The Recovery Journey | A Clinical Perspective

The road to recovery from problem gambling is a lifelong process.  Clinical Supervisor Melissa “Missy” Coffey discusses problem identifiers, insights and coping strategies for individuals that identify as problem gamblers.

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Transcript:

WAGER DANGER EPISODE 2: THE RECOVERY JOURNEY — A CLINICAL PERSPECTIVE

Host: Shane Cook

Welcome to Wager Danger, a podcast where we discuss the dangers of problem gambling. I’m your host, Shane Cook, gambling disorder program director at Gateway Foundation. Gateway is a national nonprofit that provides substance use and gambling disorder treatment through its 16 centers located throughout the state of Illinois. Gambling disorder is an addiction that can hacked anyone, regardless of age, gender, or cultural background. My guest on this episode is Missy Coffee. Missy is one of our clinical supervisors here at Gateway and we’re going to discuss Gateway’s approach to gambling disorder treatment. Welcome to the show, Missy. 

Guest: Melissa Coffey

Hi, Shane. Thank you so much. Yes, I’ve been working as a clinical supervisor at Gateway Foundation for about six years now. I am a licensed professional counselor since the year 2014. Our program has just now gotten into gambling addiction and gambling treatment. And so we’re very excited about the progress that we’ve had so far and we definitely hope to change some lives with what we do here at Gateway. 

Host: Shane Cook

Yeah, for sure. It’s great to have you join us, Missy. I know you’ve been at this for several years in the substance use treatment category, but just recently as Gateway has entered into the gambling problem gambling treatment arena, we’ve been fortunate enough to have you kind of lead that effort from a clinical perspective and working with patients on their problem gambling recovery. So I’m just curious, maybe you could share a little bit more about your background, how you got started, where your focus was and how that’s evolved over time and how you got involved with the gambling program, any special training or anything like that goes along with it, for sure. 

Guest: Melissa Coffey

Yeah. So originally I started off in the mental health addiction area and actually worked as a qualified mental health professional in a prison setting, worked with inmates and worked with trying to help them cope in their situations. Moved forward from that and started with Gateway Foundation. Like I said, I’ve been there for about six years. Started as an adolescent counselor, worked with adolescents for a little while, and then worked with adults as a counselor three, and now working as a clinical supervisor. Since receiving Gateway, received the grant money, we’ve been really focused in on the gambling recovery, gambling addiction and education piece to that. So what’s beneficial about that is that we are already a substance abuse facility. 

We treat substance abuse and so we have the capability now of educating the substance abuse patients that we have and to where they can determine whether or not they might, may have a problem or a problem with gambling or they might have gambling addiction. So that way they can also come into the treatment. 

Host: Shane Cook

Right, and there’s a lot of parallels between substance use disorder and gambling disorder, right? 

Guest: Melissa Coffey

Yeah, it’s actually what I’ve noticed. There’s a lot of similarities there. I mean, you’re still dealing with cravings, you’re dealing with coping skills, you’re dealing with all the emotional difficulties that you would see in a substance abuse addiction. So a lot of parallels there. It affects families in very similar ways. I think the difference is it’s a very hidden addiction is what they kind of refer to it as. It’s not as noticeable as you would see with someone with an addiction to drugs or anything like that. So it’s harder to identify. But there are certain signs that you can definitely look for if you have a family member that might be going through that or, you know, what have you in regards to gambling. But yes, very similar. Very similar treatment approach as well. 

Host: Shane Cook

Right. In terms of it being hidden, we often hear that when we’re talking about gambling disorders. But what’s been your experience then, as that journey begins to unfold for an individual and they come to that point where they recognize that they need to seek help? Are there some particular events that happen in that process, or is it unique by individual? 

Guest: Melissa Coffey

Yeah, I definitely think that just like any addiction, the person has to have the want to change. They have to have the desire. And usually, that takes them encountering something that is so painful that they want to make a change in their life. They have to feel that pain or that suffering more in order to have the desire to do something different with their lives. As far as it being hidden too, there’s no testing, there’s no drug test, there’s no anything that you can actually identify that it’s there. But I think with the patients, they start to see exactly how it’s really affecting their life. The gambling and the family members, they’re there as accountability factors, but I think it takes for them to get over that denial stage. 

You know, they go through the pre-contemplation stage, the contemplation stage just like you would see in a substance use addiction. But they have to take some responsibility of their addiction in order to see results in their recovery. 

Host: Shane Cook

Right. And you’re speaking of the family members in that description, or is that the individual themselves? 

Guest: Melissa Coffey

Well, the family members we do get referrals by family members as well. They want their relative to get the help they need. So you might see the person come in and say, well, I’m here for treatment because my wife made me come in. And you might see that. And so that’s the part where that’s an external factor in why you’re getting help. But eventually, treatment will help you learn that it’s because of you that you need that help. It’s that internal desire. And that’s what we want to get to because once they make that transition from the external to the internal, we’re making progress here. 

