Wilderness Therapy for Problematic Gambling: A Novel Intervention for an Increasingly Prevalent Problem
Chris Blankenship, LCSW | Clinical Therapist | Transition Age Young Adults
Gambling is a ubiquitous facet of our modern life. Podcast advertisements, social media, television, movies, road-side billboards—gambling is everywhere. For some people, spending $20 on their office March Madness pool isn’t an issue. For others, that is only one small expenditure in what can be a much larger problem. As problematic gambling increases in prevalence, so must the available treatment options. Wilderness therapy is one such impactful venue for helping young people struggling with gambling disorders.
Gambling is no longer relegated to smoky backrooms and bachelor/bachelorette parties in Las Vegas. In fact, recent studies found that:
These statistics are hardly surprising considering how easy it is to gamble in our country. In 2018 the Supreme Court ruled that states were allowed to legalize sports gambling. More than 30 states followed suit to establish betting markets that were either in person, online, or both. Commercial casinos are legal in at least 18 states and on many tribal lands, and online gambling—while only legal in six states—is increasingly available to any tech-savvy, would-be-gambler.
While these numbers are concerning enough in their own right, the number of young gamblers is what is most foreboding. The University of Buffalo found that 750,000 people aged 14–21 report having gambled more than they intended to or have stolen money to gamble.3 Unsurprisingly, these numbers contribute to increased mental health struggles.
As is typical with any addictive or problematic behavior, gambling can both be caused by mental health struggles and can cause mental health struggles. A client I recently worked with in wilderness had a long history of post-traumatic stress symptoms that contributed to his problematic gambling—a pattern that research shows is increasingly common.4 Young people struggling with problematic gambling are significantly more likely to engage in substance abuse,5 experience impulse control issues,6 and have persistently distorted thought patterns, such as illusions of control or poor harm awareness.6 In my years of working with young adults experiencing gambling issues, I’ve also witnessed clients have a preoccupation with gambling, loss of other interests, changes in mood, and a loss of financial resources. These are all typical symptoms for people struggling with a gambling problem.
Wilderness therapy is an effective treatment environment for problematic gambling due to our ability to both assess and treat individuals and families in a supportive and educational environment. Milosevic and Ledgerwood (2019) suggest that those struggling with a gambling problem can be broken into more homogeneous subgroups based on whether their gambling started because of behavioral conditioning (gradually gambling more and more due to it being rewarded), emotional vulnerability (using gambling to gain confidence or cope with emotional difficulty), or antisocial impulsivity.
My treatment approach for gambling issues is to first assess why the gambling started. The student I mentioned earlier started gambling heavily in the months following a traumatic event. The more we discussed the trauma he endured, the more we were able to determine that gambling was an act to regain control of his life. It soon became clear that he was gambling because of his emotional vulnerability and that our treatment approach needed to center on processing his previous trauma and developing new avenues for him to feel confident and regulated. This assessment is a critical component of treating problematic gambling in the wilderness setting.
Research, as well as my clinical work in the wilderness, has shown that myriad treatment approaches are effective for problematic gambling. Cognitive behavioral therapy (CBT)9 and motivational interviewing.10 are modalities that I am certified in and have been suggested to be effective in recent studies. CBT helps students understand underlying emotional drivers and maladaptive thought patterns while also developing novel behavioral approaches. The wilderness is a particularly ripe environment for this treatment because students have zero access to gambling outlets and receive daily coaching on emotional regulation, cognitive reframing, and impulse control.
Motivational Interviewing—a conversational approach that helps clients find points of tension in their thought patterns and develop new understandings of past behaviors—is especially helpful for students who are contemplating whether to change their gambling behaviors.10 This is an approach that I’ve seen help many students who had previously avoided their gambling problem.
Finally, it has been shown that remote support is often sufficiently helpful for families who are struggling with the impact of their loved one’s gambling.11 To this end, I utilize regular weekly process phone calls with students’ families to ensure that they are processing their child’s gambling issues and the impact they’ve had on the family. While these treatment approaches have shown to be effective in an outpatient setting, doing this work in the wilderness only magnifies the beneficial impact that treatment can have.
With the increased prevalence of gambling and gambling-related problems, it is important to expand the available treatment options. Here at Open Sky, I have been applying the tenets of wilderness therapy to this population and have found positive, lasting results for clients and families alike.
1 – http://www.ncrg.org/sites/default/files/uploads/docs/researchandresources2011.pdf
2 – https://www.addictions.com/gambling/
3 – https://www.buffalo.edu/cria/news_events/es/es3.html
4 – https://www.addictions.com/gambling/common-symptoms-gambling-addiction/
5- Grant, J. E., Kushner, M. G., & Kim, S. W. (2002). Pathological gambling and alcohol use disorder. Alcohol Research & Health, 26(2), 143
6 – Moragas L, Granero R, Stinchfield R, et al.: Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences. BMC Psychiatry. 2015;15:86.
7 – Menchon JM, Mestre-Bach G, Steward T, Fernández-Aranda F, Jiménez-Murcia S. An overview of gambling disorder: from treatment approaches to risk factors. F1000Res. 2018 Apr 9;7:434.
8 – Milosevic A, Ledgerwood DM: The subtyping of pathological gambling: a comprehensive review. Clin Psychol Rev. 2010;30(8):988–98.
9 – Raylu N, Oei TP, Loo JM, et al.: Testing the Validity of a Cognitive Behavioral Model for Gambling Behavior. J Gambl Stud. 2016;32(2):773–88.
10 – Hodgins DC, Currie SR, Currie G, et al.: Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better. J Consult Clin Psychol. 2009;77(5):950–60.
11 – Magnusson K, Nilsson A, Hellner Gumpert C, et al.: Internet-delivered cognitive-behavioural therapy for concerned significant others of people with problem gambling: study protocol for a randomised wait-list controlled trial. BMJ Open. 2015;5(12)