Introduction
Gambling addiction among older adults is a major issue, which is becoming more prevalent in the given age category. Although the problem as a whole is being researched, the specificities of gambling addiction among the elderly are not well-understood. There is a wide range of options when it comes to treating or managing gambling addiction, among which is motivational interviewing (MI). MI is particularly interesting when it comes to gambling addiction interventions due to its non-pharmacological nature and compactness as well as precision. Motivational interviewing is a powerful and highly effective method of treatment of gambling addiction among older adults due to its ideal fit for re-occurring gambling issues, less time-consuming, and no side effects on the overall health and well-being of the target group.
Gambling Addiction
Gambling addiction is one of the highly serious social and psychological problems in society. To date, there is no single model that fully explains the complex nature of gambling addiction. The personality of such persons is being actively studied in modern research works. The problem of a person’s choice of one or another course of action has not been fully investigated due to the complex nature of human behavior. In most definitions, personality is represented by those characteristics that are responsible for stable forms of behavior.
Gambling and Health
It is important to note that literature on gambling addiction among the elderly is not as developed and rich as for the younger populations. However, the impact of the problematic behavior can be more severe on the given group due to the vulnerabilities associated with older age. It is stated that “in the coming years, engagement in gambling as a social activity is expected to increase more sharply in the elderly than in any other age group” (Granero et al., 2019, p. 809). Therefore, one might expect an increase in the prevalence of the issue in the given age group. A systematic review states that “in elderly subjects with gambling problems, more significant medical or psychosocial comorbidities are reported than in non-gamblers or non-problem gamblers” (Guillou et al., 2019, p. 3). In other words, there are additional risk factors associated with gambling addiction when it comes to elderly individuals. In addition, it should be noted that due to the stressful nature of gambling, there are “neurophysiological changes (hyper-reactivity of the autonomous system in response to gambling-related stimuli) and neurochemical changes (elevated levels of cortisol, norepinephrine, and dopamine during casino gambling sessions)” (Guillou et al., 2019, p. 3). Older adults with gambling addictions are more exposed to stress, which further facilitates the development of various health issues.
Gambling and Other Impacts
Moreover, gambling addiction among older adults does not solely impact the overall biological health but also affects social and psychological aspects. It is stated that the problem “can be severely harmful causing psychological, financial and family problems and increasing the risk of suicide” (Guillou et al., 2017, p. 35). In other words, self-harm and suicide are noticeable risk factors when it comes to gambling among the given age group. On the basis of the information provided, it is important to note that “due to their exposure to powerful age-specific risk factors such as isolation, inactivity and failing health, older people are highly vulnerable to gambling-related problems” (Granero et al., 2019, p. 809). Thus, the cumulative impact of gambling addiction among older adults can be highly dangerous in a multitude of ways.
Motivational Interviewing
The key emphasis of the given analysis is the relevance and effectiveness of motivational interviewing as a form of treatment and interventional modality. Motivational interviewing is a type of non-pharmacological methodological framework designed to treat various psychological issues, such as gambling addiction. It can be defined as a measure, which is “goal-oriented, focused on the individual in counseling and oriented towards understanding ambivalence regarding treatment” (Potenza et al., 2019, p. 11). The key components of motivational interviewing include “assessing the patient’s readiness for change; assuming a nonjudgmental, non-confrontational and non-adversarial position; and using interventions that involve open ended questions, affirmations, reflective listening and brief summarizations” (Potenza et al., 2019, p. 11). Therefore, the method is heavily reliant on the factor of engagement from the patients.
Combinatory Treatments
In severe cases of gambling addiction, motivational interviewing is most effective when combined with another form of intervention. A study suggests that utilizing motivational interviewing in combination with cognitive behavioral therapy (CBT) can lead to a major reduction in gambling (Potenza et al., 2019). However, the given approach can be utilized on its own for less severe cases (Potenza et al., 2019). In addition, unlike CBT, MI can be more impactful for patients with co-occurring problems, which is more common among older adults due to the larger lifespan of possible co-occurrences (Potenza et al., 2019). Another major advantage of MI is its possible compactness, where shorter sessions with a higher degree of engagement can be highly effective (Potenza et al., 2019). It is stated that “MI is often brief and can be delivered as a freestanding treatment or as a motivational prelude to other treatments” (Choi et al., 2017, p. 4). In addition, “verbalized intention results in an increased probability of behavior change, particularly when it is combined with a specific plan for implementation” (Choi et al., 2017, p. 4). The given feature of MI can be considered useful for older adults, who might lack the ability to engage in longer sessions.
Motivational Interviewing and Pharmacological Treatments
One should be aware that gambling can also be treated with various pharmacological means, which tend to include opiates. However, due to the increased health risks prevalent among older adults, the drawbacks of using drug-based interventions might not always be useful. A comparative study states that “in most cases, MI is more effective than no treatment and as effective than other active treatments” (DiClemente et al., 2017, p. 862). In other words, MI is risk-free compared to pharmacological means, but it is not less effective if conducted and delivered properly. The main reason is the fact that MI is highly reliant on a practitioner’s behavior and conduct when working with patients. The given element is especially significant with older adults, who require a unique approach. A study suggests that “while MI adherent practitioner behaviors were not found to be significant predictors of improvement in participants’ problem gambling severity and psychological distress, MI non-adherent practitioner behaviors were significant predictors of deterioration in participants’ problem gambling severity and psychological distress” (Milic et al., 2021, p. 1). In other words, it is critically important to avoid being confrontational or persuasive when utilizing MI since it can lead to a worsened gaming addiction. Therefore, careful preparation and adherence to essential protocols are of paramount relevance for practitioners.