Host: Shane Cook

Yeah, well, it’s such important work that you’re doing with our patients. And I know we’ve had the program in place now, the formal program in place for just about a year now. And we recently had three recent graduates from the program, is that correct? 

Guest: Melissa Coffey

Correct. Yes. They did great. You can definitely see that it works, the treatment works. They were ready too. And that’s got to be a factor, too. You’ve got to be tired of being sick and tired. I always tell them enough is enough. That’s what allows you to follow through with the recommendations that we present or take the insight that we provide and things like that. 

Host: Shane Cook

Right. So in terms of the treatment program itself, I’m curious if you could talk a little bit more about it. For instance, how many sessions? I know we’re doing it as part of an outpatient program with COVID A lot of that has been virtual. So we’ve got people joining the outpatient groups from all over the state that you’re hosting here in our location in Swansea, at least hosting virtually. Can you kind of walk us through what that process is like and what the curriculum is like? How many sessions are there, how often is it offered, things like that. 

Guest: Melissa Coffey

Yeah. So typically we recommend about 24 sessions to complete the treatment. However, I think it’s very unique to each individual. Some patients may need a little more than others, and that’s okay. I think that’s a part of it, too, is to tailor that treatment to that patient so that way you’re meeting their specific needs. With the groups that we do run, it is based on cognitive behavioral therapy. It’s based on dialectical behavioral therapy. We use a lot of mindfulness, so it’s really a lot of the same type of treatment that you would see in substance abuse addiction treatment. But we also on top of that now we’re adding the gambling piece to this. So we’re talking specifically about gambling addiction and how that affects their lives. 

The group is a place where they can feel validated for their experience because there’s a lot of shame and a lot of guilt that’s associated with any addiction. And just to come to a place where you’re surrounded by people that understand what you’re going through is huge, is very huge. They definitely feel not alone. They feel like they can open up about things that they couldn’t before. And that’s where healing starts to begin there. 

Host: Shane Cook

Right. I’ve heard that a lot in speaking with others who have been battling with gambling disorder, that once they had an opportunity to get involved with group in a group setting and talk about their experience, what they typically refer to as it was liberating in a sort of way to be around others who had that shared experience. So I understand what you’re saying there, and that seems to be a huge part in the first step on the road, so to speak, to recovery there. 

Guest: Melissa Coffey

Yes, for sure. The relief they get, the freedom that they weren’t feeling before. 

Host: Shane Cook

Exactly. Do you find, though, with some of the people that are seeking treatment. Are people at a breaking point financially? Does that seem to be a tipping point for people to seek out treatment? 

Guest: Melissa Coffey

Yeah, like that? It depends. It depends, like I said, on the uniqueness of the patient. Some people may see that they can’t pay the bills because they have no money. They spent their whole paycheck on gambling. It’s gone. And so that in itself might be enough for that patient, it may not be. So it affects everybody differently. And also you might have a patient where they have enough money they can spend and spend. And it’s really the financial part is not what the problem is. It’s that their wife or husband is not liking what’s happening because they’re not there, they’re gone or they’re not present. So there are just different areas that can be affected, and it matters whether or not that area is enough for that person to want to change. 

Host: Shane Cook

Right. Okay, well, I kind of want to change TAC a little bit and talk a little bit about what’s going on within the state of Illinois and why having a program that tackles problem gambling is so important. When I look at the landscape across Illinois, there’s about eleven, what I would call traditional casinos that have table games and slots and things like that. There’s eleven currently in operation, and I know they have plans for more to come into the state over the next couple of years. So we’ll call those walk in casinos. We’ve got over 40,000 illinois has over 40,000 video gaming terminals throughout the state. It could be video poker or it could be video slots. And those things are typically located in your mom-and-pop shop. 

Could be a convenience store, a truck stop, a bar, a restaurant, and they also have specific gaming parlors where these things are located. Last year, legalized online sports betting was introduced in Illinois. So I’m just kind of curious, from your vantage point and as a clinician, what’s your opinion on what kind of impact that has had either with our patients or in conversations that you’ve had? Because I know part of your work is spent with folks that are in substance use recovery programs, and gambling is a part of the conversation from time to time just to kind of check in with individuals who are going through that program. But I’m curious to understand from your vantage point, how has the accessibility of gambling in Illinois, along with some pretty aggressive advertising, how much has impacted on the individuals? 

Guest: Melissa Coffey

I think tremendously. The fact that you’re at home and you can gamble at home, all you have to do is pick up a phone. And so the technology part definitely presents more of an opportunity to do it. So yeah, it’s definitely a little bit more difficult for the patients. You have to find other ways to make sure that you don’t fall into this trap that you are able to deal with these specific triggers. And we always talk about advertising. Gambling is almost just like alcohol in a way where you’re going to see billboards, you’re going to see all these commercials, so it’s in your face a lot of the time. Right. We got to figure out a way how do you cope with that? Well, you can’t tear the billboard down, you can shut off the TV. Okay, that’s fine. 

