The impact of gambling problems on families
What are the assessment and therapy options for family members?
- Approximately 20% of people accessing Australian gambling support services are family members of people who problem gamble.
- There are few established assessment tools and therapies specifically designed for families of those who have a problem with gambling.
- Several new assessment measures specifically designed to measure the impact of gambling problems on family members have recently been developed.
Given the difficulties experienced by family members, it is not surprising that they frequently seek counselling. Approximately 20% of people accessing Australian gambling support services are the family members of people with gambling problems (Dowling, Rodda, et al., 2014; Productivity Commission, 2010). Despite their frequent presentation to treatment services, there are few assessment tools and therapy approaches specifically designed for the family members of people with gambling problems.
What are the assessment options for family members?
Assessment tools are important within both clinical and research settings, as they allow clinicians and researchers to identify the exact nature of the family member impacts, to evaluate the effectiveness of therapy for family member difficulties, and to illustrate discrepancies between gamblers and their family members. Two scales designed to measure family impacts in clinical and research settings across multiple domains have recently been developed in Australia: the Problem Gambling Significant Other Impact Scale (PG-SOIS) (Dowling, Rodda, et al., 2014) and the Problem Gambling Family Impact Measure (PG-FIM) (Dowling, Suomi et al., 2014a).1 The 6-item PG-SOIS is a brief tool that can be used to screen family members for impacts across broad domains of functioning: financial, emotional distress, interpersonal relationship with the gambler, social life, employment and physical health. In contrast, the 14-item PG-FIM provides an assessment of more specific impacts across fewer domains of functioning: financial, increased responsibility, and inter/intrapersonal functioning. There are gambler and family member versions of the PG-FIM. Orford et al. (2005) has also adapted the 16-item Family Member Impact (FMI) and the 30-item Coping Questionnaire (CQ) (Dowling, Suomi et al., 2014b) from the family members of people with alcohol and drug use issues to the family members of people with gambling problems.
What are the therapy options for family members?
Psychological therapies specifically designed for the family members of people with gambling problems have also been slow to evolve. It has been suggested that most family members engage in lower intensity interventions, such as self-help telephone or online support (Hing et al., 2013). For example, family members accessing a support service found this modality attractive due to its potential for anonymity, discretion and ease of access (Rodda, Lubman, Dowling, & McCann, 2013). To date, however, there is no information available about the effectiveness of online counselling for this clientele.
Therapies specifically designed to assist family members of problem gamblers include Community Reinforcement and Family Therapy (CRAFT: Hodgins, Toneatto, Makarchuk, Skinner, & Vincent, 2007) and Coping Skills Training (CST: Rychtarik & McGillicuddy, 2006). CRAFT, which has been delivered to family members using a self-help workbook, is a cognitive-behavioural therapy that aims to improve the personal and relationship functioning of family members, engage gamblers in treatment, and decrease their gambling. CST is a face-to-face treatment aimed at increasing coping skills and decreasing the distress of family members. These programs address many of the areas identified as being important in the functioning and coping of family members. Several couple-oriented treatments, such as integrative behavioural couple therapy (Ciarrocchi, 2002), congruence couple therapy (Lee, 2009) and adapted couples therapy (Bertrand, Dufour, Wright, & Lasnier, 2008) are also available. There is some evidence that involving family members in therapy can improve gambling outcomes (Ingle, Marotta, McMillan, & Wisdom, 2008). However, interventions will not work for all family members. Given the broad range of family impacts and high representation of family members among gambling support clients, there is a clear need to develop and evaluate the assessment and therapy options for this group of people.
1 For a copy of the Problem Gambling Significant Other Impact Scale (PG-SOIS) or the Problem Gambling Family Impact Measure (PG-FIM), please contact the author <firstname.lastname@example.org>