According to a 2008 analysis of the National Comorbidity Survey Replication (NCS-R), respondents with a psychiatric disorder are 17.4 times more likely to develop pathological gambling than those without such problems (Kessler et al., 2008). To address the interaction between post-traumatic stress disorder (PTSD) and problem gambling, the NCRG presented training for Boston-area treatment providers entitled, “PTSD and Problem Gambling,” led by Lisa Najavits, Ph.D., professor of psychiatry at Boston University School of Medicine. Dr. Najavits presented information on her program “Seeking Safety,” an evidence-based treatment for PTSD and substance use disorders, and her research on problem gambling in PTSD populations. This session launched the 2011 NCRG Treatment Provider Workshop Series and was a part of this year’s NCRG Road Tour.
“Seeking Safety”
“Seeking Safety” was developed by Dr. Najavits and her colleagues more than 15 years ago and has been shown to be efficacious in the treatment of PTSD and substance abuse in many diverse groups of individuals. A complete listing of the validation studies, as well as copies of the studies themselves, is available on the Seeking Safety website. “Seeking Safety” is designed to be a flexible treatment that can be used in individual or group settings, and with both homogenous and diverse groups.
Seeking Safety was developed to address the present needs of clients, as opposed to focusing on either the past or future. The program has five key principles:
1) Safety: The overarching goal of helping clients to attain safety in their relationships, thinking, behavior and emotions.
2) Integrated treatment: Clinicians are able to address both PTSD and substance abuse at the same time.
3) An Ideal-focused Approach: Patients learn to counteract the loss of ideals in both PTSD and substance abuse.
4) Four Specific Content Areas: Clinicians can address the cognitive, behavioral, interpersonal and case management aspects of treatment simultaneously.
5) Attention to Clinician Processes: “Seeking Safety” is not always led by mental health professionals. For this reason, the program provides tools to help the group leader avoid some common pitfalls of mental health treatment and take care of their own needs.
In addition to these five key areas, the “Seeking Safety” program is broken up into 25 specific topics, including: Safety; PTSD: Taking Back Your Power; When Substances Control You; Honesty; Asking for Help; and Setting Boundaries in Relationships. A more complete description of the 25 topics is available in pdf form on the Seeking Safety website.
Research on PTSD and Pathological Gambling
Dr. Najavits also discussed the findings of a study she authored involving 106 people with current pathological gambling (PG), current PTSD or with both PG and PTSD (Najavits, Meyer, Johnson, & Korn, 2010). These individuals were evaluated for several clinical traits, such as addiction severity and personality disorders.
Dr. Najavits and her colleagues found that those with either PTSD or PG/PTSD had significantly more severe symptoms than people with only PG. This suggests that the underlying PTSD may be driving the symptoms of people with comorbid PG and PTSD more than the PG seems to influence the comorbid disorder. A more complete review of this study was published by researchers at the Division on Addictions at Cambridge Health Alliance, and it is available on their website. Also, you can download the study directly from the Seeking Safety website as the 29th study in their list.
The free NCRG treatment provider workshop was co-sponsored by the Massachusetts Council on Compulsive Gambling. Do you have thoughts or questions about PTSD and disordered gambling? Leave them in the comments section below.
References
Kessler, R.C., Hwang, I., LaBrie, R., Petukhova, M., Sampson, N.A., Winters, K.C., & Shaffer, H. J. (2008). DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychological Medicine, 38(9), 1351-1360.
Najavits, L. M., Meyer, T., Johnson, K. M., & Korn, D. (2010). Pathological Gambling and Posttraumatic Stress Disorder: A Study of the Co-Morbidity versus Each Alone. Journal of Gambling Studies / Co-Sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming. doi:10.1007/s10899-010-9230-0