But there are some things where it’s out of your control and you’ve got to find a way to deal with it. And that’s what we do talk about in our groups. We try to find ways around this so that way you’re able to control the cravings and the urges to gamble. 

Host: Shane Cook

Sure. Do you have some coping strategies that you could share? 

Guest: Melissa Coffey

Oh, absolutely. I mean, there are so many different ways to cope. And I always say with coping skills, everyone reacts differently to each coping skill, and you have to find yours. You have to find one that fits you. And a way to do that sometimes is to ask them, well, what was gambling doing for you? What was the feeling that you received and what were you trying to search for? Usually, once they list, well, I like the adrenaline rush, is what they’ll say. We’ll focus more on coping skills. That still gives you a bit of that adrenaline, but it’s not harmful. You’re not having all these consequences because of it. So you have to find that skill that is right for you, that fulfills you. Okay. That makes sense. 

Host: Shane Cook

Sure. So thinking along those same lines, there are other strategies beyond the coping skills that I believe Illinois offers. For example, a person can self-exclude themselves. Do you have any discussions about that and the process? How would a person go about self-excluding themselves and what does that mean? 

Guest: Melissa Coffey

Yeah, the person has to make that decision on whether or not they’re going to take this extra step to prevent them from falling into gambling. So you have to know yourself. Typically a person will do that because they don’t 100% trust themselves. They see that the addiction is controlling them. And so they have to take this extra step to make sure it wouldn’t be any different from having your spouse hold your money. Hold your money. I don’t trust myself when I’m holding my own money, so I have to give it to you. And this is how we’re going to have to get through this period of time. It doesn’t mean it’s permanent. It just means, like, in order to get through this period of time, I’ve got to make some changes. 

Whether or not it’s permanent or not for the casinos, the exclusion of the casino, that’s up to them. If they want to take that extra step to where they are not allowed in there, then so be it. But I think it does benefit people, for sure. 

Host: Shane Cook

Sure. As you said, I think everybody’s different. But the self-exclusionary process that’s available, there’s a couple of different ways. As I understand it, a person can go directly to a casino and register. They get put on a list. So anytime their ID is scanned, which typically happens as you enter a traditional casino, but also if you win and you go to cash out, you typically have to show ID. And it’s at that point, if somebody is on the self-exclusion list, if they’re in there, they do not receive any of those winnings. In fact, in fact, those winnings go back to the state and the state distributes those out to support groups like the Illinois Council on Problem Gambling, for example, will receive some of those funds to pursue education programs and things like that. But that’s for the walking casinos. 

I’m not exactly sure what’s out there for the video gaming terminals. I suspect it’s a very similar process if you want to self-exclude from that. And then I believe there’s for online gambling, there’s an organization, not an organization, it’s a tool called Gamban. Right? Have you heard of Gamban? It’s a piece of software that you can download which will prevent your phone from accessing any mobile gambling sites. 

Guest: Melissa Coffey

Yeah, I have not even heard any of the patients talk about that. That’s interesting. 

Host: Shane Cook

Anyway, so self-exclusion is one area. What about self-help organizations like Gamblers Anonymous, perhaps putting people in touch with somebody who can help with financial recovery? 

Guest: Melissa Coffey

Yeah, absolutely. I mean, we always recommend that our patients also involve themselves into Gambler Anonymous groups as added support. They really need someone there to open up to besides the treatment. Of course, they may need a little extra support when we’re not running groups and that’s a great way to get it right. 

Host: Shane Cook

And as far as Gateway goes, I know we have an alumni program where we work with former patients who have been through our programs and that provides another layer of support during their recovery journey. And I suspect at some point along the way here we’ll have some more alumni coming out of our gambling program and we’ll be able to grow that aspect of our overall alumni program as well. Missy, thanks again for joining us on Wage or Danger. It was a really good conversation. I appreciate you sharing your perspective on not only Gateways approach but helping people live with the gambling disorder and giving them coping strategies to move forward anytime. 

Guest: Melissa Coffey

Thank you. Thanks a lot for having me today. 

Host: Shane Cook

We love hearing from you. So please take a moment to like share and comment on our podcast. You can find us on Facebook and Twitter at recovergateway on LinkedIn at gatewayfoundation or through our website@gatewayfoundation.org. Wager Danger is supported through funding in whole or in part through a grant from the Illinois Department of Human Services and the Division of Substance Use Prevention and Recovery. Recovery is a lifelong process if you or a family member is struggling with a gambling problem, call Gateway at 8449-755-3663 and speak with one of our counselors for free confidential assessment. We look forward to you joining us for our next episode.