As seen on The Phoenix Spirit. Read the original article Here.
By Bill Stein
There is great power in learning from someone who has “been there before.” People with similar lived experience may be able to listen and provide hope and guidance in a way that is uniquely received.
So-called “mental health peer support” has existed for decades. Since the 1990s, the concept of “consumers as providers” has become a larger component in mental health service settings.
Perhaps there is no more powerful example of the power of peer support than when a recovering compulsive gambler shares their story with someone still in the throes of addiction. Indeed, programs such as Gamblers Anonymous are built largely on the idea that others with similar challenges can lead the way to recovery.
Peer support specialists are people who have been successful in the recovery process and can help others experiencing similar situations. Peer support specialists have a proven place as a key component of integrated care for recovery.
What is a Peer Support Specialist?
A peer support specialist is someone with lived experience who is able to share that perspective with another person who has not yet achieved recovery from addiction. They provide a link between clinical services and “outside” supports and can help someone navigate the behavioral health system and find appropriate community resources. A peer provides an example of empowerment and success and can be a trusted role model. It’s often easier for a person seeking to begin recovery to talk with a peer support specialist than it is to talk to a counselor or attend a Gamblers Anonymous meeting. Peer support specialists can also foster trust in a healthcare system that has often disenfranchised many of those whom it serves.
The value of lived experience is helpful throughout the time a peer support specialist spends with a client but can be particularly helpful when the gambler is vulnerable to relapsing. Some peers are available 24/7 so that a gambler in distress can reach them at any time.
Benefits of Gambling Peer Recovery Support
Recovery from any addiction is a long process. Most people need support at various points throughout the difficult journey. While everyone’s struggle to achieve recovery is different, what each person has in common is the need to receive support in one form or another. Although the faces of addiction are many, all persons on the road to recovery need the support of others, who need to be familiar with what it means to be an addict.
There are four key elements to the support provided by the peer support specialists:
Emotional support. The peer support specialist provides emotional support by encouraging the individual through empathy, concern or caring, and helping to strengthen confidence and self-esteem.
Information source. The peer support specialist shares their knowledge about resources available to guide individuals to success, including access to treatment, which is often available at no cost.
At a practical level, a peer support specialist can help people complete tasks necessary for successful recovery, such as helping with transportation and housing.
A peer support specialist helps individuals gain a sense of belonging and being with others.
Peer support specialists may get involved in a range of activities, including:
Being a voice in individual, family, and group counseling.
Providing support to family members of problem gamblers.
Helping someone through financial counseling.
Being available by phone (including after hours).
Giving presentations, teaching, and providing training.
Being the voice of recovery providing input into program planning.
Serving as a connection to the “recovery community.”
Providing support in negotiations with the criminal justice system.
Many who work in recovery are in recovery themselves
Many people believe that individuals without shared experience cannot help those with addictions or fully understand what they’ve gone through. Studies provide considerable support for this contention. A review of existing studies found that the percentage of substance use disorder treatment providers who were in recovery was 33-50 percent. Those in recovery who are involved in client care have an ability to introduce their clients and patients to 12-step and other self-help supports in ways that those not in recovery are unable to do.
Peer support specialists that work within a treatment delivery system can provide an important benefit to providers. They can offer assistance with resources for those identified with a gambling problem and/or their family members.
While specifics vary by state, there is a formal process for becoming certified as a peer support specialist. In Minnesota, peer specialists must have 30 hours of continuing education every two years in areas of mental health recovery, mental health rehabilitative services and peer support.
The Need for Gambling Peer Support Specialists in Minnesota
Unfortunately, peer support specialists are not currently approved as part of gambling treatment programs in Minnesota. However, a number of other states, including Maryland and Connecticut, recognize them as vital parts of treatment and recovery. In each of these state programs, gambling peer support specialists engage with an individual as soon as they call the state gambling helpline. While not everyone seeking help may be ready to sit down with a counselor, they may be receptive to having a conversation, or a series of conversations, with a trained peer before seeking formal counseling. In fact, each of these states have seen an increase in those seeking treatment since the inclusion of the peer support specialist, crediting the importance of those early conversations.
In Connecticut and Maryland, the gambling peer support specialist is an integral component to an individual’s recovery treatment plan, working in conjunction with the counselor as added support. Peer support specialists are also available post-treatment, maintaining connections as the person in their early recovery begins to negotiate their new way of being.
The Minnesota Alliance on Problem Gambling is working with the Minnesota Department of Human Services to bring peer support professionals into the treatment mix given their clear value in helping those with gambling addiction in their recovery journeys.
Working your recovery program is hard. To help assist those who may feel tempted to gamble online or visit a casino or card room, there are a few tools that may be helpful. None are foolproof, but if you are committed to your recovery, these tools may help.
GAMBAN – a voluntary, self-exclusion tool for online gambling sites.
Given that many gamblers may be moving online, especially during COVID-19 times, MNAPG is offering individual subscriptions for an online self-exclusion tool called Gamban. This tool enables the gambler to block tens of thousands of online gambling sites on all devices. MNAPG has purchased one-year subscriptions that can block up to 15 devices in one household. If you are interested, please email email@example.com and a link will be provided to set up the account.
