Understanding and Treating the Pathological Gambler: CrossCurrents Winter 2003/04
CrossCurrents
This book is an effort of grand scope. It addresses many gambling-related topics and is quite an ambitious endeavour, which
yields mixed results.
Stylistically, Understanding and Treating the Pathological Gambler is an easy read for the university educated and blessedly falls short of being academic or muted in tone. It reads more like
a manual. As clinical pieces go, this one is a real page-turner. It tackles complex content, ranging from the history of problem
gambling psychology, to assessment criteria, to the specifics of cognitive-behavioural therapy (CBT) approaches. But this
information is presented without a single footnote or a bibliography, a shocking and academically suspect omission. Straightforward
writing does not preclude the need for the basic formalities of an academic book.
While this book may be valuable for beginning clinicians, its usefulness to those with more experience in the field of problem
gambling treatment is less apparent. With the exception of the coverage of actual cognitive treatment strategies, much of
the content will soon be obsolete in Canada. The reliance on older, U.S. approaches to assessment (DSM-IV and SOGS) and the
absence of newer Canadian tools, such as the CPGI or the tool that co-author Ladouceur himself developed with Alex Blaczynsky,
are puzzling and disappointing. The next DSM will probably look quite different in where and how pathological gambling is
determined, and the SOGS, well, it is just plain old. The relevance of this material at this juncture in the field is questionable.
The work could have been greatly improved by addressing more current controversies around CBT, abstinence and assessment criteria.
In terms of CBT, the book makes very clear links between gambling and gamblers' faulty logic. It argues that the origins of
this faulty logic (stated as the cognitive failure of negative winning expectancies, i.e., gamblers believe they can win,
despite evidence to the contrary) are gamblers' illusions of control, their superstitions and belief in systems that cannot
conquer the inherent bias for the house in any game of "chance." Granted. The cognitive distortions clients bring to therapy
are many and clients are often stubborn. The book makes the case for CBT and details beautifully how and why it works on erroneous
gambling assumptions. This is where the book is at its best: The two chapters on cognitive therapy and behavioural therapy
are pure gold. I wish the authors had focused their attention there, where their expertise is unequivocal and access to citations
is abundant from their own body of research.
Perhaps the most problematic aspect of pure CBT as described by the authors is that they never address the role of cognitive
distortions in relation to the gambler's internal life. The book makes a strong and accurate case for the link between gamblers'
erroneous biases about gambling and their actions connected to gambling itself. But false and deeply held beliefs about gambling
are not the only ones that allow a gambler to become problematically involved, nor are they the only ones that predict relapse,
nor are they the only areas requiring cognitive therapy. Clients do not pursue gambling to the point of requiring treatment
solely because they have inaccurate thoughts about odds, randomness, control and luck. Clients' core cognitive distortions
more often centre on inaccurate self-awareness of themselves as people: they overestimate the enhancement to self-esteem and
internal worth that any gambling victories could bring. False, core beliefs about image, worth, work and personal value are
cognitive distortions that make clients vulnerable to problematic gambling in the first place. The false beliefs about odds
and chance merely fan the fire in the gambling cycle. Clients need help correcting both sets of false beliefs if they are
to enjoy ongoing recovery. Understanding and Treating the Pathological Gambler could have made this link quite strongly in a CBT tradition.
Understanding and Treating the Pathological Gambler. Robert Ladouceur, Caroline Sylvain, Claude Boutin and Celine Doucet. John Wiley & Sons, 2002, 192 pp., $50.00 US.
JANINE ROBINSON is a certified problem gambling counsellor at the Centre for Addiction and Mental Health.
Centre for Addiction
