Social Work

and the Tsunami are names of recent tragedies that have heightened our awareness of disaster. Although disasters are as old as war, pestilence, and natural catastrophes, human-made disasters or inadequate response to natural disasters have intensified suffering and made them more difficult to respond to in our time. Because we live in a time of tension, terror, and turbulence, we need to have a disaster plan. Such preparedness is both individual and systemic. The editors of this book have amassed a comprehensive collection of essays that address a wide range of issues they believe must be anticipated and prepared for before a disaster occurs. Individuals need to have a "go bag" near their beds if they need to evacuate and go. Every religious congregation needs a disaster response plan. Communities need to identify and mobilize the resources they have to respond to a disaster. This preparedness has been proven to be necessary because the majority of people affected by a past disaster have realized at some point that they "do not have the strength, faith, and ability to cope." Like any collection of essays, there is repetition and some unevenness of quality. However, the breadth of issues attended to means that there is something for everyone amidst an abundance of information and suggestions regarding Disaster Spiritual Care. The range of details that are discussed in these pages leaves nothing to chance. Numerous full-page boxes summarize information about the response to disaster and what we need to know to provide the needed spiritual care. They could also become handouts for a congregational discussion about the need for preparedness. Whatever training in spiritual care we might have had is beneficial but not sufficient. The most chaotic emergency room experience is different from working in a shelter after a hurricane or at a disaster morgue. Interspersed throughout the book, I found wisdom that has application beyond preparing for a disaster. "Before you show how much you know, show how much you love" is wisdom for ministries of care wherever they occur. "Blessed are the flexible for they shall not be broken" is a truth that is certainly applicable in every human crisis as well as disaster spiritual care. Because of the diversity of the contexts in which we live and in which disasters may occur, we need to "demonstrate culturally competent hospitality." After we decide as individuals and as congregations and communities what we can do, we must decide what we will do. "Stay where people can find you" certainly encourages restraint of our impulse to rush to the scene of any kind of crisis. Finally, the most compelling statement for me was this: "The willingness to be wounded may be all we have to offer." Compassion that converts empathy into transformative healing begins with the willingness to be affected by stories we hear and the suffering we see.

In recent years, there has been a notable trend in the world of mental health support - an increasing number of celebrities, professional athletes, and couples are seeking the guidance and expertise of Black psychoanalysts and members of the American Association of Marriage & Family Therapists. This intriguing phenomenon highlights a significant shift in how individuals in the public eye and those in high-stress professions approach their mental health and well-being. This blog post will explore the reasons behind this growing trend.

Self-exclusion is a programme utilized by the gaming industry to limit access to gaming opportunities for problem gamblers. It is based on the following principles: (1) The gaming industry recognizes that a proportion of community members gamble excessively and have difficulty controlling gambling behaviours; (2) The gaming industry has a responsibility to provide a safe gaming environment and to assist in minimizing the negative impact on individuals displaying problem gambling behaviours; (3) Individuals must accept personal responsibility for limiting gambling behaviours to affordable levels; and (4) Self-exclusion is not a treatment designed to address psychological processes. The objective of the present paper is to propose a unifying structure for self-exclusion programmes as a gateway to treatment based on a system operated by independent ‘educators’ whose roles and responsibilities include informing individuals of the purpose of self-exclusion, establishing links and a gateway for access to supplementary services and monitoring and reporting the effectiveness of the overall programme.

It is argued that there exists a relatively neglected distinct sub-group of pathological gamblers, described in the clinical literature, who display intermittent episodes of uncontrolled gambling superimposed on a background of prolonged intervening periods of abstinence. This sub-group is characterised by intense bouts of impaired control over gambling that meet core diagnostic features for pathological gambling during such defined episodes. However, they are unlikely to display significant symptoms of pathological gambling if screened during intervening periods of abstinence and report no persistent or progressive urges or preoccupation with gambling between episodes. This article discusses the concept of binge gambling with reference to illustrative case studies and by comparison to two other recognised binge behaviours, binge drinking and binge eating.