Minnesotans now have the ability to see how their gambling behavior compares with other residents of the North Star State. MNAPG now provides a survey that will provide both feedback and useful information.
The survey, produced in partnership with Evolution Health, provides information on a respondent’s gambling habits and attitudes in comparison with other Minnesotans. Survey takers are asked to provide their first names, basic demographic information and answers to questions about their level of engagement with gambling.
As answers are provided, a pie chart graph pops up so that the viewer can see how other Minnesotans participate in that particular form of gambling. The respondent will also receive a personalized report identifying where they fall in the problem gambling spectrum as well as tips and resources. The report is private and is not held by Evolution Health or MNAPG. Aggregate data will be collected and will not be identifiable by name, IP address or any other identifying method. Our hope is that as an individual is considering whether they are experiencing negative consequences relating to gambling that this will be the start of further personal awareness and opportunities to seek helpful resources. The survey can be found at HERE.
The COVID-19 pandemic has affected virtually all aspects of life. Gambling counseling is no exception.
Given the drastic reduction in social contact, we asked several gambling counselors about the state of gambling therapy and the changes they’ve observed.
Lisa Vig, Gamblers Choice More of our clients are keeping appointments than we anticipated. It tells me that staying connected to recovery support is very important at this time. They have also been initiating and requesting additional individual support as well.
We use a variety of platforms, including Teams, Zoom and the phone. One accommodation we’ve had to make using these platforms is reducing the size of groups. It’s more difficult to manage attention spans, allowances for everyone to talk and receive the attention they need with eight or nine in one group. We’ve adapted by offering shorter groups, more often, with fewer attendees.
As a counselor, I find that takes a different level of energy to conduct telehealth counseling. When you’re not in the same room sharing the same space, you have to pay more attention to their voice, inflections, participation and engagement since the ability to watch body language or other expressions is compromised. The clients we have worked with have expressed gratitude at every opportunity to stay connected.
I think telehealth counseling has a very valuable place, especially in this part of the country where we are dealing with rural living and limited availability of counselors. At least 50 percent of our clients would benefit from the option of telecounseling. Being able to utilize a combination of in person and telecounseling to customize delivery of treatment services would be ideal.
Craig Johnson, Club Recovery Once all of my clients became used to the change and requirements of the stay-at-home orders, my group attendance has been good. Most clients are participating and “showing” up for group.
Except for rare occasions, we are completely virtual. We use phone or a Telehealth platform to conduct interactions with all clients at every level of service we provide.
While counseling is not a “one size fits all” process, I think that at some level and some circumstances all clients can benefit from using a Telehealth platform. We need to adapt and move forward with as many innovations in reaching out to clients that we can. Since the beginning of the COVID-19 crisis, the treatment community has been advocating vigorously for the use of Telehealth platforms and CMS and DHS recently approved that all services we provide can be done with Telehealth. Telehealth is a capability that we must keep as an option to use when a client may not be able to access services via traditional means.
There is a great need for gambling disorder providers outside of the Twin Cities, Duluth and near Fargo. Without Telehealth, potential clients in those areas would not be able to get services. As a community of providers we must promote this capability wherever and whenever possible to reach all those who need help. This will be the main topic of discussion at the next meeting of the DHS Advisory Committee on Gambling Disorder on May 14.
Paul Mladnick, Solo Practice/Bridges & Pathways I don’t think Telehealth counseling is ideal but I don’t think that much is lost. About half of my clients prefer to cancel appointments until we have the all clear. I’d say about 30 percent are coming to my office while about 20 percent are receiving counseling over the phone.
From a practical perspective, I am keeping my office sanitized prior to each session and I do practice social distancing in my office. I have noticed that the number of referrals is down since March 17, so I have considerable availability for those with a gambling problem or those concerned for family and friends.
We asked some of Minnesota’s certified problem gambling counselors for their thoughts on the barriers for Minnesotans receiving problem gambling treatment. Here is what they said:
Cheryl Minx, Director, Freedom Center, Inc. I think people may not realize help is free to those who need it. Many people think if they’re broke and in trouble financially that there is no way to pay for help. I also think that the helplines are not very visible so that people don’t know how to find help.
Christina Pristash, MS, LMFT There can be many contributing factors that interfere with a person reaching out for help or accessing treatment for problem gambling. I know that personal fears get in the way as well as individuals/families not knowing what resources are available and/or what makes a person qualify for help. We are fortunate to have an inpatient option in our state as well as outpatient treatment options, but many people aren’t aware of these resources or the differences between the two. Continued education and information sharing will continue to create fewer barriers for people, but choosing change is still always going to be hard.
