Post on 03-Jun-2020
The Ethics of Gambling:
A Case Study of Addiction and
Ethical Decision Making
One Individual at a Time
Debra Luther, Ph.D., CCE, Corporate Director, NHS
Christopher Luther, President, CL Luther Consulting LLC
Disclosure Statement: I have no real or perceived conflicts of interest that relate to this presentation.
www.nhsonline.org
Confidential - NHS Human Services - Not for Reproduction
Objectives
1. Define three models of ethical decision making as they relate to the addiction of gambling
2. Recognize 2 ethical issues clinicians should consider when working with individuals with addictions
3. Identify how the role of the reinforcement schedule impacts the ethics of the addictive rationale
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Why do we take Ethics seminars?
• Licensure
Requirement
• Interest
• We’re unethical?
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Risks Leading to
Unethical Decisions• Organizational Culture
• Hierarchical pressure
• Groupthink
• Burnout
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Ethical Decision Making
• 6 Steps (Curtis, L.C. & Hodge, M. (1995)
• Ethics Committees
• Consultation
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6 Steps of Ethical Decision Making(Curtis, L.C. & Hodge, M. (1995)
1. Identify the problem
2. Identify the ethical issues raised
3. Review relevant guidelines/regulations etc.
4. Obtain consultation
5. Identify and list possible responses and consequences
6. Decide on the best course of action
Adapted from: Curtis, L.C. & Hodge, M. (1995). Ethics and boundaries in community support services: New Challenges. New Directions for Mental Health Services, 66, 43-60.
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Ethics Committees
.
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Ethical Consultation
• Models
▫ Adjudicatory
▫ Mediation
▫ Consultation
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Ethics and Gambling
• Historical Roots
• Prevalence
• Social acceptability – gender norm
▫ Faith based fundraisers
▫ Sports centered
▫ Available modalities
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The Daily Life of a Compulsive
Gambler
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Impact of Life Stress on Amount Bet
0
100
200
300
400
500
600
$0.00 $1,000.00 $2,000.00 $3,000.00 $4,000.00 $5,000.00 $6,000.00
Amount Bet vs. Life Change Index Scatterplot
Life Change Index
Linear Regression p = 0.011
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Life Change Index
0
100
200
300
400
500
600
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
193
88 88
138
88 88
500
362 362395
345
500 500528
129 131
271
Life Change Index
Amount Bet
Amount Bet
• Life Change Score• Amount Bet
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The Twenty Questions
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Clinical Considerations
• Moral and Value Judgments
• Threshold – Entertainment vs. Addiction
• Knowledge – Process Addiction vs. Substance
▫ Understanding etiology of this addiction
Anxiety reduction
Neural stimulation – excitation
Relief from Mood Disorder symptoms
Impulse control deficiencies
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Reinforcement Schedules
• Fixed-ratio schedules
• Variable-ratio schedules
• Fixed-interval schedules
• Variable-interval schedules
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Reinforcement Schedules
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Group Discussion
• What are some similarities between problem gambling and other addictions?
• What makes problem gambling different from other addictions?
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Summary
• 3 Models
• Ethical and Clinical Considerations in Treatment
• Reinforcement Schedules and Gambling
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Contact Information
Debra Luther
dluther@nhsonline.org
412-214-9020 x240
Christopher Luther
chrisluther13@gmail.org