ABSTRACT At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and ecological variables contributing to the development of pathological gambling. Advances in this area are hampered by imprecise definitions of pathological gambling, failure to distinguish between gambling problems and problem gamblers and a tendency to assume that pathological gamblers form one, homogeneous population with similar psychological principles applying equally to all members of the class. The purpose of this paper is to advance a pathways model that integrates the complex array of biological, personality, developmental, cognitive, learning theory and ecological determinants of problem and pathological gambling. It is proposed that three distinct subgroups of gamblers manifesting impaired control over their behaviour can be identified. These groups include (a) behaviourally conditioned problem gamblers, (b) emotionally vulnerable problem gamblers and (c) antisocial, impulsivist problem gamblers. The implications for clinical management are discussed.

The present study explores gender-related differences in the demographic and gambling-related characteristics of 2670 problem gamblers participating in a state-administered (Missouri) casino self-exclusion program between 2001 and 2003. Female (n=1298, 48.4%) and male (n=1372, 51.1%) participants ranged in age from 21 to 84 years. Gender-related differences were noted among demographic variables, patterns of gambling behavior, reasons for self-exclusion, and involvement in self-help, counseling, and bankruptcy services. Female self-excluders were more likely than males to be older at time of application, African American, and either retired, unemployed or otherwise outside the traditional workforce. In addition, female self-excluders were more likely to report a later age of gambling onset, a shorter period between onset and self-exclusion, a preference for non-strategic forms of gambling and prior bankruptcy. The main predictors for female participation in self-exclusion included a desire to gain control and prevent suicide and referral by a counselor. The desire to save the marriage was a motivating factor for all participants. Findings suggest that the most efficacious treatment strategies with this group will include family systemic therapy and financial management in addition to pharmaco-treatment and culturally-sensitive individual therapy.

The DSM-IV-TR classifies pathological gambling as a disorder of impulse control. Empirical studies have noted elevated levels of impulsivity in pathological gamblers and putative functional relationships between impulsivity, severity of gambling problems and treatment attrition. However the concept of impulsivity has been variably defined with a persistent failure to clearly articulate the specific nature of impulsivity as a state or trait or its role in the etiology and maintenance of pathological gambling. This paper: (a) reviews the literature on impulsivity as it relates to gambling behaviour; and (b) proposes a descriptive model that integrates predisposing factors, individual differences, sociological influences, cognitive factors, and affective interpretations that combine to generate dysfunctional forms of impulsivity that fuels the gambling cycle; and (c) explores directions for further theoretical and empirical investigation.

Gambling among older adults appears to be increasing, though little is known about the characteristics of older adult problem gamblers. The purpose of this study was to compare older adults to younger and middle-aged adults in a cohort of problem gamblers participating in a state-administered casino selfexclusion program. Self-reported problem gamblers (N ϭ 1,601) who voluntary banned themselves from Missouri casinos from 2001 to 2003 were categorized by age as younger adults (ages 21 to 35; n ϭ 490), middle-aged adults (ages 36 to 55; n ϭ 950), and older adults (ages 56 to 79; n ϭ 161), and were compared with respect to demographic variables, gambling participation, and reasons for self-exclusion. Older adult self-excluders typically began gambling in midlife, experienced gambling problems around age 60, reported preferences for nonstrategic forms of gambling, and identified fear of suicide as the primary reason for self-excluding. Implications for intervention, prevention and treatment are discussed.

Both suicide and problem gambling among youth are two growing areas of public health concern, though studies have yet to characterise the relationship between these issues. Youth report higher prevalence rates of problem gambling than adults, but no studies to date have investigated whether they are likewise prone to higher risks of gambling-related suicidality. This article explores the relationship of depression, suicidality, and problem gambling in youth in three studies of middle and high-school students (total N ϭ 3,941; males n ϭ 1,937, females n ϭ 2,004) conducted in 1996, 2000, and 2001 in Quebec and Ontario. All studies reported significantly higher rates of suicidality among problem and pathological gamblers as compared to non-gamblers and social gamblers, irrespective of gender, grade, or level of depression. The implications for future investigations are discussed.

