constructive and non-confrontational manner
- Talk about the pros and cons of your client's gambling behaviour
- Examine the pros and cons of your client changing their behaviour
- Highlight the difference between the client's current situation and the changes they would like to make
What does it involve?
- Recognise and appreciate that a client's problem gambling behaviour has often developed from an attempt to 'fix underlying problems'
- Focus on the problem , not on the person
- Give your client the freedom to explore
- Let the client know that the door is open to them next time
Asking permission to explore your client's lifestyle
- Discuss the client's lifestyle to identify strengths as well as areas they want to change
- Use exploratory and open questioning
- Highlight the discrepancy between the client's current situation and how they would prefer things to be
- Show sensitivity and acceptance of the gambler's situation. If your questioning meets with resistance, it is better to retreat than to push your client. It is important that your client feels that they can come back to you, rather than that you disapprove of their behaviour.
Leaving the door open
- Increase the client's awareness of the impact their behaviour has on their life
- Make it easier for the client to return should they need further support or information