Against the odds

By Nigel Bartlett

While debate rages on about the best way to limit spending on poker machines, a team of psychologists has come up with a targeted way of treating problem gamblers, and now they hope to show just how effective this method can be.

Poker machine

Barely a week has gone by over the past few months when we’ve not heard something about problem gambling in the news. All sides are arguing about how best to deal with this issue as the Federal Parliament thrashes out proposals for a mandatory pre-commitment system for poker-machine players. Away from the headlines, however, a University of Sydney team is confronting problem gambling head-on. It is making significant inroads by treating those struggling to overcome their behaviour, which causes misery and hardship both for themselves and for those close to them.

Staff at the School of Psychology’s Gambling Treatment Clinic believe they have come up with a way of working with problem gamblers that is the most effective program so far devised, and now they are planning to test it to evaluate its effectiveness against the current “gold standard” method. They believe the Cognitive Therapy (CT) program they have come up with offers a far more effective way of helping problem gamblers stay away from poker machines than the more traditional Cognitive Behavioural Therapy (CBT).

Christopher Hunt (BSc (Adv) ’03 BSc (Hons) ’05) is one of the psychologists who will be treating clients as part of an 18-month trial comparing the outcomes of CT and CBT, which is being run under the supervision of the clinic’s director, Professor Alex Blaszczynski.

Avoiding triggers

“The standard therapy of CBT is a mixture of looking at cognitions (or thoughts) and behaviours, so it focuses a lot on identifying triggers to someone’s gambling and ways of dealing with them,” Hunt explains. “The B part of CBT looks at those times when you feel the urge to gamble and what sort of behaviours you can do instead of gambling, as well as behaviours you can enact to avoid those situations that trigger you to want to gamble.”

In contrast, the program the clinic has devised avoids dealing with behaviours, but goes into tackling in far more depth the thought processes that problem gamblers experience. Given that the clinic’s average client comes for six to ten sessions, it’s a matter of ensuring he or she receives the most targeted treatment possible.

“The treatment we’ve developed deals with the specific thoughts that problem gamblers have. For example, we look at what they believe about poker machines or horse racing or sports betting, as the case may be, and what sort of logical errors or thought errors they might be making,” says Hunt. The clinician treating the gambler will then seek to challenge and correct those errors.

“A lot of the things we talk about are understanding concepts such as randomness. For instance, there’s a specific cognition called ‘the gambler’s fallacy’. This is the belief that, say, in a game of roulette the number five hasn’t come up for a while so it’s more likely to come up now, which in fact isn’t the case.”

The CT program also looks at where the gambler’s beliefs came from, based on their early experiences and history with gambling, to see how they helped form the client’s behaviour. It is this melding of psychology with numbers that attracted Hunt to working at the clinic.

“I’ve always been quite good at things like mathematics and statistics, and I enjoy dealing with questions of randomness and probability that we talk about here,” he says. “I’ve found this work fascinating because it brings together that sort of mathematical world view with the everyday world view that people have, and it helps people to reconcile those two ideas.”

The clinic has been using Cognitive Therapy for gamblers of all persuasions, including poker machines, horse racing and online sports betting

The clinic has been using CT for gamblers of all persuasions, including those who favour poker machines, horse racing and online sports betting, but the study will initially focus just on clients who use poker machines (the biggest group of problem gamblers) simply as a way of eliminating variables that might affect the trial’s outcome. The clinic hopes to study between 100 and 200 clients, who will be randomly allocated to either a CT or CBT treatment program. They will be scored according to the clinic’s Gambling Effect Scale, which allocates points according to the harm that gambling is causing in someone’s life – such as financial problems, not being able to maintain one’s home and feelings of depression and anxiety. The scale is reviewed at the start and end of treatment and at follow-up sessions to assess a client’s progress.

“We’ll follow up with clients at least six months after they’ve finished treatment, but also hopefully over longer time periods to see how they’re going,” Hunt says. “It’s one thing to have people stop gambling temporarily, but we’d like to help them stop indefinitely.”

Hunt adds that he and his colleagues hope to prove that their CT program is as effective as they believe it to be, based on their own experience of treating clients to date. “We believe it’s better than the current gold standard, but we need to do a controlled trial to ensure that that’s the case,” he explains. “If CBT proves to be more effective, then obviously the behavioural component is doing something, but if the two methods prove to be equal or if CT proves to be more successful, we’d argue it’s the cognition part that matters more.”

If that is the case, Professor Blaszczynski and his team hope to see their model for treatment being adopted more widely, and Dr Fadi Anjoul, the clinic’s Education and Training Officer, has been developing manuals for the treatment. “We want to help train other agencies in the techniques we’re using,” says Hunt, “and we’re also disseminating some of the knowledge we’ve developed here throughout the sector.”

So, while politicians argue, it’s good to know that practical help is available to those gamblers who need it the most.

The changing face of gambling

The School of Psychology’s Gambling Treatment Clinic is a free, confidential, face-to-face counselling service operating in Darlington, Campbelltown and Lidcombe. Each week it sees 30 to 40 clients, who comprise problem gamblers as well as those affected by gambling, such as partners or family members. Treatment is carried out by registered and clinical psychologists.

Christopher Hunt says that over the past few years the clinic has seen a change in the types of client coming through its doors, with a greater emphasis on online sports betting rather than gambling on horse racing.

“Most of our clients are poker-machine players, but the next biggest group used to be people who bet on the horses, usually at the TAB,” he says. “Now, though, we’ve found more people are moving to online gambling, and we’re also seeing a shift from horse racing to sports betting.”

This is partly because sports-betting laws have been liberalised in New South Wales in the past few years, removing restrictions that meant people could previously bet only on horse racing or (under certain circumstances) on rugby league.

“Now you can essentially bet on any kind of sport, and online gambling has become more and more available, so we’re seeing an increase in that area. It now exceeds what we were previously seeing in horse racing,” says Hunt.

As a result, the clinic provided a submission to a recent parliamentary select committee looking at online gambling. The clinic alerted the committee to the changes staff were seeing and also sought tighter regulations on advertising online betting services during sports matches. “The ubiquity of advertising during sporting games makes it difficult for people trying to make a change and give up gambling,” says Hunt.