However, medication is useful only if the patient takes it. It is estimated that, 50 percent of all patients don't take the medications their doctors give them. Greenstein et al. (1981) found that fewer than 10 percent of patients who began naltrexone treatment for opioid dependence were still taking it after two months. For pathological gamblers, compliance is an issue because they are often ambivalent about giving up their gambling or altering long-standing patterns of coping, no matter how ineffective. When they stop gambling, they often feel something has being taken away from them (Taber, 1985).

Addiction-based and Multimodal

This category of treatments, which has a relatively long tradition, includes a broad range of techniques used by inpatient and outpatient programs. The first gambling inpatient program, which started in 1972 at the Brecksville, Ohio, Veterans Administration hospital, was based on a preexisting program for alcoholics. Similarities with substance abuse programs continue and include the use of recovering gamblers as peer counselors, an emphasis on Gamblers Anonymous and other 12-step meetings, and an educational component about addiction, including relapse prevention (Kruedelbach, personal communication to the committee, 1998). This latter component focuses on how to avoid high-risk situations, being able to identify specific gambling triggers, and developing problem-solving skills for dealing with urges or cravings. McCormick (1994) believes that pathological gamblers are deficient in the number of coping skills they have available and in their ability to flexibly choose the skill most appropriate to the stressful, or potentially relapse-triggering, situations they face. In a comparison with nongambling substance abusers, he found that substance abusers with a gambling problem utilize significantly more avoidance and impulsive coping styles.

There are other therapeutic components commonly employed by addiction-based programs. One is autobiography (Adkins et al., 1985). Patients write a history of their gambling problem incorporated into a narrative of the significant events in their life, and then read it to the therapy group. Feedback focuses on the



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