Focus groups were conducted to identify ways persons in recovery from chemical dependence think they have benefited from their struggles with addiction. Categories of positive by-products were identified independently by two sets of readers. Several of the positive byproducts discussed by the focus group participants are commonly reported from other kinds of challenging life experiences. These include increases in self-efficacy, family closeness, closeness with others, compassion and spirituality, and changes in life priorities. Additional positive by-products were discussed by the focus group participants that may be more unique to substance abuse and other similar stressors, including increased self-knowledge, enhanced ability to help offspring with substance abuse ± related issues, and decreased naõ Èvete Â. Ways to incorporate knowledge about these positive by-products into substance abuse treatment programs are introduced. D

This study examines the relationship of impulsivity, sensation seeking, coping, and substance use to disordered gambling in a sample of 1,339 youth (637 males and 702 females), 17-21 years old. Results indicate that males with serious gambling problems were more likely than their peers to abuse substances and to use avoidant stress-coping strategies, such as seeking emotional outlets, distracting themselves with other activities, and using humor. In contrast, female disordered gamblers were less likely to engage in active coping and planning strategies. Overall, substance use, coping through distraction, and impulsivity proved the most predictive of disordered gambling for males, and intensity seeking and impulsivity proved most predictive for females. Implications for prevention, intervention, and education are discussed.

Few studies have explored gamblers' attitudes towards money despite the central role money plays in the development and maintenance of problem gambling (PG) behaviours. This study explored attitudinal differences towards money among subgroups of electronic gaming machine players (n ¼ 127) using the framework advanced by Money as tool, money as drug:

At the moment, there is no single conceptual theoretical model of gambling that adequately accounts for the multiple biological, psychological and ecological variables contributing to the development of pathological gambling. Advances in this area are hampered by imprecise definitions of pathological gambling, failure to distinguish between gambling problems and problem gamblers and a tendency to assume that pathological gamblers form one, homogeneous population with similar psychological principles applying equally to all members of the class. The purpose of this paper is to advance a pathways model that integrates the complex array of biological, personality, developmental, cognitive, learning theory and ecological determinants of problem and pathological gambling. It is proposed that three distinct subgroups of gamblers manifesting impaired control over their behaviour can be identified. These groups include (a) behaviourally conditioned problem gamblers, (b) emotionally vulnerable problem gamblers and (c) antisocial, impulsivist problem gamblers. The implications for clinical management are discussed.

Many international jurisdictions have introduced responsible gambling programs. These programs intend to minimize negative consequences of excessive gambling, but vary considerably in their aims, focus, and content. Many responsible gambling programs lack a conceptual framework and, in the absence of empirical data, their components are based only on general considerations and impressions. This paper outlines the consensus viewpoint of an international group of researchers suggesting fundamental responsible gambling principles, roles of key stakeholders, and minimal requirements that stakeholders can use to frame and inform responsible gambling programs across jurisdictions. Such a framework does not purport to offer value statements regarding the legal status of gambling or its expansion. Rather, it proposes gambling-related initiatives aimed

It is well-established that problem gambling results, in part, from erroneous perceptions about the probability of winning. While individuals retain the ultimate responsibility over gambling choices and level of participation, optimal decision-making depends, among other factors, on the availability of reliable, comprehensive information. From a public health perspective, the gaming industry, in collaboration with government and the community, must ensure that individuals receive sufficient information to enable them to make responsible gambling choices. This paper reviews key decisionmaking models and posits four primary goals that will lead to optimal choices in gambling: (a) the provision of relevant and objective information; (b) elucidation of the benefits of responsible gambling as well as potential social and personal costs of excessive gambling; (c) additional materials targeted to specific gambling subgroups; and (d) the use of a variety of communication mediums to disseminate materials. Implications for further research and public information campaigns are discussed.

The phenomenological similarities between gambling and substance dependence have led to the conceptualization of pathological gambling as an addictive disorder. Tolerance and withdrawal are important features of both disorders, suggesting commonalities in the neurobiological processes associated with neuroadaptational underpinnings. However, there are few empirical studies supporting the presence of tolerance and withdrawal reported in the gambling literature. Moreover, there are no studies comparing the equivalence of tolerance and withdrawal between gambling and alcohol dependence. This study compared tolerance and withdrawal features in samples of gamblers, alcoholics and gamblers who also met criteria for alcohol dependence. In contrast to the addiction model, findings indicate that, while a majority of participants increased bet size, the motivation to do so was not for excitement or to maintain arousal levels as indicated by the DSM-IV-TR but because of cognitive factors related to winning. Results supported the notion that pathological gamblers experienced similar levels of withdrawal symptom severity as alcohol-dependent participants. Further research is needed to evaluate whether those symptoms result from the inability to gamble or from the loss of an avoidant stress coping strategy.