Dawn Cronin, LSW NCGC Gamblers Choice, Lutheran Social Services of ND I think a significant barrier is the nonpayment to phone counseling providers. While most providers recognize phone sessions are not the preferred method for counseling, they are necessary at times. I believe the many rural areas of Minnesota and the frequent poor winter driving conditions are putting severe limitations and interruptions in treatment participation for clients. I have three clients over the age of 62 traveling over 50 miles one way for treatment who have had to interrupt treatment because of travel conditions. We also have limited numbers of Gamblers Anonymous meetings in these rural areas so we are unable to encourage participation at these meetings for the same reasons.
Craig Johnson, LADC, Club Recovery One of the greatest barriers is the lack of understanding by insurance companies, or just plain recognition, that gambling disorder is the exact same as any other psychological disorder as described in the DSM 5. I also think that clients are often told that gambling disorder is not covered and so they stop right there.
I have heard that a large hospital program discourages clients who do not have private pay insurance from seeking services because the reimbursement rate from the state gambling fund is significantly lower than what a given provider might pay.
There is a distinct lack of providers in outstate Minnesota, where access to treatment can be a challenge. We need to push telehealth as a way to reach individuals who either don’t have the means or the access to a provider near their home. I think that prevention programs need to include education on gambling disorder.
Programs aimed at young adults mention the opioid crisis, the vaping crisis, legalizing marijuana and so on, but often do not even mention gambling.
Lisa Vig, LAC, NCGC, Gamblers Choice I’m concerned about those who live in rural Minnesota who may not have access to a trained counselor, access to a GA meeting and may not have reliable transportation or funds to travel the necessary distance to receive treatment and support. We need to explore other options to reach these individuals, such as phone counseling, telehealth treatment and/or online resources. The challenge to find appropriate, reputable financial management services for this population in conjunction with treatment is also a concern.
Paul Mladnick, LADC, NCGC, LMFT, Bridges and Pathways Counseling Services One barrier that I see is a lack of awareness of gambling treatment services and that financial help is available for Minnesota residents, so I think we need to do more to advertise gambling treatment resources.
Also, there is still much ignorance over problem gambling and many people still think this is more of a moral problem or a lack of common sense. An educational campaign to alert people that this, too, is an addiction that can happen to anyone would be helpful.
Do you have a thought on barriers to treatment that you’d like to share? If so, please send your comment to firstname.lastname@example.org.
I was five months pregnant with our second daughter in August 2014 when I received a call from my husband that would forever change my life. He told me he had won $20,000 at a casino — $10,000 in cash and $10,000 in a check. I figured we’d use the money towards paying off debt and giving generously to our church.
I was surprised by this news because I wasn’t aware that he was going to the casino. When I asked him about it, he told me he’d been going for a few months. All the while he seemed tired, but I knew that something was not right with him. I later learned that he’d been gambling a lot longer than a few months when I noticed gambling activity started to show up in our credit union accounts. I also discovered that he was using money he’d put away for our daughter and started dipping into his bill money. When I confronted him about it all, he always told me he could stop whenever he wanted.
He continued to gamble after our daughter was born. He eventually made a bad personal decision and lost the job he’d held for eight years in May 2015. I was working part-time and he was the primary breadwinner. Without his $45,000 income, we were in trouble. He continued a downward spiral into depression, anxiety, cross addiction with drinking, scratch off lottery tickets, candy crush and deeper into gambling.
The stress created by my husband’s addiction took a toll on me. My blood pressure spiked and I developed alopecia in the front of my hairline. That was a wakeup call!
By August, I sought help and learned about Gamblers Anonymous (GA) for my husband and Gam-Anon for myself. He went to GA once and refused to go again. But for me, going to Gam-Anon turned out to be the next big thing that would change my life.
On numerous occasions my husband admitted to me that he had a problem, but refused to seek treatment. After being separated for a few years I filed for divorce, which was finalized in June 2019 so I could chart my own path. I am now the primary breadwinner and speak at the annual GA/Gam-Anon conference. I have focused on my career as well as learning about addiction and recovery and how to better support people that come after me, because there will always be more addicts and families affected by addiction.
I was asked what advice I might give to other spouses and families who are going through the same thing that I went through. I would tell them that addiction is a time sucker, a hell of a roller coaster ride and that even in the midst of the storm they need to realize the importance of self-care — choosing joy and finding their own purpose.
It’s easy to become so co-dependent on the addict that you stop living your life. There are things spouses and family members can do to protect themselves if the problem gambler isn’t willing to get help. Some of these things include:
Knowledge is power — learn as much as you can about addiction and how it’s an actual mental illness.
Control your financial assets and don’t allow the gambler’s behavior to damage your credit or your mortgage.
Don’t enable and bail out the gambler by helping with gambling-related debts.
Get the support you need from people who understand your situation, such as what Gam-Anon offers.
These were hard lessons to learn. It’s unfortunate that I had to go through this but if I didn’t, I wouldn’t have a story to tell and be able to influence others. The ability to speak at an annual conference, for example, is a door that never would have been opened if I didn’t have a spouse that’s an addict.
One day, my ex-husband will realize what he has thrown away and will choose recovery for himself. For me, I am excited for new beginnings. To create new traditions and memories for my daughters. I’m in control of my future and looking forward to writing the next chapter.