Thought, urge, and need - key factors in relapse of problem gamblers

A Flinders University study into relapse or a fall back into problem gambling reveals a chain of mental and behavioural events take place in an individual’s behaviour, which is changed by a ‘push’ (urge) towards and a ‘pull’ away from relapse.

The Gambling Research Australia-funded project aimed to develop a definition of relapse, examine the signs of relapse and propose the path an individual might take as they relapsed.

One part of the project - which was composed of four separate studies – was a focus group study that interviewed groups of therapists from various therapy or counselling services and clients and partners who were users of the services or from support groups.

Analysis of the study data in The definition and predictors of relapse in problem gambling (Flinders University, January 2010) found six key themes factored in the relapse process:

  • Invalid cognitions (thoughts) which can increase intensity of urge
  • An unsuccessful intervention or therapy program
  • Urge to gamble
  • Lack of social support and/or relationship issues
  • Negative emotional states that lead to events that increase risk
  • Environmental factors that act as triggers.

It also pinpointed three steps that lead to a relapse in a problem gambler:

  • An emotional response to a trigger
  • Thoughts about gambling and the urge to gamble are aroused
  • Thoughts of gambling coupled with urge become the focus of attention.

The ‘push’ factor

Thoughts and urges are the key factors that ‘push’ the relapse process. They lead to an increasing need to gamble for the problem gambler.

The study found that there appears to be a critical point in the relapse process when the need to gamble is so strong, the problem gambler decides to gamble. This is possibly in order to reduce the unease brought about by the intense need to gamble.

An individual’s decision to gamble seemed to happen at various times: either in an ‘all or none’ single decision, as a stepped decision to firstly place oneself in an ‘at risk’ situation for gambling (making relapse highly likely) and at the decision to gamble at some future time (e.g. when money became available).

The ‘pull’ factor

Factors that ‘pull’ problem gamblers away from relapse include any treatment experienced and beliefs, thought factors, avoidance, distraction, memories, fear and images of previous negative consequences, and positive social support.

Being aware that relapse could happen at any time is the key to successful management of the temptation to gamble, researchers found.

Management or ‘cure’

There appeared to be two fundamentally different ways of trying to manage relapse: by watching and avoiding getting caught up in the process of relapse or by confronting the urge by varying degrees of exposure, which appeared to result in the elimination of the urge.

Elimination of the urge to gamble seemed to remove the relapse process for some people, suggesting the possibility of a ‘cure’.

Push and pull

In summing up, the researchers said: “There is a chain of mental and behavioural events that occur in gambling relapse behaviour, which is modified by a ‘push’ towards and a ‘pull’ away from relapse”.

To help problem gamblers manage the ‘push’, coping methods were either taught in therapy, learned from peers or developed by the individuals themselves.

For some, mastery over the urge to gamble was the most powerful factor in reducing the ‘push’, as by removing the urge altogether, gamblers were not at the mercy of push or pull factors.

05.08.11