Unique Motivational Interviewing Advantages
On the basis of the information presented and analyzed, it is safe to state that MI is one of the most flexible and effective treatment measures for older adults struggling with gambling addiction. Firstly, MI is non-invasive, whereas pharmacological treatments can have side effects. For instance, it is possible for a patient to become addicted to a prescribed drug, and thus, there is a risk factor for such an approach. The latter statement is especially problematic if there are genetic predispositions to addictive behaviors in general. Secondly, MI is not exclusive of other treatment modalities, which means that its effect can be enhanced by combining MI with CBT and other methods. Therefore, MI is adjustable and flexible due to the general ease of incorporation of the process into another therapeutic format. Thirdly, MI is not time or resource intensive, which translates to a higher level of engagement and longitudinal adherence to the treatment. The notion is even more important when it comes to older adults, who might not have the physical or mental capability to maintain a high degree of engagement or commitment for long periods of time. Thus, MI can be prescribed with an adjustment for patient preferences or specificities.
Enhancing Gambling Treatment with MI
Gambling addiction occupies one of the key places in the general structure of addictions and requires serious approaches in treatment and prevention. There are two main approaches in the treatment of gambling, and these are non-drug therapy and drug therapy. Among the most successful methods in a practical sense are psychotherapy, reflexology, as well as cognitive behavioral therapy, and motivational interviewing. In severe cases, the last two are combined to cause the patient to form negative thoughts and emotions towards gambling through imaginary desensitization. It should be noted that research supports the fact that MI enhances other forms of treatment. For instance, it is stated that “factors associated with reduced efficacy include in-person delivery of feedback without motivational-interviewing and informing participants of their score on a psychological measure of gambling severity” (Peter et al., 2019, p. 447). Thus, a person first experiences withdrawals and then the formation of images of the game, associated primarily with negative emotions. In addition, this therapy includes social skills training, through which a person adapts to social life and develops the ability to control further breakdowns. Therefore, when using non-drug therapy for gambling, the most effective approach is a combination of the above methods of treatment. Due to such measures, the maximum reduction in the intensity of gambling addiction and other symptoms of pathological gambling is observed.
Adapting Treatment Measures to Reflect Full Scope of Gambling Addiction
It is important to treat gambling as a complex issue that requires multifactorial solutions. The complexity of the problem is even larger when it comes to older adults, who are more likely to have a higher number of risk factors related to health and socioeconomic factors. Therefore, adapting the traditional treatment measures can be effectively done through MI use. The problem of addiction in general and gambling, in particular, is touched upon in one way or another in most psychological concepts and directions, however, it has been worked out most deeply and multifaceted in the psychoanalytic approach. A detailed acquaintance and analysis of the problem of pathological gambling within the framework of the psychoanalytic concept is important.
Addiction to the game leads primarily to social maladaptation in relation to the family. The point is not only in financial problems but also in the disappearance of normal human attachment to the most expensive, the loss of a sense of duty, responsibility to loved ones. The gambler can become completely alienated from the reference group by distancing oneself from family and friends. For people of senile age, gambling can be a developed mechanism for overcoming some fears and complexes (Peter et al., 2019). In other words, MI can be utilized to target these issues in an effective manner.
Educational Components of Treatment
Gambling often has dire consequences in the form of severe social and financial hardship, illegal activities, and a high suicidal risk among gamblers. In addition, among gamblers, there is a high frequency of psychosomatic disorders in the mental sphere. For example, this may include affective and anxiety disorders, substance abuse, and personality disorders (Peter et al., 2019). In addition to the main therapy, a rational solution to this problem is also the social and educational prevention of gambling among the population, which can also effectively include a motivational interview. For example, it is stated that “interventions appeared to be most efficacious when used in populations of greater gambling severity when individuals were provided with gambling-related educational information, and when used in conjunction with motivational interviewing” (Peter et al., 2019, p. 447). Modern experts should be fully aware of all the consequences that gambling addiction entails for the elderly and constantly contribute to the formation of effective methods to counter gambling addiction. The latter is the main task of primary prevention of gambling, where MI can be used as a standalone treatment or enhancer of other treatment modalities.
However, the maximum effect is achieved when the gambler is fully aware of the gravity of the problem, admits their addiction, and sincerely seeks to eliminate it. Such awareness can be facilitated and maintained through various educational strategies. For instance, it is stated that “additional educational information about problematic gambling, including advice and strategies on how to reduce gambling behaviors and related problems, can be used to enhance intervention effects” (Peter et al., 2019, p. 461). Only due to the diligence of the addicted person preventive and therapeutic measures will be effective.
Conclusion
In conclusion, it is evident that gambling addiction is becoming a prevalent issue among older adults, which has a number of risks associated with it. The latter elements include direct health deterioration through stress, social isolation, family breakdowns, financial and monetary losses, and psychological ramifications. The current literature supports the notion of MI being one of the most effective and flexible methods of treating gambling addiction. Its primary advantage is the lack of direct and indirect health implications, which are common among pharmacological means of treatment. MI is also beneficial due to its flexibility, where it can be easily combined with methods, such as CBT, in order to enhance the treatment process for severe cases. Standalone MI is still effective due to its simplicity and compactness, which is highly critical among older adults. However, MI is highly reliant on the proper level of engagement from patients as well as a practitioner’s ability to utilize the given treatment method.
References
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