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versión impresa ISSN 1516-4446versión On-line ISSN 1809-452X
Rev. Bras. Psiquiatr. vol.31 no.2 São Paulo jun. 2009
CARTA AOS EDITORES
Post-therapy group for pathological gamblers - improvement beyond symptoms
Grupo pós-terapêutico para jogadores patológicos - Melhora além dos sintomas
Data about quality of life among pathological gamblers (PG) are scarce. A US survey found that 14% of PG lost one or more jobs, 19% experienced bankruptcy, 32% had been arrested, 21% incarcerated, and 54% divorced because of gambling.1
Since 1998, we offer an outpatient program for PG. The program includes gambling-focused psychotherapy, family orientation, and treatment for psychiatric comorbidities (see Tavares et al. for further details of the basic program).2 In 2006, we devised a psycho-educational program to enable PG to finish the basic program, called Post-Therapy group (PTG). Its goals were to promote quality of life and to keep gambling abstinence. Patients were divided in pilot groups of at most eight participants. Secrecy was underscored and only patients who had finished the basic program would be allowed to participate. Sessions happened on a weekly basis, starting with a brief talk followed by a debate with the patients. Therapists followed scripts for each session (Table 1). No specific sequence of sessions or minimal attendance was required, but we strongly suggested that the patients should attend at least once each type of session. The therapists recorded the sessions on sheets containing a table with the following columns: session date and theme, patients' names, any gambling in the past week, and the patients' contributions to the debate. A content analysis of these records with a special focus on reports of gambling and self-improvement was performed.3
During two years 24 patients attended the PTG program. Three patients dropped out after the second meeting and two after the fourth meeting. The remainder 19 concluded the nine themes. Seventeen patients were still regular attendees after two years; five have kept absolute abstinence from betting (29.4%). The other 12 gambled occasionally, but never met full criteria for pathological gambling again. Regular PTG attendees reported improvement beyond major symptoms of PG. They mentioned development in their communication, friendships, work, family relationships, leisure activities, and sleep quality, besides more satisfaction with theirselves.
There have been few studies on gambling treatment efficacy and fewer reports on stability of therapeutic gains. Weinstock et al. state that Gamblers Anonymous (GA) is the most popular psycho-social program for PG.4 Stewart and Brown followed 232 pathological gamblers attending Gamblers Anonymous (GA).5 One year after entry into GA, 8% of group members were still abstinent from betting and only 7% after two years. Twenty-two percent of the participants did not follow GA after the first meeting, and 70% dropped out after the tenth meeting.
Unfortunately, we do not have similar records from patients who have concluded the basic program before the establishment of the PTG program. This and the small sample size are the main constraints of the current report. Differences in time frame and methodology preclude a direct comparison between the PTG and GA regarding stability of therapeutic gains. However, the high percentage of absolute abstainers after two years and reports of self-satisfaction among PTG participants suggest that programs for pathological gambling must go beyond gambling control. Hinting and debating key strategies for behavioral adjustment seem to improve quality of life, increasing compliance with therapy and maintenance of abstinence.
We thank to the psychologists who have started the Post-therapy group and are no longer in the team, to the team of the Pathological Gambling Outpatient unit and to the Institute of Psychiatry of the Hospital das Clínicas de São Paulo.
Ana Carolina Naves Magalhães, Flávia S. Jungerman,
Márcia C. Silva, Márcia M. de Moraes, Hermano Tavares
Pathological Gambling Outpatient Unit (AMJO),
Institute of Psychiatry (IPq), Clinical Hospital, Medical School,
Universidade de São Paulo (USP),
São Paulo (SP), Brazil
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2. Tavares H, Gentil Filho V, Oliveira CS, Tavares AG. Jogadores patológicos, uma revisão: psicopatologia, quadro clínico e tratamento. Rev Psiquiatr Clin. 1999;26(4):179-87. [ Links ]
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4. Weinstock J, Ledgerwood DM, Modesto-Lowe V, Petry NM. Ludomania: cross-cultural examinations of gambling and its treatment. Rev Bras Psiquiatr. 2008;30(Suppl 1):3-10. [ Links ]
5. Stewart RM, Brown RI. An outcome study of Gamblers Anonymous. Br J Psychiatry. 1988;152:284-8. [ Links ]